Syncope and Cardiac Arrhythmias Caused by a Paratracheal Mass.

Background: Syncope is a common complaint in clinical practice. The etiologies and mechanisms can be multiple and complex. Syncope caused by a mediastinal mass compressing the vagus nerve is rare. Case Report: We report the case of a patient who presented to the emergency department experiencing recurrent syncope. Imaging revealed a large, calcified mass in the right paratracheal region. After intracranial lesions, cardiac arrhythmias, and orthostatic hypotension were excluded, we suspected that the syncope was related to vagus nerve compression. The patient underwent surgical resection of a mediastinal mass and had complete resolution of syncopal episodes after surgery. Conclusion: This case outcome suggests that recurrent syncope could be the first symptom of an intrathoracic mass.

Aortic calcification is associated with non-infective rather than infective postoperative complications following colorectal cancer resection: an observational cohort study.

OBJECTIVES: Complications following colorectal cancer resection are common. The degree of aortic calcification (AC) on CT has been proposed as a predictor of complications, particularly anastomotic leak. This study assessed the relationship between AC and complications in patients undergoing colorectal cancer resection. METHODS: Patients from 2008 to 2016 were retrospectively identified from a prospectively maintained database. Complications were classified using the Clavien-Dindo (CD) scale. Calcification was quantified on preoperative CT by visual assessment of the number of calcified quadrants in the proximal and distal aorta. Scores were grouped into categories: none, minor (< median AC score) and major (> median AC score). The relationship between clinicopathological characteristics and complications was assessed using logistic regression. RESULTS: Of 657 patients, 52% had proximal AC (> median score (1)) and 75% had distal AC (> median score (4)). AC was more common in older patients and smokers. Higher burden of AC was associated with non-infective complications (proximal AC 28% vs 16%, p = 0.004, distal AC 26% vs 14% p = 0.001) but not infective complications (proximal AC 28% vs 29%, p = 0.821, distal AC 29% vs 23%, p = 0.240) or anastomotic leak (proximal AC 6% vs 4%, p = 0.334, distal AC 7% vs 3%, p = 0.077). Independent predictors of complications included open surgery (OR 1.99, 95%CI 1.43-2.79, p = 0.001), rectal resection (OR 1.51, 95%CI 1.07-2.12, p = 0.018) and smoking (OR 2.56, 95%CI 1.42-4.64, p = 0.002). CONCLUSIONS: These data suggest that high levels of AC are associated with non-infective complications after colorectal cancer surgery and not anastomotic leak. KEY POINTS: • Aortic calcification measured by visual quantification of the number of calcified quadrants at two aortic levels on preoperative CT is associated with clinical outcome following colorectal cancer surgery. • An increased burden of aortic calcification was associated with non-infective complications but not anastomotic leak. • Assessment of the degree of aortic calcification may help identify patients at risk of cardiorespiratory complications, improve preoperative risk stratification and assign preoperative strategies to improve fitness for surgery.

Correlating Ex Vivo Carotid Calcification Measurements With Cerebrovascular Symptoms: A Proof-of-Concept Study.

BACKGROUND AND PURPOSE: The purpose of this study is to examine the ability of ex vivo derived Agatston, Volume, and Density-Volume calcium scores or calcium density measurements to differentiate between carotid plaques based on preoperative cerebrovascular symptomatology. METHODS: Thirty-eight carotid plaques were acquired from standard endarterectomy. Micro-computed tomography was performed on the ex vivo samples. Image series were downsampled to represent the resolution of clinical multidetector computed tomography. Agatston, Volume, and Density-Volume carotid calcium scores were then calculated using coronary methodologies. The fractions of low- and high-density calcification were also determined. RESULTS: The coronary calcium scores could not differentiate between carotid plaques from asymptomatic versus symptomatic patients. However, plaques from asymptomatic patients contained significantly lower fractions of low-density calcification and higher fractions of high-density calcification. CONCLUSIONS: Screening for carotid calcium density in noncontrast computed tomography could reflect plaque stability.

Pulmonary alveolar microlithiasis: Incidental finding - should we Ignore?

Pulmonary alveolar microlithiasis (PAM) is a rare entity, presenting mostly as an incidental finding. This disease has an autosomal recessive inheritance with inactivating mutations in the gene "solute carrier family 34 member 2". The present study was conducted to bring attention to this rare though preventable disease. The study was a cross-sectional descriptive study, conducted at the Department of Pathology, of a tertiary care hospital in New Dehli-India. PAMs were incidentally seen in two patients diagnosed with micronodular hepatic cirrhosis leading to reanalysis of 212 autopsies, retrospectively. Statistical analysis was done using Stata 14.0. We observed three forms (Type A, B and C) of round hyaline bodies measuring in diameter with thin delicate, radiating fibrils. These bodies were PAS positive, showed black discolouration of the pigment with von Kossa stain and birefringence on polarized microscopy using Congo red stain, however the refringence was light green as compared to apple green birefringence seen with amyloid deposition. PAM has a slow progressive course leading to a high rate of incidental detection. Drugs known to inhibit the micro-crystal growth of hydroxyapatite may slow the disease progression. The family members of patients with PAM may also be kept on follow up with regular imaging. Key messages: It is important to bring out the incidental finding as, seemingly innocuous observations may provide valuable insight into incurable diseases, especially rare diseases.

Changes in Bone Histomorphometry after Kidney Transplantation.

BACKGROUND AND OBJECTIVES: Over the past decade, the management of CKD-mineral and bone disorder has changed substantially, altering the pattern of bone disease in CKD. We aimed to evaluate the natural history of kidney bone disease in contemporary kidney transplant recipients and patients on dialysis. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: Sixty one patients on dialysis who were referred to kidney transplantation participated in this prospective cohort study during November 2009 and December 2010. We performed baseline bone biopsies while the patients were on dialysis and repeated the procedure in 56 patients at 2 years after kidney transplantation or 2 years after baseline if transplantation was not performed. Measurements of mineral metabolism and bone turnover, as well as dual energy x-ray absorptiometry scans, were obtained concurrently. RESULTS: A total of 37 out of 56 participants received a kidney transplant, of which 27 underwent successful repeat bone biopsy. The proportion of patients with high bone turnover declined from 63% at baseline to 19% at 2 years after kidney transplantation, whereas the proportion of those with low bone turnover increased from 26% to 52%. Of 19 participants remaining on dialysis after 2 years, 13 underwent successful repeat biopsy. The proportion of patients remaining on dialysis with high bone turnover decreased from 69% to 31%, and low bone turnover increased from 8% to 38%. Abnormal bone mineralization increased in transplant recipients from 33% to 44%, but decreased in patients remaining on dialysis from 46% to 15%. Trabecular bone volume showed little change after transplantation, but low bone volume increased in patients remaining on dialysis. Bone mineral density did not correlate with histomorphometric findings. CONCLUSIONS: Bone turnover decreased over time both in patients remaining on dialysis and in kidney transplant recipients. Bone mineral density and bone biomarkers were not associated with bone metabolism changes detected in bone biopsy specimens.

Proteomic Analysis of Urinary Microvesicles and Exosomes in Medullary Sponge Kidney Disease and Autosomal Dominant Polycystic Kidney Disease.

BACKGROUND AND OBJECTIVES: Microvesicles and exosomes are involved in the pathogenesis of autosomal dominant polycystic kidney disease. However, it is unclear whether they also contribute to medullary sponge kidney, a sporadic kidney malformation featuring cysts, nephrocalcinosis, and recurrent kidney stones. We addressed this knowledge gap by comparative proteomic analysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The protein content of microvesicles and exosomes isolated from the urine of 15 patients with medullary sponge kidney and 15 patients with autosomal dominant polycystic kidney disease was determined by mass spectrometry followed by weighted gene coexpression network analysis, support vector machine learning, and partial least squares discriminant analysis to compare the profiles and select the most discriminative proteins. The proteomic data were verified by ELISA. RESULTS: A total of 2950 proteins were isolated from microvesicles and exosomes, including 1579 (54%) identified in all samples but only 178 (6%) and 88 (3%) specific for medullary sponge kidney microvesicles and exosomes, and 183 (6%) and 98 (3%) specific for autosomal dominant polycystic kidney disease microvesicles and exosomes, respectively. The weighted gene coexpression network analysis revealed ten modules comprising proteins with similar expression profiles. Support vector machine learning and partial least squares discriminant analysis identified 34 proteins that were highly discriminative between the diseases. Among these, CD133 was upregulated in exosomes from autosomal dominant polycystic kidney disease and validated by ELISA. CONCLUSIONS: Our data indicate a different proteomic profile of urinary microvesicles and exosomes in patients with medullary sponge kidney compared with patients with autosomal dominant polycystic kidney disease. The urine proteomic profile of patients with autosomal dominant polycystic kidney disease was enriched of proteins involved in cell proliferation and matrix remodeling. Instead, proteins identified in patients with medullary sponge kidney were associated with parenchymal calcium deposition/nephrolithiasis and systemic metabolic derangements associated with stones formation and bone mineralization defects. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_04_24_CJASNPodcast_19_06_.mp3.

[Choroidal calcification associated to chondrocalcinosis]. / Calcificación coroidea asociada a condrocalcinosis.

Introduction: Chondrocalcinosis is a common joint condition in people over 50, characterized by the deposition of calcium pyrophosphate crystals that causes calcification in cartilage structures. Although its prevalence in the general population is 5%, sclerochoroidal calcifications are a rare finding in this pathology. Objective: Describe the case of a 60-year-old man with choroidal calcification in the left eye, associated with radiological findings of chondrocalcinosis, whose metabolic report showed parameters compatible with hyperparathyroidism. Clinical case: Male patient from Mexico City, smoker for 45 years, with medical history of calcium pyrophosphate deposition disease at age 16, attended routine eye examination. A left eye funduscopy revealed an irregularly shaped white-yellowish subretinal lesion with well-defined edges inside the upper temporal arch. Ophthalmological paraclinical studies were performed, and a choroidal hyperreflectic paramacular plate image, which did not involve the retina layers, was corroborated with five-line optical coherence tomography. Conclusions: Although the lesions are asymptomatic and do not require treatment, it is of great importance to make a differential diagnosis with choroidal metastases, choroidal melanoma, choroidal osteoma and lymphoma, since these pathologies do require more aggressive treatment.

Introducción: la condrocalcinosis es una afección articular común en personas mayores de 50 años, caracterizada por el depósito de cristales de pirofosfato de calcio que produce calcificación en estructuras cartilaginosas. Aunque su prevalencia en población general es del 5%, las calcificaciones esclerocoroideas son un hallazgo poco frecuente en esta patología. Objetivo: describir el caso de un hombre de 60 años de edad con calcificación coroidea en el ojo izquierdo, asociada a hallazgos radiológicos de condrocalcinosis, cuyo reporte metabólico evidenció parámetros compatibles con hiperparatiroidismo. Caso clínico: paciente de la Ciudad de México con antecedentes de enfermedad por depósito de pirofosfato de calcio hace 16 años y tabaquismo desde hace 45 años, acudió a revisión oftalmológica de rutina. A la fundoscopia de ojo izquierdo se observó por dentro de arcada temporal superior, una lesión subretiniana blanco-amarillenta de forma irregular con bordes bien definidos. Se le realizaron estudios paraclínicos oftalmológicos y se corrobora con tomografía de coherencia óptica de cinco líneas, imagen en placa paramacular hiperrefléctica coroidea, que no involucra las capas de la retina. Conclusiones: aunque las lesiones son asintomáticas y no requieren tratamiento es de gran importancia hacer un diagnóstico diferencial con metástasis coroideas, melanoma coroideo, osteoma coroideo y linfoma, ya que estas patologías sí implican un tratamiento más agresivo.

Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography / Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

ABSTRACT Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

RESUMO Objetivo: Identificar as características das calcificações torácicas na ressonância magnética (RM) e as correlações entre os achados de RM e TC. Métodos: Estudo retrospectivo no qual foram analisados dados referentes a 62 pacientes que foram submetidos a TC e RM de tórax em sete hospitais nos estados do Rio Grande do Sul, São Paulo e Rio de Janeiro entre março de 2014 e junho de 2016 e que apresentaram calcificações na TC. As imagens de RM ponderadas em T1 e T2 (doravante denominadas T1 e T2) foram analisadas semiquantitativamente, e a razão entre a intensidade do sinal da lesão e do músculo (LMSIR, do inglês lesion-to-muscle signal intensity ratio) foi estimada. Diferenças entre lesões neoplásicas e não neoplásicas foram analisadas. Resultados: Foram analisadas 84 lesões calcificadas. A média de densidade das lesões na TC foi de 367 ± 435 UH. A mediana da LMSIR foi de 0,4 [intervalo interquartil (II): 0,1-0,7] em T1 e 0,2 (II: 0,0-0,7) em T2. A maioria das lesões mostrou-se hipointensa em T1 e T2 [n = 52 (61,9%) e n = 39 (46,4%), respectivamente]. Além disso, 19 (22,6%) foram indetectáveis em T1 (LMSIR = 0) e 36 (42,9%) foram indetectáveis em T2 (LMSIR = 0). Finalmente, 15,5% mostraram-se hiperintensas em T1 e 9,5% mostraram-se hiperintensas em T2. A mediana da LMSIR foi significativamente maior nas lesões neoplásicas do que nas não neoplásicas. Houve uma correlação negativa muito fraca e estatisticamente insignificante entre a densidade das lesões na TC e as seguintes variáveis: intensidade do sinal em T1, LMSIR em T1 e intensidade do sinal em T2 (r = −0,13, p = 0,24; r = −0,18, p = 0,10 e r = −0,16, p = 0,16, respectivamente). A densidade das lesões na TC apresentou correlação fraca, porém significativa com a LMSIR em T2 (r = −0,29, p < 0,05). Conclusões: As calcificações torácicas apresentam intensidade de sinal variável em T1 e T2; em alguns casos, mostram-se hiperintensas. A densidade da lesão na TC aparentemente correlaciona-se negativamente com a intensidade do sinal da lesão na RM.

Costilla o dedo (falange) pélvico: una serie de casos / Pelvic Rib or Pelvic Digit: A Series of Cases

El dedo (falange) pélvico es una alteración benigna resultante de una anomalía en el desarrollo óseo, donde se encuentra una estructura ósea con apariencia radiológica característica en los tejidos blandos, especialmente en relación con la articulación coxofemoral, aunque puede tener otras localizaciones. Se trata de una entidad benigna que usualmente es asintomática y se encuentra como hallazgo incidental. Conocer su origen y características imaginológicas es de gran importancia para poderla diferenciar de otras lesiones como osificaciones postraumáticas o lesiones por avulsión, que son frecuentes en esta misma localización. Se presentan seis casos con hallazgo incidental de dedo pélvico en diferentes modalidades diagnósticas

The pelvic digit is a benign entity resulting from an abnormality in bone development, where a bony structure with a characteristic radiological appearance is found in the soft tissues, especially in relation to the hip joint, although it may be found at other locations. It is usually asymptomatic and is found as an incidental finding. Knowing its origin and imaging characteristics is of great importance to differentiate it from other injuries such as post-traumatic ossification or avulsion injuries, which are frequent in this same location. Six cases, from the institution, with incidental finding of pelvic digit in different diagnostic modalities are presented.

The Effect of Increasing Dialysate Magnesium on Serum Calcification Propensity in Subjects with End Stage Kidney Disease: A Randomized, Controlled Clinical Trial.

BACKGROUND AND OBJECTIVES: Serum calcification propensity is a novel functional test that quantifies the functionality of the humeral system of calcification control. Serum calcification propensity is measured by T50, the time taken to convert from primary to secondary calciprotein particle in the serum. Lower T50 represents higher calcification propensity and is associated with higher risk of cardiovascular events and death in patients with ESKD. Increasing magnesium in serum increases T50, but so far, no clinical trials have investigated whether increasing serum magnesium increases serum calcification propensity in subjects with ESKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a single-center, randomized, double-blinded, parallel group, controlled clinical trial, in which we examined the effect of increasing dialysate magnesium from 1.0 to 2.0 mEq/L for 28 days compared with maintaining dialysate magnesium at 1.0 mEq/L on T50 in subjects undergoing hemodialysis for ESKD. The primary end point was the value of T50 at the end of the intervention. RESULTS: Fifty-nine subjects were enrolled in the trial, and of these, 57 completed the intervention and were analyzed for the primary outcome. In the standard dialysate magnesium group, T50 was 233±81 minutes (mean±SD) at baseline (mean of days -7 and 0) and 229±93 minutes at follow-up (mean of days 21 and 28), whereas in the high dialysate magnesium group, T50 was 247±69 minutes at baseline and 302±66 minutes at follow-up. The difference in T50 between the two groups at follow-up (primary analysis) was 73 minutes (between-group difference; 95% confidence interval, 30 to 116; P<0.001), and the between-group difference in serum magnesium was 0.88 mg/dl (95% confidence interval, 0.66 to 1.10; P=0.001). CONCLUSIONS: Increasing dialysate magnesium increases T50 and hence, decreases calcification propensity in subjects undergoing maintenance hemodialysis. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_21_CJASNPodcast_18_9_B.mp3.

Avaliação da mineralização dos segundos molares inferiores como parâmetro para a classificação da idade biológica / Evaluation of the mineralization of permanent second molars as a parameter to classify the biological age of the individual

O presente trabalho teve como objetivo avaliar se a mineralização dos segundos molares inferiores permanentes pode ser usado como parâmetro para classificar a idade biológica do indivíduo. A amostra foi constituída por 129 radiografias panorâmicas, sendo 71 indivíduos do sexo feminino e 58 indivíduos do sexo masculino, na faixa etária de 7 anos à 12 anos e 1 mês. Para a análise da mineralização dental foi utilizada a tabela proposta por Nolla (1960). Os resultados da análise foram documentados numa planilha do programa Microsoft Excel 2010 contendo o nome completo, data de nascimento, data da tomada radiográfica, idade em anos e meses, número do prontuário, estágio de Nolla (1960) lado direito e lado esquerdo. Foi realizada a análise estatística (Mann-Whitney, Wilcoxon e correlação de Spearman) e pôde-se concluir que na amostra estudada não foi encontrado dimorfismo sexual, que a mineralização dentária ocorre de forma similar do lado direito e esquerdo, e que a mineralização dos segundos molares inferiores permanentes podem ser usadas como parâmetro para estimar a idade biológica e cronológica de um indivíduo.(AU)

This paper aimed to evaluate if the mineralization of permanent second molars can be used as a parameter to classify the biological age of the individual. The sample was composed of 129 panoramic radiographs, being 71 females and 58 males, aged 7 years and 12 years and 1 month. For the analysis of dental mineralization it was used a table proposed by Nolla (1960) with X-rays on the negatoscope (light box). The analysis results were documented in a Excel spreadsheet containing the full name, date of birth, date of the radiographic procedure, age in years and months, medical record number, stage of Nolla (1960) right and left side. Performed a statistical analysis, we concluded in our survey that the tooth mineralization occurs similarly in the right and left side, there is a certain precocity when compared to chronological age and the stage of mineralization in females compared to males. We also conclude that within the same chronological age, girls and boys have different mineralization stages, indicating that the dental mineralization can be used to identify the biological age, and the same is poorly correlated with chronological age.(AU)

Degenerative Mitral Stenosis: Unmet Need for Percutaneous Interventions.

Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients.

Micro-CT in the Assessment of Pediatric Renal Osteodystrophy by Bone Histomorphometry.

BACKGROUND AND OBJECTIVES: Computed tomography (CT) measurements can distinguish between cortical and trabecular bone density in vivo. High-resolution CTs assess both bone volume and density in the same compartment, thus potentially yielding information regarding bone mineralization as well. The relationship between bone histomorphometric parameters of skeletal mineralization and bone density from microcomputed tomography (µCT) measurements of bone cores from patients on dialysis has not been assessed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Bone cores from 68 patients with ESRD (age =13.9±0.5 years old; 50% men) and 14 controls (age =15.3±3.8 years old; 50% men) obtained as part of research protocols between 1983 and 2006 were analyzed by bone histomorphometry and µCT. RESULTS: Bone histomorphometric diagnoses in the patients were normal to high bone turnover in 76%, adynamic bone in 13%, and osteomalacia in 11%. Bone formation rate did not correlate with any µCT determinations. Bone volume measurements were highly correlated between bone histomorphometry and µCT (bone volume/tissue volume between the two techniques: r=0.70; P<0.001, trabecular thickness and trabecular separation: r=0.71; P<0.001, and r=0.56; P<0.001, respectively). Osteoid accumulation as determined by bone histomorphometry correlated inversely with bone mineral density as assessed by µCT (osteoid thickness: r=-0.32; P=0.01 and osteoid volume: r=-0.28; P=0.05). By multivariable analysis, the combination of bone mineral density and bone volume (as assessed by µCT) along with parathyroid hormone and calcium levels accounted for 38% of the variability in osteoid volume (by histomorphometry). CONCLUSIONS: Measures of bone volume can be accurately assessed with µCT. Bone mineral density is lower in patients with excessive osteoid accumulation and higher in patients with adynamic, well mineralized bone. Thus, bone mineralization may be accurately assessed by µCT of bone biopsy cores. Additional studies are warranted to define the value of high-resolution CT in the prediction of bone mineralization in vivo.

Intracranial Carotid Calcification on Cranial Computed Tomography: Visual Scoring Methods, Semiautomated Scores, and Volume Measurements in Patients With Stroke.

BACKGROUND AND PURPOSE: Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. METHODS: We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed. RESULTS: Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R(2)=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005). CONCLUSIONS: Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies.

Disseminated arterial calcification and enhanced myogenic response are associated with abcc6 deficiency in a mouse model of pseudoxanthoma elasticum.

OBJECTIVE: Pseudoxanthoma elasticum is an inherited metabolic disorder resulting from ABCC6 gene mutations. It is characterized by progressive calcification and fragmentation of elastic fibers in the skin, retina, and the arterial wall. Despite calcium accumulation in the arteries of patients with pseudoxanthoma elasticum, functional consequences remain unknown. In the present study, we investigated arterial structure and function in Abcc6(-/-) mice, a model of the human disease. APPROACH AND RESULTS: Arterial calcium accumulation was evaluated using alizarin red stain and atomic absorption spectrometry. Expression of genes involved in osteochondrogenic differentiation was measured by polymerase chain reaction. Elastic arterial properties were evaluated by carotid echotracking. Vascular reactivity was evaluated using wire and pressure myography and remodeling using histomorphometry. Arterial calcium accumulation was 1.5- to 2-fold higher in Abcc6(-/-) than in wild-type mice. Calcium accumulated locally leading to punctuate pattern. Old Abcc6(-/-) arteries expressed markers of both osteogenic (Runx2, osteopontin) and chondrogenic lineage (Sox9, type II collagen). Abcc6(-/-) arteries displayed slight increase in arterial stiffness and vasoconstrictor tone in vitro tended to be higher in response to phenylephrine and thromboxane A2. Pressure-induced (myogenic) tone was significantly higher in Abcc6(-/-) arteries than in wild type. Arterial blood pressure was not significantly changed in Abcc6(-/-), despite higher variability. CONCLUSIONS: Scattered arterial calcium depositions are probably a result of osteochondrogenic transdifferentiation of vascular cells. Lower elasticity and increased myogenic tone without major changes in agonist-dependent contraction evidenced in aged Abcc6(-/-) mice suggest a reduced control of local blood flow, which in turn may alter vascular homeostasis in the long term.

18F-sodium fluoride uptake is a marker of active calcification and disease progression in patients with aortic stenosis.

BACKGROUND: 18F-Sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG) are promising novel biomarkers of disease activity in aortic stenosis. We compared 18F-NaF and 18F-FDG uptake with histological characterization of the aortic valve and assessed whether they predicted disease progression. METHODS AND RESULTS: Thirty patients with aortic stenosis underwent combined positron emission and computed tomography using 18F-NaF and 18F-FDG radiotracers. In 12 patients undergoing aortic valve replacement surgery (10 for each tracer), radiotracer uptake (mean tissue/ BACKGROUND: =0.65; P=0.04) and osteocalcin (r=0.68; P=0.03) immunohistochemistry. There was no significant correlation between 18F-FDG uptake and CD68 staining (r=-0.43; P=0.22). After 1 year, aortic valve calcification increased from 314 (193-540) to 365 (207-934) AU (P<0.01). Baseline 18F-NaF uptake correlated closely with the change in calcium score (r=0.66; P<0.01), and this improved further (r=0.75; P<0.01) when 18F-NaF uptake overlying computed tomography-defined macrocalcification was excluded. No significant correlation was noted between valvular 18F-FDG uptake and change in calcium score (r=-0.11; P=0.66). CONCLUSIONS: 18F-NaF uptake identifies active tissue calcification and predicts disease progression in patients with calcific aortic stenosis. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01358513.

Fisioterapia motora no tratamento do prematuro com doença metabólica óssea: [revisão] / Motor physiotherapy in the treatment of preterm infants with metabolic bone disease: [review]

OBJETIVO: Revisar o papel da fisioterapia motora no prematuro com risco de desenvolver doença metabólica óssea. FONTES DE DADOS: Trata-se de uma revisão de literatura publicada entre 1986 e 2009, utilizando as seguintes palavras-chave: prematuro, calcificação fisiológica, modalidades de fisioterapia, doenças ósseas metabólicas e os respectivos descritores no idioma inglês. Foram selecionados 29 artigos científicos, via PubMed e ISI Web, além de um capítulo de livro nacional. SÍNTESE DOS DADOS: As doenças ósseas metabólicas compreendem um conjunto de condições relacionadas a alterações no processo de calcificação fisiológica, levando desde à fragilidade estrutural até ao desenvolvimento de fraturas. A aplicação rotineira de exercícios de mobilização passiva articular, massagem e posicionamento está relacionada ao ganho ponderal, ao aumento na densidade e no conteúdo mineral ósseo. CONCLUSÕES: A implementação de exercícios de fisioterapia motora parece proporcionar estabilidade ou estímulo para a formação óssea, podendo, consequentemente, prevenir e/ou minimizar as complicações decorrentes da doença metabólica óssea.

OBJECTIVE: To review the role of motor physiotherapy in the treatment of preterm infants at risk of developing metabolic bone disease. DATA SOURCES: This is a review of articles published between 1986 and 2009, using the following key-words: premature infant physiologic calcification, physiotherapy techniques, metabolic bone diseases and the respective Portuguese-language descriptors. Twenty nine scientific articles were selected in the PubMed and ISI Web databases, along with one chapter of a Brazilian book. DATA SYNTHESIS: Metabolic bone diseases are a set of conditions related to abnormalities in the physiologic calcification process. They lead to problems going from structural frailness to fracture development. Routine application of passive joint mobilization exercises, massage and positioning exercises correlate with weight gain and increasing bone mineral content and density. CONCLUSIONS: Implementation of motor physiotherapy exercises could provide stability or stimulation for bone formation and may consequently avoid or minimize the complications resulting from metabolic bone disease of prematurity.

O papel da vitamina D3 e da osteocalcina no metabolismo ósseo: uma análise necessária para se otimizar a osseointegração / The role of vitamin D3 and osteocalcin in the bone metabolism: a necessary analysis to optimize the osteointegration

A necessidade de uma melhor compreensão do metabolismo ósseo tornou-se crescente na Odontologia. O advento da implantodontia demandou a busca por boas condições de tecido ósseo visando à colocação de implantes osseointegráveis e também pela necessidade de preparo prévio de leitos receptores em áreas que necessitam de enxerto ósseo até as grandes reconstruções no campo da cirurgia buco-maxilo-facial que buscam reconstruir estruturas ósseas perdidas decorrentes de trauma ou de destruição tumoral tendo como área doadora a região ilíaca. A osteocalcina, produto da ação osteoblástica, intimamente relacionada à mineralização da matriz óssea tem sua ação estimulada pela vitamina D3 e é imprescindível para o processo de mineralização do tecido ósseo. Neste trabalho procurou-se fazer uma revisão dos aspectos mais importantes relacionados à atuação destas duas substâncias no metabolismo ósseo.

The need of a better understanding of the bone metabolism became growing in Dentistry. The coming of the implantology demanded the search for good conditions of bone tissue seeking to the placement of implants and also for the need of previous preparation in order to receive bone grafts in areas that need bone to great reconstructions in the of maxillofacial surgery which looks upon to rebuild bone structures lost by trauma or tumoral damages, which tends as donor area, the iliac bone. The osteocalcin, product of the osteoblastic action, intimately related to the mineralization of the bone matrix, keeps its action stimulated by the vitamin D3 and is indispensable for the process of the bone tissue mineralization. This paper intend to a revision of the most important aspects related to the performance of these two substances in the bone metabolism.