Determination of growth and developmental stages in hand-wrist radiographs : Can fractal analysis in combination with artificial intelligence be used?

PURPOSE: The goal of this work was to assess the classification of maturation stage using artificial intelligence (AI) classifiers. METHODS: Hand-wrist radiographs (HWRs) from 1067 individuals aged between 7 and 18 years were included. Fifteen regions of interest were selected for fractal dimension (FD) analysis. Five predictive models with different inputs were created (model 1: only FD; model 2: FD and Chapman sesamoid stage; model 3: FD, age, and sex; model 4: FD, Chapman sesamoid stage, age, and sex; model 5: Chapman sesamoid stage, age, and sex). The target diagnoses were accelerating growth velocity, very high growth velocity, and decreasing growth velocity. Four AI algorithms were applied: multilayer perceptron (MLP), support vector machine (SVM), gradient boosting machine (GBM) and C 5.0 decision tree classifier. RESULTS: All AI algorithms except for C 5.0 yielded similar overall predictive accuracies for the five models. In order from lowest to highest, the predictive accuracies of the models were as follows: model 1 < model 3 < model 2 < model 5 < model 4. The highest overall F1 score, which was used instead of accuracy especially for models with unbalanced data, was obtained for models 1, 2, and 3 based on SVM, for model 4 based on MLP, and for model 5 based on C 5.0. Adding Chapman sesamoid stage, chronologic age, and sex as additional inputs to the FD values significantly increased the F1 score. CONCLUSION: Applying FD analysis to HWRs is not sufficient to predict maturation stage in growing patients but can be considered a growth rate prediction method if combined with the Chapman sesamoid stage, age, and sex.

Performance Evaluation of Urine Osmolality Measurement on Sysmex UF-5000 and the Effect of Molecules and Particles in Urine.

BACKGROUND: Urine osmolality determines the concentration ability of the kidney. Therefore, it is used to assess the body's hydration status, electrolyte levels, and acid-base disturbances. We aimed to evaluate the analytical performance of osmolality measurement of the Sysmex UF-5000 (UF-5000), to examine the effect of different molecules and particles in the urine on the osmolality measurement. METHODS: Complete urinalysis and conductivity-based osmolality analysis with UF-5000 and osmolality analysis with Advanced® Model 3320 Micro-Osmometer (AI-3320) by freezing point reduction method were performed in the urine samples. Samples were grouped as negative, glucosuria, proteinuria, hematuria, pyuria, crystalluria, and urobilinogen. RESULTS: Total impressions were calculated as < 5% and accuracy values were < 1.66% in both analyzers. The regression equation was found to be y = -12.54 + 0.956x and the relative difference between the analyzers was 8.7% in 586 samples. When patients with Glucose > 2+ were excluded the regression equation of 507 samples was found as y = 5.10 + 0.948x and the relative difference was 4.6%. The percentages of samples with a difference greater than the allowable difference were 18.8%, 11.6%, 35.9%, 13.7%, 18.7%, and < 12.2% in all samples, all samples without glucosuria > 2+, glucosuria, glucosuria < 3+, proteinuria, and other subgroups, respectively. CONCLUSIONS: Considering the good accessibility of the automated routine complete urine analyzer, UF-5000 can be considered to determine whether urine osmolality is within reference or should be measured by methods based on colligative properties. Thus, referral of patients to a clinic that uses the colligative measurement method may be used more effectively.

Effect of bevacizumab, a vascular endothelial growth factor inhibitor, on a rat model of peritoneal sclerosis.

PURPOSE: Peritoneal fibrosis is almost uniform feature encountered in peritoneal dialysis patients. The transition of epithelial cells to mesenchymal phenotype, neovascularization, and consequently development of peritoneal fibrosis occur due to the involvement of peritoneal membrane by various insults such as uremia itself, peritonitis attacks, and exposure to bio-incompatible peritoneal dialysis fluids. Bevacizumab is a monoclonal antihuman antibody developed against vascular endothelial growth factor and can reduce fibrosis by preventing neovascularization. There has been no study so far that demonstrates the effect of bevacizumab on peritoneal fibrosis in a rat model. METHODS: A total of 41 female Wistar albino rats were divided into six groups. The control group (C) received 0.9 % isotonic saline (2 ml/day) intraperitoneally (i.p) for 21 days. Chlorhexidine group (CH) received 15 % ethyl alcohol and 0.1 % chlorhexidine gluconate (CG) in saline (2 ml/day) i.p for 21 days. The resting group (R) received CG 2 ml/day i.p for 21 days. The bevacizumab-1 group (B1) received CG 2 ml/day i.p for 21 days and bevacizumab 2.5 mg/kg i.p as a single dose on day 21. The bevacizumab-2 group (B2) received CG 2 ml/day for 21 days and bevacizumab 2.5 mg/kg i.p on day 0 and day 21. The bevacizumab-3 group (B3) received bevacizumab 2.5 mg/kg i.p on day 0 and day 21. Peritoneal samples were taken from the left anterior abdominal wall. The thickness, vascularization, and fibrosis scores in the peritoneal samples were assessed using a light microscope. RESULTS: On histopathological evaluations, peritoneum thicknesses, vascularization scores, and fibrosis significantly decreased in bevacizumab groups B1 and B2. CONCLUSION: Histopathologically, bevacizumab was proven to attenuate fibrotic process in experimental peritoneal sclerosis model.

Increased plasma monocyte chemoattractant protein-1 levels in patients with isolated low high-density lipoprotein cholesterol.

BACKGROUND: High-density lipoprotein cholesterol (HDL-C) inhibits inflammation associated with the development of atherosclerotic plaques. Monocyte chemoattractant protein-1 (MCP-1) contributes to the pathogenesis of atherosclerosis. The aim of this study was to evaluate the relationship between plasma MCP-1 levels and low HDL-C levels in patients without cardiovascular disease (CVD). METHODS: This study included 55 patients with low HDL-C (≤ 35 mg/dL) and 33 age- and sex-matched control subjects with normal HDL-C (˃ 35 mg/dL). In addition to MCP-1 levels, laboratory parameters associated with inflammation such as neutrophil-lymphocyte ratio (NLR), uric acid and high sensitivity C-reactive protein (hs-CRP) were also evaluated. RESULTS: HDL-C levels was significantly lower in study group compared to that of the control group (p < 0.001). MCP-1 were prominently higher in the low HDL-C group compared with those of the control group (p < 0.01). NLR, uric acid and hs-CRP levels were also higher in patients with low HDL-C than controls. CONCLUSION: These findings suggest that elevated plasma MCP-1 levels and inflammation status might be associated with the increased cardiovascular risk in patients with low HDL-C.

The relationship between vascular inflammation and target organ damage in hypertensive crises.

OBJECTIVE: Hypertensive crises, divided depending on the presence of target organ damage (TOD), are associated with increased cardiovascular mortality and morbidity. Monocyte chemoattractant protein-1 (MCP-1) is responsible for the recruitment of monocytes to sites of vascular inflammation. The aim of this study was to evaluate the role of vascular inflammation in development of TOD. METHOD: The patients were categorized according to the presence of TOD. Thirty-three patients (15 female; mean age, 68 ± 12 y) with TOD and 30 patients (14 female; mean age, 64 ± 12 y) without TOD were included to the study. In addition to routine laboratory parameters, neutrophil-lymphocyte ratio, uric acid, C-reactive protein (CRP), high sensitive CRP, and plasma MCP-1 levels were evaluated. RESULTS: Neutrophil counts, white blood cells, high sensitive CRP, and uric acid levels were higher in patients with hypertensive crises. More importantly, CRP (7.2 mg/dL [2-37.8 mg/dL] vs 4.6 mg/dL [1.5-14 mg/dL] vs 2.7 mg/dL [1-8.1 mg/dL], P < .01) and MCP-1 levels (546 pg/mL [236-1350 pg/mL] vs 407 pg/mL [78-942 pg/mL] vs 264 pg/mL [34-579 pg/mL], P < .01) were higher in the group with TOD compared with other groups. CONCLUSION: In conclusion, plasma MCP-1 levels were significantly higher in patients with TOD. According to our results, we suggest that increased vascular inflammation and MCP-1 levels might be associated with the development of TOD in hypertensive crisis.

Unusual case of severe late-onset cytomegalovirus-induced hemorrhagic cystitis and ureteritis in a renal transplant patient.

Cytomegalovirus (CMV) infection is common in solid organ transplant recipients and accounts for the majority of graft compromise. Major risk factors include primary exposure to CMV infection at the time of transplantation and the use of antilymphocyte agents such as OKT3 (the monoclonal antibody muromonab-CD3) and antithymocyte globulin. It most often develops during the first 6 months after transplantation. Although current prophylactic strategies and antiviral agents have led to decreased occurrence of CMV disease in early posttransplant period, the incidence of late-onset CMV disease ranges from 2% to 7% even in the patients receiving prophylaxis with oral ganciclovir. The most common presentation of CMV disease in transplant patients is CMV pneumonitis followed by gastrointestinal disease. Hemorrhagic cystitis is a common complication following hematopoietic stem cell transplantation. The condition is usually due to cyclophosphamide-based myeloablative regimens and infectious agents. Even in these settings, CMV-induced cases occur only sporadically. Ureteritis and hemorrhagic cystitis due to CMV infection after kidney transplantation is reported very rarely on a case basis in the literature so far. We report here a case of late-onset CMV-induced hemorrhagic cystitis and ureteritis presenting with painful macroscopic hematuria and ureteral obstruction after 4 years of renal transplantation. The diagnosis is pathologically confirmed by the demonstration of immunohistochemical staining specific for CMV in a resected ureteral section. We draw attention to this very particular presentation of CMV hemorrhagic cystitis with ureteral obstruction in order to emphasize atypical presentation of tissue-invasive CMV disease far beyond the timetable for posttransplant CMV infection.

Effects of renin-angiotensin-aldosterone system blockade on chlorhexidine gluconate-induced sclerosing encapsulated peritonitis in rats.

Sclerosing encapsulated peritonitis (SEP) is a rare complication of long term peritoneal dialysis. Renin-angiotensin-aldosterone system (RAAS) may play a role in the development of peritoneal fibrosis in CAPD patients. We aimed to evaluate the effect of aliskiren, valsartan, and aliskiren + valsartan therapy on SEP. The study included 30 Wistar albino rats which were divided into five groups: I (Control) SF solution i.p.; II (CG group) chlorhexidine gluconate i.p.; III aliskiren oral plus CG i.p.; IV valsartan oral plus CG i.p.; and V aliskiren oral, valsartan oral and CG i.p. On the twenty-first day, all of the rats were sacrificed. All of the groups were analyzed in terms of peritoneal thickness, degree of inflammation, vasculopathy, neovascularization and fibrosis. Also, the parietal peritoneal tissue samples were evaluated for matrix metalloproteinase 2 (MMP-2) using the ELISA method. Peritoneal thickness and fibrosis scores were lower in the valsartan group compared to the CG group (P < 0.05). Peritoneal fibrosis scores were lower in the aliskiren group compared to CG group (P < 0.05) but no difference was observed between the peritoneal thickness scores of the two groups (P > 0.05). Tissue MMP-2 levels were significantly higher in the CG group compared other groups (P < 0.05). There were no statistically significant differences between the aliskiren, valsartan and aliskiren + valsartan groups according to the tissue MMP-2 levels. Due to the antifibrotic properties of valsartan, it is thought to be a possible choice to prevent SEP development. We found no positive impact of aliskiren or aliskiren + valsartan combination compared to valsartan alone.

Results of 4-year analysis of conversion from calcineurin inhibitors to mTOR inhibitors in renal transplant patients: single-center experience.

In this retrospective study, 83 patients were accepted. Mammalian target of rapamycin (mTOR) group consisting of 37 patients were converted from calcineurin inhibitors (CNI), and the control group included 46 patients (initially CNI-receiving patients). As a control-match of each mTOR inhibitor patient, the succeeding patient with transplantation who continued CNI therapy was chosen. All patients received CNI, MMF, and prednisolone as an immunosuppressive therapy initially. In comparison of two groups, there was no significant difference between sex, donor organ source, donor organ ischemia time, or mismatches. However, mean age between groups was significantly different (mTOR group: 48.3 ± 12, CNI group: 38.6 ± 11, p < 0.001). Decision of conversion to mTOR inhibitors in 30 patients was made by biopsy. The reasons for conversion were determined as CNI nephrotoxicity in 15 patients, chronic allograft nephropathy in 15 patients, malignancy in 6 patients, and renal artery stenosis in 1 patient. Basal glomerular filtration rates (GFRs) were markedly lower in mTOR group than in CNI group (38.8 mL/min vs. 72.7 mL/min). At the end of 48-month follow-ups, GFR increased from 38 mL/min to 54 mL/min in mTOR group; however, it decreased to 53 mL/min from 72 mL/min in CNI group. There was no difference left between the two groups in GFR after 4-year follow-up. Hyperlipidemia was higher in mTOR group. Acute rejection rates were similar. Cytomegalovirus (CMV) disease was more prevalent in CNI group. Graft failure developed due to secondary reasons, causing mortality in both groups. We suggest that conversion to mTOR inhibitors maintains and improves graft functions well.

Are the anticardiolipin antibodies a risk factor for coronary artery disease in chronic renal failure patients?

OBJECTIVE: It has been proposed that anticardiolipin (aCL) antibodies are a risk factor for coronary artery disease (CAD) in recently studies. In this study, we aimed to investigate the existence of coronary artery disease in dialysis patients who were aCL positive and undergoing hemodialysis and peritoneal dialysis due to end stage renal failure and also to determine its relationship with risk factors in patients with coronary artery disease. METHODS: This study has been conducted in the end stage renal failure in 140 hemodialysis patients, 18 peritoneal dialysis patients, and 38 healthy controls. The urea, creatinine, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, total protein, and albumin values are obtained. In all cases, aCL levels are investigated with ELISA method. RESULTS: In the HD and CAPD patients, no significant relationship could be found between the age, gender, dialysis time, total cholesterol, HDL cholesterol, LDL cholesterol, total protein, and albumin values (p > 0.05). HD and CAPD vs. controls (aCL), 9.2% (13/140), 11.1% (2/18) vs. 2.6% (1/38), p = 0.002. No significant difference was noted between aCL-positive and -negative patients in serum urea, creatinine, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, total protein, and albumin levels. The coronary artery disease was determined in three patients out of 16 patients with aCL positivity. CONCLUSION: The prevalence of aCL antibodies positivity in our study was similar to the prevalence of aCL positivity in other studies. Therefore, we do not think aCL antibodies positivity is a risk factor for coronary artery disease.

The comparison in terms of early complications of a new technique and percutaneous method for the placement of CAPD catheters.

BACKGROUND: Starting continuous ambulatory peritoneal dialysis (CAPD) immediately after insertion of a peritoneal dialysis catheter is essential in end-stage renal disease (ESRD). In relation to the insertion methods, various mechanical and infectious complications may arise. In this study, we aimed to compare early complications of the laparoscopic tunneling method of CAPD placement that we developed recently in order to minimize the complications, with those of the conventional percutaneous method. SUBJECTS AND METHOD: Included in this study were 12 consecutive patients with ESRD to whom we introduced catheters for CAPD by way of laparoscopic tunneling between April 2003 and July 2003 and followed up for at least 6 months, and 30 patients to whom the catheters were placed percutaneously in the same time period with the same follow-up time. The complications seen during the first 6 months after catheter placement with these two different methods were compared. RESULTS: In all of the subjects, dialysis was started soon after catheter placement. No peroperative morbidity was seen in any of the patients. While with laparoscopic tunneling method no mechanical problem was seen, the percutaneous method resulted in early leakage in 10%, pericatheter bleeding in 3.3%, and hernia in 3.3% of the patients. As infectious complications, peritonitis occurred as one episode/36 patient-months in laparoscopic tunneling and one episode/22.5 patient-months in percutaneous method; catheter insertion site infection was seen in none in the laparoscopic method, while one episode/90patient-months was seen with the percutaneous method. Tunnel infection did not arise in any of the subjects. CONCLUSION: The authors of this study think that the peritoneal tunneling method for introducing CAPD, which has been recently developed and began to be routinely used by them, is rather safe in terms of early complications.

The effect of Helicobacter pylori on insulin resistance.

Helicobacter pylori causes a lifelong infection in the stomach after exposure. H. pylorihas been shown to be associated with peptic ulcer and gastric cancer development. Moreover, it is held responsible for some other nongastric diseases. Among them, coronary heart disease attracts much debate. Many studies have demonstrated a close relationship between insulin resistance and atherosclerosis. Chronic inflammation and alterations in counter-regulatory hormones are deemed responsible for the etiology of insulin resistance. We aimed to examine the effect of H. pylori on insulin resistance. Sixty-three patients were enrolled in the study. Patients were divided into two groups according to H. pylori presence. HOMA-IR (homeostasis model assessment of insulin resistance) level was used to assess insülin resistance. Thirty-six patients were H. pylori positive and 27 were H. pylori negative. There was no difference between the two groups with regard to age, gender, or body mass index. HOMA-IR level was 1.73+/- 1.1 in the H. pylori-negative group, whereas it was 2.56 +/- 1.54 in the H. pylori-positive group (P < 0.05). This study provides the first direct evidence for an association between chronic H. pylori infection and insulin resistance.

The effects of peritoneal dialysis and hemodialysis on serum tumor necrosis factor-alpha, interleukin-6, interleukin-10 and C-reactive-protein levels.

BACKGROUND: Markers of an acute phase reaction, such as C-reactive protein (CRP) or tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6, are predictive for cardiovascular morbidity and mortality in normal subjects and in chronic renal failure patients. In this study, we aimed to investigate serum TNF-alpha, IL-6, IL-10 and CRP levels in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients. MATERIALS AND METHODS: Serum levels of TNF-alpha, IL-6, IL-10 and CRP levels were measured in 30 patients who were just diagnosed with end-stage renal failure and treated, with 16 CAPD (nine female, seven male) and 14 HD (eight female, six male) patients, before CAPD or HD treatment and after 3 months from the beginning of CAPD or HD in patients with no clinical signs of infection. The control groups were 20 healthy persons of similar age and sex. Serum levels of TNF-alpha, IL-6, IL-10 and CRP were measured by enzyme-linked immunosorbent assay in stable CAPD and HD patients and in healthy persons. RESULTS: The mean serum levels of TNF-alpha, IL-6, IL-10 and CRP showed no significant differences between the CAPD and HD patients for the beginning values and the third month of treatment. However, serum TNF-alpha, IL-6, IL-10 and CRP levels were higher than the control group in the CAPD and HD patients regarding the beginning values and the third month of treatment (p < 0.001). CONCLUSIONS: CAPD and HD of the renal replacement therapy have no effects on serum CRP and cytokines.

The effects of hemodialysis and peritoneal dialysis on serum homocysteine and C-reactive protein levels.

OBJECTIVES: In this study, we aimed to investigate plasma homocysteine (Hcy) and serum C-reactive protein (CRP) levels in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, and the relation among them. MATERIALS AND METHODS: This study was carriedout on 52 HD patients, 26 CAPD patients and a control group of 22 healthy persons. Blood samples were taken from the patients for Hcy and CRP measurements. RESULTS: Serum CRP level was found to be high in 48.1% of HD patients, 69.2% of CAPD patients and 4.5% of the healthy control group. Plasma Hcy level was found out to be above the normal limits in 73.1% of HD patients, 65.4% of CAPD patients and 9% of the healthy control group. There was a significant positive relation (r = 0.384, p < 0.001) between the levels of plasma Hcy and serum CRP in HD and CAPD patients. CONCLUSION: The high levels of Hcy and CRP were found out to be higher in HD and CAPD patients than in the control group. In order to determine the risk rate of Hcy and CRP for coronary artery disease, extensive investigations are required in patients with chronic renal failure that also have coronary artery disease.