Objective: This study aimed to evaluate the impact of repeated cesarean deliveries on isthmocele formation and to investigate the diagnostic value and clinical presentation of morphometric parameters, including niche depth, width, length, residual myometrial thickness (RMT), adjacent myometrial thickness (AMT), and the depth/AMT ratio. Methods: A cross-sectional study was conducted with 116 symptomatic and asymptomatic women aged 18–45 years who had undergone one or more cesarean sections. The presence and dimensions of the isthmocele were assessed via transvaginal ultrasonography using Delphi consensus criteria. Morphometric and obstetric data were analyzed using descriptive statistics, correlation analysis, and binary logistic regression. Results: Isthmocele was identified in 71.6% of participants, with prevalence rising from 42.9% after the first cesarean to 100% after the fourth. The isthmocele group had significantly higher gravidity, parity, and cesarean numbers ( p < 0.001). Niche depth, length, and the depth/AMT ratio were significantly elevated, while RMT was reduced ( p < 0.001). The number of cesareans showed a strong negative correlation with RMT ( r = –0.499, p < 0.001) and a strong positive correlation with the depth/RMT ratio ( r = 0.615, p < 0.001). Multivariate analysis identified having three or more cesareans as an independent predictor of isthmocele (OR = 15.6; 95% CI 3.27–74.4; p < 0.001). Niche length had the highest diagnostic accuracy for symptomatic isthmocele (AUC 0.700; 95% CI 0.589–0.796; cutoff 5 mm). Conclusion: Repeated cesarean deliveries significantly increase both the risk and severity of isthmocele. In women with four cesareans, isthmocele was detected in 100% of cases. A niche length of ≥ 5 mm proved to be the most reliable morphometric marker in identifying symptomatic cases. Implications for clinical practice: These findings emphasize the importance of routine transvaginal ultrasound screening post-cesarean—especially in women with multiple cesarean sections—and the incorporation of morphometric assessment (including RMT and depth/RMT ratio) into clinical decision-making.

Background/Objectives: This study aimed to investigate the effects of thyroxine replacement therapy (TRT) on serum Maresin 1 and nuclear factor kappa beta (NF-kB) levels in patients with Hashimoto’s thyroiditis (HT). Methods: A total of 90 patients were included in this study, 60 with HT and 30 without. Patients in the HT group were divided into two groups according to whether they received TRT. Group 1 included 30 patients who underwent TRT, and Group 2 comprised 30 patients who were newly diagnosed with HT, either euthyroid or hypothyroid. The analysis included serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody (TPOAb), Maresin 1, and NF-kB. Results: The serum NF-kB level in the TRT group was significantly higher than that in the control and non-TRT groups. In the subgroup analysis of patients who did not receive TRT, the serum NF-kB level in euthyroid patients was significantly lower than that in hypothyroid patients. Maresin 1 levels in the control group were significantly higher than those in patients who did and did not receive TRT. The serum Maresin 1 level in the TRT group was significantly lower than that in the untreated group. Maresin 1 levels were higher in the euthyroid group than in the hypothyroid group. TPOAb levels were positively correlated with NF-kB and negatively correlated with Maresin 1. Conclusions: TRT maintains the euthyroid state in patients with HT, but may not contribute positively to the pro-anti-inflammatory balance in these patients.

This study aimed to verify the reference interval(s) (RIs) for routine biochemistry tests in adult Turkish population using the reflimR method and compare them with the manufacturer-provided RIs. The RIs of 19 routine biochemical parameters, analyzed using Beckman Coulter analyzers between February and October 2024, were evaluated using the reflimR algorithm. The RIs were estimated separately for females and males using five indirect approaches (reflimR, refineR, KOSMIC, Hoffmann, and Bhattacharya). A traffic light algorithm based on permissible uncertainty was used to interpret whether the RIs limits calculated with reflimR were within the tolerance limits. Using reflimR, 40 of 76 RI limits were accepted, 21 required checking, and 15 were rejected for RI verification compared with the manufacturer-provided values. The comparison of reflimR with other indirect methods generally produced concordant results, except for the alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and total bilirubin tests. The reflimR algorithm may offer a swift and accessible method for calculating and verifying RIs. Verification failures may arise from fundamental variations, including ethnicity, sex, age demographics, and geographic factors, between the manufacturer’s study results and our analyzed population.

Objectives: In clinical laboratories, it is common to obtain serum and plasma by using a barrier tube due to its various advantages. In this study, we aimed to compare 18 biochemistry analytes in outpatient clinic and outpatient oncology patients by measuring in a Barricor tube and a serum separator tube (SST). Methods: Venous blood was drawn into the Barricor tube and SST from volunteers consisting of outpatients and outpatient oncology patients. The biochemical parameters were measured using the AU2700 autoanalyser (Beckman Coulter Inc., CA, USA) and Beckman Coulter Access immunoanalyser (Beckman Coulter Inc., CA, USA). The biochemical analytes evaluated in the two participant groups were compared between the Barricor tube and SST. Results: In the study, when the results in both the outpatient group and the outpatient oncology patient group, bias (%), allowable bias (%), CV (%), allowable CV (%), total error (%), total allowable error (TEa) (%) were evaluated; potassium (K) total error (%) between Barricor tube and SST exceeded TEa, however, all other parameters were within TEa. Conclusions: Considering its various advantages and compared biochemical analytes, we think that can be switched to the Barricor tube in clinical laboratories and the reference range change can be made for K.

Background/Objectives: This study aimed to develop and externally validate machine learning (ML) models for low-density lipoprotein cholesterol (LDL-C) estimation and compare their analytical and clinical performance with conventional formulas, particularly in individuals with elevated triglyceride (TG) levels. Methods: This retrospective study included 11,681 adults whose lipid profiles were retrieved using a laboratory information system. ML models (linear regression, random forest, support vector regression, and XGBoost) were developed using routine lipid parameters and evaluated using 10-fold cross-validation. Performance was assessed using the mean absolute error (MAE), root mean squared error (RMSE), bias, correlation, Bland–Altman agreement, and clinical classification according to LDL-C categories. Subgroup analyses were conducted across TG strata, with an emphasis on TG ≥ 400 mg/dL. Results: ML models generally demonstrated lower error and higher agreement with directly measured LDL-C levels than conventional formulas. XGBoost showed the best overall performance (MAE: 14.7 mg/dL; RMSE: 20.22 mg/dL; R² = 0.780; r = 0.88) and the lowest deviation. The ML models also showed a higher clinical classification accuracy (up to 66%). Performance declined with increasing TG levels, particularly for conventional formulas, whereas ML models remained more stable, including patients with TG ≥ 400 mg/dL. External validation across independent cohorts and analytical platforms demonstrated stable performance of the XGBoost model and generally higher classification accuracy than conventional LDL-C estimation formulas. Conclusions: ML-based LDL-C estimation may represent a complementary alternative to conventional formulas, particularly in hypertriglyceridemic populations.

Background and Objectives: This study aimed to investigate the association between circulating monocyte subset profiles and carotid artery stenosis (CAS) severity and to examine their relationships with inflammatory and atherosclerosis-related parameters. Materials and Methods: This cross-sectional study included 73 adult patients who underwent carotid Doppler ultrasonography. Participants were classified according to internal CAS severity as <50% (n = 44) or ≥50% (n = 29). Monocyte subsets were analyzed using flow cytometry and categorized as classical (CD14++CD16−), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) monocytes. Serum MCP-1 concentrations were measured using an enzyme-linked immunosorbent assay. Clinical characteristics, biochemical parameters, inflammatory indices, and carotid intima–media thickness (cIMT) were compared between the groups. Multivariate logistic regression analyses were performed to identify independent associations with significant stenosis. Results: Patients with CAS ≥50% exhibited significantly higher classical monocyte percentages and lower non-classical monocyte percentages than those with CAS < 50% (p = 0.044 and p = 0.027, respectively). Intermediate monocyte percentages did not differ significantly between the groups. Significant stenosis was also associated with a higher white blood cell count, neutrophil count, systemic inflammatory response index, fibrinogen, and HbA1c levels. Non-classical monocyte percentages showed a significant inverse correlation with cIMT (r = −0.320, p = 0.006). In a multivariable model adjusted for age, sex, and systolic blood pressure, lower non-classical monocyte percentage was associated with significant CAS (OR 0.872, 95% CI 0.765–0.994; p = 0.040). However, this association was no longer statistically significant after further adjustment for fibrinogen, neutrophil count, and HbA1c, whereas fibrinogen remained independently associated with significant CAS. Conclusions: Lower circulating non-classical monocyte percentages were associated with significant CAS and inversely correlated with cIMT and inflammatory markers. However, the attenuation of this association after adjusting for inflammatory parameters suggests that monocyte subset distribution should be interpreted within the broader inflammatory context that accompanies advanced carotid atherosclerosis.