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1.
Neurol Sci ; 41(11): 3063-3065, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32965525

RESUMO

BACKGROUND: Fahr's syndrome (or Fahr's disease) is a rare, neurological disorder characterized by bilateral calcification in the cerebellum, thalamus, basal ganglia, and cerebral cortex as a result of calcium and phosphorus metabolism disorder. The patients may be asymptomatic and clinical symptoms represent a wide range of neurologic manifestations and nonspecific neuropsychiatric disorders. We report an unusual case of Fahr's syndrome which was asymptomatic and incidentally diagnosed by generalized tonic-clonic seizure in a patient with SARS-CoV-2 (COVID-19) pneumonia. CASE PRESENTATION: The patient was a 68-year-old female and admitted to our emergency department suffering from cough and fatigue. After thorax computed tomography (CT) and SARS-CoV-2 PCR test, she was diagnosed as COVID-19 pneumonia. In the intensive care unit, the patient had a tonic-clonic convulsion starting from the left arm and spreading to the whole body. Fahr's syndrome was diagnosed after a cranial CT scan and blood metabolic panel test. CONCLUSIONS: As a result of the clinical, radiological, and biochemical evaluations, the patient was diagnosed incidentally as Fahr's syndrome associated with hypoparathyroidism. Seizures could be induced by hydroxychloroquine that was in the COVID-19 treatment or the inflammation caused by COVID-19 pneumonia. The association between the mortality of COVID-19 pneumonia and Fahr's syndrome is unknown which needs further research.


Assuntos
Doenças dos Gânglios da Base/diagnóstico , Calcinose/diagnóstico , Infecções por Coronavirus/complicações , Doenças Neurodegenerativas/diagnóstico , Pneumonia Viral/complicações , Convulsões/etiologia , Idoso , Doenças dos Gânglios da Base/complicações , Betacoronavirus , Calcinose/complicações , Evolução Fatal , Feminino , Humanos , Achados Incidentais , Doenças Neurodegenerativas/complicações , Pandemias , Pneumonia Viral/virologia
3.
Ann Thorac Surg ; 110(4): e343-e345, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32389565

RESUMO

Severe mitral annulus calcifications significantly hinder surgical repair and replacement of the dysfunctional mitral valve. Herein, we present a novel surgical technique where we created an intra-atrial neomitral ring using a vascular Dacron graft in which a prosthetic valve was implanted. This approach is a simple alternative technique that can be used when anatomic prosthetic valve implantation is not feasible. Major assets of this approach are evasion of extensive debridement, implantation of an adequately sized prosthesis, and prosthetic material availability.


Assuntos
Calcinose/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso de 80 Anos ou mais , Calcinose/diagnóstico , Ecocardiografia Transesofagiana , Feminino , Humanos , Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico , Desenho de Prótese , Índice de Gravidade de Doença
4.
Br J Radiol ; 93(1112): 20200195, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32463295

RESUMO

OBJECTIVE: To compare the efficacy of contrast-enhanced ultrasound enabled reclassification of Breast Imaging Reporting and Data System (CEUS-BI-RADS) with MRI in the diagnosis of breast lesions with calcification. METHODS: A total of 52 breast lesions with calcification from 51 patients were detected by ultrasound as hyperechoic foci and categorized as BI-RADS 3-5. The 51 patients further underwent CEUS scan and MRI. The ultrasound-BI-RADS combined with CEUS 5-point score system redefined the classification of BI-RADS which was called CEUS-BI-RADS. The diagnostic efficacy of three methods was assessed by receiver operating characteristic (ROC) curve analysis. Histopathological assessment used as the gold-standard. RESULTS: The sensitivities of Ultrasound-BI-RADS, MRI classification of BI-RADS (MRI-BI-RADS) and CEUS-BI-RADS were 85%, 90% and 95% without significant difference among the three modalities (p > 0.05). The diagnostic specificities of ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS were 78.1%, 78.1% and 96.8%, respectively (p < 0.05); and the accuracy were 80.7%, 82.6% and 96.1% for ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS, respectively (p < 0.05). The area under ROC (AUROC) in differentiation of breast lesions with calcification was 0.945 for CEUS-BI-RADS, 0.907 for MRI-BI-RADS and 0.853 for ultrasound-BI-RADS, with no significant difference among the three modalities (p > 0.05). CONCLUSION: The CEUS-BI-RADS has a better diagnostic efficiency than MRI-BI-RADS in the differentiation of the breast lesions with calcification. ADVANCES IN KNOWLEDGE: •CEUS is a better method in differentiation of breast lesions with calcification.•CEUS-BI-RADS increases the efficiency of diagnosis compared to MRI.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Meios de Contraste , Imagem por Ressonância Magnética , Ultrassonografia Mamária/métodos , Adolescente , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Calcinose/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
5.
PLoS One ; 15(4): e0231508, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298308

RESUMO

OBJECTIVE: To determine if findings of "cartilage icing" and chondrocalcinosis on knee radiography can differentiate between gout and calcium pyrophosphate deposition (CPPD). METHODS: IRB-approval was obtained and informed consent was waived for this retrospective study. Electronic medical records from over 2.3 million patients were searched for keywords to identify subjects with knee aspiration-proven cases of gout or CPPD. Radiographs were reviewed by two fellowship-trained musculoskeletal radiologists in randomized order, blinded to the patients' diagnoses. Images were evaluated regarding the presence or absence of cartilage icing, chondrocalcinosis, tophi, gastrocnemius tendon calcification, and joint effusion. Descriptive statistics, sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. RESULTS: From 49 knee radiographic studies in 46 subjects (31 males and 15 females; mean age 66±13 years), 39% (19/49) showed gout and 61% (30/49) CPPD on aspiration. On knee radiographs, cartilage icing showed a higher sensitivity for CPPD than gout (53-67% and 26%, respectively). Chondrocalcinosis also showed a higher sensitivity for CPPD than gout (50-57% versus 5%), with 95% specificity and 94% positive predictive value for diagnosis of CPPD versus gout. Soft tissue tophus-like opacities were present in gout at the patellar tendon (5%, 1/19) and at the popliteus groove in CPPD (15%, 4/27). Gastrocnemius tendon calcification was present in 30% (8/27) of subjects with CPPD, and 5% (1/19) of gout. CONCLUSION: In subjects with joint aspiration-proven crystal disease of the knee, the radiographic finding of cartilage icing was seen in both gout and CPPD. Chondrocalcinosis (overall and hyaline cartilage) as well as gastrocnemius tendon calcification positively correlated with the diagnosis of CPPD over gout.


Assuntos
Calcinose/diagnóstico por imagem , Pirofosfato de Cálcio/metabolismo , Cartilagem Articular/diagnóstico por imagem , Condrocalcinose/diagnóstico por imagem , Gota/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Idoso , Calcinose/diagnóstico , Cartilagem Articular/patologia , Condrocalcinose/diagnóstico , Diagnóstico Diferencial , Feminino , Gota/diagnóstico , Humanos , Masculino , Radiografia , Estudos Retrospectivos
6.
PLoS One ; 15(4): e0230493, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32255786

RESUMO

Phosphate toxicity is a major threat to cardiovascular health in chronic kidney disease. It is associated with oxidative stress, inflammation and the accumulation of calcium phosphate commonly known as calcification in soft tissues leading to functional disorders of blood vessels. An improved calcification propensity test for the assessment of phosphate toxicity was developed, which measures the velocity of calcium phosphate mineralization from colloidal precursors in vitro. This so called T50 test measures the transformation from a primary into a secondary form of nanosized colloidal plasma protein-calcium phosphate particles known as calciprotein particles. The T50 test in its previous form required a temperature controlled nephelometer and several hours of continuous measurement, which precluded rapid bed side testing. We miniaturized the test using microfluidic polymer chips produced by ultrasonic hot embossing. A cartridge holder contained a laser diode for illumination, light dependent resistor for detection and a Peltier element for thermo control. Increasing the assay temperature from 37°C to 75°C reduced the T50 test time 36-fold from 381 ± 10 min at 37°C to 10.5 ± 0.3 min at 75°C. Incorporating sputtered micro mirrors into the chip design increased the effective light path length, and improved signal-to-noise ratio 9-fold. The speed and reproducibility of the T50 chip-based assay run at 75°C suggest that it may be suitable for rapid measurements, preferably in-line in a dialyser or in a portable microfluidic analytic device with the chip inserted as a disposable cartridge.


Assuntos
Fosfatos de Cálcio/sangue , Microfluídica/métodos , Polímeros/química , Calcinose/sangue , Calcinose/diagnóstico , Humanos , Falência Renal Crônica/patologia , Dispositivos Lab-On-A-Chip , Microfluídica/instrumentação , Diálise Renal , Razão Sinal-Ruído , Temperatura
7.
Autoimmun Rev ; 19(6): 102533, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32234404

RESUMO

Dermatomyositis (DM) is a rare idiopathic inflammatory myopathy characterized by muscle weakness and cutaneous manifestations in adults and children. Calcinosis, a complication of DM, is the abnormal deposition of insoluble calcium salts in tissues, including skin, subcutaneous tissue, tendons, fascia, and muscle. Calcinosis is more commonly seen in juvenile DM (JDM), but also develops in adult DM. Although the mechanism of calcinosis remains unclear, several pathogenic hypotheses have been proposed, including intracellular accumulation of calcium secondary to an alteration of the cellular membrane by trauma and inflammation, local vascular ischemia, dysregulation of mechanisms controlling the deposition and solubility of calcium and phosphate, and mitochondrial damage of muscle cells. Identifying calcinosis biomarkers is important for early disease detection and risk assessment, and may lead to novel therapeutic targets for the prevention and treatment of DM-associated calcinosis. In this review, we summarize myositis autoantibodies associated with calcinosis in DM, histopathology and chemical composition of calcinosis, genetic and inflammatory markers that have been studied in adult DM and JDM-associated calcinosis, as well as potential novel biomarkers.


Assuntos
Biomarcadores/análise , Calcinose/complicações , Calcinose/diagnóstico , Dermatomiosite/complicações , Adulto , Criança , Diagnóstico Precoce , Humanos
9.
BMC Bioinformatics ; 21(Suppl 2): 91, 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32164532

RESUMO

BACKGROUND: Screening programs use mammography as primary diagnostic tool for detecting breast cancer at an early stage. The diagnosis of some lesions, such as microcalcifications, is still difficult today for radiologists. In this paper, we proposed an automatic binary model for discriminating tissue in digital mammograms, as support tool for the radiologists. In particular, we compared the contribution of different methods on the feature selection process in terms of the learning performances and selected features. RESULTS: For each ROI, we extracted textural features on Haar wavelet decompositions and also interest points and corners detected by using Speeded Up Robust Feature (SURF) and Minimum Eigenvalue Algorithm (MinEigenAlg). Then a Random Forest binary classifier is trained on a subset of a sub-set features selected by two different kinds of feature selection techniques, such as filter and embedded methods. We tested the proposed model on 260 ROIs extracted from digital mammograms of the BCDR public database. The best prediction performance for the normal/abnormal and benign/malignant problems reaches a median AUC value of 98.16% and 92.08%, and an accuracy of 97.31% and 88.46%, respectively. The experimental result was comparable with related work performance. CONCLUSIONS: The best performing result obtained with embedded method is more parsimonious than the filter one. The SURF and MinEigen algorithms provide a strong informative content useful for the characterization of microcalcification clusters.


Assuntos
Mama , Calcinose/diagnóstico , Aprendizado de Máquina , Algoritmos , Área Sob a Curva , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico , Bases de Dados Factuais , Feminino , Humanos , Mamografia , Curva ROC
11.
Plast Reconstr Surg ; 145(3): 530e-537e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097306

RESUMO

BACKGROUND: Breast augmentation with fat grafting is used as an alternative to breast implants. However, a systematic evaluation of the complication rates after fat grafting using only studies with consecutive patients has not previously been performed. In this study, the authors compiled studies reporting complication rates and radiologic changes in consecutive patients undergoing cosmetic breast augmentation with fat grafting. METHODS: Studies reporting on consecutive patients undergoing breast augmentation with fat grafting were included. Complication rates, radiologic changes, Breast Imaging Reporting and Data System assessments, and the number of patients undergoing revision surgery were extracted. Mean complication rates and radiologic changes were calculated with meta-analytical methods. RESULTS: Twenty-two studies with 2073 patients were included. The rates of major complications were low (hematoma, 0.5 percent; infection, 0.6 percent; and seroma, 0.1 percent). None of these patients needed revision surgery. The most frequent minor complication was palpable cysts in 2.0 percent of the patients; 67 percent of these were treated with aspiration. The radiologic changes in the patients after fat grafting were as follows: oil cysts, 6.5 percent; calcifications, 4.5 percent; and fat necrosis, 1.2 percent. The risk of being referred for additional radiologic imaging (e.g., to exclude malignant changes) was 16.4 percent, and the risk of being referred for biopsy was 3.2 percent. CONCLUSIONS: The complication rates after breast augmentation with fat grafting are low and support fat grafting as an alternative to breast augmentation with implants. The rates of radiologic changes are high after fat grafting, but the changes do not seem to have any therapeutic consequences for the patients.


Assuntos
Tecido Adiposo/transplante , Cisto Mamário/epidemiologia , Calcinose/epidemiologia , Necrose Gordurosa/epidemiologia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Mama/diagnóstico por imagem , Mama/cirurgia , Cisto Mamário/diagnóstico , Cisto Mamário/etiologia , Calcinose/diagnóstico , Calcinose/etiologia , Necrose Gordurosa/diagnóstico , Necrose Gordurosa/etiologia , Feminino , Humanos , Mamoplastia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
12.
Cancer Res ; 80(8): 1762-1772, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32094303

RESUMO

Breast microcalcifications are a common mammographic finding. Microcalcifications are considered suspicious signs of breast cancer and a breast biopsy is required, however, cancer is diagnosed in only a few patients. Reducing unnecessary biopsies and rapid characterization of breast microcalcifications are unmet clinical needs. In this study, 473 microcalcifications detected on breast biopsy specimens from 56 patients were characterized entirely by Raman mapping and confirmed by X-ray scattering. Microcalcifications from malignant samples were generally more homogeneous, more crystalline, and characterized by a less substituted crystal lattice compared with benign samples. There were significant differences in Raman features corresponding to the phosphate and carbonate bands between the benign and malignant groups. In addition to the heterogeneous composition, the presence of whitlockite specifically emerged as marker of benignity in benign microcalcifications. The whole Raman signature of each microcalcification was then used to build a classification model that distinguishes microcalcifications according to their overall biochemical composition. After validation, microcalcifications found in benign and malignant samples were correctly recognized with 93.5% sensitivity and 80.6% specificity. Finally, microcalcifications identified in malignant biopsies, but located outside the lesion, reported malignant features in 65% of in situ and 98% of invasive cancer cases, respectively, suggesting that the local microenvironment influences microcalcification features. This study confirms that the composition and structural features of microcalcifications correlate with breast pathology and indicates new diagnostic potentialities based on microcalcifications assessment. SIGNIFICANCE: Raman spectroscopy could be a quick and accurate diagnostic tool to precisely characterize and distinguish benign from malignant breast microcalcifications detected on mammography.


Assuntos
Doenças Mamárias/metabolismo , Doenças Mamárias/patologia , Mama/patologia , Calcinose/metabolismo , Calcinose/patologia , Análise Espectral Raman/métodos , Biomarcadores/análise , Biópsia , Mama/química , Carcinoma de Mama in situ/química , Carcinoma de Mama in situ/diagnóstico , Carcinoma de Mama in situ/patologia , Doenças Mamárias/diagnóstico , Neoplasias da Mama/química , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Calcinose/diagnóstico , Fosfatos de Cálcio/análise , Carbonatos/análise , Feminino , Humanos , Fosfatos/análise , Sensibilidade e Especificidade
14.
J Stomatol Oral Maxillofac Surg ; 121(5): 592-598, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32109597

RESUMO

INTRODUCTION: Synovial sarcoma (SS) is a malignant soft-tissue sarcoma primarily affecting the lower extremities of young adults. Synovial sarcoma occurring in the head and neck region is rare. OBSERVATION: We report a case of a 32-year-old female with a biphasic synovial sarcoma, showing extensive calcification, arising in the temporomandibular joint (TMJ). For effective diagnosis and treatment of synovial sarcomas in the TMJ, we reviewed relevant cases reported in the English literature and further discussed the clinicopathologic features, differential diagnosis, treatment strategies and prognosis. DISCUSSION: The typical slow growth and clinical symptoms of SS in the TMJ region may often be misdiagnosed as temporomandibular disorders (TMD) or other benign neoplasms. Differential diagnosis to include primary parotid tumours should be considered and immunohistochemistry along with molecular studies can be helpful to verify the diagnosis. A multimodal treatment approach consisting of a wide surgical excision and postoperative radiotherapy should be taken into consideration.


Assuntos
Calcinose , Neoplasias Parotídeas , Sarcoma Sinovial , Transtornos da Articulação Temporomandibular , Adulto , Calcinose/diagnóstico , Calcinose/terapia , Feminino , Humanos , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/terapia , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia
15.
J Refract Surg ; 36(1): 20-27, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31917847

RESUMO

PURPOSE: To describe and analyze the impact of calcification on the optical quality of segmented refractive bifocal intraocular lenses (IOLs). METHODS: Eight segmented refractive bifocal IOLs made of hydrophilic acrylic were explanted from 8 patients due to opacification (and one opacified IOL that was not explanted) and analyzed in a cross-sectional study with laboratory analysis. Nine cases comprised three IOL models: LS-313 MF30 (5 cases), LS-312 MF30 (3 cases), and LS-313 MF15 (1 case). Material analysis with scanning and transmission electron microscopy confirmed IOL calcification. Measurements of modulation transfer function (MTF) and straylight permitted assessment of the IOL optical quality. Values were compared to a control lens. RESULTS: Except for one case of Nd:YAG (neodymium:yttrium-aluminum-garnet) capsulotomy, there was no secondary surgical procedure in the patients' histories. Eight of nine patients reported deteriorated visual quality, ultimately requiring IOL exchange. Material evaluation revealed fine granules of a calcium phosphate. Despite calcification, all but one lens still showed two distinct foci on the MTF measurements. Straylight values were higher than in a cataractous lens (33.1 deg2/sr) in all cases, with an average value of 170.1 ± 71.5 deg2/sr. CONCLUSIONS: Optical quality assessment showed that IOL calcification had a small effect on the MTF of segmented refractive bifocal lenses but a large impact on the straylight levels. Accordingly, in the clinical case, straylight levels were elevated. [J Refract Surg. 2020;36(1):20-27.].


Assuntos
Calcinose/diagnóstico , Lentes Intraoculares/efeitos adversos , Óptica e Fotônica , Idoso , Calcinose/cirurgia , Estudos Transversais , Remoção de Dispositivo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Desenho de Prótese , Falha de Prótese
17.
Chest ; 157(1): e9-e12, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31916972

RESUMO

CASE PRESENTATION: A 59-year-old man presented to the ED with a chief complaint of shortness of breath. His past medical history was significant for end-stage renal disease secondary to lithium toxicity, immunosuppression subsequent to cadaveric renal transplantation, bipolar disorder, and hypertension. His shortness of breath had begun 6 months previously and was initially intermittent; it then progressed to constant shortness of breath over the few weeks before presentation. He had no fever, hemoptysis, or chest pain. The patient was admitted to hospital for further evaluation.


Assuntos
Calcinose/etiologia , Dispneia/etiologia , Transplante de Rim , Pneumopatias/etiologia , Insuficiência Renal Crônica/complicações , Calcinose/diagnóstico , Calcinose/terapia , Diagnóstico Diferencial , Progressão da Doença , Humanos , Pneumopatias/diagnóstico , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia
19.
Ann Thorac Surg ; 110(2): 537-544, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31962117

RESUMO

BACKGROUND: Traditionally, quantification of aortic valve calcium (AVC) has been performed with noncontrast computed tomography (NCCT) using the Agatston method. This study sought to derive and validate a systematic method enabling AVC quantification using computed tomographic angiography (CTA) in patients with aortic stenosis (AS). METHODS: The study included 134 consecutive patients with AS who underwent both NCCT and CTA and were subdivided into derivation (n = 71) and validation cohorts (n = 63). AVC on NCCT (AVCNCCT) was quantified using the Agatston method using the software developed for semiautomatic assessment of coronary calcium. On CTA, the mean contrast attenuation of the aorta in Hounsfield units (AortaHU) and SD was measured in the region of interest at the level of the sinotubular junction. RESULTS: Using an adjusted calcium detection threshold of AortaHU + 2 SD, we calculated AVC on CTA (AVCCTA) using the same software without modifying other variables. Correlation between AVCNCCT and AVCCTA in the derivation cohort was excellent (r = 0.9679; P < .001). We used a linear regression model to derive a formula for predicting AVCCTA that enabled conversion of AVCCTA to AVCDerived (AVCDerived = 1.821 × AVCCTA). Applying this formula in validation cohort, we calculated AVCDerived, which showed excellent agreement with AVCNCCT (intraclass correlation coefficient, 0.9648; 95% confidence interval, 0.9427-0.9782). Excellent correlation was also found between categorized AVCNCCT and AVCDerived scores (κ = 0.9044; 95% confidence interval, 0.7989-1.0000), with 95.24% (60 of 63) of scores falling within the same severity category. CONCLUSIONS: AVC quantification on CTA is feasible with high accuracy and reliability and shows excellent agreement with the standard AVCNCCT score. With the systematic approach using "dynamic thresholds" being largely independent of the scan acquisition protocol, AVCDerived can potentially replace AVCNCCT, eliminating the need for separate NCCT acquisition solely for AVC quantification.


Assuntos
Estenose da Valva Aórtica/diagnóstico , Valva Aórtica/diagnóstico por imagem , Calcinose/diagnóstico , Cálcio/metabolismo , Angiografia por Tomografia Computadorizada/métodos , Adulto , Valva Aórtica/metabolismo , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/metabolismo , Calcinose/complicações , Calcinose/metabolismo , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
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