Predictive factors of thoracic aortic calcification in patients candidate for cardiac surgery.

BACKGROUND: The presence of the severe thoracic aortic calcification (TAC) in cardiac surgery patients is associated with adverse post-operative outcome. However, the relationship between cardiovascular risk factors and aortic plaque burden remains unknown. The objective of this study was to determine the predictive factors of TAC in patients candidate for cardiac surgery. METHODS: Patients who underwent thoracic CT scan prior to cardiac surgery between August 2020 to April 2021 were included. Of 556 patients, 209 (36.7%) had a thoracic aortic calcium score (TACS) ≥ 400 mm [3] and were compare with the remaining patients. Predictors of severe TAC were assessed through stepwise multivariable logistic regression analysis. RESULTS: The patients with TACS ≥ 400 had a higher mean age (67.3 ± 7.1 vs. 55.7 ± 10.6; p < 0.001) with a higher frequency of diabetes mellitus (40.7% vs. 30.8%; p = 0.018), dyslipidemia (49.8% vs. 38.6%; p = 0.010), hypertension (60.8% vs. 44.7%; p < 0.001), opium addiction (18.2% vs. 11.2%; p = 0.023), peripheral vascular disease (PVD) (7.7% vs. 2.3%; p = 0.005) as compared with TACS < 400. The multiple determinants of TAC were PVD (OR = 2.86) followed by opium addiction, diabetes and age. CONCLUSIONS: Thoracic CT scan prior to cardiac surgery for patients with older age, diabetes, opium addiction and PVD is recommended. Our study could serve as a foundation for future research endeavors aimed at establishing a risk score for TAC.

Short and mid-term outcomes of valve-sparing, aortic root reimplantation (David's procedure).

BACKGROUND: In the current study, we aimed to report the short- and mid-term outcomes of patients undergoing valve-sparing aortic root reimplantation (VSARR) and our center's experience with the procedure. METHODS: Forty patients with aortic root aneurysms underwent VSARR at our center from 2010 until 2022. We retrospectively reviewed the medical records of these patients and extracted the relevant data. After carefully examining the aortic valve, the surgeon decided to perform Bentall or David's procedure during the operation. RESULTS: The study population comprised 31 (77.5%) men and nine (22.5%) women, with a mean age of 55.35 ± 15.40. One patient developed hemodynamic instability post-surgery in the hospital and died from multi-organ failure. Another patient had severe AI in the intraoperative echocardiography, and aortic valve replacement with a prosthetic graft was performed during the same operation. In pre-operation echocardiography, 25 (62.5%) patients had severe, nine (22.5%) had moderate, and six (15%) had mild AI. In the in-hospital post-operation follow-up echo, AI was improved, and no patients had severe AI (P < 0.001). Only eight patients had moderate AI in post-one-year follow-up echo exams, while the rest had mild AI. CONCLUSION: David's procedure showed excellent mid-term results in our center, with only one in-hospital mortality.

The Association of Coronary Artery Calcium Score and Osteoporosis in Postmenopausal Women: A Cross-Sectional Study.

BACKGROUND: The association between osteoporosis, a common metabolic bone disorder, and atherosclerosis has been reported in different studies. In this study, we aimed to investigate the association between the coronary artery calcium score (CACS) and bone mineral density (BMD) at different sites and bone biomarkers in postmenopausal women. METHODS: A total of 184 participants were enrolled in this study. The CACS and BMD at different sites, including the spinal, total hip, and femoral neck, were measured using computed tomography angiography and dual energy X-ray absorptiometry, respectively. Serum levels of osteocalcin, ß-C-terminal telopeptide (ß-CTX), parathyroid hormone, and 25-hydroxy-vitamin D were measured. RESULTS: A negative association between CACS and bone biomarker levels (osteocalcin, P=0.021; ß-CTX, P=0.013) was noted. The univariable model showed an association between CACS and osteoporosis of the femoral neck (P=0.03). It was found that with an increase of 10 U in CACS, the odds of osteoporosis at the femoral neck escalates by 2% (odds ratio=1.02, 95% confidence interval, 1.002-1.03) using the multivariate logistic regression model, while such an association with osteoporosis could not be found at the spinal site. The best cutoff point of the calcium score was estimated to be 127. CONCLUSIONS: The results suggest that in postmenopausal women, coronary atherosclerosis is independently associated with osteoporosis of the femoral neck, but such an association could not be detected with spinal osteoporosis. The importance of screening for osteoporosis in patients with cardiovascular disease and the implications of preventive measures in the primary care setting were highlighted considering the common risk factors.

Comparison of conventional scoring systems to machine learning models for the prediction of major adverse cardiovascular events in patients undergoing coronary computed tomography angiography.

Background: The study aims to compare the prognostic performance of conventional scoring systems to a machine learning (ML) model on coronary computed tomography angiography (CCTA) to discriminate between the patients with and without major adverse cardiovascular events (MACEs) and to find the most important contributing factor of MACE. Materials and methods: From November to December 2019, 500 of 1586 CCTA scans were included and analyzed, then six conventional scores were calculated for each participant, and seven ML models were designed. Our study endpoints were all-cause mortality, non-fatal myocardial infarction, late coronary revascularization, and hospitalization for unstable angina or heart failure. Score performance was assessed by area under the curve (AUC) analysis. Results: Of 500 patients (mean age: 60 ± 10; 53.8% male subjects) referred for CCTA, 416 patients have met inclusion criteria, 46 patients with early (<90 days) cardiac evaluation (due to the inability to clarify the reason for the assessment, deterioration of the symptoms vs. the CCTA result), and 38 patients because of missed follow-up were not enrolled in the final analysis. Forty-six patients (11.0%) developed MACE within 20.5 ± 7.9 months of follow-up. Compared to conventional scores, ML models showed better performance, except only one model which is eXtreme Gradient Boosting had lower performance than conventional scoring systems (AUC:0.824, 95% confidence interval (CI): 0.701-0.947). Between ML models, random forest, ensemble with generalized linear, and ensemble with naive Bayes were shown to have higher prognostic performance (AUC: 0.92, 95% CI: 0.85-0.99, AUC: 0.90, 95% CI: 0.81-0.98, and AUC: 0.89, 95% CI: 0.82-0.97), respectively. Coronary artery calcium score (CACS) had the highest correlation with MACE. Conclusion: Compared to the conventional scoring system, ML models using CCTA scans show improved prognostic prediction for MACE. Anatomical features were more important than clinical characteristics.

Catheter-Directed Thrombolysis vs Anticoagulation in Patients With Acute Intermediate-High-risk Pulmonary Embolism: The CANARY Randomized Clinical Trial.

Importance: The optimal treatment of intermediate-high-risk pulmonary embolism (PE) remains unknown. Objective: To assess the effect of conventional catheter-directed thrombolysis (cCDT) plus anticoagulation vs anticoagulation monotherapy in improving echocardiographic measures of right ventricle (RV) to left ventricle (LV) ratio in acute intermediate-high-risk PE. Design, Setting, and Participants: The Catheter-Directed Thrombolysis vs Anticoagulation in Patients with Acute Intermediate-High-Risk Pulmonary Embolism (CANARY) trial was an open-label, randomized clinical trial of patients with intermediate-high-risk PE, conducted in 2 large cardiovascular centers in Tehran, Iran, between December 22, 2018, through February 2, 2020. Interventions: Patients were randomly assigned to cCDT (alteplase, 0.5 mg/catheter/h for 24 hours) plus heparin vs anticoagulation monotherapy. Main Outcomes and Measures: The proportion of patients with a 3-month echocardiographic RV/LV ratio greater than 0.9, assessed by a core laboratory, was the primary outcome. The proportion of patients with an RV/LV ratio greater than 0.9 at 72 hours after randomization and the 3-month all-cause mortality were among secondary outcomes. Major bleeding (Bleeding Academic Research Consortium type 3 or 5) was the main safety outcome. A clinical events committee, masked to the treatment assignment, adjudicated clinical outcomes. Results: The study was prematurely stopped due to the COVID-19 pandemic after recruiting 94 patients (mean [SD] age, 58.4 [2.5] years; 27 women [29%]), of whom 85 patients completed the 3-month echocardiographic follow-up. Overall, 2 of 46 patients (4.3%) in the cCDT group and 5 of 39 patients (12.8%) in the anticoagulation monotherapy group met the primary outcome (odds ratio [OR], 0.31; 95% CI, 0.06-1.69; P = .24). The median (IQR) 3-month RV/LV ratio was significantly lower with cCDT (0.7 [0.6-0.7]) than with anticoagulation (0.8 [0.7-0.9); P = .01). An RV/LV ratio greater than 0.9 at 72 hours after randomization was observed in fewer patients treated with cCDT (13 of 48 [27.0%]) than anticoagulation (24 of 46 [52.1%]; OR, 0.34; 95% CI, 0.14-0.80; P = .01). Fewer patients assigned to cCDT experienced a 3-month composite of death or RV/LV greater than 0.9 (2 of 48 [4.3%] vs 8 of 46 [17.3%]; OR, 0.20; 95% CI, 0.04-1.03; P = .048). One case of nonfatal major gastrointestinal bleeding occurred in the cCDT group. Conclusions and Relevance: This prematurely terminated randomized clinical trial of patients with intermediate-high-risk PE was hypothesis-generating for improvement in some efficacy outcomes and acceptable rate of major bleeding for cCDT compared with anticoagulation monotherapy and provided support for a definitive clinical outcomes trial. Trial Registration: ClinicalTrials.gov Identifier: NCT05172115.

Evaluating the association between amino acid and acylcarnitine profiles and different levels of coronary artery disease risk in postmenopausal women using targeted metabolomics technique.

OBJECTIVES: Postmenopausal women are at increased risk of developing coronary artery disease (CAD). Metabolomic approaches aim at discovering more helpful biomarkers of CAD to reduce the disease burden in the future. Here, we intend to find potential blood biomarkers, amino acids, and acylcarnitines in postmenopausal women with different severity of CAD by using high-throughput methods. METHOD: This cross-sectional study was performed on postmenopausal women ( n = 183) who underwent coronary CT scans. Coronary artery calcium scoring (CACS) was assessed to detect plaque burden and degree of coronary artery obstruction. The participants were divided into three groups based on the score as follows (i) "low CACS" ( n = 96); a score of 0 to 10, (ii) "medium CACS" ( n = 35); a score between 11 and 100 and (iii) "high CACS" ( n = 52); a score greater than 100. Metabolites, including amino acids and acylcarnitines, were quantified using a targeted mass spectrometry method in serum samples. The association between metabolites and disease status was evaluated using univariate and multivariate regression analyses with adjustment for confounding factors. Factor analysis was used to deal with multiple comparisons. RESULTS: Metabolites, including proline, glutamic acid, and phenylalanine, were significantly lower in the high CACS group than the low CACS one. Also, a lower level of lysine and phenylalanine in high CACS compared with medium one was observed. Concerning acylcarnitines, it was found that C4 and C8:1 significantly were higher in women with high CACS. The logistic regression analysis revealed that the circulating levels of these metabolites (except C4) were associated with the presence of coronary artery calcification independently of age, body mass index, and time of menopause. Also, the amino acids were associated independently of medication and diabetes. CONCLUSIONS: The present study indicated that circulating levels of amino acids and acylcarnitines profile in postmenopausal women are partly associated with the severity of CAD in these participants.

Dual-Source Dual-Energy CT-Scan Confirms the Diagnosis of Ancient Hydatid Cysts Recovered from a Late Roman Burial in Amiens, France.

Background: Two calcified objects recovered from an adolescent in a burial site in Amiens, France, have been previously identified as hydatid cysts using thin-section petrography. The importance of ancient hydatidosis besides the value of these unique archeological excavated materials encouraged the authors to look at this attractive subject more interdisciplinary by implementing medical radiology. Methods: In the current experiment, which has been carried out in the Radiology Department, Tehran Heart Center (THC), Tehran, Iran, the conventional and dual-energy dual-source Tomography, X-Ray Computed-scan was used in studying the remaining structures of the two calcified masses. The imaging procedure was carried out based on X-Ray attenuation by two different tube voltages. Results: A high concentration of calcium sediment in the cyst walls was revealed in Hounsfield units, the measuring of the elements in CT. Taking advantage of implementing this imaging technique the oxalate calcium was also shown as the dominant component of the samples. The results were all in favor of diagnosing hydatid cysts. Conclusion: The achieved pictorial results in the present paper have highlighted the important role of CT scan as a noninvasive confirming technique in paleopathological investigations. Using Dual-source dual-energy CT-scan in reconfirming these previously identified hydatid cysts, is an encouraging message towards the necessity of sequential studies on invaluable biological excavated pieces.

Circulating amino acids and acylcarnitines correlated with different CAC score ranges in diabetic postmenopausal women using LC-MS/MS based metabolomics approach.

BACKGROUND: Diabetes mellitus (DM) and its cardiovascular disease (CVD) complication are among the most frequent causes of death worldwide. However, the metabolites linking up diabetes and CVD are less understood. In this study, we aimed to evaluate serum acylcarnitines and amino acids in postmenopausal women suffering from diabetes with different severity of CVD and compared them with healthy controls. METHODS: Through a cross-sectional study, samples were collected from postmenopausal women without diabetes and CVD as controls (n = 20), patients with diabetes and without CVD (n = 16), diabetes with low risk of CVD (n = 11), and diabetes with a high risk of CVD (n = 21) referred for CT angiography for any reason. Metabolites were detected by a targeted approach using LC-MS/MS and metabolic -alterations were assessed by applying multivariate statistical analysis. The diagnostic ability of discovered metabolites based on multivariate statistical analysis was evaluated by ROC curve analysis. RESULTS: The study included women aged from 50-80 years with 5-30 years of menopause. The relative concentration of C14:1, C14:2, C16:1, C18:1, and C18:2OH acylcarnitines decreased and C18 acylcarnitine and serine increased in diabetic patients compared to control. Besides, C16:1 and C18:2OH acylcarnitines increased in high-risk CVD diabetic patients compared to no CVD risk diabetic patients. CONCLUSION: Dysregulation of serum acylcarnitines and amino acids profile correlated with different CAC score ranges in diabetic postmenopausal women. (Ethic approval No: IR.TUMS.EMRI.REC.1399.062).

Bilateral proximal deep vein thrombosis and COVID-19 in a patient with absence of inferior vena cava: A case report and review of literature.

Bilateral proximal deep vein thrombosis (DVT) in the lower extremities of young patients should raise suspicion over pro-thrombotic conditions and venous anatomical abnormalities, even in the presence of other precipitating factors, such as viral infection. The authors present a 33-year-old man with bilateral DVT and absence of inferior vena cava (AIVC), who also had concurrent COVID-19, and discuss the management of this patient.

Spontaneous descending colon hematoma due to a rare complication of warfarin therapy: A case report.

Intramural hematoma of the colon should be considered as a diagnosis in anticoagulated patients who present with prolonged INR and GI symptoms. In stable cases, conservative medical treatment can be sufficient to avoid unnecessary procedures.

Predicting the outcome in confirmed COVID-19 patients with coronary artery disease: a key role for the first chest computed tomography.

BACKGROUND: Serial chest computed tomography (CT) scans are used to detect coronavirus disease 2019 (COVID-19) pneumonia and monitor the disease course. This study investigates relationship between total severity score by first chest CT and the outcome of coronavirus COVID-19 patients with coronary artery disease (CAD). RESULTS: A total of 48 patients with a history of CAD (mean age=60.83±3.06 years, 75% male) with positive real-time reverse transcription-polymerase chain reaction for COVID-19 were included. Outcome was defined as acute respiratory distress syndrome or death. The unadjusted and adjusted effects of the CT score on the outcome were reported through odds ratio (OR) with 95% confidence interval (CI). Outcome occurred in 17 (35.5%) patients (8 deaths). The CT score was directly and significantly correlated with the outcome in the univariate analysis (OR 1.38, 95% CI 1.12-1.70; P=0.003) and remained significant after adjustment for diabetes, hypertension, body mass index, and serum level of highly sensitive C-reactive protein (OR 1.51, 95% CI 1.11-2.05; P=0.009). Outcome rate was 24.1% in patients with a CT score <2.5, whereas it was 8.3% in patients with a CT score>2.5. CONCLUSIONS: The first chest CT score could be a robust predictor of adverse events in confirmed COVID-19 patients with coronary artery disease.

Pulmonary Embolism and Right Heart Thrombi: A Single-Center Experience.

Background: The right heart thrombus (RHT) embolizes from deep venous thrombi and sits in the right atrium or the right ventricle. We aimed to determine the occurrence and prognosis of the RHT in patients with pulmonary embolism. Methods: We reviewed the cohort data of 622 patients with acute pulmonary embolism obtained from the registry of Tehran Heart Center. Demographic, physiological, clinical, and echocardiographic data, as well as clinical outcomes, were compared between patients with and without the RHT. Results: The study population comprised 622 patients, including 329 men (52.8%). The mean age of the patients was 60.2±17.0 years. Thirty patients (4.8%) had echocardiographically proven RHT. Baseline demographic and clinical characteristics were not different between the 2 groups. Right ventricular dysfunction was more prevalent in the RHT (+) group, and more patients in this group were treated with thrombolysis (P=0.013 and P<0.001, respectively). Overall, 3 out of 21 patients (14.2%) in the RHT (+) group vs 29 out of 306 patients (9.4%) in the RHT (-) group died at 1 month (P=0.445) and 5 out of 21 patients (23.8%) in the RHT (+) group vs 56 out of 307 patients (18.2%) in the RHT (-) group died at 1 year (P=0.562). Conclusion: The RHT is an influential complication in patients with pulmonary emboli, and it seems to increase the mortality rate of patients with acute pulmonary embolism.

Occurrence of acute coronary syndrome, pulmonary thromboembolism, and cerebrovascular event in COVID-19.

COVID-19 causes significant hypoxia along with an exacerbated inflammatory milieu, which may be a trigger for atherosclerotic plaque rupture and/or thromboembolic events. Herein, we presented a case of COVID-19 presented with acute coronary syndrome followed by pulmonary thromboembolism and cerebrovascular accident.

Does Baseline BUN Have an Additive Effect on the Prediction of Mortality in Patients with Acute Pulmonary Embolism?

Background: In patients with heart failure, elevated levels of blood urea nitrogen (BUN) is a prognostic factor. In this study, we investigated the prognostic value of elevated baseline BUN in short-term mortality among patients with acute pulmonary embolism (PE). Methods: Between 2007 and 2014, cardiac biomarkers and BUN levels were measured in patients with acute PE. The primary endpoint was 30-day mortality, evaluated based on the baseline BUN (≥14 ng/L) level in 4 groups of patients according to the European Society of Cardiology's risk stratification (low-risk, intermediate low-risk, intermediate high-risk, and high-risk). Results: Our study recruited 492 patients with a diagnosis of acute PE (mean age=60.58±16.81 y). The overall 1-month mortality rate was 6.9% (34 patients). Elevated BUN levels were reported in 316 (64.2%) patients. A high simplified pulmonary embolism severity index (sPESI) score (OR: 5.23, 95% CI: 1.43-19.11; P=0.012), thrombolytic or thrombectomy therapy (OR: 2.42, 95% CI: 1.01-5.13; P=0.021), and elevated baseline BUN levels (OR: 1.04, 95% CI: 1.01-1.03; P=0.029) were the independent predictors of 30-day mortality. According to our receiver-operating characteristics analysis for 30-day mortality, a baseline BUN level of greater than 14.8 mg/dL was considered elevated. In the intermediate-low-risk patients, mortality occurred only in those with elevated baseline BUN levels (7.2% vs. 0; P=0.008). Conclusion: An elevated baseline BUN level in our patients with PE was an independent predictor of short-term mortality, especially among those in the intermediate-risk group.

Association between elevated red blood cell distribution width and long-term mortality in acute pulmonary embolism

Background/aim: The prognostic value of the red cell distribution width (RDW) as a cost-effective and noninvasive test in acute pulmonary embolism (PE) is still unknown. We aimed to investigate the prognostic value of the admission RDW level in the long-term survival of PE patients. Materials and methods: In this registry-based, prospective cohort study, a total of 378 patients (mean age: 60.4 ± 17.11 years, 47.4% female) who presented with acute PE were enrolled. All the clinical data for each patient were obtained from our institutional PE registry. The follow-up was performed at a median time of 17 months. The primary endpoint was death at follow-up. Results: The mean RDW in study patients was 14.67 ± 2.13. The all-cause mortality rate during the follow-up was 15.6% (n = 59). After adjustment for potential confounders, the relationship between RDW and long-term mortality showed a trend of a significant level (hazard ratio: 1.109; 95% CI, 0.998−1.232; P = 0.053). We divided patients into 3 groups based on the European Society of Cardiology's classification. As we moved from the low risk to the higher risk categories, the mean RDW increased significantly (P = 0.037). Conclusion: It seems there may be an independent association between RDW at presentation and PE mortality within 17 months.

Semi-automated carotid lumen segmentation in computed tomography angiography images.

Carotid artery stenosis causes narrowing of carotid lumens and may lead to brain infarction. The purpose of this study was to develop a semi-automated method of segmenting vessel walls, surrounding tissues, and more importantly, the carotid artery lumen by contrast computed tomography angiography (CTA) images and to define the severity of stenosis and present a three-dimensional model of the carotid for visual inspection. In vivo contrast CTA images of 14 patients (7 normal subjects and 7 patients undergoing endarterectomy) were analyzed using a multi-step segmentation algorithm. This method uses graph cut followed by watershed and Hessian based shortest path method in order to extract lumen boundary correctly without being corrupted in the presence of surrounding tissues. Quantitative measurements of the proposed method were compared with those of manual delineation by independent board-certified radiologists. The results were quantitatively evaluated using spatial overlap surface distance indices. A slightly strong match was shown in terms of dice similarity coefficient (DSC) = 0.87±0.08; mean surface distance (Dmsd) = 0.32±0.32; root mean squared surface distance (Drmssd) = 0.49±0.54 and maximum surface distance (Dmax) = 2.14±2.08 between manual and automated segmentation of common, internal and external carotid arteries, carotid bifurcation and stenotic artery, respectively. Quantitative measurements showed that the proposed method has high potential to segment the carotid lumen and is robust to the changes of the lumen diameter and the shape of the stenosis area at the bifurcation site. The proposed method for CTA images provides a fast and reliable tool to quantify the severity of carotid artery stenosis.

Comparing the effect of cardiac biomarkers on the outcome of normotensive patients with acute pulmonary embolism.

Acute pulmonary embolism (PE) is a cardiovascular challenge with potentially fatal consequences. This study was designed to observe the association of novel cardiac biomarkers with outcome in this setting. In this prospective study, from 86 patients with a confirmed diagnosis of PE, 59 patients met the inclusion criteria (22 men, 37 women; mean age, 63.36±15.04 y).The plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), growth differentiation factor-15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), tenascin-C, and D-dimer were measured at the time of confirmed diagnosis. The endpoints of the study were defined as the short-term adverse outcome and long-term all-cause mortality. Totally, 11.8% (7/59) of the patients had the short-term adverse outcome. The mean value of logNT-proBNP was 6.40±1.66 pg/ml. Among all the examined biomarkers, only the mean value of logNT-proBNP was significantly higher in the patients with the short-term adverse outcome (7.88±0.67 vs. 6.22± 1.66 pg/ml; OR, 2.359; 95% CI, 1.037 to 5.367; P=0.041). After adjustment, a threefold increase in the short-term adverse outcome was identified (OR, 3.239; 95% CI, 0.877 to 11.967; P=0.078).Overall, 18.64% (11/59) of the patients had expired by the long-term follow-up. Moreover, adjustment revealed an evidence regarding association between increased logNT-proBNP levels and long-term mortality (HR, 2.163; 95%CI, 0.910 to 5.142; P=0.081). Our study could find evidences on association between increased level of NT-proBNP and short-term adverse outcome and/or long-term mortality in PE. This biomarker may be capable of improving prediction of outcome and clinical care in non-high-risk PE.

Coronary Artery Calcium Score and Bone Metabolism: A Pilot Study in Postmenopausal Women.

BACKGROUND: Since 1991 many studies evaluated the link between cardiovascular diseases and osteoporosis, two age-related conditions, but the main common pathologic pathway has not been determined yet. The histological similarity between arterial calcified plaque and bone matrix and involvement of similar cells and mediators provide a special field of research. Therefore in the present study, we aimed to evaluate the relationship between coronary artery calcium score (CACS) as a surrogate marker of atherosclerosis and bone mediators and parameters in postmenopausal women. METHODS: Eleven postmenopausal women who had CACS higher than 80 were enrolled into the study and underwent bone densitometry. In addition, their serum and urine samples were taken for measuring osteoprotegerin, osteocalcin, and ß cross laps. Patients' 10-year probability of fracture was calculated by the World Health Organization fracture-risk assessment tool (FRAX). RESULTS: The regression analysis of our results showed the association between CACS and OC (std ß=0.66, 95% confidence interval [CI] 5.47-72.27, P=0.027), femoral bone density (std ß=-0.6, 95% CI -6864.34-14.27, P=0.05) and T-score (std ß=-0.6, 95% CI -773.08-1.28, P=0.05) which remained significant after adjustment for age, weight, years since menopause and body mass index. No association was found between CACS and osteoprotegerin, spinal bone density and FRAX score. CONCLUSIONS: In conclusion, this pilot study with small sample size showed the potential association between CACS and osteocalcin, femoral bone density and T-score. However, the relationship between CACS and osteoprotegerin, receptor activator of nuclear factor-kappa B ligand, FRAX score and other bone parameters remain to be clarified in larger sample size studies.

A combined registration and finite element analysis method for fast estimation of intraoperative brain shift; phantom and animal model study.

BACKGROUND: Finite element models for estimation of intraoperative brain shift suffer from huge computational cost. In these models, image registration and finite element analysis are two time-consuming processes. METHODS: The proposed method is an improved version of our previously developed Finite Element Drift (FED) registration algorithm. In this work the registration process is combined with the finite element analysis. In the Combined FED (CFED), the deformation of whole brain mesh is iteratively calculated by geometrical extension of a local load vector which is computed by FED. RESULTS: While the processing time of the FED-based method including registration and finite element analysis was about 70 s, the computation time of the CFED was about 3.2 s. The computational cost of CFED is almost 50% less than similar state of the art brain shift estimators based on finite element models. CONCLUSIONS: The proposed combination of registration and structural analysis can make the calculation of brain deformation much faster.