Sürdürülebilir Kalkınma Amaçları
Yayınlar
- MakaleYalnız künye2026Contralateral DTI-ALPS index as a prognostic biomarker in IDH-wildtype glioblastoma: integrating extent of resection and sex-stratified analyses
Aygün, Tayfun; Keskin, Arif; Palanci, Ozgur; Öztanir, Mustafa Namik; Yücel, Nurullah; Hekimoglu, Gulam
Aim This study aimed to evaluate the independent prognostic value of the contralateral DTI-ALPS index in IDH-wildtype glioblastoma, incorporating tumor morphometry, extent of resection, and sex-stratified analyses within a multivariable framework.Methods A retrospective analysis was performed on 153 IDH-wildtype glioblastoma patients from the publicly available UPENN-GBM dataset. Contralateral DTI-ALPS was calculated using DSI Studio via manual ROI placement; tumor morphometry was derived from expert-annotated segmentation labels using 3D Slicer. Survival analyses included Kaplan-Meier estimation, multivariable Cox regression, time-dependent ROC, restricted cubic spline, and sequential C-index comparison with likelihood-ratio testing.Results The contralateral DTI-ALPS index independently predicted overall survival after adjustment for age, sex, tumor volume, and GTR status (HR = 0.405, 95% CI: 0.227-0.725, p = 0.002). Each one standard deviation increase in DTI-ALPS was associated with a 24.2% reduction in mortality risk. GTR >= 90% (HR = 0.651, p = 0.017) and age (HR = 1.021, p = 0.007) also retained independent significance. DTI-ALPS significantly improved model discrimination beyond age alone (C-index: 0.625 -> 0.653 -> 0.668; likelihood-ratio test p = 0.002). Time-dependent AUC reached 0.741 at 6 months. ALPS-based stratification was more pronounced in the subtotal resection subgroup. Sex-stratified analyses showed numerically stronger associations in females, but formal interaction testing did not confirm effect modification. In an exploratory MGMT subset (n = 57), DTI-ALPS did not retain independent significance after MGMT adjustment.Conclusion The contralateral DTI-ALPS index may provide complementary prognostic information beyond established clinical predictors in IDH-wildtype glioblastoma; however, given the incomplete MGMT methylation data and ongoing methodological debate regarding the biological validity of DTI-ALPS, these findings should be considered exploratory. Prospective validation in cohorts with complete molecular and treatment data is required.
- MakaleAçık Erişim2025Optimizing CPR performance: the role of body composition and ergonomic positioning
Aygun, Tayfun; Karaoglu, Olcay; Senturk, Hakan; Keskin, Arif; Yucel, Nurullah; Hekimoglu, Gulam
Background: Quality cardiopulmonary resuscitation (CPR) is associated with improved survival rates in prehospital arrest cases. Although CPR guidelines emphasize compression depth, rate, and recoil, individual anatomical and biomechanical factors influencing CPR performance remain underexplored. This study aims to determine the optimal CPR position by focusing on individual positional conditions and anthropometric data to improve CPR effectiveness and guide team member selection in emergency scenarios. Methods: A cross-sectional study involving 123 paramedic associate degree students was conducted. Anthropometric measurements including upper extremity length, biceps circumference, and femur length were obtained. CPR performance was assessed using a feedback-capable mannequin, with data collected on compression depth, frequency, rhythm quality, and compression/decompression ratios. Positional parameters such as knee and hip angles, distance between knees, and distance from the mannequin were recorded and analyzed in relation to CPR outcomes. Results: Male participants demonstrated significantly higher CPR quality scores than females (65.09 ± 28.26 vs. 48.85 ± 27.11, p = 0.004). Positive correlations were found between BMI (r = 0.239, p = 0.008), upper extremity length (r = 0.364, p < 0.001), biceps circumference (r = 0.350, p < 0.001), and CPR quality metrics. A moderate inter-knee position (shoulder-width distance) provided superior compression depth and rhythm stability compared to narrow or wide positions (p < 0.001). Conclusion: Anthropometric and positional factors significantly influence CPR performance. Emergency team members with appropriate physical profiles (e.g., greater muscle mass, limb length, BMI) and adopting occupational ergonomic factors (e.g., moderate knee range, limited joint flexion) may improve CPR quality in the prehospital setting.