WoS İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/20.500.14627/6
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Article Fully Synthetic, Nature-Inspired Exosome-Mimetics for Melanoma Therapy(Elsevier B.V., 2026) Arda Ozturk N.Z.; Majchrzak O.B.; Ulivi G.; Kirmizibayrak P.B.; Borchard G.; Patrulea V.; Ozer O.; Ozturk, Nahide Zeren Arda; Borchard, Gerrit; Ozer, Ozgen; Patrulea, Viorica; Majchrzak, Oliwia Barbara; Arda Ozturk, Nahide Zeren; Kirmizibayrak, Petek Ballar; Ulivi, GianlucaFully synthetic exosome-mimetics (FSEMs) represent a nature-inspired drug delivery system designed to replicate the key physicochemical and biological properties of natural exosomes, while offering the potential to address limitations in scalability and reproducibility associated with natural exosomes. In this study, we prepared FSEMs at the laboratory scale. We loaded them with (–)-epigallocatechin-3-gallate (EGCG) and microRNA-23a (miR-23a), aiming to co-deliver therapeutic small molecules and nucleic acids for the treatment of melanoma. FSEMs were fabricated using three methods: thin-film hydration, ethanol injection, and microfluidics. They were surface-functionalized with either CD9, a tetraspanin involved in membrane fusion, or TSP-1, an adhesion protein promoting cellular interactions. Through physicochemical characterization via dynamic light scattering, we found that FSEMs were ∼ 100 nm in size, of low polydispersity (∼0.2) and showed a negative zeta potential (∼–55 mV). Both EGCG and miR-23a were efficiently encapsulated. SDS-PAGE analysis confirmed successful protein incorporation and correct positioning. In vitro release studies showed minimal premature leakage, supporting their suitability for cellular uptake-mediated delivery. When tested on melanoma cells (MDA-MB-435) and progenitor human dermal fibroblasts (FE002-SK2), FSEMs selectively killed melanoma cells while sparing fibroblasts. Importantly, EGCG within FSEMs was more effective than the free compound. Compared to conventional DOTAP-based liposomes, FSEMs were more selective and induced less off-target cytotoxicity. This study presents a proof-of-concept for fully synthetic, protein-functionalized FSEMs as dual carriers for both chemical and gene-based agents, offering a safer and potentially more effective alternative to traditional cationic liposomes. These results lay the groundwork for future in vivo validation and translational cancer research. © 2026 The Author(s)Article The Relationship Between Nurses Anxiety and Attitudes Towards Artificial Intelligence and Examination of Influencing Factors(BMC, 2026) Nirgiz, Cansu; Sari, Merve Kiymac; Cayli, NazanAim to explore the relationships between nurses'anxiety and attitudes toward artificial intelligence (AI) and the factors associated with them. Background Although AI technologies are increasingly integrated into healthcare, research exploring nurses ' psychological readiness and emotional responses to AI remains limited. Existing studies have primarily focused on nursing students or general healthcare professionals, leaving a gap in understanding how practicing nurses perceive and emotionally adapt to AI within real clinical environments-particularly in T & uuml;rkiye, where digital transformation in healthcare is accelerating. Addressing this gap is essential, as nurses play a pivotal role in ensuring the safe and ethical implementation of AI-driven tools in patient care. Methods This descriptive and correlational study included 562 nurses from 14 branches of a private hospital chain across seven Turkish cities between November 2024 and January 2025.This sample was selected because it represents nurses actively engaged in clinical decision-making within healthcare systems that are rapidly adopting AI technologies. According to a power analysis performed in G*Power (rho = 0.25, alpha = 0.05, power = 0.95), the required sample size was 202 participants. Data were collected through an online questionnaire comprising a Descriptive Information Form, the AI Anxiety Scale, and the General Attitudes toward AI Scale. Descriptive statistics, independent samples t-tests, ANOVA (F), Tukey post hoc test, Pearson correlation, and multiple regression analyses were conducted. Ethical approval was obtained from the Fenerbah & ccedil;e University Ethics Committee, and informed consent was obtained digitally. Results Nurses reported moderate anxiety levels and generally positive attitudes toward AI. Male nurses showed an association with lower anxiety levels and higher positive attitude scores than female nurses. Single individuals and those with higher levels of education showed higher positive attitudes toward AI. Those with 0-3 years of experience in the profession were associated with lower anxiety and higher positive attitude scores. Nurses who used AI in practice, were knowledgeable about its use, or perceived it as reliable showed a relationship with lower anxiety and more positive attitudes. Regression analysis showed that each one-unit increase in the learning and AI configuration subscales of the AI Anxiety Scale was associated with a 0.740-and 0.716-point lower score in the total attitude score, respectively. Conclusion The findings suggest that lower levels of anxiety related to learning and AI configuration are associated with more positive attitudes toward AI. Addressing these specific anxiety domains may be related to the successful integration of AI technologies into clinical practice and could be linked to the digital transformation in healthcare.Article Mapping the Evolution of Stigmatization in Mental Disorders: A Bibliometric Analysis From 1974 to 2024(Springer Heidelberg, 2026) Goktas, Polat; Dikec, GulBackgroundThis bibliometric study scrutinizes the thematic evolution of research on stigma and discrimination in mental disorders, covering a span of five decades. It reflects on the shifting paradigms within the stigma-focused mental health research community from 1974 to 2024.MethodsA comprehensive bibliometric analysis was employed using the Bibliometrix R package and VOSviewer software, analyzing 1,892 articles from databases like Scopus, Web of Science, PubMed Central, and APA PsycInfo. Adherence to PRIBA guidelines ensured a holistic representation of the evolving research narrative.ResultsThe analysis outlined three distinct periods: the Genesis Period (1974 - 2007), focusing on foundational concepts of mental disorders and stigma; the Growth Period (2008 - 2015), which experienced a broadening into themes of discrimination and diagnostic refinement; and the Rapid Growth Period (2016 - 2024), characterized by a surge in research on child mental disorders and the impacts of posttraumatic stress disorder. Network analyses highlighted significant journals, key authors, and international collaborations that have shaped this field.ConclusionsThe study maps a significant transformation in stigma-focused mental health research themes over fifty years, highlighting the growing complexity and the need for ongoing research into stigma and discrimination. It calls for interdisciplinary approaches to tackle these enduring challenges effectively.Article Machine Learning Model for Predicting Multidrug Resistance in Clinical Klebsiella pneumoniae Isolates(MDPI, 2026) Akkaya, Yuksel; Aydin, Irfan; Tanyildizi-Kokkulunk, Handan; Erturk, Ayse; Kilic, Ibrahim HalilBackground/Objectives: Klebsiella pneumoniae is an opportunistic pathogen increasingly resistant to carbapenems and broad-spectrum antibiotics, complicating timely infection management. In critical cases like septic shock, where initiating effective antibiotics within 3 h improves survival, culture-based resistance testing is often too slow. This study evaluates machine learning (ML) algorithms for faster antimicrobial resistance prediction than conventional methods. Methods: In this retrospective study, antibiogram results of 607 Klebsiella pneumoniae isolates collected between 2017 and 2024 were combined with demographic and clinical information of the patients from whom the isolates were obtained. Four different ML algorithms, namely Decision Tree (DT), Support Vector Classifier (SVC), K-Nearest Neighbors (KNN) and Random Forest (RF), were applied to classify the resistance status for 22 antibiotics. Model performances were evaluated using accuracy, precision, recall, F-score, AUC and feature importance metrics. Results: The RF model showed the highest overall performance in accurately predicting resistance to 22 antibiotics, achieving an average AUC value of 0.96. In particular, it predicted resistance to treatment-critical antibiotics such as Ertapenem (100%), Imipenem (93%) and Meropenem (95%) with high accuracy. Conclusions: ML models, especially RF, offer a powerful tool for rapid antibiotic resistance prediction, supporting accurate empirical treatment decisions and antimicrobial stewardship.Article Nurses on the Frontline of Disaster: A Qualitative Metasynthesis of Post-Earthquake Care Experiences(Wiley, 2026) Kolac, Nurcan; Taylan, Secil; Eroglu, NerminBackground Earthquakes generate urgent and complex care needs, positioning nurses as key responders. Exploring their post-earthquake care experiences is vital for strengthening disaster preparedness and nursing practice.Aim This study aimed to synthesise qualitative evidence on nurses' experiences of providing care in the aftermath of earthquakes.Study Design This research was conducted through a systematic review and meta-synthesis of qualitative studies. The data were analysed using thematic analysis. The qualitative systematic review was conducted using Sandelowski and Barroso's four-step meta-synthesis methodology. This metasynthesis study, conducted in accordance with the PRISMA statement, is registered in PROSPERO. The following electronic databases and platforms were used for the literature review: MEDLINE, Academic Search Ultimate, CINAHL Complete, Complementary Index, Supplemental Index, Directory of Open Access Journals and WOS.Findings Based on 27 included studies, the research identified four main themes and 13 sub-themes related to nurses' post-earthquake care experiences. These themes were: (1) early post-earthquake nursing challenges, (2) conflict experiences, (3) valued experiences and methods of coping with challenges and (4) impact of rescue experiences.Conclusions This research highlighted nurses' post-earthquake care experiences, emphasising how they overcame challenges, redefined their profession and emerged stronger. It also identified the limitations and facilitators within the post-earthquake care environment, providing valuable insights for enhancing care settings during future earthquakes.Relevance to Clinical Practice This study identified limitations and facilitators in the post-earthquake care environment of clinical settings, providing valuable insights to improve care environments during future earthquakes.Article Verification Trials Can Create the Illusion of VO2max in Addition to Contributing to Its Confirmation(Wiley, 2026) Cabuk, Refik; Alp, Egemen; Murias, Juan Manuel; Karsten, BettinaThis study examined whether constant-workload verification trials performed at intensities below, at, and above the ramp-incremental peak power output (PPO) contribute to confirming maximal oxygen uptake (VO2max). Fifteen trained to well-trained male cyclists (VO2max: 63.6 +/- 5.6 mL & centerdot;kg(-1)& centerdot;min(-1)) completed maximal ramp testing followed by seven randomized verification trials (80%-110% PPO at 5% intervals) on separate days. Differences in VO2 responses were analyzed using linear mixed-effects models. Effect size was calculated using Hedges' g. The peak VO2 attained during the verification trials was expressed relative to the ramp-derived VO2max and classified as lower (< 95%), within normal variability (95%-105%), or higher (> 105%). The peak VO2 values at 80%, 105%, and 110% PPO were significantly lower than ramp-derived VO2max (p < 0.05), whereas no significant differences were observed at 85%, 90%, and 95% PPO. Effect sizes were small at 85%-95% PPO (Hedges' g = 0.29-0.32), medium at 100%-105% PPO (Hedges' g = 0.63-0.66), and large at 80% and 110% PPO (Hedges' g = 1.21-1.34). Of 105 verification trials, 81 were within +/- 5% of ramp VO2max, 22 were lower (mainly at 80% and 110% PPO), and two exceeded ramp VO2max (at 85% and 95% PPO). Although verification trials did not meaningfully contribute to the verification of VO2max, trials performed at 85%-95% PPO provided the best chances of confirming VO2max in trained individuals. Interpretation of verification trials relative to ramp-derived PPO is protocol dependent, which may limit generalizability across different ramp designs.Article Investigating Text Neck Syndrome and Duration of Mobile Phone Use, Muscle Activity, Hand Grip Strength, Posture, and Disability(Elsevier Sci Ltd, 2026) Yasaci, Zeynal; Zirek, Emrah; Mustafaoglu, Rustem; Ozdincler, Arzu RazakNeck and shoulder musculoskeletal symptoms related to smartphone use are becoming increasingly prevalent, yet the underlying mechanisms including smartphone usage duration, muscle activity, hand grip strength, posture, and disability remain incompletely understood. This study examined the interaction between text-neck syndrome and factors such as smartphone usage duration, muscle activity, hand grip strength, posture, and disability. Forty participants (Text Neck group: n = 18; 14 females or Control group: n = 22; 15 females) underwent neuromuscular assessment. Surface electromyography measured bilateral muscle activity in the upper trapezius (UT) and abductor pollicis brevis (APB) muscles during smartphone use. Secondary outcomes included the Visual Analogue Scale (VAS) to assess pain intensity, hand grip strength, New York Posture Rating Scale (NYPRS), Neck Disability Index (NDI), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The Text Neck group demonstrated significantly higher smartphone use (p < 0.001), higher texting time (p = 0.006), and lower muscle activation at activity in the dominant APB (p = 0.011), dominant UT (p < 0.001), and non-dominant UT (p = 0.008). These findings provide novel insights into how excessive smartphone use alters muscle function and postural alignment in individuals with text-neck syndrome. Understanding these mechanisms may inform targeted prevention and rehabilitation strategies to mitigate musculoskeletal risk associated with modern technology use.Article Effect of Inspiratory Muscle Training on Diaphragm Function and Activity Performance in Subacute Ischemic Stroke Patients: A Single-Blind Randomized-Controlled Trial(SAGE Publications Inc., 2026) Akçay S.; Akyol D.K.; Erkut Ü.; Karagözoğlu Coşkunsu D.; Kunduracilar Z.; Bajrami A.; Dinç Yavaş A.; Kunduracilar, Zuhal; Coskunsu, Dilber Karagozoglu; Bajrami, Arsida; Akçay, Sümeyye; Akyol, Dudu Kübra; Erkut, Ümit; Karagözoğlu Coşkunsu, Dilber; Yavas, Arzu Dinc; Dinç Yavaş, ArzuBackground: Respiratory dysfunction is common after stroke and may negatively affect functional recovery. Inspiratory muscle training (IMT) has been proposed to enhance diaphragmatic function and activity performance in this population. Objective: To investigate the effects of IMT on diaphragm function and activity performance in patients with subacute ischemic stroke. Methods: In this randomized controlled, single-blind trial, 26 patients with subacute ischemic stroke (>1 month post-onset) were randomly allocated to an intervention group (IG, n = 13) or control group (CG, n = 13). Both groups received standard neurorehabilitation, aerobic training, and the Active Cycle of Breathing Technique (ACBT). The IG additionally underwent IMT, 5 days per week for 6 weeks (30 sessions). Assessments included maximal inspiratory and expiratory pressures (MIP, MEP), diaphragmatic thickness (Ti, Te) and excursion via ultrasonography, 6-minute walk test (6MWT), and Canadian Occupational Performance Measure (COPM). Results: Twenty-two participants completed the study (IG = 11; CG = 11). Significant within-group improvements were observed in both groups for MIP, MEP, Ti, TF, excursion, 6MWT, and COPM scores (P < .05). Between-group analyses showed significantly greater improvements in the IG for ΔMIP (P < .001), ΔMEP (P = .003), affected-side ΔTi (P = .007), ΔTF (P = .008), and Δexcursion (P = .005). No significant differences were found for 6MWT and COPM (P > .05). Conclusions: IMT effectively improves respiratory muscle strength, diaphragmatic thickness, and excursion in subacute ischemic stroke and may be a valuable addition to post-stroke rehabilitation programs. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06210516. © The Author(s) 2026Article Early Detection of Lower Adherence to Long-Term E-Diary Recording: A Checkpoint to Target Early Educational Intervention in Seasonal Allergic Rhinitis(Wiley, 2026) Dramburg, S.; Hernandez Toro, C. J.; Grittner, U.; Tripodi, S.; Arasi, S.; Acar Sahin, A.; Matricardi, P. M.Background: Digital symptom monitoring via e-Diary apps can support the diagnosis and management of chronic diseases with trigger-induced exacerbations such as pollen allergies. Attrition is a major challenge for continuous e-Diary usage with an unsupervised approach. Objective: To investigate adherence to e-Diary reporting, its early determinants and predictors in a blended care setting among pollen allergic patients with heterogeneous cultural backgrounds. Methods: The @IT.2020 observational multicenter study recruited patients with diagnosed seasonal allergic rhinitis from seven Southern European/Mediterranean countries. Baseline characteristics were investigated through questionnaires, skin prick tests and serum specific IgE measurements. The study doctors asked patients to record their allergy symptoms via e-Diary (AllergyMonitor, TPS) daily during the clinically relevant season of pollination and increased mould concentrations. Results: Among 815 patients (467 adults, 348 children), the average prescribed e-Diary recording period was 106 (SD 47.1) days, with an average completion rate of 75.2% (SD 21.2%). Children (>= 10 years) filled 73.8% (95% CI 68.1-79.4) of prescribed days without parental support. We identified a stable 'higher' and a more variable 'lower' adherence cluster. Adherence was weakly associated with disease severity, but not with age, gender, country, education or digital literacy. Short-term (first 3 weeks) adherence was strongly associated with long-term adherence (partial R-2 = 0.387, p < 0.001), with 87.6% of lower adherent patients remaining poorly adherent beyond 3 weeks. Conclusion: In a blended care setting, adherence to e-Diary compilation among pollen allergic patients is high, irrespective of age and cultural background. Early identification of lower adherence is possible and might inform early interventions to improve patient adherence.Article Evaluation of Octenidine Dihydrochloride-Induced Cytotoxicity, Apoptosis, and Inflammatory Responses in Human Ocular Epithelial and Retinal Cells(MDPI, 2025) Ciftci, Ihsan Hakki; Deveci Ozkan, Asuman; Erman, Gulay; Kilbas, Imdat; Aydemir, OzlemBackground/Objectives: Octenidine dihydrochloride (OCT-D) is a broad-spectrum antiseptic with high chemical stability, low toxicity, and no reported microbial resistance, making it a strong candidate for use on mucosal surfaces. Despite increasing interest in its potential ophthalmic applications, limited data exist regarding its cellular effects on ocular tissues. This study aimed to investigate the cytotoxic, apoptotic, inflammatory, and transcriptional responses induced by OCT-D in human conjunctival (IOBA-NHC) and retinal pigment epithelial (ARPE-19) cells. Methods: Cells were exposed to varying concentrations of OCT-D, and viability was assessed using the WST-1 assay to determine IC50 and IC50/2 values. These concentrations were subsequently used in molecular assays. Pro-inflammatory cytokines (IL-6, IL-1 beta, TNF-alpha, IFN-gamma) were quantified by ELISA. Apoptotic activation was evaluated through caspase-3/7 activity assays. Gene expression analysis of apoptotic (Bax, Bcl-2), DNA damage-related (ATM, Rad51), and inflammatory markers was performed using RT-qPCR. Results: OCT-D induced a marked, dose-dependent reduction in cell viability in both cell lines, with ARPE-19 showing greater sensitivity. Caspase-3/7 activity increased significantly at IC50 and IC50/2, confirming intrinsic apoptotic activation. OCT-D markedly suppressed the release of key inflammatory cytokines and downregulated transcription of inflammatory genes. RT-qPCR revealed upregulation of pro-apoptotic and DNA damage-associated genes, demonstrating coordinated activation of apoptotic and genomic stress pathways. Conclusion: OCT-D triggers integrated cytotoxic, apoptotic, and immunomodulatory responses in conjunctival and retinal epithelial cells. While these findings provide important mechanistic insights into OCT-D's cellular effects, further studies using primary cells, advanced 3D ocular models, and disease-relevant systems are required to support its potential translational use in ophthalmology.