Features Of Calcification Research Articles

Calciphylaxis with pseudoxanthoma elasticum-like changes: A case series.

Calciphylaxis and pseudoxanthoma elasticum (PXE) are rare, clinically distinct disorders that share a common feature of cutaneous calcification and that vary widely in their cutaneous presentation. We conducted a descriptive, retrospective review of biopsy specimens collected over a 2-year period. Only specimens with a histologic and clinical diagnosis of calciphylaxis were included in the review. Specimens were then histologically examined for features of PXE in the dermis and/or subcutaneous fat, utilizing hematoxylin and eosin staining. Von Kossa and Verhoeff-Van Gieson special stains were also performed to examine calcification and elastic fibers, respectively. We reviewed 13 biopsy specimens from 9 patients with known clinical and histologic evidence of calciphylaxis, both uremic and non-uremic types. Upon re-examination, we found that 46.2% (n = 6/13) of the specimens showed concomitant PXE-like changes uniquely localized to the subcutaneous fat. The presence of PXE-like changes in the subcutis may heighten suspicion for a diagnosis of calciphylaxis in the appropriate clinical setting and be helpful when classic histologic features are subtle or absent.

Relationships of ductal carcinoma in situ calcification feature and ER, PR and HER2 expression

Objective To discuss the relationships of ductal carcinoma in situ calcification feature and estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) expression. Methods The mammary gland molybdenum target X-ray results of 226 patients with ductal carcinoma in situ were retrospectively analyzed in our hospital during January 2013 to December 2016. All patients were divided into calcification group (n=110) and no calcium group (n=116). Immunohistochemical method was used to detect the expressions of ER, PR and HER2, and their relationships with calcification feature were analyzed. Results The positive expression rates of ER and PR in calcification group were 72.73% and 54.55%, significantly higher than those in no calcium group (39.66% and 38.79%; χ2=25.033, P 30, with mass were the independent prediction factors of ER, PR and HER2 expressions (all P<0.001). Conclusion The mammary gland molybdenum target calcification features of ductal carcinoma in situ are associated with ER, PR and HER2 expressions, the small polymorphic form, cluster distribution, number>30, with mass can be used as important reference indexes to preliminarily predict biological therapy and expressions of prognostic factors. Key words: Carcinoma, intraductal, noninfiltrating; Calcinosis; Receptors, estrogen; Receptors, progesterone; Receptor, epidermal growth factor

Examination of concomitant glenohumeral pathologies in patients treated arthroscopically for calcific tendinitis of the shoulder and implications for routine diagnostic joint exploration

BackgroundGlenohumeral exploration is routinely performed during arthroscopic removal of rotator cuff calcifications in patients with calcific tendinitis of the shoulder (CTS). However, evidence on the prevalence of intraarticular co-pathologies is lacking and the benefit of glenohumeral exploration remains elusive. The aim of the present study was to assess and quantify intraoperative pathologies during arthroscopic removal of rotator cuff calcifications in order to determine whether standardized diagnostic glenohumeral exploration appears justified in CTS patients.MethodsOne hundred forty five patients undergoing arthroscopic removal of calcific depots (CD) that failed conservative treatment were included in a retrospective cohort study. Radiographic parameters including number/localization of calcifications and acromial types, intraoperative arthroscopic findings such as configuration of glenohumeral ligaments, articular cartilage injuries, and characteristics of calcifications and sonographic parameters (characteristics/localization of calcification) were recorded.ResultsOne hundred forty five patients were analyzed. All CDs were removed by elimination with a blunt hook probe via “squeeze-and-stir-technique” assessed postoperatively via conventional X-rays. Neither subacromial decompression nor refixation of the rotator cuff were performed in any patient. Prevalence of glenohumeral co-pathologies, such as partial tears of the proximal biceps tendon (2.1%), superior labral tears from anterior to posterior (SLAP) lesions (1.4%), and/or partial rotator cuff tears (0.7%) was low. Most frequently, glenohumeral articular cartilage was either entirely intact (ICRS grade 0 (humeral head/glenoid): 46%/48%) or showed very mild degenerative changes (ICRS grade 1: 30%/26%). Two patients (1.3%) required intraarticular surgical treatment due to a SLAP lesion type III (n = 1) and an intraarticular rupture of CD (n = 1).ConclusionsRoutine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of CTS due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. Exploration of the glenohumeral joint in arthroscopic removal of CD should only be performed in case of founded suspicion of relevant concomitant intraarticular pathologies.

Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology?

BackgroundThere is controversy about the accuracy of the fine-needle aspiration (FNA) cytology results in large sized thyroid nodules. Our aim was to evaluate the false-negative rate of FNA for large thyroid nodules and the usefulness of the Thyroid Imaging Reporting and Data System (TIRADS) in predicting false-negative cytology for large thyroid nodules with benign cytology.Methods632 thyroid nodules larger than or equal to 3cm in size with subsequent benign cytology on US-guided FNA were included. US features of internal composition, echogenicity, margin, calcifications, and shape were evaluated, and nodules were classified according to TIRADS. TIRADS category 3 included nodules without any of the following suspicious features:solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. Category 4a, 4b, 4c, and 5 were assigned to nodules showing one, two, three or four, or five suspicious US features, respectively. US features associated with malignancy for these lesions were analyzed and malignancy risk according to TIRADS was calculated.ResultsOf the 632 lesions, 23 lesions(3.6%) were malignant and 609(96.4%) were benign, suggesting a 3.6% false-negative rate for FNA cytology. Of the 23 malignant lesions, final pathology was mainly follicular carcinoma minimally invasive(65.2%, 15/23) and the follicular variant of papillary carcinoma(26.1%, 6/23). The malignancy risks of categories 3, 4a, 4b, and 4c nodules were 0.9%, 4.6%, 10.0%, and 11.8%, respectively.ConclusionLarge thyroid nodules with benign cytology had a relatively high false-negative risk of 3.6% and TIRADS was helpful in predicting false-negative cytology for these lesions.

PD-L1 and PD-1 expression are correlated with distinctive clinicopathological features in papillary thyroid carcinoma

BackgroundImmune checkpoint blockade targeting PD-1/PD-L1 has shown efficacy in several types of cancers. However, the correlation between PD-L1/PD-1 expression and the specific clinicopathological features in papillary thyroid carcinoma (PTC) has not been investigated.MethodsWe examined the immunohistochemical expression of PD-L1, PD-1, and BRAF V600E on whole-tissue sections from 126 cases of primary PTC more than 1 cm in size. The correlation between the PD-L1/PD-1 expression and the clinicopathological features was evaluated.ResultsPD-L1 was positively expressed in 53.2% PTCs, and its expression was positively correlated with rich tumor-infiltrating lymphocytes (TILs), background chronic lymphocytic thyroiditis (CLT), female gender, absence of psammoma bodies, and PD-1 expression. Among these parameters, rich TILs, female gender, and absence of psammoma bodies were independent factors affecting PD-L1 expression on the multivariate logistic regression analysis. PD-1 expression was detected in the TILs and was positively correlated with rich TILs, background CLT, and absence of stromal calcification. Lack of stromal calcification was an independent factor affecting PD-1 expression. Neither PD-L1 nor PD-1 expression showed significant correlation with BRAF V600E expression.ConclusionsOur results show that the distinctive pathological features of PTCs, including TILs, background CLT, female gender, psammoma bodies, and stromal calcification, are useful parameters for predicting PD-L1 or PD-1 expression.

Clinical and radiological diversity in genetically confirmed primary familial brain calcification

Primary familial brain calcification (PFBC) is a rare neuropsychiatric disorder with characteristic symmetrical brain calcifications. Patients with PFBC may have a variety of symptoms, although they also may be clinically asymptomatic. Parkinsonism is one of the most common movement disorders; however, the underlying mechanism remains unclear. This condition is typically transmitted in an autosomal dominant fashion. To date, mutations in SLC20A2, PDGFRB, PDGFB, and XPR1 have been reported to cause PFBC. The aim of the study was to identify the genetic cause of brain calcification in probands from three PFBC families and in 8 sporadic patients and to perform clinical and radiological assessments focusing on parkinsonism in mutation carriers. Three familial PFBC probands and their relatives and eight sporadic patients affected with brain calcifications were enrolled in this study. Whole-exome sequencing identified three novel mutations: c.269G > T, p.(Gly90Val) and c.516+1G > A in SLC20A2 in familial cases, and c.602-1G > T in PDGFB in a sporadic patient. The c.516+1G > A mutation resulted in exon 4 skipping in SLC20A2 (p.Val144Glyfs*85). Dopamine transporter single photon emission computed tomography using 123I-ioflupane and 123I-metaiodobenzylguanidine cardiac scintigraphy revealed pre-synaptic dopaminergic deficit and cardiac sympathetic nerve dysfunction in two SLC20A2-related PFBC patients with parkinsonism.

Calcification depths of planktonic foraminifera from the southwestern Atlantic derived from oxygen isotope analyses of sediment trap material

Abstract We present a multi-year record of shell fluxes and δ18O of six planktonic foraminifera species (Globigerinoides ruber pink, Globigerinoides ruber white, Trilobatus sacculifer, Orbulina universa, Neogloboquadrina dutertrei, Globorotalia menardii) from sediment traps located in the southwestern Atlantic. Among the six species, only the fluxes of G. ruber white and N. dutertrei exhibit a significant seasonal component, with G. ruber white showing a single flux peak in austral summer, and N. dutertrei exhibiting two flux peaks in spring and autumn. To estimate calcification depths of the studied species, we then compare their measured δ18O to vertical δ18O profiles predicted for each collection time from in-situ temperature profiles and climatological salinity profiles. For the majority of the cases, the measured δ18O could be accounted for by in-situ calcification, assuming species-specific temperature-δ18O calibrations. The resulting estimates of the calcification depth imply that each species exhibits a characteristic typical mean calcification depth. The estimated calcification depths for N. dutertrei (mode 60–70 m) and G. menardii (mode 70–80 m) appear to track the depth of the thermocline in the region, whereas the calcification depths of the remaining four species correspond to conditions in the mixed layer. Among the apparent mixed-layer calcifiers, G. ruber pink and white appeared to calcify consistently shallower (mode 30–40 m) while T. sacculifer calcified deeper (mode 50–60 m). Because of the low flux seasonality, the observed oxygen isotope offsets among the species are similar to the flux-weighted mean annual δ18O offsets, indicating that isotopic offsets among the species in sediment samples are mainly due to different calcification depths. Since the habitat offsets among the species are consistent across seasons, δ18O in sedimentary shells can be used to track conditions in different parts of the water column and the difference in the oxygen-isotope composition between surface species (best represented by G. ruber pink) and thermocline species (best represented by N. dutertrei) can be used as a proxy for stratification in the southwestern Atlantic.

Morphometric age and survival following kidney transplantation.

As patients with chronic kidney disease become older, there is greater need to identify who will most benefit from kidney transplantation. Analytic morphomics has emerged as an objective risk assessment tool distinct from chronologic age. We hypothesize that morphometric age is a significant predictor of survival following transplantation. A retrospective cohort of 158 kidney transplant patients from 2005 to 2014 with 1-year preoperative imaging was identified. Based on a control population comprising of trauma patients and kidney donors, morphometric age was calculated using the validated characteristics of psoas area, psoas density, and abdominal aortic calcification. The primary outcome was post-transplant survival. Cox regression showed morphometric age was a significant predictor of survival (hazard ratio, 1.06 per morphometric year [95% confidence interval, 1.03-1.08]; P<.001). Chronological age was not significant (hazard ratio, 1.03 per year [0.98-1.07]; P=.22). Among the chronologically oldest patients, those with younger morphometric age had greater survival rates compared to those with older morphometric age. Morphometric age predicts survival following kidney transplantation. Particularly for older patients, it offers improved risk stratification compared to chronologic age. Morphomics may improve the transplant selection process and provide a greater assessment of prospective survival benefits.

HISTOPATHOLOGICAL ANALYSIS OF REGIONAL ODONTODYSPLASIA

Regional odontodysplasia (ROD) is an uncommon localized disorder of tooth development with unknown etiology. It is characterized by defective formation of both enamel and dentin, and formation of calcifications in pulp and dental follicle. Because enamel and dentin are the products of ameloblasts and odontoblasts, respectively, findings in ROD indicate that abnormality occurs in both of these cell types. However, knowledge regarding changes in odontogenic cells in ROD is mostly lacking. Therefore, the purpose of this study was to analyze the histopathological features of odontogenic cells and the characteristic calcifications, presumably the products of the odontogenic cells, in ROD. Clinical information and biopsy materials of 12 ROD cases were analyzed. Three types of calcifications were found in ROD affected teeth: 1) globular basophilic calcifications associated with reduced enamel epithelium (REE); 2) small round calcifications associated with spindle cells arranged in a storiform pattern; and 3) eosinophilic calcifications with globular purple calcified material, previously described as enameloid conglomerates. Odontoblasts in ROD affected teeth were flattened and showed vacuolization. Using Picro Sirius red stain, a histochemical stain for collagen type I and III, the second and the third types of calcifications showed collagen birefringence. Our findings showed that the morphology of odontoblasts in ROD is altered; and support that the globular type calcifications in ROD are dystrophic enamel calcifications, most likely products of REE. It also suggests that enameloid conglomerates are likely the products of stem cells in dental follicle. These findings serve as the basis for further immunohistochemical and/or ultrastructural investigations.

Revisiting the Role of Interleukin-1 Pathway in Osteoarthritis: Interleukin-1α and -1β, and NLRP3 Inflammasome Are Not Involved in the Pathological Features of the Murine Menisectomy Model of Osteoarthritis.

Background: Innate immune response components such as toll-like receptors (TLRs) and NLRP3-inflammasome act in concert to increase IL-1α/β secretion by synovial macrophages. Previous results suggest that IL-1α/β could be an important mediator involved in the pathogenesis of osteoarthritis (OA).Objectives: The aim of our study was to evaluate the role of NLRP3, IL-1β, and IL-1α in the menisectomy (MNX) model of murine OA.Methods: Murine chondrocytes (CHs) and bone marrow-derived machrophages (BMDM) were stimulated with hydroxyapatite (HA) crystals, a form of calcium-containing crystal found in human OA, and IL-1β and IL-6 secretion assayed by ELISA.Conversely, the ability of IL-1β and IL-6 to induce CHs calcification was assessed in vitro by Alizarin red staining. Knees from 8 to 10 weeks old C57Bl/6J wild-type (WT) (n = 7), NLRP3−/− (n = 9), IL-1α−/− (n = 5), and IL-1β−/− (n = 5) mice were menisectomized, using the sham-operated contralateral knee as control. 8 weeks later, knee cartilage degradation and synovial inflammation were evaluated by histology. In addition, apoptotic chondrocytes, metalloproteases activity, and collagen-type 2 expression were evaluated in all mice. Joint calcification and subchondral bone parameters were quantified by CT-scan in WT and IL-1β−/− menisectomized knees.Results: In vitro, HA crystals induced significant increased IL-6 secretion by CHs, while IL-1β remained undetectable.Conversely, both IL-6 and IL-1β were able to increase chondrocytes mineralization. In vivo, operated knees exhibited OA features compared to sham-operated knees as evidenced by increased cartilage degradation and synovial inflammation. In menisectomized KO mice, severity and extent of cartilage lesions were similar (IL-1α−/− mice) or exacerbated (IL-1β−/− and NLRP3−/− mice) compared to that of menisectomized WT mice. Metalloproteases activity, collagen-type 2 expression, chondrocytes apoptosis, and synovial inflammation were similar between KO and WT mice menisectomized knees. Moreover, the extent of joint calcification in osteoarthritic knees was comparable between IL-1β−/− and WT mice.Conclusions: MNX knees recapitulated features of OA, i.e, cartilage destruction, synovial inflammation, cell death, and joint calcification. Deficiency of IL-1α did not impact on the severity of these features, whereas deficiency of IL-1β or of NLRP3 led to increased cartilage erosion. Our results suggest that IL-1α and IL-1β are not key mediators in this murine OA model and may explain the inefficiency of IL-1 targeted therapies in OA.

Characteristics of Chinese Costal Cartilage and Costa Calcification Using Dual-Energy Computed Tomography Imaging

To assess characteristics of Chinese costal cartilage and costa calcification using Dual-Energy computed tomography(DECT). 154 patients who underwent chest DECT scanning were included in our study. They were divided into following groups: less than 30 years old, 31–40 years old, 41–50 years old, 51–60 years old and over 60 years old. The sixth, seventh and eighth costal cartilages and costas were evaluated. Calcification patterns of cartilage were classified as central(C), peripheral(P), mixed(M) and no calcification(N) types. Calcification degree of cartilage was distinguished as 1(0–25%), 2(26–50%) and 3(>50%). CT value, calcium and water concentrations were measured in costal cartilage, cortical or cancellous bone respectively. An increasing C pattern of cartilage was displayed in females, while P type preferred in males as age increased. Calcification degree generally changed from 1 to 2 or 3 in females. CT value and calcium concentration of cartilage went through a gradual rising course and peaked in their 40–50 years, while those two indices of cancellous bone decreased gradually since their 50 years in females. The findings suggest a gradual calcification of the costal cartilage took place before 40–50 years old and a sharp bone loss of the costa happened after 40–50 years old in females.

Association Between Carotid Atherosclerotic Plaque Calcification and Intraplaque Hemorrhage: A Magnetic Resonance Imaging Study.

Carotid intraplaque hemorrhage (IPH) is associated with cardiovascular events. Calcification, which frequently accompanies IPH, may play a role in IPH occurrence. In this study, we aimed to investigate the associations between calcification characteristics and IPH in carotid plaques. One hundred seventeen patients with cerebrovascular symptoms and carotid plaques detected by ultrasound were recruited and underwent multicontrast magnetic resonance imaging. Advanced carotid plaques with composition measured by magnetic resonance imaging were included in the analysis. Carotid calcifications were divided into the following categories: surface, mixed, and deep calcification. They were also classified into single and multiple calcifications according to quantity. Logistic regression models utilizing generalized estimating equations were performed to evaluate the relationship between calcification and IPH. Of 117 subjects, 85 with 142 plaques were included in the final analysis, whereas 32 were excluded because of lack of plaque compositions. Of the 142 plaques, 40 (28.2%) had IPH. Plaques with IPH showed greater prevalence of calcification than those without (87.5% versus 55.9%; P=0.005). After adjusting for age, low-density lipoprotein, maximum wall thickness, and maximum soft plaque thickness, multiple calcifications (odd ratio, 10.1; 95% confidence interval, 3.3-30.4), surface calcification (odd ratio, 29.4; 95% confidence interval, 4.1-210.8), and mixed calcifications (odd ratio, 27.9; 95% confidence interval, 7.3-107.1) were found to be strongly associated with the presence of IPH (all P<0.05). Surface calcification and multiple calcifications in carotid atherosclerotic plaques are independently associated with the presence of IPH, suggesting that both quantity and location of calcification may play important roles in the occurrence of IPH. These findings may provide novel insights for understanding mechanisms of IPH.

Abstract P5-03-08: Use of natural language processing on mammography and pathology findings to supplement BI-RADS to improve clinical decision making in breast cancer care

Abstract Breast Imaging Reporting and Data System (BI-RADS) is a standard system used by clinicians to describe mammogram findings and sort the results into categories numbered 0 through 6; this makes accurately communicating about these test results and following up after the tests much easier. For example, the BI-RADS 4 score is given to lesions that carry a risk of malignancy between 2 and 95% such that a majority (69 to 95%) of BI-RADS 4 lesions are biopsied. Our goal is to create a better risk estimate score to stratify patients by developing a more accurate threshold for biopsy. To accomplish this goal, we defined the personal risk factors, relevant descriptors in the mammography and pathology findings for every patient with BI-RADS 3, 4, or 5 risk score. Clinical data were sourced from the Methodist Environment for Translational and Outcomes Research (METEOR) data warehouse at the Houston Methodist Hospital. METEOR data warehouse contains 135,280 unique patient mammogram reports dating from January 1, 2006 to May 30, 2015. Manual abstraction from this large number of free text reports is not feasible due to the constraints on time and labor costs, and risk of human-error during manual extraction. We developed a natural language processing (NLP) tool called Methodist hOspital Text Teaser (MOTTE) to extract defined clinical parameters and derive the desired meaning from the volumes of free text reports automatically. MOTTE is a rule-based software tool programmed in Java, Structured Query Language (SQL) and an open source machine learning toolkit, OpenNLP. MOTTE combines regular expressions and algorithms to identify where in the dictionary keywords and phrases related to a concept are found. Mammography findings from January 2006 to May 2015 were extracted including breast density as well as the presence of mass, calcifications, architectural distortion, asymmetric density, and calcification characteristics. A total of 717 patients with BI-RADS 5 mammograms who underwent breast biopsy within 3 months of the abnormal mammogram report date were identified using MOTTE, which also extracted personal history, family history, and subtype information (ER, PR, and HER2 status) of those patients. Clinical data including age, race, height, weight, and body mass index (BMI) were extracted from the METEOR data warehouse for those 717 patients. The extracted data were verified and validated with 99% accuracy by assessing a random 10% of records against a gold standard of manual chart review, which was completed by the clinical coauthors. MOTTE surpasses the manual method in terms of consistency, time, cost, and data preparation. Our ongoing study is to apply the MOTTE to extract distinct characteristics of BI-RADS 4 scored patients. The finding would help to refine biopsy recommendations and create a predictive model to drive evidence-based biopsy decision-making in breast cancer care. Citation Format: Puppala M, He TC, Ogunti R, Wong STC. Use of natural language processing on mammography and pathology findings to supplement BI-RADS to improve clinical decision making in breast cancer care [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-03-08.

Specific Characteristics of Coronary Atherosclerosis

In this review, we present modern aspects of etiology and pathogenesis of atherosclerosis. We describe the roles played by inflammatory cells, components of cellular response in allergic reactions, disturbances of carbohydrate metabolism, cellular aging, and infection at various stages of formation of atherosclerotic plaques. Special attention is given to the specific characteristics of atherosclerosis and calcification of coronary arteries. We show the influence of age and gender on the disease progression. The review includes information on the importance of myocardial bridges for the change of hemodynamics in segments of coronary arteries. The data presented indicate that differences in localization of atherosclerotic lesions between systems of the right and left coronary arteries depends on their hemodynamic, anatomical and physiological characteristics. According to the literature, anterior descending artery is more vulnerable in this respect.

Intelligent System for Detection of Micro-Calcification in Breast Cancer

Recently; medical image mining has become one of the well-recognized research area(s) of machine learning and artificial intelligence techniques have been vastly used in various computer added diagnostic systems. Specifically; breast cancer classification problem is considered as one of the most significant problems. For instance, complex, diverse and heterogamous malignant features of micro-calcification in DICOM (Digital Communication in Medicine) images of mammography are very difficult to classify because the persistence of noise in mammogram images creates lots of confusions for doctors. In order to reduce the chances of misdiagnosis and to discernment the difference between malignant and benign lesions of micro-calcification this paper proposes a system so called “Intelligent System For Detection of Micro-Calcification in Breast Cancer” by considering all above stated problems. Overall our system comprises over three main stages. In first stage, adaptive threshold algorithm is used to reduce the noise, and canny edge detection algorithm is used to detect the edges of every macro or micro classification. In second stage, deginated as feature selection is done by using auto-crop algorithm, which crops all types of calcifications and lesions by proposed algorithm so called CFEDNN (Calcification Feature Extraction Deep Neural Networks) which is designed to avoid the manual ROIs (Region of Interest). Decision model is constructed by using DNN (Deep Neural Networks) and the best classification accuracy is measured as 95.6%.

Chronic Kidney Disease-Mineral Bone Disorder in Korean Patients: a Report from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD).

This study examined the characteristics of biochemical parameters, bone diseases, and vascular calcification in Korean patients with chronic kidney disease (CKD) not yet on dialysis. Serum levels of fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 (25D), and 1,25-dihydroxyvitamin D3 (1,25D); lumbar spine, total hip, and femur neck bone mineral densities; and brachial-to-ankle pulse wave velocity (baPWV) representing vascular calcification were measured at baseline for 2,238 CKD patients in the KoreaN Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Increases in serum FGF23 and iPTH preceded changes in serum calcium and phosphate, similar to Western populations. However, the 25D and 1,25D levels decreased earlier than serum FGF23 or iPTH increased, with a decreased estimated glomerular filtration rate (eGFR) in Korean CKD patients. Vitamin D deficiency occurred in 76.7% of patients with CKD stage 1. Bone mineral densities were lowest in CKD stage 5 (lumbar spine, −0.64 ± 1.67; total hip, −0.49 ± 1.21; femur neck, −1.02 ± 1.25). Osteoporosis was more prevalent in patients with higher CKD stages. The mean baPWV, abdominal aortic calcification (AAC), and coronary calcium score also increased, with declined eGFR. In conclusion, a decline in serum vitamin D levels was observed in early CKD stages before significant increases of FGF23 and iPTH in the Korean CKD population compared with that in Western populations. Increased bone disease and vascular calcification occurred in early-stage CKD.

The association between mammographic calcifications and breast cancer prognostic factors in a population‐based registry cohort

Mammographic calcifications can be a marker of malignancy, but their association with prognosis is less well established. In the current study, the authors examined the relationship between calcifications and breast cancer prognostic factors in the population-based Carolina Mammography Registry. The current study included 8472 invasive breast cancers diagnosed in the Carolina Mammography Registry between 1996 and 2011 for which information regarding calcifications occurring within 2 years of diagnosis was reported. Calcification-specific Breast Imaging Reporting and Data System (BI-RADS) assessments were reported prospectively by a radiologist. Tumor characteristic data were obtained from the North Carolina Central Cancer Registry and/or pathology reports. Multivariable-adjusted associations between the presence of calcifications in the breast affected by cancer and tumor characteristics were estimated using logistic regression. Statistical tests were 2-sided. The presence of calcifications was found to be positively associated with tumors that were high grade (vs low grade: odds ratio [OR], 1.43; 95% confidence interval [95% CI], 1.10-1.88) or had an in situ component (vs without: OR, 2.15; 95% CI, 1.81-2.55). Calcifications were found to be inversely associated with hormone receptor-negative status (vs positive status: OR, 0.73; 95% CI, 0.57-0.93), size >35 mm (vs ≤8 mm: OR, 0.47; 95% CI, 0.37-0.61), and lobular tumors (vs ductal: OR, 0.39; 95% CI, 0.22-0.69). The association between the presence of calcifications and an in situ component was limited to BI-RADS category 4 and 5 calcifications and was absent for BI-RADS category 2 or 3 calcifications (P for heterogeneity <.01). The association with tumor size was found to be strongest for BI-RADS categories 3 and 4 (P for heterogeneity <.01). Calcifications were found to be associated with both unfavorable (high grade) and favorable (small size, hormone receptor positivity) prognostic factors. Detailed analysis of the biological features of calcifications is necessary to understand the mechanisms driving these associations. Cancer 2017;123:219-227. © 2016 American Cancer Society.

Diagnostic Value of Brain Calcifications in Adult-Onset Leukoencephalopathy with Axonal Spheroids and Pigmented Glia.

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia is a rare neurodegenerative disease resulting from mutations in the colony stimulating factor 1 receptor gene. Accurate diagnosis can be difficult because the associated clinical and MR imaging findings are nonspecific. We present 9 cases with intracranial calcifications distributed in 2 brain regions: the frontal white matter adjacent to the anterior horns of the lateral ventricles and the parietal subcortical white matter. Thin-section (1-mm) CT scans are particularly helpful in detection due to the small size of the calcifications. These calcifications had a symmetric "stepping stone appearance" in the frontal pericallosal regions, which was clearly visible on reconstructed sagittal CT images. Intrafamilial variability was seen in 2 of the families, and calcifications were seen at birth in a single individual. These characteristic calcification patterns may assist in making a correct diagnosis and may contribute to understanding of the pathogenesis of leukoencephalopathy.

Towards the characterisation of carotid plaque tissue toughness: Linking mechanical properties to plaque composition

The morphological manifestation of calcification within an atherosclerotic plaque is diverse and the response to cutting balloon angioplasty remains an elusive target to predict in the presence of extensive calcification. This study examines the resistance of plaque tissue to blade penetration by characterising the underlying toughness properties and stratifying the upper and lower scale toughness limits based on the strong mechanical influence of calcification. Mechanical toughness properties of the common, bifurcation and internal carotid artery (n=62) were determined using guillotine-cutting tests measuring the energy required to pass a surgical blade through a unit length of plaque tissue. The corresponding structural composition of the dissected plaque segments was characterised using Fourier transform infrared analysis, electron microscopy and energy dispersive x-ray spectroscopy. Mechanical results reveal a clear distinction in toughness properties within each region of the carotid vessel with significantly tougher properties localised in the bifurcation (p=0.004) and internal region (p=0.0003) compared to the common. The severity of the intra-plaque variance is highest in plaques with high toughness localised in the bifurcation region (p<0.05). Structural examination reveals that the diverse mechanical influence of the level of calcification present is characteristic of specific regions within the carotid plaque. The energy required to overcome the calcific resistance and propagate a controlled cut in the calcified tissue at each region varies further with the degree of plaque progression. The identification of the localised calcification characteristics is a key determinant in achieving successful dissection of the severely toughened plaque segments during cutting balloon angioplasty. Calcification plays a fundamental role in plaque tissue mechanics and demonstrates a diverse range of material moduli properties. This work addresses the characterisation of the toughness properties in human carotid plaque tissue using a fracture mechanics approach. Toughness determines the energy required to propagate a controlled cut in the plaque material. This parameter is crucial for predicting the cutting forces required during endovascular cutting balloon angioplasty intervention. Results demonstrate that a strong relationship exists between the structural calcification configurations, fracture mechanisms and associated toughness properties that are characteristic of specific regions within the carotid artery plaque. The identification of the morphological characteristics of localised calcification may serve as a valuable quantitative measure for cutting balloon angioplasty treatment.

Study of ultrasonographic features in predicting reginal lymph node metastasis in patients with papillary thyroid carcinoma

To demonstrate the ultrasonographic features of papillary thyroid carcinoma (PTC) in predicting associated cervical lymph nodes metastasis (LNM). A total of 136 patients diagnosed with PTC in Beijing Tongren Hospital between January 2014 and September 2014 were enrolled.Of 136 cases, forty patients were confirmed with cervical lymph node metastasis.Seven were males, 33 were females, aged from 18 to 65 years old, mean age was (39.6±10.3) years .The remaining 96 were reported without lymph node metastasis.Twenty-one were males, 75 were females, aged from 23 to 86 years old, mean age was (47.7±12.8) years.Medical record was reviewed for demographic characteristics and pathological findings.The ultrasonographic features of each case were evaluated retrospectively.The difference of ultrasonographic features between the patients with and without LNM was examined. There were 178 PTCs confirmed with pathology, 159 lesions (89.3%) were detected by ultrasonography, the remaining 19 lesions (10.7%) were under-detected.Of 136 patients with PTC, 40 cases (40/136, 29.4%) were confirmed with cervical LNM, while the remaining 96 cases (96/136, 70.6%) were determined without cervical LNM.PTC with cervical LNM was more frequently seen in the patients who were younger (P=0.000 5) and presenting with multifocal tumors (P=0.014 6). Ultrasonographic features of PTC which significantly associated with LNM were ill-defined margins (P=0.018), solid appearance (P=0.003), and presence of calcification (P=0.000). Of 40 cases with LNM, central cervical LNM was seen in 32 cases (80%), 72.5% of whom appeared as unilateral distribution. Patients diagnosed with PTC with younger age and identified with multiple foci of tumors at the time of diagnosis are in an increased risk of associated cervical LNM.Ultrasonographic features of ill-defined margins, solid appearance and calcification in PTC are significant predictors of LNM.