Risk stratifying individuals with zero, minimal, and mild coronary artery calcium for cardiovascular disease by determining coronary plaque burden.

BACKGROUND AND AIMS: Use of coronary artery calcium (CAC) continues to expand, and several different categories of risk have been developed. Some categorize CAC as <10, 11-100 and â€‹> â€‹100, while others use CAC â€‹= â€‹0,1-10, 11-100 and â€‹> â€‹100 as categories. We sought to evaluate the plaque burden in patients with CAC 0, 1-10 and 11-100 to evaluate the best use of CAC scoring for risk assessment. METHODS: Patients were recruited from existing prospective CCTA trials with CAC scores ≤100 and quantitative coronary plaque analysis (QAngio, Medis). CAC was categorized into three groups: zero (CAC â€‹= â€‹0), minimal (CAC 1-10), and mild (CAC 11-100). Plaque levels (low attenuated, fibrous, fibro-fatty, dense calcified, total non-calcified) were assessed using multivariable linear regression adjusted for cardiovascular risk factors (age, ethnicity, BMI, gender, hypertension, dyslipidemia, diabetes mellitus, past smoking). RESULTS: 378 subjects were included, with an average age of 53.9 â€‹± â€‹10.7 years and 53 â€‹% female. Among them, 51 â€‹% had 0 CAC, 16 â€‹% had minimal CAC (scores 1-10), and 33 â€‹% had mild CAC (scores 11-100). The minimal and mild CAC groups were significantly older, with higher rates of diabetes, hypertension, and hyperlipidemia. Multivariable analysis found no significant difference in low attenuated, fibro-fatty, and dense calcified plaque levels between the minimal and zero CAC groups. However, minimal CAC subjects had significantly higher fibrous, total non-calcified, and total plaque volumes than zero CAC. All plaque types were significantly higher in the mild group when comparing mild CAC to minimal CAC. CONCLUSION: Individuals with minimal calcium scores (1-10) had greater noncalcified coronary plaque (NCAP) and total plaque volume than individuals with a calcium score of zero. The increased presence of NCAP and total plaque volume in the minimal CAC (1-10) is clinically significant and place those patients at higher coronary vascular disease (CVD) risk than individuals with absent CAC (CAC â€‹= â€‹zero). Therefore, the use of CAC â€‹= â€‹0, 1-10 and 11-100 is prudent to better categorize CVD risk.

Grading the severity of the rotator cuff tendinosis on MRI: Assessment of inter-observer agreement and evaluation of a novel objective assessment tool.

INTRODUCTION: MRI is generally considered the modality of choice for the assessment of rotator cuff pathology including tendinosis. Assessment of severity is currently subjective primarily based on tendon morphology and signal intensity. Limited data are available evaluating the inter-observer agreement regarding the assessment of tendinosis severity. METHODS: One hundred and twenty-four patients were prospectively enrolled in the study. Patients included were referred to two private radiology practices for shoulder MRI for any reason. Two musculoskeletal radiologists assessed the severity of tendinosis independently. Supraspinatus tendon signal was evaluated with a ROI and compared to the adjacent deltoid muscle signal, generating a ratio of tendon: muscle signal, termed the 'objective TM ratio'. The relationship between the subjective assessment of tendinosis severity and objective ratio was examined. Inter-observer agreement was also calculated. RESULTS: Tendinosis severity was graded as normal in 36 and 11 patients by readers 1 and 2, respectively, mild in 45 and 48 patients, moderate in 26 and 48 patients and severe in 10 and 10 patients. Inter-observer agreement is classified as fair (0.31 kappa co-efficient). Mean objective TM ratio increased on both the PD and TS F2 sequences as the subjective grade of tendinosis severity increased. CONCLUSION: A novel means of evaluating rotator cuff tendinosis severity is presented, demonstrated to correlate with the subjective grade of tendinosis severity. Further research is required to assess the utility of such objective measurements across varying imaging protocols whilst understanding the inherent limitations with quantifying signal intensity on MRI.

Eosinophilic Fasciitis With a Malignant Outcome.

Eosinophilic fasciitis (EF) is an uncommon localized fibrosing disorder affecting the fascial layers of the human body. To date less than 300 cases of EF have been reported worldwide. Due to the limited prevalence, extensive studying of its pathogenesis and treatment has not yet been established. Furthermore, little is known regarding the long-term prognosis and comorbidities associated with EF. In this case study, we discuss a 72-year-old female patient who was diagnosed with EF and subsequently developed squamous cell carcinoma (SCC) of the skin in areas of previously exposed EF. This case represents the first reported case of SCC of the skin in a patient with previously active EF in the same area of skin.

Paget's sarcoma of the patella.

Paget's sarcoma is a rare complication of Paget's disease and isolated Paget's disease of the patella is extremely rare. We describe a unique case of Paget's sarcoma of the patella in a 69-year-old male farmer who had a remote history of a fracture in the same patella 40 years previously. In this case, imaging and pathogenesis of Paget's disease of bone is described and factors implicated in the development of Paget's disease in this patient are evaluated.

Evaluation of effectiveness of connective tissue graft as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans: 4-year clinical results.

OBJECTIVE: Connective tissue grafts (CTGs) have been used as a barrier for closing mandibular Class II furcation defects. The present study compared long-term (48 months) effectiveness of CTG as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans. METHOD AND MATERIALS: Twenty chronic periodontitis patients with a single Class II furcation defect on the buccal surface of mandibular teeth were included in the study. Vertical probing pocket depth (V-PPD), vertical relative attachment level (V-RAL), and relative gingival margin level (RGML) were recorded at baseline, 6 months, 12 months, and 48 months post-surgery. RESULTS: The mean V-PPD reductions observed in the test group and control group were statistically significant at all time intervals when compared with the baseline. Similarly, the mean V-RAL gain at 6 months, 12 months, and 48 months were statistically significant, compared with the baseline data in both the groups. At 48 months the difference in V-RAL gain between the groups was found to be statistically significant, with greater improvements in test group. Complete closure of furcation and improvement in horizontal classification were better in the test group than in the control group. CONCLUSION: It can be concluded that both treatment modalities result in improvement in clinical parameters. However, the results obtained with CTG appeared to be more stable.

Periodontitis as a potential risk factor for chronic obstructive pulmonary disease: a retrospective study.

AIMS AND OBJECTIVES: A relationship between poor periodontal health and respiratory disease has been suggested by a number of recent studies. The present study was undertaken to evaluate potential association between respiratory diseases and periodontal health status and to co-relate the severity of periodontal disease with that of chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: 150 patients of COPD (test group) and 50 Patients without COPD (control group) were recruited for the study. Information regarding patient's demographic and socioeconomic status and lifestyle (history of smoking) were considered in the study. Patients with COPD were grouped into mild, moderate and severe category on the basis of Spirometry. Periodontal health was assessed by measuring probing pocket depth, Clinical Attachment Loss (CAL) and Oral Hygiene Index (OHI). RESULTS: The results showed that the subjects with COPD had significantly more mean CAL) and a higher mean OHI than those without COPD. The risk for COPD appeared to be significantly elevated when attachment loss was found to be severe. A trend was noted in that lung function appeared to diminish as the amount of attachment loss increased. CONCLUSION: On the basis of the observed results of the study it can be concluded that the risk for COPD appeared to be significantly elevated when attachment loss was found to be severe. It is conceivable that oral interventions that improve oral health status may prove to lower the severity of lung infection in susceptible populations.