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Role of Latissimus Dorsi–Thoracolumbar Fascia Complex Stretching on Pain and Pain-Related Parameters in Patients with Chronic Low Back Pain: A Randomised Clinical Trial
(John Wiley and Sons Inc, 2025) Uluǧ, N.; Kodak, S.B.; Kodak, M.İ.; Aslan, S.N.; 01. Atılım University
Background: Fascial stretching is gaining interest as a potential intervention for pain management. However, evidence regarding the effect of latissimus dorsi–thoracolumbar fascia (LD-TLF) complex stretching in patients with chronic low back pain (CLBP) remains limited. Therefore, this study aimed to investigate the effects of LD-TLF complex stretching on pain-related factors and disability in patients with CLBP. Methods: Thirty patients with CLBP were randomly assigned to a study group (n = 15; 7 men, 8 women) and a control group (n = 15; 7 men, 8 women). The study group received 4 weeks of LD-TLF complex stretching in combination with conventional physiotherapy, while the control group received conventional physiotherapy only. Outcomes were assessed before and after the interventions, including primary measures of pain pressure thresholds (PPT) at thoracolumbar fascia levels (L1, L3 and 12th costa), and secondary measures included the Pain Sensitivity Questionnaire (PSQ), the effects of pain on daily activities measured by the Brief Pain Inventory (BPI), and disability assessed by the Oswestry Disability Questionnaire (ODQ). Results: Pre- and post-treatment PPTs, at the L1, L3 vertebrae and 12th costa levels, demonstrated significant differences between the study group and control groups. Post-treatment thresholds were significantly higher compared to pre-treatment thresholds (p < 0.001, ηp2 = 0.67; p < 0.001, ηp2 = 0.61; p < 0.001, ηp2 = 0.74). Additionally, significant improvements were found in PSC, BPI and ODQ scores in the study group compared to the control group (p < 0.05). Conclusion: The results of this study suggest that stretching the LD-TLF complex may be a beneficial addition to the conventional physiotherapy approach for patients with CLBP. Specifically, LD-TLF complex stretching, when used in combination with conventional physiotherapy, appears to provide improved pain thresholds, decreased pain sensitivity and pain during activity, as well as reduced disability compared to conventional physiotherapy alone in patients with CLBP. Significance Statement: Chronic low back pain (CLBP) is a multifactorial condition, with the thoracolumbar fascia increasingly recognized as a potential contributing factor. This study suggests that stretching the latissimus dorsi-thoracolumbar fascia complex in combination with conventional physiotherapy, enhances pain thresholds, reduces pain sensitivity, and decreases disability in individuals with CLBP. Incorporating fascia-specific interventions into CLBP treatment programs could offer significant benefits for both patients and clinicians. © 2025 Elsevier B.V., All rights reserved.
Erratum: Correction to: Stem Cell and Advanced Nano Bioceramic Interactions (Advances in Experimental Medicine and Biology (2018) 1077 Doi: 10.1007/978-981-13-0947-2_17.)
(2018) Köse, S.; Kankilic, B.; Gizer, M.; Ciftci Dede, E.; Bayramli, E.; Korkusuz, P.; Korkusuz, F.; 01. Atılım University
Factors Affecting Dentists' Intention To Adopt Artificial Intelligence: An Extension of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model
(Emerald Group Publishing Ltd, 2025) Alqaifi, Faten; Tengilimoglu, Dilaver; Business; 05. School of Business; 01. Atılım University
PurposeAdvancements in science and technology have integrated artificial intelligence (AI) into dentistry, improving treatment processes, operational efficiency, and clinical outcomes. However, AI adoption among dentists remains underexplored, hindering progress in oral healthcare. This study aims to identify key barriers to AI adoption and examine factors influencing dentists' intention to use AI.Design/methodology/approachA quantitative cross-sectional approach was employed, utilizing self-administered questionnaires distributed online and across various dental clinics and hospitals in Ankara, Turkey. A total of 440 dentists participated in the study. Data analysis was conducted using SPSS and SmartPLS.FindingsThe study found that AI-anxiety negatively affects the intention to adopt AI in dentistry, showing a medium (almost large) effect that is stronger than other UTAUT factors such as performance expectancy, effort expectancy, and social influence, which demonstrated only small effects. Dentists with higher anxiety about learning and sociotechnical blindness are less likely to adopt AI, while concerns about job replacement and AI-configuration have less but still significant impact.Research limitations/implicationsThese results contribute to the growing body of knowledge on technology adoption in oral healthcare and provide practical implications for technology developers, policymakers, and other stakeholders seeking to facilitate AI integration in dentistry.Originality/valueThis study provides novel insights into AI adoption in dentistry, offering guidance for future development and integration, and addressing a critical research gap in a growing field-particularly in Turkey, where implementation is still in its early stages.
Transcatheter Aortic Valve Implantation in Nonagenarians: A Comparative Analysis of Baseline Characteristics and 1-Year Outcomes
(MDPI, 2025) Guney, Murat Can; Bozkurt, Engin; 01. Atılım University
Background: Transcatheter aortic valve implantation (TAVI) is increasingly used in elderly patients with severe aortic stenosis, yet data on nonagenarians remain limited. This study aimed to compare clinical characteristics and outcomes of patients aged >= 90 years with those aged <90 years undergoing TAVI. Methods: We retrospectively analyzed 620 patients who underwent transfemoral TAVI. Patients were divided into two groups: <90 years (n = 545) and >= 90 years (n = 75). Baseline clinical, procedural, and outcome data were compared. Results: Nonagenarians had lower body mass index (BMI) and a lower prevalence of comorbidities such as diabetes, hyperlipidemia, and prior coronary artery bypass grafting CABG (all p < 0.05). All-cause mortality was higher in nonagenarians at 1 month (8.0% vs. 5.5%, p = 0.425), 6 months (9.3% vs. 7.9%, p = 0.838), and 1 year (21.3% vs. 16.7%, p = 0.405), though these differences were not statistically significant. In-hospital stroke occurred more frequently in patients >= 90 years (6.7% vs. 2.2%, p = 0.044). Conclusions: Despite a higher rate of in-hospital stroke, nonagenarians undergoing TAVI had comparable mortality outcomes to younger patients. These findings support the feasibility of TAVI in selected very elderly patients, while highlighting the need for tailored stroke prevention strategies. Trial Registration: The trial is retrospectively registered, and a clinical trial number is not applicable.
The Effect of Perceived Birth Trauma in Women With Planned Cesarean Section on Maternal and Paternal Attachment: Path Analysis Model
(Sage Publications Ltd, 2025) Mert-Karadas, Merve; Topal, Cansu Akdag; Karakurt, Irem; Boztepe, Handan; Nursing; 07. School of Health Sciences; 01. Atılım University
Perceived birth trauma can disrupt parent-infant bonding and affect family dynamics. This study examined the impact of perceived birth trauma on maternal and paternal attachment using path analysis. An analytical cross-sectional study was conducted with 134 mother-father pairs in Turkey, 6 months postpartum, following planned cesarean sections. Data were collected using the Traumatic Childbirth Perception Scale, Mother-to-Infant Bonding Scale, and Paternal-Infant Attachment Scale. Descriptive statistics and reliability analyses were conducted using R software. Path analysis was performed with the R package "lavaan" to assess direct and indirect relationships. Higher perceived birth trauma was significantly associated with increased maternal bonding difficulties and decreased paternal bonding. A significant negative covariance between maternal and paternal bonding scores indicated interdependent bonding dynamics. The model explained 6% of the variance in maternal bonding and 3.7% in paternal bonding. These findings underscore the need for family-centered, trauma-informed postpartum care to support healthy parent-infant attachment.
Citation - WoS: 1
Utilising Uniportal Video-Assisted Thoracoscopic Surgery for Pericardial Window: A 12-Year Single-Centre Experience in the Diagnosis and Treatment of Pericardial Effusion
(Wolters Kluwer Medknow Publications, 2025) Agar, Mehmet; Gulcek, Ilham; Kalkan, Muhammed; Ulutas, Hakki; Celik, Muhammet Reha; Surgical Sciences; 08. Medical School; 01. Atılım University
Introduction:Uniportal video-assisted thoracoscopic surgery (Uni-VATS) is an effective minimally invasive technique for pericardial drainage, biopsy and window creation in cases of pericardial effusion (PE).Patients and Methods:This retrospective study evaluated 73 patients with PE who underwent pericardial window procedures between 2012 and 2024. Intraoperative and post-operative data related to Uni-VATS were assessed.Results:The mean age of the patients was 53.79 +/- 17.79 years (10-82 years), with 34 (46.6%) females and 39 (53.4%) males. The mean volume of pericardial fluid drained after window creation was 446.23 +/- 199.81 cc (75-1100 cc). The mean operation time was 42.87 +/- 12.79 min, and chest drain removal occurred after an average of 1.8 +/- 1.2 days. The mean duration until discharge or referral to the follow-up clinic was 5.98 +/- 2.14 days. In addition to the pericardial window procedure, pleural biopsy was performed in 12 patients, mediastinal mass biopsy in eight patients and wedge resection for parenchymal nodules in six patients. Microbiologic and virologic cultures of the fluids were negative in all cases. Among the 41 patients with benign cytology, pericardial biopsy results indicated tuberculosis in four patients (5.4%), amyloidosis in one patient (1.3%) and chronic or subacute nonspecific pericarditis in the remaining patients.Conclusion:Uni-VATS is a novel and safe technique that may be the preferred choice for pericardial window due to its diagnostic and therapeutic efficacy, ability to perform simultaneous procedures, favourable impact on operation duration/hospital stay, low complication rates and superiority compared to traditional methods.
Development and Validation of an ICF-Based New Scale-Atilim Kinesiophobia Scale: A Methodological Study
(Lippincott Williams & Wilkins, 2025) Ulug, Naime; Parmaksiz, Ayhan; Begen, Sena Nur; Can Karahan, Zehra; Yilmaz, Seval; Adali, Mehmet Fatih; Kilic, Erden; Er, Dudu Melek; 01. Atılım University; Child Development; 07. School of Health Sciences
It is important to assess kinesiophobia, which increases the risk of disability by limiting physical activity. In this cross-sectional study, we aimed to develop a scale that assesses kinesiophobia with the multidimensional structure of International Classification of Functioning, Disability and Health (ICF). Atilim Kinesiophobia Scale (AKS) was developed in Turkish by an expert panel using questionnaires replied by 367 subjects. Finally, 38 questions based on the sub-domains of the ICF described by World Health Organization. In the scope of this cross-sectional study content validity and reliability were assessed; construct validity (both convergent and divergent validity) was checked against Tampa Kinesiophobia Scale-17 and Visual Analog Scale. AKS demonstrated good internal consistency and convergent validity, with significant correlations observed with the Tampa Scale for Kinesiophobia-17 (r = 0.478, P < .001). Divergent validity was supported by insignificant correlations with the Visual Analog Scale (r = 0.019, P = .855). The Cronbach alpha coefficient of 0.862 indicates a high level of internal consistency for the AKS. Based on these findings, the final version of AKS was refined to include 4 factors and 14 items, demonstrating good internal validity. We developed and validated the AKS to assess kinesophobia in patients with acute and/or chronic musculoskeletal pain. This new ICF-based scale can be used to assess kinesiophobia; however further studies are required to prove its validity and reliability in other languages.
Citation - WoS: 1
Anti-Immigration Conspiracy Beliefs Are Associated With Endorsement of Conventional and Violent Actions Opposing Immigration and Attitudes Towards Democracy Across 21 Countries
(SpringerNature, 2025) Thomas, Emma F.; Stothard, Christina; Besta, Tomasz; Akbas, Gulcin; Becker, Julia C.; Becker, Maja; van Zomeren, Martijn; Department of Psychology; 02. School of Arts and Sciences; 01. Atılım University
Despite widespread speculation that conspiracy beliefs foster anti-democratic outcomes, the empirical picture is inconsistent. To clarify this literature, we examine the relationships that conspiracy beliefs have with commitment to reactionary action and criticism of democracy, focusing on a global issue: immigration. We expected that people who believe that their government uses immigration to diversify the population against citizens' wishes (anti-migration conspiracy beliefs) would be more committed to conventional and violent action to oppose immigration, and more critical of democracy. However, societal-level factors - economic performance and democratic functioning - were expected to influence (strengthen, weaken) these links. As hypothesized, multi-level analyses (N = 4353) from 21 countries revealed that economic prosperity attenuated the positive link between anti-migration conspiracy beliefs and commitment to reactionary action. Paradoxically, more democratic societies evidenced stronger links between conspiracy beliefs and conventional (but not violent) action to oppose immigration. Thus, more democratic societies appear to invite conventional forms of action to oppose immigration which may, in turn, weaken democratic norms of inclusion. Results highlight the interplay of individual- and societal-level factors underlying illiberal movements.
Prevalence of Toxoplasma Gondii in Patients with Schizophrenia and Its Association with Clinical Symptoms
(Pergamon-Elsevier Science Ltd, 2025) Kurkcu, Muhammed Furkan; Korkut, Gizem; Varli, Mehmet Ridvan; Yilmaz, Gulsum; Usluca, Selma; Bakir, Ayfer; Basic Sciences; 08. Medical School; 01. Atılım University
Background: Schizophrenia is a multifactorial neuropsychiatric disorder influenced by both genetic predisposition and environmental factors. Recent evidence suggests a possible link between latent Toxoplasma gondii infection and schizophrenia, though the underlying mechanisms remain unclear. Objective: To compare the seroprevalence of T. gondii in patients with schizophrenia and healthy individuals, and to evaluate the relationship between seropositivity and clinical parameters. Methods: A total of 265 participants (155 schizophrenia patients and 110 healthy controls) were enrolled. IgG and IgM antibodies were detected using electrochemiluminescence immunoassay (ECLIA), avidity was assessed using ELISA, and DNA presence was tested with real-time PCR. Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS). Statistical analysis included logistic regression and non-parametric tests (p < 0.05). Results: T. gondii IgG seropositivity was significantly higher in schizophrenia patients (29 %) than in controls (18.2 %) (p = 0.044, OR = 1.84; 95 % CI: 1.01-3.34). IgM positivity and DNA detection did not differ significantly. All seropositive participants showed high IgG avidity, indicating latent infection. BPRS scores and illness duration were higher in IgG-positive individuals, but the differences were not significant. Conclusion: Latent T. gondii infection may be associated with schizophrenia. However, further multicenter studies integrating molecular and serological approaches are needed to clarify its role in disease pathogenesis.
Factors Influencing the Transition Time From Psoriasis to Psoriatic Arthritis: A Real-World Multicenter Analysis
(Springer Heidelberg, 2025) Kilic, Gamze; Kilic, Erkan; Tekeoglu, Ibrahim; Sargin, Betul; Cengiz, Gizem; Balta, Nihan Cuzdan; Nas, Kemal; 01. Atılım University
To identify clinical and demographic predictors associated with the timing of transition from psoriasis (PsO) to psoriatic arthritis (PsA), and to compare the characteristics of patients with concurrent PsO-PsA onset versus those with prolonged transition. A multi-center, observational study was conducted using data from the Turkish League Against Rheumatism (TLAR) network including PsA patients fulfilling CASPAR criteria. Patients were categorized into two groups: Group 1 (concurrent PsO and PsA onset within +/- 1 year) and Group 2 (prolonged transition to PsA, > 1 year after PsO). Demographic, clinical, and laboratory characteristics, disease activity, and patient-reported outcomes were compared between groups. Logistic regression was employed to determine independent predictors of prolonged transition. Among 799 patients (mean age 46.8 +/- 12.3 years), 237 (29.7%) had concurrent onset and 562 (70.3%) had a prolonged transition, with a mean PsO-to-PsA interval of 12.9 +/- 9.6 years. Depression (p = 0.005) and fatigue levels (p = 0.011) were significantly higher in patients with prolonged transition to PsA. Multivariate analysis revealed that scalp psoriasis (OR = 7.162), nail psoriasis (OR = 3.270), family history of PsO (OR = 1.813), and enthesitis ever (OR = 2.187) were associated with prolonged transition. Conversely, family history of PsA (OR = 0.421) and older age at PsO onset (OR = 0.957) predicted shorter transition. Prolonged transition from PsO to PsA is influenced by distinct clinical and demographic factors. Scalp/nail psoriasis, family history of PsO, and enthesitis ever may signal higher risk for prolonged PsA onset. Recognizing these markers can support timely referral and intervention, minimizing diagnostic delay and improving long-term patient outcomes.
Toxoplasma gondii Coinfection in HIV-Positive Patients at a Tertiary Care Hospital
(Bentham Science Publ Ltd, 2025) Kurkcu, Muhammed Furkan; Bakir, Ayfer; Kaba, Semiha Berra Topsakal; Kusabbi, Ilknur Alkan; Usluca, Selma; Basic Sciences; 08. Medical School; 01. Atılım University
Introduction: Toxoplasma gondii (T. gondii) can cause serious complications in both immunocompetent and immunosuppressed individuals. This study aims to assess the seroprevalence of T. gondii among HIV-positive individuals and to investigate its association with age, sex, CD4+ T cell count, HIV RNA levels, and hematological parameters. Methods: This study included 247 HIV-positive individuals followed up at a tertiary care hospital between November 1, 2022, and November 30, 2024. We analyzed serum samples for T. gondii IgG antibodies using electrochemiluminescent microparticle immunoassay. Results: The prevalence of T. gondii IgG seropositivity was found to be 32.8% (n=81; 95% CI: 26.9-39). The median age of seropositive individuals was 52 years (IQR: 42-61), which was significantly higher compared to seronegative individuals (p<0.001). The highest IgG seropositivity rate (66.7%) was observed in the 61-80 age group. Hemoglobin levels were significantly lower in IgG seropositive individuals (p=0.040). Logistic regression analysis indicated an increased risk of T. gondii infection with advancing age. The odds ratio for the 41-60 age group was 13.3 (95% CI: 1.6-106, p=0.02), while for the 61-80 age group, it was 28 (95% CI: 3.3-240, p=0.002). Discussion: The seroprevalence of T. gondii in HIV-positive individuals was lower than both global and regional averages. Age was identified as an independent risk factor for T. gondii seropositivity. Additionally, hematological alterations associated with anemia were observed in seropositive individuals. Further large-scale, multi-center, and regionally representative studies are required to optimize T. gondii infection management and screening strategies in people living with HIV. Conclusion: These findings suggest that T. gondii infection in HIV-positive individuals increases with age and may be associated with anemia, highlighting the need for age-focused screening and management strategies.
Serum Progesterone Variability on Embryo Transfer Day in Hormone Replacement Therapy Cycles Using Intramuscular Injections During Frozen Embryo Transfers
(Springer/plenum Publishers, 2025) Boynukalin, Fazilet Kubra; Tohma, Yusuf Aytac; Demir, Berfu; Gultomruk, Meral; Polyzos, Nikolaos P.; Bahceci, Mustafa; Bozda, Gurkan; 01. Atılım University
Purpose To assess the intra-individual variability of serum progesterone (P) levels on embryo transfer (ET) day, when the same dose of intramuscular progesterone (IM-P) was used in two consecutive hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles. Methods A total of 75 patients undergoing two consecutive HRT-FET cycles in one year performed at Bahceci Ankara IVF Center between November 2019 and February 2022 were retrospectively analyzed. Serum P levels were measured at the 117th-119th hours of support by a single laboratory. The two measurements of P levels performed on the day of the first and the second FET were compared to evaluate the intra-individual variability of serum P levels. Results Comparisons between the 1st and 2nd FET cycles revealed statistically significant intra-individual variation, with an average difference of -2.47 ng/mL (95% CI: -4.65 to -0.29, p = 0.027) between the two consecutive measurements. To assess their consistency, the limit of agreement was also tested with the Bland-Altman method, in which the mean difference (+ 1.96 x SD and -1.96 x SD) was -2.47 (16.1 and -21.1). Based on a previous study, the frequency of low P levels, as expressed by being > 20.6 ng/mL on ET day, was similar between the 1st and 2nd FET cycles (14.7% vs. 9.3%, p = 0.31). Notably, most patients had improved P levels in the second cycle if initially low, while decreases were rare among those with initially higher levels. Conclusion Serum P levels may vary within the same individual across FET cycles despite the use of the same dosage of IM-P. Increasing maternal age, high body mass index, and fluctuating estradiol levels on the day of ET were identified as risk factors contributing to this variability.
Physical and Mental Effects of Different Radical Prostatectomy Techniques on Urologic Surgeons
(PeerJ Inc, 2025) Olcucu, Mahmut T.; Bolat, Mustafa S.; Yildirim, Kadir; Ozgok, Yasar; Tokas, Theodoros; Gozen, Ali; 01. Atılım University
Objective In this web-based international survey study, we aimed to show an association between physical exhaustion and patient, relatives, and employer-related mental stress for surgeons performing open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and robot-assisted laparoscopic prostatectomy (RALP). Additionally, we also aimed to compare the outcomes of three approaches. Methods We sent a ten-question survey to the urologists performing ORP, LRP, and RALP via e-mail and social media. Only fully completed surveys were included in the study analysis. We asked questions about age, the preferred surgical approach for radical prostatectomy, frequency of weekly exercise, and their possible associations with physical exhaustion and musculoskeletal complaints. Results A total of 160 urologists completed the survey. The RALP group showed a lower physical exhaustion rate and increased eye strain (p < 0.001) and p = 0.002, respectively). Although walking was the most preferred sports activity, no correlation was found between regular sport or exercise and musculoskeletal complaints (p > 0.05). Conclusion Compared to ORP and LRP, physical exhaustion was lower in the RALP technique. Although the number of participants was limited, regular exercise weakly improved physical exhaustion and musculoskeletal complaints. We believe that regular sports activities by urologists dealing with LRP and RALP will help relieve physical discomfort.
Potential Role of SGLT-2 Inhibitors in Improving Allograft Function and Reducing Rejection in Kidney Transplantation
(Wiley, 2025) Demir, Mehmet Emin; Helvaci, Ozant; Yildirim, Tolga; Merhametsiz, Ozgur; Sezer, Siren; 01. Atılım University
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated renoprotective and cardioprotective benefits beyond their antiglycemic effects. Their potential utility in kidney transplant recipients (KTRs) for preserving graft function and reducing rejection risk is currently under active investigation. Preliminary studies indicate that SGLT-2i therapy stabilizes estimated glomerular filtration rate (eGFR), decreases glomerular hyperfiltration, and improves metabolic outcomes in KTRs. Emerging clinical evidence also suggests that SGLT-2i may be associated with reduced rates of acute rejection, although direct immunosuppressive actions remain unclear. Experimental findings further suggest that SGLT-2i modulates gene regulation pathways involved in inflammation, oxidative stress, and fibrosis, contributing to improved allograft outcomes. Current safety data in KTRs are reassuring, without significant increases in urinary tract infections or adverse graft events. Nevertheless, long-term prospective studies specific to transplant populations are lacking. This review summarizes available evidence regarding the mechanisms of action, clinical efficacy, and safety profile of SGLT-2i in kidney transplantation, emphasizing their metabolic, hemodynamic, inflammatory, and immunomodulatory effects.
Minimization of Greenhouse Effects by Optimal Plankton Feeding: A Simulation-Based Study
(Springer Science and Business Media B.V., 2025) Doruk, R.O.; Electrical-Electronics Engineering; 06. School Of Engineering; 01. Atılım University
Global warming and related greenhouse effects possess significant threats to environmental sustainability. This research investigates the possibility of reducing the greenhouse gas levels and associated ambient temperature by manipulating the plankton population in a given forecasting period. To achieve this goal, an optimal control strategy is developed by Pontryagin’s minimum principle, and it is applied to a recently derived nonlinear marine ecosystem model describing the variation of greenhouse gas levels, ambient temperature, and fish interactions. The main goal is to determine an external plankton generation profile that is expected to reduce the greenhouse gas levels and associated ambient temperature to the highest possible extent. The simulation results reveal that the optimal feeding strategy enables one to achieve a reduction of 54% in greenhouse gas levels and 95% in the associated ambient temperature. This research proposes a biological-based novel control approach that can serve as an alternative solution to environmental degradation. © 2025 Elsevier B.V., All rights reserved.
Patient Safety in Healthcare: A Proposal for Ensuring the Use of Regulation-Compliant Safety Devices
(Springer Heidelberg, 2025) Bayrak, Tuncay; 01. Atılım University
Medical devices used in health care should fulfill the requirements of the technical regulations to protect patient health. Difficulties in enforcing stricter rules in the new medical device regulations may negatively affect the continuity of care. This study examines the status of manufacturers' compliance with medical device regulations, based on predefined criteria, and proposes a collaborative action plan and an approach to verify regulatory compliance. We conducted a nationwide survey comprising questions grouped by criteria to understand the status of the manufacturers in terms of compliance with the Medical Device Regulation. Four hundred sixty-seven manufacturers participated in the survey. We achieved a Cronbach's alpha of 0.77, which indicates that the survey is statistically reliable. We applied the independent samples t-test to the responses to determine significant features per question and employed factor analysis to investigate the relationships of the questions. The results of independent samples t-tests showed statistically significant differences across groups in replies to several survey items (p < 0.05), indicating that participants' opinions varied based on their demographic characteristics. We applied Exploratory Factor Analysis to introduce the relationships between the questions. The analysis revealed that manufacturers continue to face substantial challenges in acquiring sufficient knowledge and operational capability to meet MDR requirements. In light of these findings, we focused on the person responsible for regulatory compliance, who plays a central role in maintaining regulatory compliance within manufacturing organizations. We proposed an action plan at the macro level to introduce more effective action plans in cooperation with other stakeholders, including healthcare providers, and a verification approach for regulatory compliance to enhance the Person Responsible for Regulatory Compliance's competence. Manufacturers should implement effective postmarketing clinical follow-up plans involving device-oriented parameters for monitoring in the healthcare system, especially in collaboration with health professionals.
Citation - Scopus: 1
Effects of Reformer Pilates on Pain, Psychological Factors, and Sleep in Chronic Musculoskeletal Pain: A Randomized Controlled Trial
(Springernature, 2025) Sahan, Nilay; Ulug, Naime; Ozeren, Aysenur; 01. Atılım University
BackgroundMusculoskeletal disorders that follow a chronic course are associated with many symptoms, the most striking one is chronic pain that gradually worsens. The aim of this randomized controlled and single- center study was to investigate the effect of Reformer Pilates exercises on pain severity, pain coping methods, pain beliefs, fear of movement, fatigue and sleep quality in young adult patients with chronic low back pain and neck pain.MethodsA total of 54 women aged between 30 and 50 were randomized into two groups. The Reformer Pilates (RP) group received a 6-week exercise program (45 min/twice per week), while the control group (CG) didn't receive any exercise program. Outcomes measured before and after the interventions were, Brief Pain Questionnaire, Pain Coping Scale, Pain Beliefs Scale, Tampa Kinesiophobia Scale, FACIT Fatigue Scale and Pittsburg Sleep Quality Index.ResultsThe groups were homogeneous at baseline. Statistical differences were found in favour of RP with small to large effect size in pain parameters (p < 0.05; Cohen's d = 0.17-1.45), large effect size in fear of movement, small effect size in fatigue and medium effect size in sleep quality (p < 0.05; Cohen's d = 0.43-0.86). No statistical difference between the groups was observed only in the pain beliefs organic sub-heading of the Pain Beliefs Scale and in the passive strategies sub-headings of the Pain Coping Scale (p > 0.05).DiscussionThe results of the current study suggest that Reformer Pilates increased active living in patients with chronic low back pain and chronic neck pain engenders a comprehensive enhancement in both physical and mental health, in addition to the capacity of patients to proactively manage their condition.Trial registrationRegistration number: NCT06706037. Date of registration: 11/25/2024.
A Niche-Based Perspective to Stem and Cancer Stem Cells of the Lung
(Springer, 2025) Boyacıoğlu, Özge; Kalali, Berfin Deniz; Tongün, Ege; Korkusuz, Petek; Basic Sciences; 08. Medical School; 01. Atılım University
Lungs carry the principle function for the conduction and exchange of air through the primary, secondary, tertiary bronchi, bronchioles, and alveoli, resulting in the exchange of oxygen to carbon dioxide within the human tissues. Lung stem and progenitor cells enable differentiation of parenchymal and stromal elements and provide homeostasis and regeneration in the microenvironment against pulmonary diseases. Tumor-initiating cancer cells (TICs) refer to a subpopulation named as cancer stem cells (CSCs) of lung cancer exhibiting high self-renewal and proliferation capacity by Notch, Hippo, Hedgehog, and Wnt signaling pathways that leads to tumor development or recurrence. Lung cancer stem cells (LCSCs) are characterized by distinct genotypic or phenotypic alterations compared to healthy lung stem cells (LSCs) that provide a potential target to treat lung cancer. Therefore, understanding the cascades responsible for the transformation of healthy to CSCs is essential to develop new targeted therapy approaches. In this chapter, we precisely highlight the latest researches on LSCs and CSCs, key signaling mechanisms within the perspective of novel targeted therapy strategies. © 2025 Elsevier B.V., All rights reserved.
Biotechnological Preparedness for Novel Pandemics: Diagnostic Performance of IVDS Against SARS-CoV
(Wiley, 2025) Kavruk, Murat; Ercan, Meltem; Borsa, Baris Ata; Ozalp, Veli Cengiz; Hernandez, Frank J.; Basic Sciences; Nutrition and Dietetics; 07. School of Health Sciences; 08. Medical School; 01. Atılım University
Although the COVID-19 pandemic has created many challenges and negative impacts around the world, some of which will persist into the future, its technological challenge has created a unique opportunity in a globalized world. It is a rare event that almost all of humanity to be directed towards a single goal and to try to produce solutions, but the necessity of a similar global action in the future has begun to enter the agenda again. The predictions made on the basis of countries and institutions against the possibility of a pandemic, which is defined as Disease X, are shaped by the experience of the COVID-19 pandemic. Technologically, one of the know-how we have gained in this pandemic is the performance of IVD and test systems in terms of quality and quantity. A comprehensive analysis of the products produced by combining biotechnology with different strategies has not been conducted. In this context, we have analyzed the technical preferences, limitations, and other performance parameters of IVDs and test kits that could be developed against a future Disease X. The performance parameters of 2,882 biotechnological products listed for use in the European Union have been analyzed, and areas that could be targeted for increased effectiveness have been identified. Our study is the first of its kind in this field and can serve as a guide for those who want to work on detection methods, diagnostics, and novel technologies for deployment in future pandemics.
The Predictive Effect of "Real Amylase Value": A More Accurate Predictor for Postoperative Pancreatic Fistula
(Wiley, 2025) Emral, Ahmet Cihangir; Cetinkaya, Gokay; Dikmen, Kuersat; Kerem, Mustafa; Surgical Sciences; 08. Medical School; 01. Atılım University
BackgroundPostoperative pancreatic fistula (POPF) is a common and serious complication following pancreatic surgery. While several studies have attempted to predict the development of POPF using drain amylase concentration, predictive values vary widely due to factors like abdominal irrigation and chylous drainage, which can dilute the amylase levels. This study aims to evaluate whether the "Real Amylase Value" (RAV), calculated as the product of drain amylase concentration and drainage volume, provides a more reliable prediction of POPF compared to conventional amylase concentration. Better prediction of pancreatic fistula development could lead to closer clinical monitoring of these patients, reassessment of hospital stay duration, and more careful management of drains over an extended period. Additionally, carefully managing the timing of drain removal may improve patient recovery and discharge process.MethodologyData from 198 patients who underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were retrospectively analyzed. Drain amylase concentrations and drainage volumes were measured on postoperative days (POD) 1 and 3, and the RAV (U) was calculated. Real Amylase Value (RAV) (U) was calculated using the formula: RAV (U) = Drain Amylase Concentration (U/L) x Drainage Amount (L). Predictive values for POPF were evaluated using receiver operating characteristic (ROC) curve analysis, comparing conventional amylase concentration (U/L) and RAV (U).ResultsOn POD1, the RAV (U) demonstrated greater predictive value for POPF compared to the conventional drain amylase concentration (U/L) with an area under the ROC curve (AUROC) of 0.85 versus 0.79, respectively. Similarly, on POD3, RAV showed superior predictive accuracy (AUROC 0.89) compared to amylase concentration (AUROC 0.79).ConclusionThe RAV (U) offers a more accurate and reliable prediction of POPF than traditional drain amylase concentration (U/L), with improved sensitivity and specificity. This method could refine clinical management, particularly in the timing of drain removal and early intervention strategies for patients at high risk of developing pancreatic fistulas.

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