The effect of acid use as a preservative on the results of biochemical tests measured in 24-h urine.

Twenty-four-hour urine measurements play a crucial role in the diagnosis, follow-up and treatment of various diseases. There are different approaches to the collection of urine in patients who need to collect multiple urine samples at a time, especially in hospitals with heavy workloads. In this study, we compared the sodium, potassium, chloride, amylase, calcium, creatinine, phosphorus, microalbumin, protein, magnesium, urea, uric acid, adrenaline, noradrenaline, dopamine, metanephrine, normetanephrine, vanillylmandelic acid, 5-hydroxyindoleacetic acid and homovanillic acid results of 24-h urine samples analyzed immediately without acid addition, which we accepted as the reference and baseline measurement, with the results of the samples analyzed after waiting for 24 h without acid addition, analyzed immediately with acid addition and analyzed after waiting for 24 h with acid addition. Chloride, microalbumin, amylase and protein tests, which are recommended to be measured in the sample without preservatives, are affected by acid addition. Adrenaline, noradrenaline and dopamine, which are the tests recommended to be measured in acid-added urine are degraded in the samples without acid, and the levels of metanephrine and normetanephrine were not significantly degraded in the absence of preservatives.

Effects of Medium Cutoff Membranes on Pro-Inflammatory Cytokine and Oxidative Marker Levels in Patients with Sepsis Who Developed Acute Kidney Injury.

INTRODUCTION: There is insufficient data on the role of the medium cutoff (MCO) membranes in the clearance of pro-inflammatory cytokines and oxidant radicals in patients with sepsis requiring hemodialysis. METHODS: The study consisted of 38 septic patients who developed acute kidney injury (AKI) and who were scheduled to undergo 2 sessions of hemodialysis. Nineteen patients underwent their first dialysis session with the MCO membrane and 19 patients with the high-flux (HF) membrane. In the second session, the membranes were switched. Pro-inflammatory cytokine and oxidative marker levels were measured in blood samples obtained before and after both dialysis sessions. Reduction ratios were compared for the 2 types of hemodialysis membranes. RESULTS: After the first session, there was a greater reduction in tumor necrosis factor (TNF)-α with the MCO membrane (28.2 ± 21.1 vs. 8.0 ± 6.6, p = 0.001). After the second session, there was a greater reduction in interleukin (IL)-6 (27.8 ± 26.5 vs. 5.9 ± 13.3, p = 0.003) and IL-1ß (20.5 ± 21.1 vs. 4.0 ± 6.5, p = 0.004) with the MCO membrane. When the first and second sessions of all 38 patients were compared, the reductions in TNF-α, IL-6, and IL-1ß were consistently greater for MCO than HF (p = 0.001, p = 0.006, p < 0.001, respectively). The reductions in total antioxidant status, total oxidant status, and myeloperoxidase were not statistically different for the 2 types of dialysis membranes. CONCLUSIONS: MCO membrane was superior to HF membrane in the removal of cytokines in septic patients with AKI. However, a similar effect was not observed for oxidative stress markers.

The effects of transport by pneumatic tube system on urine analysis.

The pneumatic tube transport system (PTS) is used frequently for the transport of samples in hospitals. Effects of PTS on urine components are unknown. In our study, we aim to examine the influence of PTS on the quality of routine urine microscopic parameters. Urine samples were divided into two groups: group 1 were transported to the laboratory manually and group 2 were transported to the laboratory via the PTS. Each of 187 urine samples was studied with iQ200 automated urine devices for erythrocytes, leukocytes, epithelial cells, crystal, cast and yeast cells. No statistically significant differences were detected between group 1 and group 2 for urine parameters. For erythrocytes, leukocytes, and epithelial cells, the gamma was 0.982, 0.959, and 1.0, respectively. For crystal, cast and yeast cells, the kappa values were 0.952, 0.866, and 1.0, respectively. PTS has no effect on erythrocytes, leukocytes, epithelial cells, crystal, cast, and yeast cells in urine analysis. We concluded that PTS can be used in the transport of urine samples.

Serum TNF- Related Weak Inducer of Apoptosis (TWEAK), TNF- Related Apoptosis-Inducing Ligand (TRAIL) Levels in Patients with Bipolar Depression, Major Depression and a Healthy Control Group.

BACKGROUND: A low-grade inflammation is presumed to be related to the etiopathogenesis of major depressive disorder (MDD) and bipolar disorder. Tumor necrosis factor (TNF) superfamily members have roles in the pathogenesis of neuropsychiatric disorders because of the relationship with inflammation and neurogenesis. The aim of this study was to investigate the serum TNF-related weak inducer of apoptosis (TWEAK) and TNF-related apoptosis-inducing ligand (TRAIL) levels in patients with bipolar depression (BD), MDD and a healthy control (HC) group to determine any differences between MDD and BD in terms of inflammation biomarkers. SUBJECTS AND METHODS: After a 12-hour overnight fast, 5 milliliter (mL) samples of fasting blood were obtained from the participants. The TWEAK and TRAIL plasma levels were calculated using ELISA kits. RESULTS: The TWEAK levels were found to be higher in the BD group than in the HC group (p=0.03). No statistically significant differences were determined between the BD vs MDD and MDD vs HC groups (p=0.17, p=0.37, respectively). There were no statistically significant differences between the three groups (BD vs HC; BD vs MDD; MDD vs HC) in terms of TRAIL levels (p=0.21). CONCLUSION: To the best of our knowledge, this study is the first to have explored TWEAK levels in patients with BD. The higher TWEAK levels in BD than in the control group is compatible with the inflammation hypothesis of BD. Limitations of the study were the differences in medications of the patient groups and that it was a cross-sectional study. There is a need for further longitudinal studies with larger sample size and medication-free patients.

Evaluation of BD Barricor™ Plasma Blood Collection Tube for Biochemical Tests.

BACKGROUND: Blood from patients who are receiving anticoagulant therapy may take longer to clot. Anticoagulation is an important component of the dialysis prescription. We compared BD Vacutainer® Barricor™ Plasma Blood Collection Tubes (BD BarrricorTM), BD Vacutainer® PST™ Lithium Heparin Tubes (BD PST™), and BD (Becton-Dickinson, Franklin Lakes, NJ, USA) Vacutainer Serum Separator Tubes (BD SST), as reference tube in dialysis patients to examine whether they had an effect on routine biochemical tests. MATERIALS AND METHODS: A total of 29 chronic hemodialysis patients were included in this study. Samples were collected into BD BarrricorTM, BD PST™, and BD SST tubes after the dialysis. All the tubes were centrifuged by NF 1200R rotor (1,300 g for 10 minutes at 22°C, 1,200 g for 10 minutes at 4°C, 2,400 g for 10 minutes at 22°C, respectively) after the incubation period. Eleven routine clinical chemistry parameters (Creatinine, Urea, Na, K, Cl, AST, ALT, Total Bilirubin, Direct Bilirubin, Calcium, Cholesterol) were analyzed on a Beckman Coulter AU 5800. RESULTS: Results of creatinine, K and cholesterol were statistically significantly different between the SST and LiH (p = 0.014, p = 0.009, and p < 0.001, respectively). In terms of other biochemical parameters we tested for all three tubes there was no clinically significance inspite of the statistically significance. CONCLUSIONS: BD Barricor™ tubes provide fast, clean, high-quality plasma samples, safe results, and may lower times and costs.

Serum Sphingosine 1 Phosphate Levels in Patients with and without Coronary Collateral Circulation.

BACKGROUND: Sphingosine 1 phosphate, an active sphingolipid metabolite, functions in both healthy and diseased cardiovascular systems. It has been reported to play a role in angiogenesis and arteriogenesis in various tissues, which are the proposed mechanisms for the development of coronary collateral circulation. To the best of our knowledge, no data exist regarding serum sphingosine 1 phosphate levels and the presence of coronary collateral circulation in the literature. Thus this study aimed to investigate serum sphingosine 1 phosphate levels in patients with and without coronary collateral circulation. METHODS: A total of 140 patients were included (70 with coronary collateral circulation and 70 with normal coronary arteries and stable coronary artery disease without collaterals). Rentrop collateral grade and the number of coronary arteries with collateral circulation were recorded. RESULTS: Serum sphingosine 1 phosphate levels were higher in the collateral group than in the control group [186.6 (142.3-243.5) µg/l vs. 128.5 (105.0-161.6) µg/l, p < 0.001]. Multivariate logistic regression analysis revealed that the presence of multivessel disease, high serum sphingosine 1 phosphate levels and previous history of P2Y12 use were independent predictors of coronary collateral circulation. Median sphingosine 1 phosphate levels in different Rentrop grades in the collateral group were similar, and there was no significant difference in median serum sphingosine 1 phosphate level with a higher number of coronary arteries with collateral circulation. CONCLUSIONS: Our findings demonstrated higher levels of sphingosine 1 phosphate in the patients with coronary collateral circulation.

Comparison of vacuum and non-vacuum urine tubes for urinary sediment analysis.

Urine collection systems with aspiration system for vacuum tubes are becoming increasingly common for urinalysis, especially for microscopic examination of the urine. In this study, we aimed to examine whether vacuum aspiration of the urine sample has any adverse effect on sediment analysis by comparing results from vacuum and non-vacuum urine tubes. The study included totally 213 urine samples obtained from inpatients and outpatients in our hospital. Urine samples were collected to containers with aspiration system for vacuum tubes. Each sample was aliquoted to both vacuum and non-vacuum urine tubes. Urinary sediment analysis was performed using manual microscope. Results were evaluated using chi-square test. Comparison of the sediment analysis results from vacuum and non-vacuum urine tubes showed that results were highly concordant for erythrocyte, leukocyte and epithelial cells (gamma values 1, 0.997, and 0.994, respectively; p < .001). Results were also concordant for urinary casts, crystals and yeast (kappa values 0.815, 0.945 and 1, respectively; p < .001). The results show that in urinary sediment analysis, vacuum aspiration has no adverse effect on the cellular components except on casts.

The relationship between procalcitonin and thyroid autoantibodies in patients with autoimmune thyroiditis.

BACKGROUND: The aim of this study is to investigate the serum levels of procalcitonin and its association with autoantibodies in patients with euthyroid Hashimoto's thyroiditis. METHODS: A total of 80 participants were included in the study; 40 of which were newly diagnosed with Hashimoto's thyroiditis, aged over 18, and 40 of which were healthy volunteers. The serum levels of procalcitonin were measured by enzyme-linked immunosorbent assay kit. Thyroid function tests were analyzed in hormone laboratory with Electro-chemiluminescence immunoassay. RESULTS: Hashimoto's thyroiditis patients had higher median procalcitonin levels than those of the control group (34.3 pg/mL vs 27.8 pg/mL respectively; P=.037). Also, male patients had higher median procalcitonin levels as compared to female patients (37 pg/mL vs 27 pg/mL respectively; P=.013). In the Hashimoto's thyroiditis group, procalcitonin level was positively correlated with anti-thyroglobulin and anti-thyroid peroxidase levels (r=.559, P<.001; r=634, P<.001, respectively). The procalcitonin and anti-thyroid peroxidase levels were identified to be an independent predictor in diagnosis of Hashimoto's thyroiditis. CONCLUSIONS: The fact that procalcitonin was found to be correlated with thyroid autoantibodies and found to be an independent risk factor for Hashimoto's thyroiditis in the regression analysis in the framework of this study urges us to think that procalcitonin may be associated with the autoimmunity.

Admission Value of Serum Cathepsin D Level Can be Useful for Predicting In-Hospital Mortality in Patients with NSTEMI.

BACKGROUND: We aimed to investigate the association of serum cathepsin D levels with in-hospital mortality and Syntax scores (SXscore) in non-ST elevation myocardial infarction (NSTEMI) patients. METHODS: A total of 88 patients were included in the study. The patients were divided into two groups: those with in-hospital mortality (-), and those with in-hospital mortality (+). The receiver operating characteristics curve was used to show the sensitivity and specificity of serum cathepsin D levels, and the optimal cut-off value for predicting in-hospital mortality and high SXscore. RESULTS: Patients with (+) in-hospital mortality and high SXscore had lower serum cathepsin D levels compared to the patients with (-) in-hospital mortality and low SXscore. Using a cutoff score of < 16 for the cathepsin D level, in-hospital mortality was predicted with a sensitivity and specificity of 73.4% and 77.6%, respectively, and also predicted high SXscore with a sensitivity and specificity of 72.4% and 67.6%, respectively. CONCLUSIONS: Serum cathepsin D levels established upon admission were significantly and independently lower in NSTEMI patients with high rate of mortality, high SXscores, and low left ventricular ejection fraction.

Association of thiol disulfide homeostasis with slow coronary flow.

Objective The aim of this study was to investigate the role of thiol disulfide homeostasis in the presence of slow coronary flow. Material and methods In this cross-sectional study, a total of 110 patients who admitted to our hospital between March 2014 and December 2015 were included in the study. There were 65 patients in the slow coronary flow, and 45 patients in the normal flow groups. Results We found significant differences between slow coronary flow and the normal flow groups for thiol disulfide homeostasis, and the results of our study indicated that hsCRP, and thiol disulfide ratio were independently associated with slow coronary flow. Conclusion Our study showed that thiol disulfide homeostasis was significantly and independently related to the presence of slow coronary flow.

Are increased oxidative stress and asymmetric dimethylarginine levels associated with masked hypertension?

OBJECTIVE: In this study, our aim was to determine total oxidative stress and asymmetric dimethylarginine (ADMA) levels in patients with masked hypertension (MHT) and to examine their association with blood pressure. METHODS: Fifty patients diagnosed with MHT and 48 healthy volunteers without any known chronic diseases have been included in this study. RESULTS: When compared to the control group, patients with MHT had higher levels of mean ADMA (p < 0.001), total oxidant status (TOS) (p < 0.001), and oxidative stress index (OSI) (p < 0.001), and a lower mean total antioxidant status (TAS) (p < 0.001) level. While a positive correlation was determined between the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with ADMA, TOS, and OSI levels, a negative correlation was determined with the TAS level. During the stepwise multivariable logistic regression analysis, age (OR = 1.221; p = 0.003), body mass index (OR = 1.512; p = 0.005), low density lipoprotein (OR = 0.925; p = 0.016), ADMA (OR = 1.200; p = 0.002), and OSI (OR = 3.750; p = 0.002) levels were determined to be the predictors of MHT. During the linear regression analysis, it was determined that the independent risk factors of SBP and DBP are ADMA and OSI, and the independent risk factor of TOS, OSI, and ADMA is SBP. Our study found out that oxidative stress and ADMA levels of patients with MHT are higher than those of the control group. ADMA and OSI were determined to be predictors of MHT. CONCLUSION: Based on these results, it could be said that oxidative stress, and therefore the ADMA level, could have an effect on the etiopathogenesis of MHT.

Is disulphide/thiol ratio related to blood pressure in masked hypertension?

Dynamic thiol/disulphide homeostasis plays a critical role in numerous intracellular enzymatic pathways including antioxidant defence and detoxification. In this study, we sought to investigate dynamic thiol/disulphide homeostasis in patients with masked hypertension (MHT) and its relationship with blood pressure. Forty patients (23 men, 17 women) with newly diagnosed MHT and not yet on medical therapy, and 40 healthy volunteers (21 men, 19 women) were enrolled. Blood thiol/disulphide homeostasis was measured in both groups. Serum native and total thiol levels were measured using the novel, fully automated colorimetric method developed by Erel et al. Serum disulphide level was calculated as (serum total thiol - serum native thiol)/2. Native and total thiol levels (p = 0.001) and native thiol/total thiol ratio (p = 0.023) were found to be lower in patients with MHT when compared to those of the control group. Disulphide level and ratios of disulphide/native thiol and disulphide/total thiol were higher in patients with MHT than in the control group (p = 0.001). A positive correlation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed with disulphide/native thiol ratio (p < 0.001). Stepwise multivariable regression analysis showed disulphide/native thiol ratio to be an independent risk factor of SBP and DBP, and SBP to be an independent risk factor of disulphide/thiol ratio (p = 0.001). In this study, we found that dynamic thiol/disulphide homeostasis shifted towards disulphide formation due to thiol oxidation in patients with MHT. Prospective randomised controlled studies are required to elucidate whether abnormal thiol/disulphide status lies in the pathogenesis of MHT or is a consequence of MHT.

Dynamic thiol/disulfide homeostasis in patients with autoimmune subclinical hypothyroidism.

OBJECTIVE: The aim of this study was to investigate dynamic thiol/disulfide homeostasis in autoimmune subclinical hypothyroidism. METHODS: Forty-eight patients with a new diagnosis of subclinical hypothyroidism due to Hashimoto thyroiditis who were not yet under medical therapy, and 48 healthy control subjects were enrolled. Thiol/disulfide homeostasis [native thiol-disulfide exchanges] was measured in both groups using the automated method developed by Erel and Neselioglu. An absolute difference of 0.5 between the total thiol and native thiol concentrations revealed the disulfide bond amount. RESULTS: The native thiol level (p = 0.014) and native thiol/total thiol ratio (p = 0.001) were lower in patients with subclinical hypothyroidism than in the control group. Meanwhile, the disulfide level (p = 0.004), disulfide/native thiol ratio (p = 0.001), and disulfide/total thiol (p = 0.001) ratio were higher in patients with subclinical hypothyroidism than in the control group. The antithyroid peroxidase and anti-thyroglobulin levels were positively correlated with the disulfide/native thiol ratio (r = 0.339, p = 0.019; r = 0.243, p = 0.023, respectively) and the disulfide/total thiol ratio (r = 0.133, p = 0.019; r = 0.238, p = 0.026, respectively) and negatively correlated with the native thiol/total thiol ratio (r = -0.292, p = 0.004; r = -0.233, p = 0.022, respectively). CONCLUSION: We found that thiol/disulfide homeostasis shifted to disulfide formation in patients with subclinical hypothyroidism and that thyroid autoantibodies were positively correlated with thiol oxidation. It is not clear whether abnormal thiol/disulfide homeostasis is a cause or a consequence in Hashimoto thyroiditis. Further studies are required.

Comparison of Improvacuter™ tubes with BD Vacutainer™ tubes for various hormones in the aspects of stability and influence of gel separators.

BACKGROUND: Validation of blood collection tubes are important to determine the role of different collection tubes which influence the assurance of laboratory results. We compared two different tubes (Improvacuter™ and Becton Dickinson [BD] Vacutainer™) and investigated the effect of gel and storage time in comparison with each other. METHODS: We compared the results of nine immunoassays performed on UniCel® DxI 800 using blood samples collected in BD Vacutainer SST II Advance tubes, Improvacuter Gel and Clot Activator tubes, BD Vacutainer Clot Activator tubes and Improvacuter tubes. Analytes were measured in all tubes on 3 consecutive days to study the effect of long-term storage. Evaluation of clinical significance was performed based on total allowable error. RESULTS: Estradiol and testosterone concentrations obtained from Improvacuter Gel and Clot Activator tubes and BD Vacutainer SST II Advance tubes remained below the lower limits of analytical range for the same analytes while they were within the limits in BD Vacutainer Clot Activator tubes and Improvacuter tubes. Statistical significance of stability was not clinically significant for the hormone parameters we tested in all four tubes. CONCLUSIONS: Gel containing tubes (both BD and Improve) gave comparable results with the tubes which do not contain gel except for estradiol and testosterone. The use of gel containing tubes for estradiol and testosterone are not recommended on UniCel® DxI 800 according to our results. The change in the analyte concentrations over 48 h remained within the TEA limits for the studied analytes. Improve tubes gave similar results to BD tubes.

Relationship between oxidative stress parameters and asymptomatic organ damage in hypertensive patients without diabetes mellitus.

OBJECTIVE: We aimed to evaluate the levels of oxidative stress (OS) parameters such as total antioxidant status or TAS, total oxidant status (TOS), OS index (OSI), paraoxonase 1 (PON1), arylesterase, and total thiol in hypertensive patients with and without asymptomatic organ damage (AOD), and to determine the relationship between these parameters and AOD. DESIGN: Sixty-six patients (21 men, 45 women) with AOD and 66 patients without AOD (21 men, 45 women) were enrolled in the study. Serum OS parameters were measured by colorimetric method. RESULTS: The OSI levels were found to be higher while PON1, PON1/high-density lipoprotein, and arylesterase levels were found to be lower in patients with AOD compared with those in the patients without AOD. Stepwise regression analysis showed high 24-h mean systolic blood pressure, OSI, and low arylesterase level to be independent predictors of AOD. CONCLUSION: OS level was found to be higher in hypertensive patients with AOD compared with the patients without AOD. However, it is not clear whether increased OS leads to AOD or AOD increases the level of OS. For this purpose, OS level needs to be decreased by antioxidant therapies and patients need to be followed up for a longer duration.

Association of thiol/disulfide ratio with syntax score in patients with NSTEMI.

OBJECTIVE: The aim of this study was to investigate the relation between native thiol/disulfide ratio (TDR) and severity of coronary atherosclerosis as assessed by the Syntax score (SXscore) in patients with non-ST elevation myocardial infarction (NSTEMI) who underwent coronary angiography. MATERIAL AND METHODS: A total of 290 patients with NSTEMI who underwent coronary angiography, were included in the study between January and August 2014. Baseline coronary angiography determined the SXscore. The patients were divided into two groups: one with low SXscores (< 23) and the other with high SXscores (≥ 23). RESULTS: TDR was significantly lower in patients with high SXscores (p < 0.001). In-hospital mortality was higher in the group with low TDR and high SXscores. The cut-off value of TDR on admission that predicted a high SXscore in the groups combined was 14, with a sensitivity of 73% and a specificity of 68%. CONCLUSION: TDR can be determined by an easy, inexpensive, automated, or optionally manual spectrophotometric assay, and correlates inversely with SXscore in patients with NSTEMI.

Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis.

INTRODUCTION: Adrenal incidentalomas (AIs) have been associated with an increased incidence of several cardiovascular risk factors. The aim of this study was to investigate plasma adiponectin, leptin, resistin, homocysteine, high sensitive C-reactive protein levels, and carotid intima media thickness (CIMT) in patients with non-functioning AI (NFAI). MATERIALS AND METHODS: This study included data from 28 patients with NFAI (Group 1) and 41 controls (Group 2). Of the patients, 50 were female and 19 were male, and the mean age was 46.7 (range 37-65) years. RESULTS: There were no significant differences between Group 1 and 2 in terms of age, sex, or BMI. Hypertension prevalence was significantly higher in the NFAI group than in the control group (p = 0.01). Both groups had similar lipid, blood glucose, homocysteine, uric acid, high-sensitivity CRP levels. Adiponectin, leptin, and resistin levels were similar in both groups. CIMTs were significantly higher in the NFAI group. CONCLUSION: There is increasing evidence that several cardiometabolic risk factors occur with higher prevalence in non-functioning adrenal incidentaloma patients compared to age-matched healthy subjects. In our study, hypertension prevalence and CIMT were higher in the NFAI group. Serum adipokine levels were similar for both groups.

The relationship between asymptomatic organ damage, and serum soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and Interleukin-17A (IL-17A) levels in non-diabetic hypertensive patients.

BACKGROUND: This study aimed to measure the serum soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and interleukin-17A (IL-17A) levels in hypertensive patients with/without asymptomatic organ damage (AOD), as well as to determine the relationship between the serum sTWEAK and IL17-A levels, and carotid intima media thickness (CIMT), proteinuria, retinopathy, and the left ventricle mass index (LVMI). METHODS: The study included 159 patients diagnosed with and followed-up for primary hypertension (HT); 79 of the patients had AOD (61 female and 18 male) and 80 did not (52 female and 28 male). sTWEAK and IL-17A levels were measured in all patients. RESULTS: The sTWEAK level was significantly lower in the patients with AOD than in those without AOD (858.4 pg/mL vs. 1151.58 pg/mL, P = 0.001). The sTWEAK level was negatively correlated with the mean microalbuminuria level and LVMI. The median IL-17A level was significantly higher in the patients with AOD than in those without AOD (2.34 pg/mL vs. 1.80 pg/mL, P = 0.001). There was a positive correlation between mean IL-17A level, and mean microalbuminuria level, CIMT, and LVMI. Multivariate logistic regression analysis showed that patient age, sTWEAK level, and mean 24-h systolic blood pressure were predictors of AOD. CONCLUSIONS: The sTWEAK level was lower and IL-17A level was higher in the patients with AOD. It remains unknown if sTWEAK and IL-17A play a role in the pathophysiology of AOD. Prospective observational studies are needed to determine the precise role of sTWEAK and IL-17A in the development of target organ damage.

Evaluation of adipocytokine levels and vascular functions in young aged to middle aged men with idiopathic hypogonadotrophic hypogonadism.

OBJECTIVE: Hypogonadism has major effects on the urogenital system, in addition to other systems, the cardiovascular system in particular. There have been few studies conducted on markers of atherosclerosis, such as flow mediated dilatation (% FMD), carotid intima-media thickness (CIMT) and adipocytokine levels in idiopatic hypogonadotropic hypogonadal (IHH) males mostly in adult patients. The aim of this study was to evaluate the relationship between androgens and adipocytokines and parameters of vascular functions in hypogonadal men. MATERIALS AND METHODS: The study population consisted of 11 treatment naive IHH patients (group 1) and 15 age-matched healthy control males (group 2). A fasting blood sample was obtained for leptin, adiponectin and resistin. The endothelial functions were evaluated by studying % FMD and CIMT by high resolution B-mode ultrasound. RESULTS: No significant differences in age, body mass index, systolic and diastolic blood pressure were recorded between the two groups. The leptin level was significantly higher in group 1, whereas adiponectin and resistin levels were same between two groups. There was a negative correlation between total testosterone and carotid intima-media thickness (r=-0.656, p=0.008), and a negative correlation between total testosterone and leptin level (r=-0.794, p<0.001). No correlation was found between leptin and CIMT (p=0.184). CONCLUSION: Testosterone deficiency in hypogonadal men is associated with vascular parameters of atherosclerosis. The findings may establish indications for testosterone replacement therapy in hypogonadal men.

Explainable artificial intelligence for LDL cholesterol prediction and classification.

INTRODUCTION: Monitoring LDL-C levels is essential in clinical practice because there is a direct relation between low-density lipoprotein cholesterol (LDL-C) levels and atherosclerotic heart disease risk. Therefore, measurement or estimate of LDL-C is critical. The present study aims to evaluate Artificial Intelligence (AI) and Explainable AI (XAI) methodologies in predicting LDL-C levels while emphasizing the interpretability of these predictions. MATERIALS AND METHODS: We retrospectively reviewed data from the Laboratory Information System (LIS) of Ankara Etlik City Hospital (AECH). We included 60.217 patients with standard lipid profiles (total cholesterol [TC], high-density lipoprotein cholesterol, and triglycerides) paired with same-day direct LDL-C results. AI methodologies, such as Gradient Boosting (GB), Random Forests (RF), Support Vector Machines (SVM), and Decision Trees (DT), were used to predict LDL-C and compared directly measured and calculated LDL-C with formulas. XAI techniques such as Shapley additive annotation (SHAP) and locally interpretable model-agnostic explanation (LIME) were used to interpret AI models and improve their explainability. RESULTS: Predicted LDL-C values using AI, especially RF or GB, showed a stronger correlation with direct measurement LDL-C values than calculated LDL-C values with formulas. TC was shown to be the most influential factor in LDL-C prediction using SHAP and LIME. The agreement between the treatment groups based on NCEP ATPIII guidelines according to measured LDL-C and the LDL-C groups obtained with AI was higher than that obtained with formulas. CONCLUSIONS: It can be concluded that AI is not only a reliable method but also an explainable method for LDL-C estimation and classification.