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Barriers to Adherence After A Self-Management Lymphedema Education Program Among Women with Breast Cancer-Related Lymphedema
(Lippincott Williams and Wilkins, 2026) Uçar, G.C.; Kapucu, S.; Arıkan Dönmez, A.A.; Ozdemir, O.
Objectives: – Lymphedema associated with breast cancer is a chronic condition that negatively affects women’s physical functioning, psychosocial well-being, and quality of life. Although self-management education is a fundamental component of lymphedema care, many women struggle to maintain recommended practices in daily life over time. To explore how women with breast cancer-related lymphedema integrate self-management education into daily life over time and to identify barriers to sustained adherence 1 year or more after completing a self-management lymphedema education program (SMLEP). Methods: – A descriptive phenomenological qualitative design was used. In-depth, semistructured interviews were conducted with 17 women diagnosed with breast cancer-related lymphedema. Data were analyzed using qualitative content analysis. Results: – Two overarching themes were identified: problems caused by lymphedema and barriers to self-management. Problems included limitations in activities of daily living, pain, restricted social participation, and body image disturbance. Barriers included economic difficulties, decreased belief in treatment effectiveness, boredom and forgetfulness, lack of family support, absence of monitoring mechanisms, use of the dominant arm, and symptom regression. Conclusions: – Women with breast cancer-related lymphedema face interconnected physical, emotional, and contextual challenges that limit long-term self-management adherence beyond knowledge deficits alone. © 2026
Social Determinants of Health and Risk of Lower Extremity Amputation in Patients with Peripheral Artery Disease in Canada: Protocol for a Systematic Review and Meta-Analysis
(BMJ Publishing Group, 2026) Chowdhury, Abhiroop; Sheikh, Fatima; Azab, Sandi M.; De Souza, Russell J.; Banfield, Laura; Balakrishnan, Narayanaswamy; Anand, Sonia S.
Introduction Peripheral artery disease (PAD) affected approximately 800 000 Canadians aged 25 years or older in 2015 and it poses a substantial risk of lower extremity amputation (LEA). While clinical risk factors for amputation are well-established, the impact of social determinants of health (SDoH) on amputation risk remains unclear, particularly in a Canadian context.Objectives This systematic review aims to: (1) synthesise evidence on the associations between multilevel SDoH domains and LEA (both major and/or minor) risk in Canadian PAD patients including intersectional effects of race and ethnicity with another SDoH domain, and (2) evaluate the statistical methodologies used in the researched literature to inform future study design and analysis approaches.Methods and analysis We will systematically search MEDLINE, Embase, EmCare, Global Health, Cumulative Index to Nursing and Allied Health Literature and Web of Science for studies examining SDoH and LEA in Canadian patients with PAD (including chronic limb-threatening ischaemia which is a severe form of PAD). Date limits for each database will be from inception through December 2025. SDoH will be categorised using a modified Healthy People 2030 SDoH framework under six domains: economic stability, education, food, neighbourhood and physical environment, healthcare system and community and social context. Two reviewers will independently screen titles, abstracts and full texts, with discrepancies resolved by a third reviewer. Data will be extracted on study characteristics, SDoH measures, outcomes and statistical methods. Risk of bias will be assessed using RoB 2 for randomised trials, ROBINS-I for non-randomised studies of interventions and ROBINS-E for studies investigating exposures. A narrative synthesis, and where data permit, a Bayesian hierarchical meta-analysis using both effect size and contingency table approaches will be conducted. Statistical heterogeneity will be explored through subgroup analyses and meta-regression, examining study design, SDoH measurement approaches and population characteristics.Ethics and dissemination As a systematic review and meta-analysis, ethics approval is not required. For institutional oversight, we provide the contact of Dr Sonia Anand (Associate Vice-President, Global Health, McMaster University; anands@mcmaster.ca). Results will be reported following PRISMA guidelines and disseminated through a peer-reviewed publication.PROSPERO registration number CRD420251115759.
Skull Base Surgery in the Pediatric Population-The 2nd International Collaborative Study (1995-2015)
(Wiley, 2026) Fliss, Dan M.; Ungar, Omer J.; Levyn, Helena; Valero, Cristina; Adilbay, Dauren; Eagan, Alana; Shah, Jatin P.
Background The current study presents the efforts of a global collaborative group to review the management and outcomes of malignant tumors of the skull base in the pediatric population worldwide.Patients and Methods A total of 28 institutions contributed data on 3061 patients. From this, there were 64 pediatric patients (2.1%). Clinical variables, overall and disease-free survival (OS and DFS) outcomes, and multivariable factors associated with outcome were evaluated.Results The male-to-female ratio was 37:27 and the median [IQR] age at diagnosis was 14.0 [9.6-16.0] years. The most common malignancy was sarcoma (57.8%), followed by esthesioneuroblastoma (25.0%) and carcinoma (17.2%). Negative margins were achieved in 53.1% children. Dural invasion was associated with reduced OS and DFS. Adjuvant radiotherapy was associated with improved survival outcomes.Conclusions Open approaches were widely used for pediatric skull base tumor resection in the period between 1995 and 2015 but we saw a rise in the use of endoscopic and combined techniques by the end of the period covered by this study. Our results may represent a transitional era in which alternative endoscopic techniques continue to expand.
Randomized Controlled Trials in Europe: A Call to Action to Protect National Healthcare Systems from the Upcoming Tsunami of Kidney Failure
(Oxford University Press, 2026) Ortiz, Alberto; Arici, Mustafa; Goumenos, Dimitrios S.; Adamczak, Marcin; Eller, Kathrin; Ferreira, Ana Carina; Torra, Roser
Kidney diseases are among the fastest-growing global health burdens, with chronic kidney disease projected to become the third leading cause of death by 2050. Despite this, therapeutic innovation remains limited: no European Medicines Agency-approved treatment exists for acute kidney injury, and no drugs have demonstrated survival benefits in patients on dialysis. Randomized controlled clinical trials, although pivotal for advancing care, face persistent challenges in nephrology, including patient heterogeneity, multimorbidity, high dropout rates and small populations in rare diseases. In Europe, these intrinsic obstacles are compounded by fragmented implementation of the Clinical Trials Regulation (536/2014), excessive safety reporting demands and lack of nephrology-specific guidance, discouraging academic-led initiatives and limiting pragmatic research. The Coalition for Reducing Bureaucracy in Clinical Trials, a broad alliance of medical societies and patient advocates, has recently published the 'Clinical research in Europe: putting quality and patient safety first' recommendations calling for regulatory harmonization, simplified safety reporting and patient-centred consent. The European Renal Association, a member of the Coalition and contributor to the report, fully supports these recommendations. Implementing such measures is critical to fostering efficient, high-quality nephrology trials in Europe and delivering urgently needed, evidence-based, life-saving and safe therapies for patients with kidney disease.
Evaluation of Central Auditory Processing in Children with Developmental Dyslexia
(Elsevier Ireland Ltd, 2026) Begen, Senanur Kahraman; Ciyiltepe, Muge Muzeyyen; Arslan, Berkay
Objective: Developmental dyslexia is a neurodevelopmental disorder primarily characterized by phonological and reading difficulties. This study aimed to investigate temporal auditory processing and dichotic listening performance in children with developmental dyslexia and to explore their potential contribution to reading-related difficulties. Methods: Sixty children aged 8-13 years participated in the study, including 30 children diagnosed with developmental dyslexia and 30 age-matched typically developing peers. Central auditory processing was assessed using the Staggered Spondaic Word (SSW) test for dichotic listening and the Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Random Gap Detection Test (RGDT) for temporal auditory processing. Results: Children with developmental dyslexia demonstrated significantly poorer performance than controls across all temporal and dichotic auditory processing measures (p < 0.05). In the SSW test, the greatest performance difference was observed in the left competing condition. Temporal processing deficits were evident in frequency discrimination, duration pattern recognition, and gap detection tasks. Conclusion: Children with developmental dyslexia exhibit weaknesses in temporal and dichotic auditory processing tasks. Given the linguistic demands inherent in some dichotic measures, these findings likely reflect an interaction between auditory and language-related processing rather than isolated auditory pathway dysfunction. Incorporating central auditory processing assessment into multidisciplinary dyslexia evaluations may contribute to more targeted diagnostic and intervention approaches.
Investigation of Toxoplasma Gondii and Human Papillomavirus in Paraffin-Embedded Spontaneous Abortus Materials
(Oxford Univ Press inc, 2026) Usluca, Selma; Bakir, Ayfer; Kurkcu, Muhammed Furkan; Caglar, Melike; Duran, Firdevs Sahin
Objective Toxoplasma gondii and human papillomavirus (HPV) can cause spontaneous abortus. This study aimed to investigate the prevalence of these pathogens in formalin-fixed, paraffin-embedded placenta samples from women diagnosed with spontaneous abortus.Methods A total of 288 formalin-fixed, paraffin-embedded placenta tissue blocks stored in the archives of Etlik City Hospital Pathology Laboratory were included in the study between October 1, 2022, and June 23, 2023. The presence of T gondii and HPV in formalin-fixed, paraffin-embedded placenta samples was investigated using real-time polymerase chain reaction.Results The T gondii DNA was not detected in the samples. However, anti-T gondii IgG antibody was positive in 10.4% (11/106) of the patients. Human papillomavirus DNA was positive in 5.4% of the samples, with HPV 18 and HPV 31/58/66 being the most frequently detected HPV types.Conclusions Our study revealed that HPV could infect the placenta by detecting high-risk HPV in placental samples. However, no relationship was found between HPV positivity and previous stillbirth or spontaneous abortus. Prospective studies with larger populations are needed to further understand the role of these factors in the cause of spontaneous abortus.
Assessment of the Effectiveness of Serum-Infrared Spectroscopy in Conjunction with Multivariate Analysis Methods for Atherosclerosis Diagnosis
(Nature Portfolio, 2026) Cevik, Dilek; Telkoparan-Akillilar, Pelin; Yonar, Dilek
Atherosclerosis is a progressive disease characterized by lipid accumulation and fibrous elements in large and medium-sized arteries, and remains a leading cause of death worldwide. A deeper understanding of its molecular nature is critical for developing novel strategies for the prevention, diagnosis, and treatment. This study evaluates attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy combined with multivariate analysis techniques to differentiate and classify atherosclerosis by identifying disease-specific spectral variations. Spectral analyses indicated statistically significant differences in lipid (p < 0.0001), protein (p < 0.01), nucleic acid (p < 0.0001), and glucose (p < 0.0001) content of serum samples in the atherosclerosis group compared to controls. Patients with atherosclerosis exhibit altered lipid metabolism, marked by a decrease in saturated lipids and an increase in unsaturated lipids compared to healthy individuals. Additionally, elevated levels of protein, RNA, glucose, and conformational changes in DNA were key spectral features, distinguishing atherosclerosis from controls. Principal component analysis (PCA) successfully differentiated patients from controls, while classification models based on linear discriminant analysis (LDA) and support vector machine (SVM) achieved accuracies of 96.61% and 93.22%, respectively. The ability of FTIR spectroscopy to detect subtle biochemical alterations suggests its potential for early diagnosis. These molecular markers may appear prior to clinical symptoms, highlighting the method's potential for future screening, pending validation in at-risk or preclinical cohorts.
Artificial Intelligence Based Resuscitation Simulation: A Pilot Study of a Novel Approach to Team Leadership Training
(BMC, 2026) Kanbakan, Altug; Berikol, Goksu Bozdereli; Ilhan, Bugra; Altintas, Emel; Doganay, Fatih
Introduction Team leadership training is essential alongside with technical training for effective resuscitation management. Addressing this gap, we developed a novel simulation system leveraging Large Language Models (LLMs) to create Artificial Intelligence (Al) agents simulating team members in Advanced Cardiovascular Life Support (ACLS) scenarios. This pilot study aimed to to develop a novel LLM-based ACLS simulation training platform and evaluate its performance in simulated resuscitation scenarios on established protocols.
Method Using the Claude 3.5 Sonnet API, we designed a simulation system with four Al agents assigned specific roles as healthcare staff within an ACLS team. Each agent strictly followed the 2020 American Heart Association (AHA) ACLS guidelines while interacting with an ACLS certified emergency medicine specialist user. The ten patient scenario transcripts were evaluated with three blinded emergency medicine specialists whether all the recommended steps are completed. Inter-rater reliability was assessed using Kendall's W and Krippendorff's Alpha statistics to evaluate agreement both within raters and the model.
Results Al agents consistently adhered to the AHA 2020 ACIS algorithm across scenarios, with a high inter-rater reliability (Kendall's W > 0.75 ) . Krippendorff's Alpha values for agreement ranged from substantial (0.84) to almost perfect (0.99), indicating robust compliance with guidelines and effective simulation of resuscitation responses.
Conclusion This study highlights the potential of LL.M-powered simulations as an adjunct to traditional resuscitation training. The system effectively supported team leadership training by providing consistent and guideline-compliant responses. While the results are promising, further research with larger participant samples is necessary to evaluate the long-term educational impact and scalability of such systems.
Rehabilitation in Neuromuscular Diseases: Best Turkish Practice Recommendations by Multidisciplinary Experts (Nov, 10.1007/S13760-025-02923-8, 2025)
(Springer Heidelberg, 2026) Umay, Ebru; Tanigor, Goksel; Toraman, Fusun; Karaahmet, Ozgur; Bilgilisoy, Meral; Sertpoyraz, Filiz; Kasapoglu, Banu
A Benchmark of Expert-Level Academic Questions to Assess AI Capabilities
(Nature Portfolio, 2026) Phan, Long; Gatti, Alice; Li, Nathaniel; Khoja, Adam; Kim, Ryan; Ren, Richard; Scaramuzza, Davide; Park, Jongee
Benchmarks are important tools for tracking the rapid advancements in large language model (LLM) capabilities. However, benchmarks are not keeping pace in difficulty: LLMs now achieve more than 90% accuracy on popular benchmarks such as Measuring Massive Multitask Language Understanding(1), limiting informed measurement of state-of-the-art LLM capabilities. Here, in response, we introduce Humanity's Last Exam (HLE), a multi-modal benchmark at the frontier of human knowledge, designed to be an expert-level closed-ended academic benchmark with broad subject coverage. HLE consists of 2,500 questions across dozens of subjects, including mathematics, humanities and the natural sciences. HLE is developed globally by subject-matter experts and consists of multiple-choice and short-answer questions suitable for automated grading. Each question has a known solution that is unambiguous and easily verifiable but cannot be quickly answered by internet retrieval. State-of-the-art LLMs demonstrate low accuracy and calibration on HLE, highlighting a marked gap between current LLM capabilities and the expert human frontier on closed-ended academic questions. To inform research and policymaking upon a clear understanding of model capabilities, we publicly release HLE at https://lastexam.ai.
Complex Multisource Sound Induces Greater Neurodegeneration in Neonatal Rat Brain than Single-Source Sound
(Frontiers Media SA, 2026) Daltaban, Iskender Samet; Aydin, Mehmet Dumlu; Eyupoglu, Eylem Eren; Demirci, Elif; Okuyan, Aybike Aydin; Demir, Mehmet Emin
Background: Excessive noise exposure is a known environmental health hazard linked to neurological injury and cognitive deficits. Whether complex sound waveforms from multiple sources exacerbate brain damage compared to a single-source noise of equal intensity remains unclear. We investigated the effects of identical music played either through one or four loudspeakers on the developing brain of newborn rats. Methods: Forty-one newborn Sprague-Dawley rat pups (both sexes), along with their dams, were randomly assigned to three groups: control (no noise, n = 6), single-speaker exposure (n = 15), and multi-speaker exposure (n = 20). From postnatal day 0 to 30, the exposure groups were subjected to an 8-min music track (similar to 85 dB SPL) either via one loudspeaker (simple waveform) or simultaneously via four loudspeakers (complex interfering waveform), six times daily at 4-h intervals. Sound intensity was calibrated at the cages with a sound-level meter. All procedures followed ARRIVE guidelines and the EU Directive 2010/63/EU for animal research, with institutional ethical approval. After 1 month, rat brains were examined histologically. Unbiased stereology was used to estimate neuronal densities in the temporal lobe (including amygdala and hippocampal dentate gyrus). Immunohistochemistry for neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP) and TUNEL assay (terminal deoxynucleotidyl transferase dUTP nick-end labeling) was performed to identify neuronal integrity, astroglial response, and apoptosis, respectively. Outcome measures were degenerated (TUNEL-positive) neuron densities and histopathological lesions. Statistical comparisons were made using Student's t-tests or ANOVA and chi-square tests (with p < 0.05 considered significant). Results: Eight of 20 pups (40%) in the multi-speaker group died during the exposure period, compared to 5/15 (33%) in the single-speaker group and 3/6 (50%) in controls (differences not statistically significant). Maternal rats exhibited agitation, stress behaviors, and weight loss under noise; some eventually ceased escape attempts (habituation/helplessness behavior) in both noise-exposed groups. Histologically, the multi-speaker exposure caused more severe brain injury than the single-speaker exposure. Pups in the multi-speaker group showed frequent subarachnoid hemorrhages and cortical microvascular bleeding in the temporal lobes, whereas these lesions were mild or infrequent in the single-speaker group and absent in controls. Neurons in noise-exposed brains displayed morphological signs of degeneration (shrunken, angulated cell bodies with pyknotic nuclei and condensed cytoplasm), which were markedly pronounced in the multi-speaker group. Stereological cell counting revealed a significant increase in apoptotic neuron density in both sound-exposed groups, with the multi-speaker group highest. For example, in the hippocampal dentate gyrus, the mean density of TUNEL-positive (degenerating) neurons was 13,450 +/- 1,560 per mm(3) in the multi-speaker group vs. 7,600 +/- 980 per mm(3) in the single-speaker group and only 200 +/- 34 per mm(3) in unexposed controls (p < 0.05). In the amygdala, apoptotic neuron density averaged 3,460 +/- 863 per mm(3) (multi-speaker) vs. 1,470 +/- 285 (single-speaker) and 1,321 +/- 234 (control), with the multi-speaker group showing a significantly higher burden of neuronal cell death (p < 0.005 for complex vs. simple waveforms). Correspondingly, multi-speaker exposed brains showed intense immunostaining for NSE and GFAP fragmentation, indicating widespread neuronal loss and reactive astroglial injury, whereas single-speaker exposure caused only moderate changes. Conclusion: Identical musical noise caused substantially more neurodegeneration in the developing brain when delivered as complex wave interference from multiple speakers rather than as a single-source sound of the same intensity. Complex multisource waveforms appear to amplify the harmful effects of noise on neonatal brain tissue, likely through interference-driven pressure fluctuations. These findings have clinical and public health implications, suggesting that current noise exposure guidelines should consider not only sound intensity and duration but also the acoustic complexity and source configuration, especially to protect vulnerable populations such as infants and children from high-intensity multisource noise environments.
Endoscopic Management of Congenital Middle Ear Ossicular Chain Anomalies: A Multicenter Study
(Lippincott Williams & Wilkins, 2026) Orhan, Kadir Serkan; Celik, Mehmet; Ozdek, Ali; Gulsen, Secaattin; Yorgancilar, Ediz; Surmelioglu, Ozgur; Guneri, Enis Alpin
Objective: This study evaluates the surgical and audiological outcomes of transcanal endoscopic ear surgery (TEES) in patients with congenital ossicular chain anomalies (COCAs) using the Teunissen-Cremers classification system. Study design: Multicenter, retrospective clinical study. Setting: Tertiary referral centers with experienced endoscopic ear surgeons. Patients: A total of 51 patients were diagnosed with COCAs and treated with TEES. Patients with chronic otitis media, cholesteatoma, tympanosclerosis, otosclerosis, or those requiring microscopic/endaural/retroauricular approaches were excluded. Intervention: Transcanal endoscopic ossicular chain reconstructions were performed using various techniques, including stapedotomy, partial and total ossicular prosthesis or autologous bone or cartilage graft placements, and bone cement bridging. Main outcome measures: Air-bone gap (ABG) closure, operation duration, hospital stay, and postoperative complications. Results: The mean preoperative ABG was 42.5 +/- 10.9 dB HL, which improved to a mean postoperative ABG of 20.3 +/- 12.3 dB HL, yielding a mean ABG closure of 22.3 +/- 12.2 dB HL. Patients classified as Class 1, 2, and 3 demonstrated significantly greater ABG closure rates compared with Class 4 cases ( P <0.059). The mean surgical duration was 72.1 +/- 19.9 minutes, and the mean hospital stay was 29.6 +/- 15.3 hours. No intraoperative or immediate postoperative complications were observed. Five patients required revision surgery due to recurrent conductive hearing loss. Conclusions: TEES is a safe and effective technique for managing COCAs, offering significant ABG improvement, particularly in Class 1 to 3 anomalies. The minimally invasive nature of TEES, combined with superior exposure and visualization, results in favorable audiological outcomes with minimal complications and reduced hospital stay.
The Role of Emotional Intelligence in the Relationship between Burnout and Perceived Quality of Care Among Oncology Nurses
(Elsevier Sci Ltd, 2026) Sari, Tugba; Calis, Behice Belkis; Pars, Hatice; Guner, Perihan
Purpose: This study aimed to examine the relationships between burnout, emotional intelligence, and perceived caring behaviours among oncology nurses and to assess the predictive and mediating roles of these variables in explaining caring behaviours. Methods: A descriptive, cross-sectional study was conducted with 202 oncology nurses in T & uuml;rkiye. Data were collected using validated instruments measuring burnout, emotional intelligence, and caring behaviors. Data analysis employed descriptive statistics, Pearson correlation analyses, multiple linear regression, and structural equation modeling. Results: Emotional intelligence was positively associated with caring behaviours (r = .359, p < .001) and negatively associated with burnout subdimensions. Caring behaviours were inversely related to emotional exhaustion (r = -.258, p < .001), depersonalisation (r = -.397, p < .001), and reduced personal accomplishment (r = -.214, p = .002). In the regression model (R2 = .214, p < .001), emotional intelligence significantly predicted caring behaviours positively ((3 = .218, p = .002), while depersonalisation was a significant negative predictor ((3 = -.288, p < .001). However, emotional intelligence did not mediate the relationship between burnout and caring behaviours (Sobel test p = .332). Conclusion: While emotional intelligence was positively associated with caring behaviours and buffered the impact of burnout-particularly depersonalisation-it did not mediate the relationship between burnout and caring. These findings support the value of enhancing emotional intelligence to improve care quality and nurse well-being, though contextual factors may influence its mediating role.
Glycaemic Control and Complications in Haemodialysis Patients: The TURK-HEMODIAB Study
(Oxford University Press, 2026) Gungor, Ozkan; Korucu, Berfu; Oguz, Ebru Gok; Eren, Necmi; Ural, Zeynep; Dheir, Hamad; Arici, Mustafa
Background The most common cause of end-stage kidney disease is diabetes mellitus (DM). The most commonly used renal replacement therapy in Turkey and in many countries around the world is haemodialysis (HD). Glycaemia control is important in these populations. In this study we aimed to screen for glycaemic control and complications in a large population of diabetic HD patients in Turkey. Methods A total of 16 043 patients were screened in 253 dialysis centres in Turkey and 5038 diabetic HD patients were included in the study. At participating centres, patients' diabetes history, complications, medications, haemoglobin A1c (HbA1c) and other laboratory data were reviewed and recorded by nephrologists. Results The average age of the patients was 64.0 +/- 11.2 years and 56% were male. The mean HbA1c was 7.4 +/- 1.5%. Patients were divided into three groups according to the HbA1c level (<6.5%, 6.5-8% and >8%). As the HbA1c levels increased, the mean systolic blood pressure and diastolic blood pressure increased significantly. In addition, as the HbA1c levels increased, the number of patients with coronary artery disease, patients undergoing coronary artery bypass graft surgery and the rate of patients with diabetic retinopathy and vision loss increased. Diabetic foot disease and amputation rates were also higher in the group with poor glycaemic control. The number of patients using intensive or mixed insulin was also higher in the group with high HbA1c levels. In ordinal logistic regression analysis, age significantly decreased and higher body mass index slightly increased the risk of a higher HbA1c. Also, the need for a diabetic diet was greater in those with high HbA1c levels. Conclusion Our study highlights that the target values for diabetic HD patients in Turkey are partially compatible with the 2022 Kidney Disease: Improving Global Outcomes guidelines for diabetes management. Nevertheless, more effort and teamwork are needed to improve patient outcomes.
Citation - Scopus: 1
Randomised Comparison Between Navigation and Non-Navigation Camera Control Performance in a Surgical Simulation Task Using a Haptic Device Interface
(Wolters Kluwer Medknow Publications, 2026) Cagiltay, Nergiz Ercil; Topalli, Damla; Tuner, Emre; Berker, Mustafa
Introduction:Navigation skills for controlling the camera in the surgical field are critical for many minimally invasive surgery (MIS) procedures. Currently, endoscopes lack integrated navigation aids, making camera control a challenging task. This experimental study aims to investigate the effect of navigation guidance on the performance of beginners.Patients and Methods:A custom computer-based simulation environment was developed for this study, featuring two conditions - one with navigation guidance and one without - focussed on a camera-cleaning task. Participants (64 beginners) were randomly assigned to one of these groups and used two haptic devices to simulate the endoscope and surgical tools.Results:Participants in the guided condition performed significantly better than those in the unguided condition. Notably, female participants completed the task in significantly less time under the guided condition compared to the unguided one.Conclusion:These findings suggest that incorporating navigation aids into endoscope interfaces could improve user performance, especially for beginners. Medical device manufacturers should consider adding navigation features to enhance usability. In addition, simulation-based instructional systems should integrate navigation aids to better support surgical training.
Reply to Letter to the Editor: Critical Appraisal of Caval Valve Implantation Procedure in 7 Cases of Torrential Tricuspid Regurgitation
(Kare Publ, 2026) Bozbas, Huseyin; Barcin, Cem; Asfour, Mohamed; Celebi, Savas A.; Cam, Ersin; Ilkay, Erdogan
Utilizing POCUS in the Diagnosis of Small Bowel Obstruction and the Barriers to Its Implementation in Resource-Limited Settings: A Systematic Review
(Springer Int Publ AG, 2026) Razakh, Ayesha; Uzor, Angelina; Htoon, April; Valko, Michal
PurposeSmall bowel obstruction (SBO) is a common surgical emergency that can lead to significant morbidity, mortality, and healthcare costs, particularly when diagnosis is delayed. In rural and resource-limited emergency settings, advanced imaging techniques like computed tomography (CT) may not be readily available. As a result, clinicians often rely on physical examinations and plain radiographs which can be unreliable. Point-of-care ultrasound (POCUS) provides a rapid, radiation-free and cost-effective diagnostic alternative that can be performed directly at the bedside.MethodsWe conducted a systematic review of published literature evaluating the diagnostic accuracy and clinical utility of POCUS in identifying SBO on the following databases PubMed, Web of Science, Cochrane Library and Google Scholar databases from January 2000 to December 2024. Studies were screened and selected based on the inclusion and exclusion criteria adhering to PRISMA 2020 guidelines.ResultsThe sensitivity of POCUS for SBO ranged from 85.0 to 100%, while specificity ranged from 54.0 to 100%. Diagnostic accuracy remained high across a broad range of expertise overcoming operator dependence. Examination durations are approximately 10-11 min, which is markedly shorter than 45-min to 3-h by CT.ConclusionPOCUS presents as a practical, scalable and cost-saving tool for diagnosing SBO in rural emergency care, addressing significant gaps where CT is not available and also facilitates faster diagnosis by timely identification of specific features. Future efforts should focus on developing validated algorithms for resource-limited settings allowing immediate care management.
Comparison of Voice Call Based and Multimodal Telerehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial
(Taylor & Francis Inc, 2026) Aslan, Sema Nur; Bozgeyik-Bagdatli, Sibel; Demirel, Murat; Atilla, Bulent; Kinikli, Gizem Irem
Background Telerehabilitation has emerged as a promising approach in postoperative care following total knee arthroplasty(TKA);nevertheless,the relative effectiveness of different telerehabilitation modules is still under discussion, leaving room for alternative and multimodal program approaches. Objectives This study aimed to compare the effectiveness of a multimodal telerehabilitation(MTR) and voice call based telerehabilitation(VTR) in patients undergoing TKA. Methods A two-arm randomized controlled trial was conducted with 24 patients (68.42 +/- 9.28y) in the MTR group and 21(71.19 +/- 7.26y) in the VTR group. The MTR group received weekly digital booklets containing asynchronous exercise videos, one voice call, one video call,and text messages,for a total of three contacts per week. The VTR group received weekly printed booklets and voice calls three times a week(on alternate days) over the 8-week intervention period. Outcomes were assessed face to face at discharge, and at the 4th and 8th postoperative weeks. Measures included Visual Analog Scale(VAS), active and passive range of motion(ROM), Knee Osteoarthritis Outcome Score-Physical Function(KOOS-PS), Five Repetition Sit to Stand Test(5xSST), Brief Fear of Movement(BFoM) Scale, isometric Quadriceps muscle strength, Forgotten Joint Score-12(FJS-12),Exercise Adherence Rating Scale(EARS). The primary outcome was active knee flexion ROM. Statistical significance was set at p < .05; effect sizes (r, W) were reported for the Mann - Whitney U and Wilcoxon tests. Results After 8 weeks, a statistically significant difference in pain during activity was observed between the MTR and VTR groups (p < .001, r = 0.62). Both groups showed significant gains in active and passive knee flexion ROM, 5xSST, and KOOS-PS scores (all p < .001), while the MTR group also improved in rest pain, knee extension, and BFoM (all p < .001). At week 8, statistically significant differences were observed between the MTR and VTR groups across all outcome measures (all p < .001). Conclusion Both telerehabilitation approaches were effective in improving pain, ROM, and functional outcomes after TKA.Although this study did not compare outcomes with conventional in-person rehabilitation, MTR showed greater overall improvements than VTR. Nevertheless, VTR remains a reasonable alternative when MTR cannot be implemented.
Trends and Scientific Evolution in Endovascular Aneurysm Repair (EVAR) Research: A Comprehensive Bibliometric Study Using Vosviewer
(Sage Publications Inc, 2026) Sever, Sinem Nur; Oktem, Hale; Jamil, Yusuf; Pelin, Can
Background: Endovascular aneurysm repair (EVAR) has become a standard treatment for abdominal aortic aneurysms. However, the evolution of EVAR research and its global landscape remain underexplored. This bibliometric analysis aims to map publication trends, identify key contributors, and analyze thematic shifts in EVAR literature over the past three decades.Methods: Data were collected from the Web of Science Core Collection (SCIE) in May 2025. A total of 4264 original research articles on EVAR were analyzed using VOSviewer for co-authorship, co-citation, and keyword co-occurrence mapping. Citation trends, geographical distribution, and institutional contributions were also assessed.Results: Research on EVAR showed steady growth, with a peak of 295 publications in 2024. The United States contributed the largest share (33.02%) of publications. Prolific authors such as Schermerhorn and Verhagen, affiliated with leading institutions like Harvard University, played a pivotal role in advancing the field. Keyword analysis revealed a shift from technical terms (e.g., "stent graft") to clinical outcomes (e.g., "reintervention") over time. The integration of artificial intelligence (AI) in EVAR research is emerging as a key focus area.Conclusion: This study highlights the growth and evolving focus of EVAR research, with a notable shift toward patient-centered outcomes. Despite strong contributions from high-income countries, there is a significant gap in research from low-resource settings. Future directions should include addressing gaps in radiation safety, emergency EVAR applications, and exploring AI-driven clinical decision-making for personalized treatments. Complex EVAR research continues expanding, reflecting guideline evolution and advancing practice in anatomically challenging cases.Clinical Impact This bibliometric analysis demonstrates how EVAR has progressed from an emerging minimally invasive technique to a guideline driven standard of care, with a growing emphasis on complex fenestrated and branched procedures. For clinicians, the findings clarify where the evidence base is well established, particularly for standard infrarenal EVAR, and where further caution and innovation are required, including complex anatomies, long term durability, and reintervention risk. By synthesizing influential studies, key guideline milestones, and evolving research themes, this study supports evidence based clinical decision making, improves patient counseling, and reinforces the importance of lifelong surveillance. Its innovation lies in translating three decades of global research into clinically actionable insight.
Comparison of the Effects of Breast Milk and Hamamelis Virginiana (Witch Hazel) on the Healing of Diaper Dermatitis in Infants: A Randomized Trial
(Mary Ann Liebert, Inc, 2025) Sevimli Guler, Dondu; Vural, Gulsen; Turan, Zekiye; Unal Toprak, Filiz; Melek Arsoy, Hacer Efnan
Background: Diaper dermatitis (DD) is a very common problem in infants between 1 and 6 months. While it rarely causes long-lasting problems, it can cause serious short-term problems for both infants and parents. Accordingly, this study compared the effect of breast milk and diaper rash cream containing Hamamelis virginiana (12 mg/100 g) on the healing process in 0-6 month-old infants with DD. Methods: This randomized, single-blinded trial was conducted with 60 infants aged 0-6 months diagnosed with DD. Participants were assigned to either the breast milk group (BG) or the comparison group (CG) receiving Hamamelis virginiana cream. Demographic characteristics and DD severity were assessed using a structured demographic questionnaire and the validated Assessment of the Severity of Uncomplicated DD in Infants Scale. Statistical analyses included Shapiro-Wilk, Mann-Whitney U, Wilcoxon signed rank, Chi-square, and Fisher's exact tests. Significance was set at p < 0.05. Results: Before the intervention, the mean scale score was 5.17 +/- 0.46 in the BG, 2.83 +/- 1.37 in the CG, which was a statistically significant difference. After the intervention, there was a significant decrease in the mean scale score in the BG to 0.03 +/- 0.18, whereas the mean decrease was smaller in the CG (1.53 +/- 1.11). The difference in the mean scale scores between the groups was statistically significant (p < 0.001). Furthermore, the postintervention mean scale score of the BG was significantly lower than that of the CG. However, baseline severity differences limit direct comparison of treatment efficacy. Conclusions: Topically applied breast milk appears to be a safe, accessible, and cost-effective option for treating uncomplicated DD, with greater improvement than cream containing Hamamelis virginiana. However, baseline severity differences limit direct comparison. Further studies using block randomization are recommended.

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