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1.
Sci Rep ; 12(1): 7685, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35538104

RESUMO

Opacification through calcification of hydrophilic acrylic intraocular lenses (IOL) is a severe complication after cataract surgery. Causing symptoms that range from glare through to severe vision loss, the only effective therapy is explantation of the opacified IOL so far. Although IOL calcification is a well-described phenomenon, its pathogenesis is not fully understood yet. The purpose of the current study was to develop a laboratory model to replicate IOL calcification. Calcification could be reproduced using a horizontal electrophoresis and aqueous solutions of calcium chloride and disodium hydrogen phosphate. The analysis of the in vitro calcified IOLs was performed using light microscopy, Alizarin Red and Von Kossa staining, scanning electron microscopy, energy dispersive x-ray spectroscopy and electron crystallography using transmission electron microscopy and electron diffraction. The presented laboratory model could be used to identify hydrophilic IOLs that are at risk to develop calcification and to assess the influence of associated risk factors. In addition, it can serve as a research tool to further understand this pathology.


Assuntos
Calcinose , Opacificação da Cápsula , Lentes Intraoculares , Facoemulsificação , Calcinose/patologia , Remoção de Dispositivo/efeitos adversos , Humanos , Lentes Intraoculares/efeitos adversos , Microscopia Eletrônica de Varredura , Facoemulsificação/efeitos adversos , Falha de Prótese
2.
Pediatr Rheumatol Online J ; 20(1): 30, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35443665

RESUMO

BACKGROUND: We present two cases of Nodular Regenerative Hyperplasia (NRH) associated with Juvenile Dermatomyositis (JDM). CASE PRESENTATION: Case 1: A nine-year-old Caucasian male with refractory JDM and anti-NXP2 autoantibodies was diagnosed at age two. Over seven years, he developed arthritis, dysphagia, dysphonia, severe calcinosis, and colitis. Complications included recurrent cellulitis, infections, and hepatosplenomegaly. Multiple medications were chronically used, including prednisone, methotrexate, azathioprine, cyclophosphamide, mycophenolate mofetil, rituximab, tacrolimus, etanercept, abatacept, infliximab, and tocilizumab. Case 2: A 19-year-old Asian female with chronically active JDM and anti-MDA5 autoantibodies was diagnosed at age 15. Symptomatology included ulcerative skin lesions, Raynaud's phenomenon with digital ulcers, arthritis, interstitial lung disease with pulmonary hypertension, and calcinosis. Medications included chronic use of prednisone, methotrexate, abatacept, cyclophosphamide, mycophenolate mofetil, rituximab, tofacitinib, and sildenafil. In both patients, clinical symptomatology was not suggestive of liver disease or portal hypertension, but laboratory studies revealed elevated serum transaminases with progressive thrombocytopenia and no active liver-associated infections. The first patient's liver ultrasound showed coarse hepatic texture with mild echogenicity, splenomegaly, and portal hypertension. The second patient's liver ultrasound was normal, but elastography indicated increased stiffness. Liver biopsy confirmed NRH in both patients. CONCLUSIONS: It is difficult to recognize NRH in JDM, as it often presents with elevated transaminases which may be mistaken for JDM muscle flare, corticosteroid-related fatty liver, or medication-related transaminitis. NRH has been associated with several medications used to treat JDM, including methotrexate, azathioprine, and cyclophosphamide, which should be discontinued if NRH develops. Providers should consider NRH in JDM patients with severe, refractory disease who have persistently elevated transaminases and persistent thrombocytopenia.


Assuntos
Artrite , Calcinose , Dermatomiosite , Hipertensão Portal , Trombocitopenia , Abatacepte/uso terapêutico , Adolescente , Autoanticorpos , Azatioprina/uso terapêutico , Calcinose/patologia , Criança , Ciclofosfamida/uso terapêutico , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Feminino , Humanos , Hiperplasia/complicações , Hiperplasia/patologia , Hipertensão Portal/complicações , Hipertensão Portal/patologia , Fígado/patologia , Masculino , Metotrexato/uso terapêutico , Ácido Micofenólico/uso terapêutico , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Esplenomegalia , Trombocitopenia/complicações , Transaminases/uso terapêutico , Adulto Jovem
3.
Int J Mol Sci ; 23(7)2022 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-35409134

RESUMO

Parathyroid hormone (PTH) is a key regulator of calcium, phosphate and vitamin D metabolism. Although it has been reported that aortic valve calcification was positively associated with PTH, the pathophysiological mechanisms and the direct effects of PTH on human valvular cells remain unclear. Here we investigated if PTH induces human valvular endothelial cells (VEC) dysfunction that in turn could impact the switch of valvular interstitial cells (VIC) to an osteoblastic phenotype. Human VEC exposed to PTH were analyzed by qPCR, western blot, Seahorse, ELISA and immunofluorescence. Our results showed that exposure of VEC to PTH affects VEC metabolism and functions, modifications that were accompanied by the activation of p38MAPK and ERK1/2 signaling pathways and by an increased expression of osteogenic molecules (BMP-2, BSP, osteocalcin and Runx2). The impact of dysfunctional VEC on VIC was investigated by exposure of VIC to VEC secretome, and the results showed that VIC upregulate molecules associated with osteogenesis (BMP-2/4, osteocalcin and TGF-ß1) and downregulate collagen I and III. In summary, our data show that PTH induces VEC dysfunction, which further stimulates VIC to differentiate into a pro-osteogenic pathological phenotype related to the calcification process. These findings shed light on the mechanisms by which PTH participates in valve calcification pathology and suggests that PTH and the treatment of hyperparathyroidism represent a therapeutic strategy to reduce valvular calcification.


Assuntos
Estenose da Valva Aórtica , Calcinose , Valva Aórtica/patologia , Estenose da Valva Aórtica/patologia , Calcinose/patologia , Diferenciação Celular/genética , Células Cultivadas , Células Endoteliais/metabolismo , Humanos , Osteocalcina/genética , Osteocalcina/metabolismo , Osteogênese , Hormônio Paratireóideo/metabolismo , Fenótipo
4.
Am J Case Rep ; 23: e936296, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35440533

RESUMO

BACKGROUND Caseous calcification of the mitral annulus (CCMA) is an uncommon form of mitral annular calcification and can be misdiagnosed as heart abscess, neoplasm, or other lesions occupying the atrioventricular groove. Data regarding imaging follow-up of patients with CCMA are limited. This report presents a case of CCMA with a 3-year imaging follow-up. CASE REPORT A 66-year-old asymptomatic woman was referred to our cardiology department for further evaluation of a rapidly expanding intracardiac mass observed using transthoracic echocardiography (TTE) in an outpatient setting. A neoplasm was suspected. Echocardiographic examination was normal 5 years ago, and 2 years later, TTE revealed an echodense structure (10×10 mm) occupying the atrioventricular groove. Three years later, TTE revealed an increase in the size of the lesion (21×18 mm) and a mild acoustic shadow. Cardiac magnetic resonance imaging revealed a pathological mass (20×20×37 mm) in the posterior portion of the mitral annulus that extended into the left ventricle. Using computed tomography, a round mass (20×19×39 mm) with a demarcated area of calcification was revealed in the posterior portion of the mitral annulus. Thus, the intracardiac mass was diagnosed as CCMA. Although there was a considerable increase in lesion size (doubling of lesion size within 3 years), normal intracardiac flow and asymptomatic course of the disease remained. Therefore, this patient underwent conservative management with imaging follow-up. CONCLUSIONS In cases of atypical presentation of CCMA, multimodal imaging may provide an accurate diagnosis and important information regarding the course of the disease.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Idoso , Calcinose/diagnóstico por imagem , Calcinose/patologia , Ecocardiografia/métodos , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia
5.
Analyst ; 147(8): 1641-1654, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35311860

RESUMO

Ductal carcinoma in situ (DCIS) is frequently associated with breast calcification. This study combines multiple analytical techniques to investigate the heterogeneity of these calcifications at the micrometre scale. X-ray diffraction, scanning electron microscopy and Raman and Fourier-transform infrared spectroscopy were used to determine the physicochemical and crystallographic properties of type II breast calcifications located in formalin fixed paraffin embedded DCIS breast tissue samples. Multiple calcium phosphate phases were identified across the calcifications, distributed in different patterns. Hydroxyapatite was the dominant mineral, with magnesium whitlockite found at the calcification edge. Amorphous calcium phosphate and octacalcium phosphate were also identified close to the calcification edge at the apparent mineral/matrix barrier. Crystallographic features of hydroxyapatite also varied across the calcifications, with higher crystallinity centrally, and highest carbonate substitution at the calcification edge. Protein was also differentially distributed across the calcification and the surrounding soft tissue, with collagen and ß-pleated protein features present to differing extents. Combination of analytical techniques in this study was essential to understand the heterogeneity of breast calcifications and how this may link crystallographic and physicochemical properties of calcifications to the surrounding tissue microenvironment.


Assuntos
Neoplasias da Mama , Calcinose , Carcinoma Intraductal não Infiltrante , Calcinose/patologia , Carcinoma Intraductal não Infiltrante/patologia , Durapatita , Feminino , Humanos , Espectroscopia de Infravermelho com Transformada de Fourier , Microambiente Tumoral , Difração de Raios X
7.
J Am Heart Assoc ; 11(6): e023274, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35229617

RESUMO

Background Inflammation of the perivascular adipose tissue (PvAT) may be related to atherosclerosis; however, the association of polarized macrophages in the pericoronary PvAT with measurements of atherosclerosis components in humans has not been fully investigated. Methods and Results Coronary arteries were dissected with surrounding PvAT. We evaluated the percentage of arterial obstruction, intima-media thickness, fibrous cap thickness, plaque components, and the number of vasa vasorum. The number of proinflammatory (M1) and anti-inflammatory (M2) macrophages in the periplaque and control PvAT were evaluated using immunohistochemistry. Regression models adjusted for sociodemographic and clinical variables were used. In 319 segments from 82 individuals, we found a correlation of the M1/M2 macrophage density ratio with an increase in arterial obstruction (P=0.02) and lipid content (P=0.01), and a decrease in smooth muscle cells (P=0.02). M1 and the ratio of M1/M2 macrophages were associated with an increased risk of thrombosis (P=0.03). In plaques with thrombosis, M1 macrophages were correlated with a decrease in fibrous cap thickness (P=0.006), an increase in lipid content (P=0.008), and the number of vasa vasorum in the adventitia layer (P=0.001). M2 macrophages were correlated with increased arterial obstruction (P=0.01), calcification (P=0.02), necrosis (P=0.03) only in plaques without thrombosis, and decrease of the number of vasa vasorum in plaques with thrombosis (P=0.003). Conclusions M1 macrophages in the periplaque PvAT were associated with a higher risk of coronary thrombosis and were correlated with histological components of plaque progression and destabilization. M2 macrophages were correlated with plaque size, calcification, necrotic content, and a decrease in the number of vasa vasorum in the adventitia layer.


Assuntos
Aterosclerose , Calcinose , Doença da Artéria Coronariana , Placa Aterosclerótica , Trombose , Tecido Adiposo/patologia , Aterosclerose/patologia , Calcinose/patologia , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Humanos , Lipídeos , Macrófagos/patologia , Placa Aterosclerótica/patologia , Trombose/patologia
8.
Can Vet J ; 63(2): 139-142, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35110769

RESUMO

A 12-year-old, spayed female, Maltese dog with a round and firm mass on the dorsal part of the left rear paw and a cervical mass was brought to the clinic. The paw mass was contiguous to the adjacent tendon; it was composed of neoplastic mesenchymal cells and had scattered foci of calcification with chondroid differentiation microscopically. The neoplastic cells were positive for vimentin and S100, but negative for desmin and smooth muscle actin. Microscopic features and immunohistochemistry results were consistent with calcifying aponeurotic fibroma (CAF). The cervical mass was composed of polygonal cells forming acini with marked anisocytosis and anisokaryosis and diagnosed as thyroid follicular carcinoma. No recurrence or metastasis occurred during follow-up. To the best of our knowledge, this is the first case of canine CAF with features identical to its human counterparts. Key clinical message: This report describes the rare case of calcifying aponeurotic fibroma on the paw in a dog. This is apparently the first case in the veterinary literature with identical clinical and pathological features to the human counterpart.


Fibrome aponévrotique calcifiant sur la patte chez un chien. Une chienne maltaise stérilisée âgée de 12 ans avec une masse ronde et ferme sur la partie dorsale de la patte arrière gauche et une masse cervicale a été amenée à la clinique. La masse de la patte était contiguë au tendon adjacent; il était composé de cellules mésenchymateuses néoplasiques et présentait des foyers de calcification dispersés avec une différenciation chondroïde au microscope. Les cellules néoplasiques étaient positives pour la vimentine et le S100, mais négatives pour la desmine et l'actine des muscles lisses. Les caractéristiques microscopiques et les résultats d'immunohistochimie étaient compatibles avec un fibrome aponévrotique calcifiant (CAF). La masse cervicale était composée de cellules polygonales formant des acini avec une anisocytose et une anisocaryose marquées et diagnostiquée comme un carcinome folliculaire de la thyroïde. Aucune récidive ou métastase n'est survenue au cours du suivi. À notre connaissance, il s'agit du premier cas de CAF canin avec des caractéristiques identiques à ses homologues humains.Message clinique clé :Ce rapport décrit le cas rare de fibrome aponévrotique calcifiant sur la patte chez un chien. C'est apparemment le premier cas dans la littérature vétérinaire avec des caractéristiques cliniques et pathologiques identiques à son homologue humain.(Traduit par Dr Serge Messier).


Assuntos
Calcinose , Doenças do Cão , Fibroma Ossificante , Fibroma , Neoplasias de Tecidos Moles , Animais , Calcinose/patologia , Calcinose/cirurgia , Calcinose/veterinária , Doenças do Cão/cirurgia , Cães , Feminino , Fibroma/patologia , Fibroma/cirurgia , Fibroma/veterinária , Fibroma Ossificante/veterinária , Neoplasias de Tecidos Moles/veterinária
9.
AJNR Am J Neuroradiol ; 43(3): 429-434, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35210276

RESUMO

BACKGROUND AND PURPOSE: The CTA "rim sign" has been proposed as an imaging marker of intraplaque hemorrhage in carotid plaques. This study sought to investigate such findings using histopathologic confirmation. MATERIALS AND METHODS: Included patients had CTA neck imaging <1 year before carotid endarterectomy. On imaging, luminal stenosis and the presence of adventitial (<2-mm peripheral) and "bulky" (≥2-mm) calcifications, total plaque thickness, soft-tissue plaque thickness, calcification thickness, and the presence of ulcerations were assessed. The rim sign was defined as the presence of adventitial calcifications with internal soft-tissue plaque of ≥2 mm in maximum thickness. Carotid endarterectomy specimens were assessed for both the presence and the proportional makeup of lipid material, intraplaque hemorrhage, and calcification. RESULTS: Sixty-seven patients were included. Twenty-three (34.3%) were women; the average age was 70.4 years. Thirty-eight (57.7%) plaques had a rim sign on imaging, with strong interobserver agreement (κ = 0.85). A lipid core was present in 64 (95.5%) plaques (average, 22.2% proportion of plaque composition); intraplaque hemorrhage was present in 52 (77.6%), making up, on average, 13.7% of the plaque composition. The rim sign was not associated with the presence of intraplaque hemorrhage (P = .11); however, it was associated with a greater proportion of intraplaque hemorrhage in a plaque (P = .049). The sensitivity and specificity of the rim sign for intraplaque hemorrhage were 61.5% and 60.0%, respectively. CONCLUSIONS: The rim sign is not associated with the presence of intraplaque hemorrhage on histology. However, it is associated with a higher proportion of hemorrhage within a plaque and therefore may be a biomarker of more severe intraplaque hemorrhage, if present.


Assuntos
Calcinose , Estenose das Carótidas , Endarterectomia das Carótidas , Placa Aterosclerótica , Idoso , Calcinose/patologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Hemorragia/complicações , Hemorragia/etiologia , Humanos , Lipídeos , Masculino , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem
10.
Cell Mol Life Sci ; 79(3): 146, 2022 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-35190902

RESUMO

Calcific aortic valve disease (CAVD) is a common valve disease characterized by the fibro-calcific remodeling of the aortic valves, which is an actively regulated process involving osteogenic differentiation of valvular interstitial cells (VICs). MicroRNA (miRNA) is an essential regulator in diverse biological processes in cells. The present study aimed to explore the role and mechanism of miR-22 in the osteogenic differentiation of VICs. The expression profile of osteogenesis-related miRNAs was first detected in aortic valve tissue from CAVD patients (n = 33) and healthy controls (n = 12). miR-22 was highly expressed in calcified valve tissues (P < 0.01), and the expression was positively correlated with the expression of OPN (rs = 0.820, P < 0.01) and Runx2 (rs = 0.563, P < 0.01) in VICs isolated from mild or moderately calcified valves. The sustained high expression of miR-22 was also validated in an in-vitro VICs osteogenic model. Adenovirus-mediated gain-of-function and loss-of-function experiments were then performed. Overexpression of miR-22 significantly accelerated the calcification process of VICs, manifested by significant increases in calcium deposition, alkaline phosphate activity, and expression of osteoblastic differentiation markers. Conversely, inhibition of miR-22 significantly negated the calcification process. Subsequently, calcium-binding protein 39 (CAB39) was identified as a target of miR-22. Overexpression of miR-22 significantly reduced the expression of CAB39 in VICs, leading to decreased catalytic activity of the CAB39-LKB1-STRAD complex, which, in turn, exacerbated changes in the AMPK-mTOR signaling pathway, and ultimately accelerated the calcification process. In addition, ROS generation and autophagic activity during VIC calcification were also regulated by miR-22/CAB39 pathway. These results indicate that miR-22 is an important accelerator of the osteogenic differentiation of VICs, and a potential therapeutic target in CAVD.


Assuntos
Estenose da Valva Aórtica/patologia , Valva Aórtica/patologia , Calcinose/patologia , Proteínas de Ligação ao Cálcio/metabolismo , Diferenciação Celular , MicroRNAs/genética , Osteogênese , Idoso , Valva Aórtica/metabolismo , Estenose da Valva Aórtica/genética , Estenose da Valva Aórtica/metabolismo , Calcinose/genética , Calcinose/metabolismo , Proteínas de Ligação ao Cálcio/genética , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Int J Med Sci ; 19(2): 242-256, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35165510

RESUMO

The paper displayed the pathological changes and relationships of the modified Mankin score, tidemark roughness and calcified cartilage (CC) thickness by extracorporeal shockwave therapy (ESWT) (0.25 mJ/ mm2 with 800 impulses) on different positions of the medial and lateral rat knee OA joint. After the experiments, the articular cartilage was assessed using histomorphometry, image analysis and statistical method. In the micro-CT analysis, ESWT on medial groups were better than lateral groups in the trabecular volume and trabecular number. The data showed a strong negative correlation between the modified Mankin score and tidemark roughness (r = -0.941; P < 0.001). In terms of the relationship of tidemark roughness with CC thickness, the medial and Sham groups showed a significant negative correlation (r = -0.788, P = 0.022). Additionally, the Euclidean distance derived from 3D scatter plot analysis was an indicator of chondropathic conditions, exhibiting a strong correlation with OA stage in the articular cartilage of the femur (r = 0.911, P < 0.001) and tibia (r = 0.890, P < 0.001) after ESWT. Principle component analysis (PCA) further demonstrated that ESWT applied to medial locations had a better outcome than treatment at lateral locations for knee OA by comparing with Sham and OA groups, and CC thickness was the most important factor affecting hyaline cartilage repair after ESWT.


Assuntos
Calcinose/patologia , Calcinose/terapia , Tratamento por Ondas de Choque Extracorpóreas , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/terapia , Animais , Calcinose/diagnóstico por imagem , Cartilagem Articular/patologia , Modelos Animais de Doenças , Articulação do Joelho/patologia , Osteoartrite do Joelho/diagnóstico por imagem , Ratos , Microtomografia por Raio-X
12.
J Investig Med ; 70(4): 907-913, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35074856

RESUMO

Calcific aortic valve disease (CAVD) is an active pathological process mediated by abnormal activation and transdifferentiation of valvular interstitial cells (VICs). The present study aims to investigate the function and underlying mechanism of the basic fibroblast growth factor (BFGF) on osteogenic differentiation of VICs. Porcine VICs cultured with osteogenic induction medium are supplemented with or without BFGF. Morphology of VICs is identified by fluorescein isothiocyanate-labeled phalloidin, the cell viability is assessed by the cell counting kit-8 method, and protein and mRNA expression level of osteogenic differentiation markers, including Runx2, osteopontin, and Sp7, are verified by western blot analysis and quantitative real-time PCR, respectively. RNA sequencing is used to identify changes in gene profiles. Alizarin Red S staining is used to measure calcium deposition. The results demonstrate that the content of calcium deposition and the expression level of osteogenic markers are downregulated by supplementing BFGF. Notch1 signaling pathway is extracted as a candidate target after bioinformatics analysis by RNA sequencing. The transfection of si-Notch1 abolishes the calcification inhibitory effect of BFGF. Taken together, our findings shed the light on the mechanism and potential therapeutics of BFGF for CAVD.


Assuntos
Estenose da Valva Aórtica , Calcinose , Animais , Valva Aórtica/metabolismo , Valva Aórtica/patologia , Estenose da Valva Aórtica/genética , Estenose da Valva Aórtica/metabolismo , Estenose da Valva Aórtica/patologia , Calcinose/genética , Calcinose/metabolismo , Calcinose/patologia , Cálcio/metabolismo , Células Cultivadas , Fator 2 de Crescimento de Fibroblastos/metabolismo , Fator 2 de Crescimento de Fibroblastos/farmacologia , Humanos , Osteogênese/genética , Receptor Notch1/metabolismo , Suínos
14.
Stroke ; 53(2): 370-378, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34983237

RESUMO

BACKGROUND AND PURPOSE: Incidence of ischemic stroke differs between men and women, with substantially higher rates in men. The underlying mechanism of this difference remains poorly understood but may be because of differences in carotid atherosclerosis. Using an in-depth imaging-based approach, we investigated differences between carotid plaque composition and morphology in male and female patients with stroke, taking into account differences in total plaque burden. Additionally, we investigated all possible within-artery combinations of plaque characteristics to explore differences between various plaque phenotypes. METHODS: We included 156 men and 68 women from the PARISK (Plaque At Risk) study, a prospective cohort study of patients with recent ischemic cerebrovascular symptoms and <70% ipsilateral carotid stenosis. Plaque characteristics (intraplaque hemorrhage [IPH], lipid-rich necrotic core [LRNC], calcifications, thin-or-ruptured fibrous cap, ulcerations, total plaque volume) were assessed with magnetic resonance imaging and multidetector-row computed tomography angiography. We used multivariable logistic and linear regression analyses to assess sex differences in plaque characteristics. RESULTS: We found significant difference in total plaque volume between men and women (ß=22.9 mm3 [95% CI, 15.4-30.5]; mean volume in men 1399±425 mm3, in women 1011±242 mm3). Additionally, men were more likely to have IPH (odds ratio [OR]=2.8 [95% CI, 1.3-6.3]; IPH proportion in men 49%, in women 16%) and LRNC (OR=2.4 [95% CI, 1.2-4.7]; LRNC proportion in men 73%, in women 41%) even after adjustment for total plaque volume. We found no sex-specific differences in plaque volume-corrected volumes of IPH, LRNC, and calcifications. In terms of coexistence of plaque characteristics, we found that men had more often a plaque with coexistence of calcifications, LRNC, and IPH (OR=2.7 [95% CI, 1.2-7.0]), with coexistence of thin-or-ruptured fibrous cap/ulcerations, LRNC, and IPH (OR=2.4 [95% CI, 1.1-5.9]), and with coexistence of all plaque characteristics (OR=3.0 [95% CI, 1.2-8.6]). CONCLUSIONS: In symptomatic patients with mild-to-moderate carotid stenosis, men are more likely to have a high-risk carotid plaque with IPH and LRNC than women, regardless of total plaque burden. Men also have more often a plaque with multiple vulnerable plaque components, which could comprise an even higher stroke risk. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01208025.


Assuntos
Estenose das Carótidas/epidemiologia , Estenose das Carótidas/patologia , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/patologia , Idoso , Isquemia Encefálica/etiologia , Calcinose/epidemiologia , Calcinose/patologia , Doenças das Artérias Carótidas/complicações , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/patologia , Estudos de Coortes , Angiografia por Tomografia Computadorizada , Efeitos Psicossociais da Doença , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose , Fenótipo , Estudos Prospectivos , Medição de Risco , Fatores Sexuais
15.
J Comput Assist Tomogr ; 46(1): 6-10, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35099130

RESUMO

OBJECTIVE: To evaluate the relationship between computed tomography (CT)-detected calcification patterns and Magnetic Resonance Imaging (MRI) enhancement as a surrogate for viability in untreated uterine leiomyomas. METHODS: We queried 2 university hospital databases to identify patients with: (1) at least 1 calcified leiomyoma on CT greater than 1 cm (2) contrast-enhanced MRI of the pelvis performed within 5 years of the CT, and (3) no prior history of uterine fibroid embolization (UFE). Computed tomography was used to analyze calcification pattern and contrast-enhanced MRI to analyze size and viability. RESULTS: There were 12,862 reports that fit the criteria. After exclusion, 50 patients with 74 calcified untreated leiomyomas were analyzed. Three calcification patterns were identified: rim (n = 22), diffuse (n = 9), and coarse either less than or greater than 50% (n = 43). Four of 22 (18%) of leiomyomas with rim calcification were viable. Three of 9 (33%) of leiomyomas with diffuse calcification were viable. All leiomyomas with coarse calcifications were viable, 43 of 43 (100%). CONCLUSIONS: Leiomyomas with coarse calcifications are viable, whereas the majority with rim or diffuse calcification are not. This information may be helpful when triaging symptomatic women to treatment.


Assuntos
Calcinose , Leiomioma , Neoplasias Uterinas , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/patologia , Feminino , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia , Útero/diagnóstico por imagem
16.
Clin Neurol Neurosurg ; 212: 107062, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34861470

RESUMO

PURPOSE: To report the safety and efficacy of posterolateral approach for thoracic disc herniation (TDH) via a consecutive clinical case series of 30 central thoracic disc herniations that were all operated through a posterolateral approach. METHODS: A retrospective review was conducted of all patients with symptomatic TDH who underwent surgical intervention from 2016 to 2021. A total of 23 patients comprising 30 central TDH were included in the study. Age, gender, location of the lesion, preoperative and post-operative Frankel and Nurick scores, surgical approach and instrumented vertebrae, and length of stay were recorded. FINDINGS: 23 patients with an average age of 62 were included in the study. 30 of the 32 symptomatic TDH were centrally located. 8/32 TDH were calcified while 24/32 TDH were non-calcified. Unilateral and bilateral transpedicular approach was used in the treatment of 12/32 and 10/32 disc herniations respectively. A transfacet-pedicle sparing approach was used in 10/32 disc herniations. 19/23 (82.6%) of the patients had improvement in Nurick score while 12/23 (52.2%) patients had improvement in their Frankel scores. The average length of stay was 4.5 days. No major complications were encountered. All patients underwent a short-segment instrumented construct with no need for revision surgery for thoracic disc herniation, worsening myelopathy, or instrumentation failure. CONCLUSIONS: 83% of the patients who underwent a transfacet or transpedicular decompression for the treatment of symptomatic TDH had improvement in their myelopathy with no neurological deterioration in any of the patients. Given the familiarity and low morbidity associated with a transfacet or transpedicular approach, posterolateral-based approaches remains an excellent alternative for surgical management of majority of the patients with thoracic disc herniations.


Assuntos
Descompressão Cirúrgica/métodos , Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Calcinose/patologia , Feminino , Humanos , Deslocamento do Disco Intervertebral/patologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Vértebras Torácicas/patologia
17.
Acta Radiol ; 63(5): 586-595, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-33887963

RESUMO

BACKGROUND: Mammographic features of calcifications on mammograms showing invasive breast cancer are associated with survival. Less is known about mammographic features and progression to invasive breast cancer among women treated for ductal carcinoma in situ (DCIS). PURPOSE: To investigate mammographic features of calcifications in screen-detected DCIS in women who later did and did not get diagnosed with invasive breast cancer. MATERIAL AND METHODS: This registry-based nested case-control study analyzed data from women with screen-detected DCIS in BreastScreen Norway, 1995-2016. Within this cohort of women with DCIS, those who were later diagnosed with invasive breast cancer (cases) were matched (1:2) to women who were not diagnosed with invasive breast cancer (controls) after their DCIS and by the end of 2016. Information on mammographic features were collected by a national radiological review, where screening mammograms were reviewed locally at each of the 16 breast centers in Norway. We used conditional logistic regression analysis to estimate associations between mammographic features of calcifications in the DCIS mammogram and the risk of subsequent invasive breast cancer. RESULTS: We found a higher risk of invasive breast cancer associated with fine linear branching (casting) morphology (odds ratio 20.0; 95% confidence interval [CI] 2.5-158.9) compared to fine linear or fine pleomorphic morphology. Regional or diffuse distribution showed an odds ratio of 2.8 (95% CI 1.0-8.2) compared to segmental or linear distribution. CONCLUSION: Mammographic features of calcifications in screen-detected DCIS were of influence on the risk of invasive breast cancer. Unfavorable characteristics of DCIS were fine linear branching morphology, and regional or diffuse distribution.


Assuntos
Neoplasias da Mama , Calcinose , Carcinoma Ductal de Mama , Carcinoma Intraductal não Infiltrante , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Calcinose/diagnóstico por imagem , Calcinose/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Estudos de Casos e Controles , Feminino , Humanos , Mamografia
18.
Acta Radiol ; 63(2): 222-231, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33497274

RESUMO

BACKGROUND: High-grade pineal region tumors are rare and heterogeneous types of primary central nervous system neoplasms; radiological differential diagnosis is challenging but it is important because it has a therapeutic relevance. PURPOSE: To discriminate among high-grade pineal region tumors by combining apparent diffusion coefficient (ADC) volumetric values and qualitative features in order to predict their histology. MATERIAL AND METHODS: Twenty-two patients with high-grade pineal region tumors were assessed by qualitative and quantitative analysis. Margins, T2-weighted signal intensity, contrast enhancement, hemorrhage, calcifications, different volumetric ADC fractions (ADCmean, ADCmax, ADCmin) were evaluated and were compared to the histopathologic findings (cell count and proliferation index). RESULTS: Our qualitative imaging data showed that only margins were different among different tumors and each tumor type showed peculiar age onset. ADCmean was found the best quantitative value to discriminate high-grade tumors of the pineal region. ADCmean correlated with proliferation index but not with cell count. ADCmean values were lower in tumors with higher proliferation rate and a significant difference in ADCmean values were found between germinomas and pineoblastomas, between germinomas and papillary tumors and between papillary tumors and pineoblastomas. Moreover, the cut-off value of 0.865 × 10-3 mm2/s for ADCmean (ADC mean threshold value) could differentiate germinoma from pineoblastomas with the best combination of sensitivity and specificity. CONCLUSION: The ADCmean value measured on the whole tumor, reflecting tumor proliferative activity, may be a practical and non-invasive marker for predicting tumor histology in high-grade pineal region lesions and might be useful in preoperative assessment.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Imagem de Difusão por Ressonância Magnética , Neuroimagem , Glândula Pineal/diagnóstico por imagem , Glândula Pineal/patologia , Adolescente , Adulto , Calcinose/diagnóstico por imagem , Calcinose/patologia , Proliferação de Células , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/patologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
19.
Virchows Arch ; 480(2): 415-423, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34432164

RESUMO

Calcifying pseudoneoplasm of neuroaxis (CAPNON) is a rare lesion of the central nervous system with uncertain histogenesis. We further explored phenotypic spectrum of the entity with respect to possible histogenesis. We collected 5 cases of CAPNONs, performed a detailed morphological assessment, and performed an extensive immunohistochemical analysis (EMA, progesterone receptors, MUC4, SSTR2A, cytokeratin AE1/3, cytokeratin 18, GFAP, neurofilaments, desmin, nestin, synaptophysin, S100 protein, SOX10, CD56, Podoplanin, SATB2, ERG, CD45, and CD163) to elucidate the histogenesis. Furthermore, we performed NGS analysis of one case. The clinical course was benign in all cases. All lesions showed extensively calcified matrix in multilobular arrangement, with a palisade of osteoblast-like cells. Characteristic fibrohyaline matrix was notable in 4/5 cases, while one case was myxoid with rod-like calcifications. Metaplastic lamellar bone was present in 4/5 cases and psammoma bodies were present in 2/5 cases. In 4/5 cases, areas of entrapped glial tissue were present. Expression of EMA was focally present in 3/5 cases, SSTR2A and nestin in 2/5 cases, and progesterone receptor in 2/5 cases in rare cells. We did not observe concomitant expression of EMA, SSTR2A, and progesterone receptor in the same cellular subsets. In one case, NGS showed multiple chromosomal alterations and missense mutation in PIK3CA, attributable to the admixed meningothelial population compatible with meningioma. In another case, biphasic proliferation with myoepithelial phenotype was present. The lesions showed no lineage-specific immunoprofile. Additional pathology was identified in two cases, furthermore suggestive of a possible reactive origin of the lesion.


Assuntos
Calcinose , Neoplasias Meníngeas , Meningioma , Calcinose/patologia , Humanos , Nestina , Receptores de Progesterona
20.
Virchows Arch ; 480(2): 425-432, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34480613

RESUMO

Native cardiac valves may undergo calcification in the setting of chronic injury, subsequently impeding normal valve structure and function. In the same setting, there may be evidence of metaplasia-specifically osseous metaplasia-with lamellar bone admixed with dystrophic calcification. In this study, the histologic features of 123 native aortic valves (identified from 1094 sequentially reviewed native valves of all types that included a total of 754 aortic valves) with osseous metaplasia are focused upon, as well as correlation with other histopathologic features, and clinical and echocardiographic findings. Osseous metaplasia was identified in aortic and significantly less frequently in mitral valves, and never in tricuspid or pulmonic valves. Notable observations included that osseous metaplasia in aortic valves were seen in patients with greater body mass index, and less commonly identified in patients with a history of autoimmune disease. Aortic valves with osseous metaplasia were more commonly tricuspid (as opposed to bicuspid), and with smaller aortic valve area and greater peak and mean gradients. The rate of osseous metaplasia in aortic valves increased with increasing degree of stenosis and decreasing degree of regurgitation. The rates of the presence of chondromatous metaplasia, smooth muscle, arterial vessels, capillary bed formation, chronic inflammation, and hemosiderin laden macrophages were greater in aortic valves with osseous metaplasia compared to valves without osseous metaplasia. Further investigation is required to determine potential physiologic and/or pathologic consequence of the presence of valvular osseous metaplasia.


Assuntos
Valva Aórtica , Calcinose , Valva Aórtica/anormalidades , Valva Aórtica/patologia , Calcinose/patologia , Humanos , Macrófagos/patologia , Metaplasia/patologia
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