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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14411/22
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Article 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, 2026-02) 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.Article Skull Base Surgery in the Pediatric Population-The 2nd International Collaborative Study (1995-2015)(Wiley, 2026-02-11) 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.Article Randomized Controlled Trials in Europe: A Call to Action to Protect National Healthcare Systems from the Upcoming Tsunami of Kidney Failure(Oxford University Press, 2026-01-24) Ortiz, Alberto; Arici, Mustafa; Goumenos, Dimitrios S.; Adamczak, Marcin; Eller, Kathrin; Ferreira, Ana Carina; Torra, RoserKidney 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.Article Assessment of the Effectiveness of Serum-Infrared Spectroscopy in Conjunction with Multivariate Analysis Methods for Atherosclerosis Diagnosis(Nature Portfolio, 2026-01-03) Cevik, Dilek; Telkoparan-Akillilar, Pelin; Yonar, DilekAtherosclerosis 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.Article Artificial Intelligence Based Resuscitation Simulation: A Pilot Study of a Novel Approach to Team Leadership Training(BMC, 2026-01-05) Kanbakan, Altug; Berikol, Goksu Bozdereli; Ilhan, Bugra; Altintas, Emel; Doganay, FatihIntroduction 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.<br /> 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.<br /> 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.<br /> 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.Article Glycaemic Control and Complications in Haemodialysis Patients: The TURK-HEMODIAB Study(Oxford University Press, 2025-04-18) Gungor, Ozkan; Korucu, Berfu; Oguz, Ebru Gok; Eren, Necmi; Ural, Zeynep; Dheir, Hamad; Arici, MustafaBackground 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.Article Clinicopathological Predictors of Central Lymph Node Metastasis in Clinically Node-Negative Papillary Thyroid Carcinoma: A Retrospective Cohort Analysis(Springer, 2025-11-25) Sakiz, Davut; Calapkulu, Murat; Sencar, Muhammed Erkam; Unsal, Ilknur Ozturk; Kartal, Mehmet Zabit; Ucan, Bekir; Cakal, ErmanPurposeThis retrospective cohort study aimed to identify clinicopathological predictors of central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC).MethodsA total of 503 patients with PTC who underwent thyroidectomy with central lymph node dissection were included. Preoperative clinical data, ultrasonographic features, and postoperative histopathological characteristics were analyzed.ResultsCLNM was detected in 209 (41.55%) patients. Male sex (odds ratio [OR] = 3.12, 95% CI: 1.82-5.35), irregular nodule borders (OR = 2.02, 95% CI: 1.25-3.26) and higher risk categories in the American Thyroid Association (ATA) ultrasonographic pattern stratification system (OR = 13.312, 95% CI: 8.623-20.551) were identified as independent preoperative predictors of CLNM. A simplified model incorporating only the ATA ultrasonographic pattern stratification system and male sex achieved 83.5% accuracy in predicting CLNM. Histopathological evaluation revealed lymphovascular invasion (OR = 4.61, 95% CI: 2.81-7.55), extrathyroidal extension (OR = 2.41, 95% CI: 1.52-3.83), and multifocality (OR = 1.58, 95% CI: 1.04-2.40) as independent predictors of CLNM, while lymphocytic thyroiditis (OR = 0.59, 95% CI: 0.39-0.89) was a protective factor.ConclusionThis study establishes that ATA ultrasonographic suspicion patterns combined with the male sex provide an accurate and simplified model for preoperative CLNM prediction in PTC, outperforming complex nomograms. Key independent predictors included male sex, irregular nodule margins, ATA high-risk patterns, lymphovascular invasion, extrathyroidal extension, and multifocality, while lymphocytic thyroiditis was protective. According to the current study, risk assessment and personalized management should favor a holistic approach, rather than focusing solely on individual risk factors.Article Citation - WoS: 1Citation - Scopus: 1From Street Canyons To Corridors: Adapting Urban Propagation Models for an Indoor IQRF Network(MDPI, 2025-11-13) Doyan, Talip Eren; Yalcinkaya, Bengisu; Dogan, Deren; Dalveren, Yaser; Derawi, MohammadAmong wireless communication technologies underlying Internet of Things (IoT)-based smart buildings, IQRF (Intelligent Connectivity Using Radio Frequency) technology is a promising candidate due to its low power consumption, cost-effectiveness, and wide coverage. However, effectively modeling the propagation characteristics of IQRF in complex indoor environments for simple and accurate network deployment remains challenging, as architectural elements like walls and corners cause substantial signal attenuation and unpredictable propagation behavior. This study investigates the applicability of a site-specific modeling approach, originally developed for urban street canyons, to characterize peer-to-peer (P2P) IQRF links operating at 868 MHz in typical indoor scenarios, including line-of-sight (LoS), one-turn, and two-turn non-line-of-sight (NLoS) configurations. The received signal powers are compared with well-known empirical models, including international telecommunication union radio communication sector (ITU-R) P.1238-9 and WINNER II, and ray-tracing simulations. The results show that while ITU-R P.1238-9 achieves lower prediction error under LoS conditions with a root mean square error (RMSE) of 5.694 dB, the site-specific approach achieves substantially higher accuracy in NLoS scenarios, maintaining RMSE values below 3.9 dB for one- and two-turn links. Furthermore, ray-tracing simulations exhibited notably larger deviations, with RMSE values ranging from 7.522 dB to 16.267 dB and lower correlation with measurements. These results demonstrate the potential of site-specific modeling to provide practical, computationally efficient, and accurate insights for IQRF network deployment planning in smart building environments.Article Effectiveness of Boric Acid in Sepsis in Rats With Cecal Perforation(Springer Nature, 2025-11-28) Kurtipek, Ali Can; Dursun, Ali Dogan; Yigman, Zeynep; Ozdemir, Cagri; Kucuk, Aysegul; Gonullu, Ugur; Arslan, MustafaIntroduction and AimSepsis is a systemic inflammatory response that develops in the host against microorganisms, which results in end-organ damage. Boric acid (BA) has been shown to have immune modulatory effects in vitro and in animal studies. The aim of the study is to investigate the effects of high dose BA on lung and kidney tissues in rats with sepsis induced by the CLP method.Method28 rats were randomly divided into four groups: Group C (control group), Group BA, Group CLP (cecal ligation and puncture), and Group CLP + BA. Cecum was ligated below the ileocecal valve and punctured. BA was administered to the treatment groups at an intraperitoneal dose of 200 mg/kg, and at the end of 24 h, lung and kidney tissue samples were collected and evaluated for biochemical and histopathological parameters.ResultsHistopathologically, in kidney tissue, CLP + BA group showed significantly less peritubular capillary dilatation and brush border loss in the proximal tubule epithelium compared to the CLP group. In lung tissue, CLP + BA group had significantly less alveolar wall thickening compared to the CLP group. Biochemical analyses indicated that BA administration reduced oxidative stress in both renal and lung tissues.ConclusionWe found that intraperitoneal administration of high dose boric acid partially ameliorated the tissue damage in rats subjected to CLP induced sepsis. Further studies are needed regarding the dosage and application at different time points.Article Evaluation of Anti-Tetanus IgG Antibody Levels and Influencing Factors in Patients Undergoing Hemodialysis(Frontiers Media Sa, 2025-12-03) Ozsoy, Metin; Ozturk, Hakki; Tuna, Aysegul; Varlibas, Artuner; Cesur, Salih; Aksoy, Altan; Demir, Mehmet EminAim: This study aimed to assess anti-tetanus IgG antibody levels and identify determinants of inadequate tetanus immunity among maintenance hemodialysis (HD) patients. <bold>Methods:</bold> In this cross-sectional study, anti-tetanus IgG levels were measured by quantitative ELISA in 162 adult HD patients from two dialysis centers in Ankara, Turkey. Protective immunity was evaluated using both international (>= 0.1 IU/mL) and robust (>= 0.5 IU/mL) cut-offs. Demographic and clinical factors associated with immunity were analyzed by multivariate logistic regression. <bold>Results:</bold> Only 16.7% of HD patients achieved robust protection (>= 0.5 IU/mL), whereas 49.8% had minimal protection (>= 0.1 IU/mL). Protective immunity was independently associated with younger age (OR 1.07 per year; p = 0.004), shorter dialysis duration (OR 1.07; p = 0.030), male sex (female OR 2.92; p = 0.048), and recent booster vaccination within 10 years (OR 0.11; p < 0.001). Diabetes mellitus was not an independent factor. <bold>Conclusion:</bold> Most HD patients lacked durable tetanus immunity, particularly older females on long-term dialysis. The findings highlight the need for regular antibody monitoring, early revaccination, and structured booster programs to maintain adequate protection in this high-risk population.