RESUMO
Osteoporosis is characterized by low bone mineral density (BMD) and fragility fracture and affects over 200 million people worldwide. Bone quality describes the material properties that contribute to strength independently of BMD, and its quantitative analysis is a major priority in osteoporosis research. Tissue mineralization is a fundamental process requiring calcium and phosphate transporters. Here we identify impaired bone quality and strength in Slc20a2-/- mice lacking the phosphate transporter SLC20A2. Juveniles had abnormal endochondral and intramembranous ossification, decreased mineral accrual, and short stature. Adults exhibited only small reductions in bone mass and mineralization but a profound impairment of bone strength. Bone quality was severely impaired in Slc20a2-/- mice: yield load (-2.3 SD), maximum load (-1.7 SD), and stiffness (-2.7 SD) were all below values predicted from their bone mineral content as determined in a cohort of 320 wild-type controls. These studies identify Slc20a2 as a physiological regulator of tissue mineralization and highlight its critical role in the determination of bone quality and strength. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
Assuntos
Osso e Ossos/fisiologia , Proteínas Cotransportadoras de Sódio-Fosfato Tipo III/genética , Animais , Animais Recém-Nascidos , Desenvolvimento Ósseo , Reabsorção Óssea/fisiopatologia , Osso e Ossos/diagnóstico por imagem , Calcificação Fisiológica , Calcinose/diagnóstico por imagem , Calcinose/genética , Células Cultivadas , Condrócitos/metabolismo , Humanos , Incisivo/ultraestrutura , Camundongos Endogâmicos C57BL , Camundongos Knockout , Osteoblastos/metabolismo , Fenótipo , Crânio/diagnóstico por imagem , Proteínas Cotransportadoras de Sódio-Fosfato Tipo III/deficiência , Dente/crescimento & desenvolvimento , Microtomografia por Raio-XRESUMO
OBJECTIVE: To report our experience with the Embolus Retriever with Interlinked Cage (ERIC) stentriever for use in mechanical endovascular thrombectomy (MET). METHODS: Thirty-four consecutive patients with acute stroke (21 men and 13 women; median age 66â years) determined appropriate for MET were treated with ERIC and prospectively included over a 6-month period at three different centers. The ERIC device differs from typical stentrievers in that it is designed with a series of interlinked adjustable nitinol cages that allow for fast thrombus capture, integration, and withdrawal. The evaluated endpoints were successful revascularization (Thrombolysis in Cerebral Infarction (TICI) 2b-3) and good clinical outcomes at 3â months (modified Rankin Scale (mRS) 0-2). RESULTS: Locations of the occlusions included the middle cerebral artery (13 patients), terminal carotid artery (11 patients), basilar artery (1 patient), and tandem occlusions (9 patients). IV thrombolysis was performed in 20/34 (58.8%) patients. Median times from symptom onset to recanalization and from puncture to recanalization were 325.5â min (180-557) and 78.5â min (14-183), respectively. Used as the first-line device, ERIC achieved a successful recanalization in 20/24 (83.3%) patients. Successful recanalization was associated with lower National Institutes of Health Stroke Scale scores at 24â h (8±6.5 vs 21.5±2.1; p=0.008) and lower mRS at 3â months (2.7±2.1 vs 5.3±1.1; p=0.04). Three procedural complications and four asymptomatic hemorrhages were recorded. Good clinical outcomes at 3â months were seen in 15/31 (48.4%) patients. CONCLUSIONS: The ERIC device is an innovative stentriever allowing fast, effective, and safe MET.
Assuntos
Transtornos Cerebrovasculares/cirurgia , Procedimentos Endovasculares/instrumentação , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/cirurgia , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodos , Resultado do Tratamento , Adulto JovemRESUMO
Three months after a kidney transplant, a man experienced an internuclear ophthalmoplegia. Magnetic resonance imaging found a punctuate hyperintensity of the brainstem. Afterwards, the patient presented with peripheral facial paralysis. A complete morphologic assessment showed an increase of the brainstem lesion, together with an excavated pulmonary nodule. Combination therapy with high-dose liposomal amphotericin B and voriconazole was begun for the putative aspergillosis. Owing to its atypical clinical presentation and negative detection of Aspergillus galactomannan antigen on sera, a biopsy specimen of the lung lesion was obtained. Histopathological and mycological investigations allowed the diagnosis of mucormycosis owing to Rhizopus microsporus. Accordingly, voriconazole was replaced with posaconazole. After 5 months, regression of the cerebral lesion was noted. Disseminated mucormycosis in solid-organ recipients is uncommon and mycological diagnosis is challenging. Mortality is high and is increased by diagnostic delay. Treating mucormycosis requires surgical debridement and appropriate antifungal therapy (usually intravenous liposomal amphotericin B). This report suggests that a combination of liposomal amphotericin B and posaconazole can be a therapeutic option in patients with a poor prognosis.