Total Calcification Research Articles

Explainable machine-learning model to classify culprit calcified carotid plaque in embolic stroke of undetermined source.

Embolic stroke of undetermined source (ESUS) may be associated with carotid artery plaques with <50% stenosis. Plaque vulnerability is multifactorial, possibly related to intraplaque hemorrhage (IPH), lipid-rich-necrotic-core (LRNC), perivascular adipose tissue (PVAT), and calcification morphology. Machine-learning (ML) approaches in plaque classification are increasingly popular but often limited in clinical interpretability by black-box nature. We apply an explainable ML approach, using noncalcified plaque components and calcification features with SHapley Additive exPlanations (SHAP) framework to classify calcified carotid plaques as culprit/non-culprit. In this retrospective cross-sectional study, patients with unilateral anterior circulation ESUS who underwent neck CT angiography and had calcific carotid plaque were analyzed. Calcification-level features were derived from manual segmentations. Plaque-level features were assessed by a neuroradiologist blinded to stroke-side and by semi-automated software. Calcifications/plaques were classified as culprit if ipsilateral to stroke-side. Eight baseline ML models were compared. Three CatBoost models were trained: Plaque-level, Calcification-level, and Combined. SHAP was incorporated to explain model decisions. 70 patients yielded 116 calcific carotid plaques (60 ipsilateral to stroke; 270 calcifications (146 ipsilateral)). 17 plaque-level and 15 calcification-level features were extracted. Baseline CatBoost model outperformed other models. Combined model achieved test AUC 0.77 (95% CI: 0.59-0.92), accuracy 0.82 (95% CI: 0.71 - 0.91), mean cross-validation AUC 0.78. Plaque-level and calcification-level models performed lower (AUC 0.41 95% CI: 0.15-0.68, 0.60 95% CI 0.44-0.76). Combined model utilized five features: plaque thickness, IPH/LRNC volume ratio, PVAT volume, calcification minimum density, and total calcification volume over mean density ratio. Plaque thickness was most important feature based on SHAP values, with potential threshold at >2.6 mm. ML model trained with noncalcified plaque and calcification features can classify culprit calcific carotid plaque with greater accuracy than models trained using only plaque-level or calcification-level features. Model using clinically interpretable features with SHAP framework provides explanations for its decisions and allows identification of potential thresholds for high-risk features.

Femoropopliteal Bypass Surgery for Total Calcification of the Iliofemoral Segment

Calcification of the lower extremities arteries is an unfavorable factor for vascular surgery. Extensive lesions of the femoral segment are an indication for femoropopliteal bypass surgery. Calcification of the femoral arteries complicates the construction of a proximal anastomosis because it precludes clamping the arteries. In addition to technical difficulties in the construction of an anastomosis, significant calcification increases the risks of bleeding and embolic complications and the duration of surgery. In cases of total calcification of the femoral and iliac arteries, balloon occlusion during the construction of an anastomosis makes it possible to occlude the arteries without clamping, which reduces the risks of perioperative complications. We report a case of femoropopliteal bypass surgery in a patient with total calcification of the iliofemoral segment and occlusion of the superficial femoral artery.

Inter-and intrarater agreement of Computed Tomographic brain calcification scoring in Primary Familial Brain Calcification.

The Total Calcification Score (TCS) is a visual rating scale to measure Primary Familial Brain Calcification (PFBC) related calcification severity on Computed Tomography (CT). We investigated the inter-and intrarater agreement of a modified TCS. Patients aged ≥18 years with PFBC or Fahr's syndrome who visited the outpatient clinic of a Dutch academic hospital were included. The TCS was modified, for example by adding hippocampal calcification, and ranged from 0 to 95 points. Fifteen raters evaluated all CTs, of whom three evaluated the CTs twice. Their Entrustable Professional Activity (EPA) level ranged from II (medical student) to V (neuroradiologist). Agreement was assessed using the intraclass correlation coefficient (ICC) for the total score. Kendall's W and weighted Cohen's Kappa were used to determine the inter- and intrarater agreement for individual locations, respectively. Forty patients were included (mean age 60 years, 53% female). The median modified TCS was 34 (range 4-76). For all EPA levels, the interrater agreement of the modified TCS was excellent (ICC=0.97 (95% CI 0.95-0.98)). Kendall's W's were good to excellent for commonly affected locations, but poor to moderate for less commonly affected locations for raters with lower levels of expertise. The intrarater agreement of the modified TCS was excellent. Kappa's of most locations were substantial to almost perfect. The modified TCS can be used with excellent reproducibility of the overall amount of brain calcifications and with limited training, although for some individual calcification locations more expertise is needed. CI, Confidence Interval; CT, Computed Tomography; EPA, Entrustable Professional Activity; IBGC, Idiopathic Basal Ganglia Calcification; ICC, Intraclass Correlation Coefficient; IQR, Interquartile Range; PFBC, Primary Familial Brain Calcification; SD, Standard Deviation, TCS, Total Calcification Score; UMCU, University Medical Center Utrecht.

Cyclical Etidronate Reduces the Progression of Arterial Calcifications in Patients with Pseudoxanthoma Elasticum: A 6-Year Prospective Observational Study.

Background: Pseudoxanthoma elasticum (PXE), a rare genetic disorder presenting with slowly progressing calcification of various tissues, including the arteries, is caused by mutations in the ABCC6 gene that lead to the reduction of pyrophosphate, a natural inhibitor of calcification. We showed that, compared to a placebo, the cyclical administration of etidronate, a stable pyrophosphate analog, significantly reduced arterial calcification assessed by low-dose CT scans after one year. The aim of the present prospective, single center, observational cohort study was the assessment of the efficacy and safety of cyclical etidronate in patients treated for periods longer than one year. Methods: Seventy-three patients were followed for a median of 3.6 years without etidronate and 2.8 years with etidronate, and each patient served as their own control. Results: The median absolute yearly progression of total calcification volume during the period with etidronate (388 [83-838] µL) was significantly lower than that without etidronate (761 [362-1415] µL; p < 0.001). The rates of the relative progression of arterial calcification were 11.7% (95% CI: 9.6-13.9) without etidronate compared to 5.3% (95% CI: 3.7-7.0) with etidronate, after adjustment for confounders. Conclusions: The cyclical administration of etidronate for nearly 3 years significantly reduced the progression rate of arterial calcification in patients with PXE with pre-existing calcifications without any serious adverse effects.

Novel findings in a Swedish primary familial brain calcification cohort

IntroductionBrain calcifications are frequent findings on imaging. In a small proportion of cases, these calcifications are associated with pathogenic gene variants, hence termed primary familial brain calcification (PFBC). The clinical penetrance is incomplete and phenotypic variability is substantial. This paper aims to characterize a Swedish PFBC cohort including 25 patients: 20 from seven families and five sporadic cases. MethodsLongitudinal clinical assessment and CT imaging were conducted, abnormalities were assessed using the total calcification score (TCS). Genetic analyses, including a panel of six known PFBC genes, were performed in all index and sporadic cases. Additionally, three patients carrying a novel pathogenic copy number variant in SLC20A2 had their cerebrospinal fluid phosphate (CSF-Pi) levels measured. ResultsAmong the 25 patients, the majority (76%) displayed varying symptoms during the initial assessment including motor (60%), psychiatric (40%), and/or cognitive abnormalities (24%). Clinical progression was observed in most patients (78.6%), but there was no significant difference in calcification between the first and second scans, with mean scores of 27.3 and 32.8, respectively. In three families and two sporadic cases, pathogenic genetic variants were identified, including a novel finding, in the SLC20A2 gene. In the three tested patients, the CSF-Pi levels were normal. ConclusionsThis report demonstrates the variable expressivity seen in PFBC and includes a novel pathogenic variant in the SLC20A2 gene. In four families and three sporadic cases, no pathogenic variants were found, suggesting that new PFBC genes remain to be discovered.

Vascular calcification in Takayasu arteritis: relationship with metabolic syndrome, left ventricular mass index, and intima-media thickness

ObjectiveThe present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT). MethodsA cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches. ResultsForty-seven patients (95.9%) were female and mean age was 33.45 ± 8.53 years. Total calcification score (mean ± SD; 5223.9 ± 18041.1 AU vs. 35.87 ± 72.70 AU (p = 0.05)), CIMT, and LVMI were found to be significantly higher in TA patients than HCs (p < 0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (−) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (−) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (−) group (p < 0.05). ConclusionVascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.

The Association between Intracranial Calcifications and Symptoms in Patients with Primary Familial Brain Calcification

(1) Background: Primary Familial Brain Calcification (PFBC) is a neurodegenerative disease characterized by bilateral calcifications of the basal ganglia and other intracranial areas. Many patients experience symptoms of motor dysfunction and cognitive disorders. The aim of this study was to investigate the association between the amount and location of intracranial calcifications with these symptoms. (2) Methods: Patients with suspected PFBC referred to our outpatient clinic underwent a clinical work-up. Intracranial calcifications were visualized on Computed Tomography (CT), and a Total Calcification Score (TCS) was constructed. Logistic and linear regression models were performed. (3) Results: Fifty patients with PFBC were included in this study (median age 64.0 years, 50% women). Of the forty-one symptomatic patients (82.0%), 78.8% showed motor dysfunction, and 70.7% showed cognitive disorders. In multivariate analysis, the TCS was associated with bradykinesia/hypokinesia (OR 1.07, 95%-CI 1.02–1.12, p &lt; 0.01), gait ataxia (OR 1.06, 95%-CI 1.00–1.12, p = 0.04), increased fall risk (OR 1.04, 95%-CI 1.00–1.08, p = 0.03), and attention/processing speed disorders (OR 1.06, 95%-CI 1.01–1.12, p = 0.02). Calcifications of the lentiform nucleus and subcortical white matter were associated with motor and cognitive disorders. (4) Conclusions: cognitive and motor symptoms are common among patients with PFBC, and there is an association between intracranial calcifications and these symptoms.

Robot-Assisted Thoracofemoral Bifurcation Bypass

INTRODUCTION: Thoracofemoral bypass surgery for occlusion of aortofemoral segment is a variant of choice for treatment of patients with impossibility of performing traditional aortofemoral bypass. The use of robot-assisted technologies in the formation of a proximal anastomosis permits to reduce the trauma of surgical access and to improve the results of surgical intervention. The article reports a case of a patient with occlusion of the aorto-iliac segment and total calcification of the infrarenal aorta, who underwent robot-assisted thoracofemoral bifurcation bypass surgery.&#x0D; CONCLUSION: Use of modern technologies in the vascular surgery permits to reduce traumatization, minimize the effect of the human factor, improve visualization and freedom of movement and shorten the recovery period and the period of hospital stay.

Calcification circumference, area, and location are associated with carotid stent expansion rate: high-resolution magnetic resonance vessel wall imaging study.

The plaque imaging findings associated with the stent expansion rate (SER) of the carotid artery are not well known. The purpose of this study was to investigate the imaging findings associated with SER. It was a retrospective investigation. Based on the kind of carotid stents used, retrospective data from 89 patients who had carotid artery stenting (CAS) for atherosclerotic carotid stenosis were gathered and divided into two groups: open-cell stents and closed-cell stents. Patients underwent preoperative carotid high-resolution magnetic resonance vessel wall imaging (HR-VWI). Use HR-VWI to quantitatively evaluate carotid wall thickness and plaque components. Calculate SER using digital subtraction angiography (DSA). All patients' baseline and HR-VWI imaging features were retrospectively analyzed. Simple and multivariable linear regression analysis was used to determine the imaging findings associated with SER of open-cell and closed-cell stents. A total of 89 patients (mean age, 70±8 years; 69 men) were included in the final analysis. Among 89 patients, 35 patients were treated with open-cell stents. Fifty-four patients were treated with closed-cell stents. In the open-cell stents group, the Maximum single-slice calcification circumference score, maximum wall thickness (WTmax), and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that only the Maximum single-slice calcification circumference score (β=-9.35; 95% CI: -18.15 to -0.56; P=0.03) was associated with SER of open-cell stents. In the closed-cell stents group, the Maximum single-slice calcification circumference score, WTmax, maximum area percentage of calcification, calcification volume, and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that the Maximum area percentage of calcification (β=-0.67; 95% CI: -1.29 to -0.05; P=0.03), Maximum single-slice calcification circumference score (β=-8.43; 95% CI: -13.36 to -3.49; P=0.001) and total calcification location score (β=-0.37; 95% CI: -1.08 to 0.09; P=0.02) were associated with SER of closed-cell stents. Calcified plaques are associated with SER of the carotid artery. Calcification circumference correlates with SER of open-cell stents. Calcification circumference, calcification area, and calcification location are related to SER of closed-cell stents, which may provide a new consideration for clinicians when choosing carotid artery stents.

A Propensity-Matched Comparison of Ischemic Brain Lesions on Postprocedural MRI in Endovascular versus Open Carotid Artery Reconstruction.

(1) Study purpose: The aim of our prospective single-center, matched case-control study was to compare the number and volume of acute ischemic brain lesions following carotid endarterectomy (CEA) versus carotid artery stenting (CAS) using a propensity-matched design. (2) Methods: Carotid bifurcation plaques were analyzed by using VascuCAP software on CT angiography (CTA) images. The number and volume of acute and chronic ischemic brain lesions were assessed on MRI scans taken 12-48 h after the procedures. Propensity score-based matching was performed at a 1:1 ratio to compare the ischemic lesions on postinterventional MR. (3) Results: A total of 107 patients (CAS, N = 33; CEA, N = 74) were included in the study. There were significant differences in smoking (p = 0.003), total calcification plaque volume (p = 0.004), and lengths of the lesion (p = 0.045) between the CAS and CEA groups. Propensity score matching resulted in 21 matched pairs of patients. Acute ischemic brain lesions were detected in ten patients (47.6%) of the matched CAS group and in three patients (14.2%) in the matched CEA group (p = 0.02). The volume of acute ischemic brain lesions was significantly larger (p = 0.04) in the CAS group than in the CEA group. New ischemic brain lesions were not associated with neurological symptoms in either group. (4) Conclusions: Procedure-related new acute ischemic brain lesions occurred significantly more frequently in the propensity-matched CAS group.

Association of the Calcification Score of the Abdominal Aorta, Common Iliac, and Renal Arteries with Outcomes in Living Kidney Donors.

Vascular calcification is an ever-more-common finding in protocoled pre-transplant imaging in living kidney donors. We intended to explore whether a connection could be found between the Agatston calcification score, prior to kidney donation, and post-donation renal function. This is a retrospective analysis of 156 living kidney donors who underwent living donor nephrectomy between January 2010 and December 2016. We quantified the total calcification score (TCaScore) by calculating the Agatston score for each vessel, abdominal aorta, common iliac, and renal arteries. Donors were placed into two different groups based on their TCaScore: <100 TCaScore group and ≥100 TCaScore group. The relationship between TCaScore, 1-year eGFR, proteinuria, and risk of 1 measurement of decreased renal function (eGFR < 60 mL/min/1.73 m2) over 5 years of follow-up was investigated. The ≥100 TCaScore group consisted of 29 (19%) donors, with a median (interquartile range) calcification score of 164 (117-358). This group was significantly older, 56.7 ± 6.9 vs. 45.5 ± 10.6 (p < 0.001), had a higher average BMI (p < 0.019), and had a lower preoperative eGFR (p < 0.014). The 1-year eGFR was similarly diminished, 69.9 ± 15.7 vs. 76.3 ± 15.5 (p < 0.048), while also having an increased risk of decreased renal function during the follow-up, 22% vs. 48% (p < 0.007). Our study, through univariate analyses, found a relationship between a TCaScore > 100, lower 1-year eGFR, and decreased renal function in 5 years. However, a higher-than-expected vascular calcification should not be an excluding factor in donors, although they may require closer monitoring during follow-up.

Endodontic treatment of teeth that undertook calcic pulp metamorphosis

The pulp-dentin complex is primarily responsible for the color of teeth. Increasing the thickness of the dentin and decreasing or eliminating the pulp tissue implies changing the tooth color. Calcific Metamorphosis of the Pulp, partial or total calcification of the root canal, replaced by sclerotic dentin is often perceived by darkening of the tooth followed by aseptic pulp necrosis. Endodontic treatment in these cases becomes very difficult due to atresia or even total calcification of the pulp space, requiring the use of specific techniques, knowledge and mastery of internal dental anatomy. In this article we present a clinical case in which we performed the root canal of a tooth that suffered Calcific Pulp Metamorphosis, employing an ultrasonic insert in the modeling of the canal.

Total calcification and dislocation of a long-standing ureteral catheter-stent installed during pregnancy

Total calcification and dislocation of a long-standing ureteral catheter-stent installed during pregnancy

Novel nanodiamond coatings for durable xenogenic heart valve prostheses: Mechanical properties and in vivo stability

Nanodiamond adsorption coatings were obtained on the surface of the collagen tissue crosslinked by glutaraldehyde for enhancing its mechanical properties, including stress at break, elongation at break, and elastic modulus (Young's modulus). The effect of nanodiamonds of positive and negative surface charge was compared. Negatively charged nanodiamonds strongly influenced the mechanical characteristics compared with positively charged particles on the background of its smaller surface concentration that was determined using tritium-labeled nanodiamonds. A chitosan layer was applied from the solution of supercritical CO2 to prevent calcification of the tissue. In vivo experiments showed that the nanodiamond layer is stable and does not lead to additional calcification of the tissue. However, we observed higher metal concentrations on the tissue covered with negatively charged nanodiamonds. Note that the total calcification of bovine pericardium was less than for non-covered tissue. Our data revealed that layer-by-layer applied nanodiamond and chitosan films significantly enhance the mechanical properties of the bovine pericardium and allowed us to hope for the creation of a wear-resistant material based on it.

Quantitative comparison between carotid plaque hardness and histopathological findings: an observational study

BackgroundPlaque hardness in carotid artery stenosis correlates with cerebral infarction. This study aimed to quantitatively compare plaque hardness with histopathological findings and identify the pathological factors involved in plaque hardness.MethodsThis study included 84 patients (89 lesions) undergoing carotid endarterectomy (CEA) at our institution. Plaque hardness was quantitatively measured immediately after excision using a hardness meter. Collagen and calcification were evaluated as the pathological factors. Collagen was stained with Elastica van Gieson stain, converted to a gray-scale image, and displayed in a 256-step histogram. The median gray-scale median (GSM) was used as the collagen content. The degree of calcification was defined by the hematoxylin–eosin stain as follows: "0:" no calcification, "1:" scattered microcalcification, or "2:" calcification greater than 1 mm or more than 2% of the total calcification. Carotid echocardiographic findings, specifically echoluminance or the brightness of the narrowest lesion of the plaque, classified as hypo-, iso-, or hyper-echoic by comparison with the intima-media complex surrounding the plaque, and clinical data were reviewed.ResultsPlaque hardness was significantly negatively correlated with GSM [Spearman's correlation coefficient: -0.7137 (p < 0.0001)]: the harder the plaque, the higher the collagen content. There were significant differences between plaque hardness and degree of calcification between "0" and "2" (p = 0.0206). For plaque hardness and echoluminance (hypo-iso-hyper), significant differences were found between hypo-iso (p = 0.0220), hypo-hyper (p = 0.0006), and iso-hyper (p = 0.0015): the harder the plaque, the higher the luminance. In single regression analysis, GSM, sex, and diabetes mellitus were significant variables, and in multiple regression analysis, only GSM was extracted as a significant variable.ConclusionsPlaque hardness was associated with a higher amount of collagen, which is the main component of the fibrous cap. Greater plaque hardness was associated with increased plaque stability. The degree of calcification may also be associated with plaque hardness.

Association of Coronary Events with Burden and Distribution of Coronary Artery Calcification: Results from the Multi-Ethnic Study of Atherosclerosis

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Coronary artery calcium (CAC), even when mild, is associated with increased risk for coronary heart disease (CHD) events. <h3>Objective/Purpose</h3> We sought to characterize the association between number of vessels with CAC and specific artery involvement with incident CHD. <h3>Methods</h3> We evaluated participants with baseline CAC >0, free of cardiovascular disease (CVD), and follow-up from the Multi-Ethnic Study of Atherosclerosis (MESA) Exam 1 visit until adjudicated CHD, death, or censoring date of December 31st, 2018. We used Cox proportional hazard regression analyses to characterize incident CHD by number of vessels with CAC and specific artery involvement with sequential multivariable models adjusting for ASCVD risk score, body mass index, and log-transformed total calcification volume. <h3>Results</h3> There were 3,290 participants (mean age, 66 years; 42% female) with baseline CAC >0. Among these, 33% had CAC >0 in only 1 artery, 25% in 2 arteries, 30% in 3 arteries, and 12% in all 4 coronary arteries. Of those with single-vessel involvement, CAC was most frequently in the left anterior descending artery (LAD) (75%), followed by the right coronary artery (RCA) (12%), left circumflex (LCx) (10%), and left main (LM) (3%). Over follow-up of 18.5 years, 589 participants (18%) developed CHD with a mean time to event of 12.6 years. In the multivariable- adjusted Cox model, CHD risk was 1.7x higher for 3- vs 1- (95% CI 1.2-2.3, p=0.002) and 1.6x higher for 3- vs 2-vessel involvement (95% CI 1.2-2.0, p=0.0004), though similar for 1- vs 2- (p=0.7) and 3- vs 4 (p=0.8) [Figure]. Single-vessel CAC in the LAD conferred a similar risk for CHD when compared to single-vessel CAC in the LM (p=0.66), LCx (p=0.83), and RCA (p=0.31). <h3>Conclusions</h3> Subclinical coronary artery disease was most commonly in 1, 2, and 3 number of arteries, and most frequently included the LAD. Compared with having CAC in only 1 to 2 arteries, those with CAC in 3 to 4 arteries had a 60-70% higher risk of incident CHD. In the context of the multivariable-adjusted model accounting for total CAC volume, no specific artery conferred a higher CHD risk than others. Number of vessels with CAC but not specific artery distribution were important characteristics for individualized risk stratification.

Relationship between aortic calcifications and DXA and Radiofrequency Echographic Multi-Spectrometry (REMS) acquisitions

Data on the relationship between peritoneal dialysis (PD), BMD and aortic calcifications (AOC) are lacking. to study the relationship between the degree of AOC and DXA and Radiofrequency Echographic Multi-Spectrometry (REMS) acquisitions. Consecutive patients referring to the PD our clinic were enrolled. Lumbar spine (LS) and proximal femur REMS scans were performed, and LS (anteroposterior and laterolateral) and proximal femur DXA scans were performed as well. The degree of AOC was assessed through the semiquantitative score described by Kauppila et al and applied to the laterolateral LS DXA scans. To test for correlations between different variables, we used the Pearson's correlation for continuous variables and Spearman's rho for discrete variables. Multiple regression analysis was performed to adjust for age and body mass index (BMI) the correlation between BMD and the CKD duration. Written informed consent was obtained from all participants (protocol 1483CESC). 41 total patients were enrolled (table 1). We found a statistically significant positive correlation of moderate strength between the total calcification score and the difference between the DXA AP T-score and the DXA LL T-score at the LS (p< 0.01, Spearman's rho = 0.402), figure 1. After adjustment for confounders, we found a significant negative between the LS and femoral neck BMD measured through REMS and CKD duration (table 2). The same correlation was not significant then BMD was assessed with DXA. Our study confirmed that the overestimation of DXA BMD assessed with the anteroposterior scan is indeed influenced by AOC. Furthermore, our data suggest that REMS might be an interesting tool for the investigation of bone changes in CKD. Figure 1: scatter plot reporting the relationship between the difference between the AP and LL T-scores and the aortic calcifications score.

Clinical characteristics of severe aortic stenosis patients combined with diabetes mellitus after transcatheter aortic valve replacement and short-term outcome.

Type 2 diabetes (T2DM) is a common comorbidity in patients with degenerative aortic stenosis (AS).As a key item of the American Society of Thoracic Surgeons (STS) score, it has a vital impact on the clinical prognosis of traditional thoracic surgery. T2DM has an adverse effect on the morbidity and mortality of cardiovascular diseases. At the same time, studies have shown that T2DM are associated with myocardial hypertrophy and remodeling, decreased left ventricular function, and worsening heart failure symptoms in the AS patients. Transcatheter aortic valve replacement (TAVR) as an interventional method to replace the aortic valve has better safety for middle and high risk patients in surgery, but the impact of T2DM on the clinical outcome of TAVR in AS patients is not clear.By analyzing the clinical and image characteristics of patients with AS and T2DM who received TAVR treatment, so as to explore the effect of T2DM on the perioperative complications and prognosis of TAVR. A total of 100 consecutive patients with severe AS, who underwent TAVR treatment and were followed up for more than 1 month, were selectedin the Second Xiangya Hospital of Central South University from January 2016 to December 2020.Among them, 5 patients who were treated with TAVR due to simple severe aortic regurgitation were not included, therefore a total of 95 patients with severe aortic stenosis were enrolled in this study.The age of the patients was (72.7±4.8) years old, and there were 58 males (61.1%), and the patients with moderate or above aortic regurgitation had 30 cases (31.6%). The patients were divided into a diabetic group and a non-diabetic group according to whether they were combined with T2DM.There was no statistical difference in age, gender, body mass index (BMI), STS score, and New York Heart Association (NYHA) cardiac function classification between the 2 groups (all P>0.05). The primary end point was defined as a composite event consisting of all-cause death and stroke one month after surgery, and the secondary end point was defined as TAVR-related complications immediately after surgery and one month after surgery.The preoperative clinical data, cardiac ultrasound data, CT data, postoperative medication and the incidence of each endpoint event were compared between the 2 groups.The predictive model of adverse events was constructed by single factor and multivariate logistic regression. Compared with the non-diabetic group, the diabetic group had high blood pressure and chronic renal insufficiency.There was no significant difference in preoperative ultrasound echocardiography between the 2 groups. Preoperative CT evaluation found that the anatomical structure of the aortic root in the diabetic group was smaller than that in the non-diabetic group, and there was no significant difference in the incidence of bicuspid aortic valve between the 2 groups (all P<0.05). In terms of postoperative medication, the use of statins in the diabetes group was significantly higher than that in the non-diabetic group. In the diabetes group, 6 patients (37.5%) received insulin therapy, and 9 patients (56.3%) received oral medication alone.Univariate logistic regression analysis showed that the all-cause death and stroke compound events was increased in the diabetes group in 30 days after TAVR (OR=6.86; 95% CI: 2.14 to 21.79; P<0.01). Heart disease (OR=2.80; 95% CI: 0.99 to 7.88; P<0.05) and chronic renal insufficiency (OR=3.75; 95% CI: 1.24 to 11.34; P<0.05) were also risk factors for all-cause death and stroke compound events.In a multivariate analysis, after adjusting for age, gender, BMI, comorbidities, N-terminal pro-B type natriuretic peptide (NT-proBNP), total calcification score, ejection fraction, and degree of aortic regurgitation, T2DM was still a risk factor for all-cause death and stroke compound events in 30 days after TAVR (OR=12.68; 95% CI: 1.76 to 91.41; P<0.05). T2DM is a risk factor for short-term poor prognosis in patients with symptomatic severe AS after TAVR treatment. T2DM should play an important role in the future construction of the TAVR surgical risk assessment system, but the conclusions still need to be further verified by long-term follow-up of large-scale clinical studies.

The combined effects of ocean acidification and copper on the physiological responses of the tropical coral Stylophora pistillata

A decrease in ocean pH of 0.3 units will likely double the proportion of dissolved copper (Cu) present as the free metal ion, Cu2+, the most bioavailable form of Cu, and one of the most common marine pollutants. We assess the impact of ocean acidification and Cu, separately and in combination, on calcification, photosynthesis and respiration of sub-colonies of a single tropical Stylophora pistillata colony. After 15 days of treatment, total calcification rates were significantly decreased in corals exposed to high seawater pCO2 (∼1000-μatm, 2100 scenario) and at both ambient (1.6–1.9 nmols) and high (2.5–3.6 nmols) dissolved Cu concentrations compared to controls. The effect was increased when both stressors were combined. Coral respiration rates were significantly reduced by the combined stressors after 2 weeks of exposure, indicating the importance of experiment duration. It is therefore likely rising atmospheric CO2 will exacerbate the negative effects of Cu pollution to S. pistillata.

Analysis of tissue volume and calcification of the 6th to 8th costal cartilage in 70 woman patients

To study the tissue size, calcification characteristics and the correlation between calcification, age, and on whether side of the 6th, 7th, and 8th costal cartilages in women, so as to provide reference for clinical application. A total of 70 cases of female costal cartilage applied with dual-source CT three-dimensional reconstruction were selected from the radiology storage center of Second Xiangya Hospital. The length, width, thickness, calcification rate, calcification degree, calcification type, calcification location, and the relation between calcification, age, and side of bilateral 6th, 7th, and 8th costal cartilages were observed and analyzed on volume reconstruction and maximum density projection images. (1) The respective length, width, and thickness of 6th, 7th, and 8th costal cartilages on both sides were measured. There were significant differences in length, width, and thickness between unilateral costal cartilages with different ordinal numbers. (2) Significant difference was confirmed in the total calcification types of the 6th, 7th, and 8th costal cartilages. (3) The higher the age, the higher the calcification rate was. The calcification degree of the 6th, 7th, and 8th costal cartilages was higher with the increase of age. Preoperative three-dimensional reconstruction and image post-processing of costal cartilage with dual-source CT can accurately measure the amount of cartilage tissue and define the characteristics of calcification, so as to guide the clinical selection of costal cartilage. In female patients of different ages, the calcification rate of costal cartilage increased with age, but no positive correlation was observed.