Arteriovenous fistula(AVF)calcification is a common complication in hemodialysis patients that leads to AVF dysfunction and decreases the AVF survival,but the mechanisms of AVF calcification,especially the role of hem...Arteriovenous fistula(AVF)calcification is a common complication in hemodialysis patients that leads to AVF dysfunction and decreases the AVF survival,but the mechanisms of AVF calcification,especially the role of hemodynamic changes in AVF calcification have not been fully investigated.In this study,a computational fluid dynamics(CFD)model was carried out based on AVF,at the distal anastomosis of the cephalic vein and radial artery,generated from a patient-specific computed tomography(CT)angiography and Doppler ultrasound image.Hemodynamic factors were considered to explore the mechanisms responsible for the initiation and progression of AVF calcification.Five stages in one cardiac cycle were chosen to be studied for the velocity field,pressure,time-averaged wall shear stress(TAWSS),and oscillatory shear index(OSI).Blood pressure was higher in the arteriovenous anastomosis,and variations of great amplitude of pressure were examined during the cardiac cycle.Blood pressure,transient shear stress,TAWSS,and OSI were higher in the arteriovenous anastomosis and at the bottom of expanded outflow vein,and these sites were highly consistent with the calcified areas shown on CT angiography.On the contrary,no calcification was found in sites where streamline was stable,blood pressure did not change dramatically,as well as TAWSS and OSI were lower.It was shown that AVF calcification was correlated with hemodynamic changes,which may contribute to further understanding the mechanisms of AVF calcification and providing scientific evidence to inform the optimization of surgical strategies and the development of personalized interventional measures in clinical contexts.展开更多
The effect of atorvastatin on warfarin-induced aortic medial calcification and systolic blood pressure （SBP） of rats induced by warfarin was studied. Thirty healthy and adult rats were randomly divided into Warfarin...The effect of atorvastatin on warfarin-induced aortic medial calcification and systolic blood pressure （SBP） of rats induced by warfarin was studied. Thirty healthy and adult rats were randomly divided into Warfarin group （n=10）, Atorvastatin group （n=10） and normal control group （n=10）. Caudal arterial pressure of rats was measured once a week, and 4 weeks later, aorta was obtained. Elastic fiber, collagen fiber and calcium accumulation in tunica media of cells were measured by Von Kossa staining. The results showed that warfarin treatment led to elevation of systolic blood pressure and aortic medial calcification. The chronic treatment also increased collagen, but decreased elastin in the aorta. However, the atorvastatin treatment had adverse effects. It was concluded that treatment with atorvastatin presented evidence of blood pressure lowing and calcification reducing. These data demonstrate that atorvastatin protected aortic media from warfarin-induced calcification and elevation of systolic blood pressure.展开更多
Aortic valve calcification is a common disease in the elderly, but its cellular and molecular mechanisms are not clear. In order to verify the hypothesis that Wnt/β-catenin signaling pathway is involved in the proces...Aortic valve calcification is a common disease in the elderly, but its cellular and molecular mechanisms are not clear. In order to verify the hypothesis that Wnt/β-catenin signaling pathway is involved in the process of calcification of aortic valve, porcine aortic valve interstitial cells（VICs） were isolated, cultured and stimulated with oxidized low density lipoprotein（ox-LDL） for 48 h to induce the differentiation of VICs into osteoblast-like cells. The key proteins and genes of Wnt/β-catenin signaling pathway, such as glycogen synthase kinase 3β（GSK-3β） and β-catenin, were detected by using Western blotting and real-time polymerase chain reaction（PCR）. The results showed that the VICs managed to differentiate into osteoblast-like cells after the stimulation with ox-LDL and the levels of proteins and genes of GSK-3β and β-catenin were increased significantly in VICs after stimulation for 48 h（P0.05）. It is suggested that Wnt/β-catenin signaling pathway may play a key role in the differentiation of VICs into osteoblast-like cells and make great contribution to aortic valve calcification.展开更多
Background: Arterial calcification is a predictive marker in patient on hemodialysis (HD), but the relationship between arterial calcification and calciprotein particles (CPPs) is unclear. Methods: We examined the eff...Background: Arterial calcification is a predictive marker in patient on hemodialysis (HD), but the relationship between arterial calcification and calciprotein particles (CPPs) is unclear. Methods: We examined the effects of ferric citrate hydrate (JTT-751) on CPP level and evaluated changes in aortic arch calcification (AoAC) grade in patients on maintenance HD (MHD). In total, 70 MHD patients were enrolled in the study and followed for 24 months. We measured serum CPP levels and fibroblast growth factor 23 (FGF 23) among propensity score-matched MHD patients. One group (n = 35) was treated with CaCO3 and the other (n = 35) was treated with ferric citrate hydrate (JTT-751). AoAC was assessed on chest-X rays. Eligible patients continued the same treatment. Results: All 70 patients completed the study. Serum CPP levels reduced in the JTT-751 group, but were not significantly different in the CaCO3 group. Among patients whose baseline AoAC score (AoACS) was ≤ 4 (median), median AoACS increased from 0 (0 - 3) to 3 (2 - 4) (p 3 group, median AoACS increased from 2 (0 - 2) to 3 (0 - 4) (p Conclusion: These results indicate that the administration of JTT-751 decreased serum CPP levels but did not inhibit AoAC progression in patients on MHD.展开更多
OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturb-ances after transcatheter aortic valve implantation(TAVI).METHODS We retrospectively analyze...OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturb-ances after transcatheter aortic valve implantation(TAVI).METHODS We retrospectively analyzed the preoperative clinical characteristics,electrocardiograms,contrast-enhanced mul-tidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017.Quantification of calcium volume was performed for each aortic cusp above(aortic valve)and below(left ventricular outflow tract,LVOT)the basal plane.Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block(BBB),transient and permanent atrioventricular block(tAVB,pAVB).RESULTS A total of 569 patients were included in the study.Six different prostheses were implanted(Edwards Sapien XT,n=162;Edwards Sapien 3,n=240;Medtronic CoreValve,n=27;Medtronic CoreValve Evolut R,n=21;Symetis Acurate,n=56;Sy-metis Acurate neo,n=63).The logistic regression analysis for BBB showed association with baseline left anterior hemiblock.The logistic regression for tAVB,found the prior valvuloplasty and the balloon post-dilatation associated with the outcome.Baseline left and right BBB,degree of oversizing,and LVOT calcification beneath the non-coronary cusp were associated with pAVB.Neither the prosthesis model,nor the use of a self-expandable prosthesis showed statistical significance with the above-men-tioned outcomes on univariate analysis.CONCLUSIONS LVOT calcification beneath the non-coronary cusp,baseline left anterior hemiblock,right BBB,balloon post-dilatation,prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI.Use of a self-expandable prosthesis may show a lower incidence of AVB,if applied in lower calcified aortic valves.展开更多
Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benef...Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benefit of antihypertensive drugs for CAVS.Methods Using genome-wide association studies(GWAS)summary statistics,we performed bidirectional two-sample univariable mendelian randomization(UVMR)to assess the causal associations of systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)with CAVS.Multivariable mendelian randomization(MVMR)was conducted to evaluate the direct effect of hypertension on CAVS,adjusting for confounders.Drug target mendelian randomization(MR)and summary-level MR(SMR)were used to estimate the effects of 12 classes of antihypertensive drugs and their target genes on CAVS risk.Inverse variance weighting was the primary MR method,with sensitivity analyses to validate results.Results UVMR showed SBP,DBP,and PP have causal effects on CAVS,with no significant reverse causality.MVMR confirmed the causality between hypertension and CAVS after adjusting for confounders.Drug-target MR analyses indicated that calcium channel blockers(CCBs),loop diuretics,and thiazide diuretics via SBP lowering exerted protective effects on CAVS risk.SMR analysis showed that the CCBs target gene CACNA2D2 and ARBs target gene AGTR1 were positively associated with CAVS risk,while diuretics target genes SLC12A5 and SLC12A1 were negatively associated with aortic stenosis risk.Conclusions Hypertension has a causal relationship with CAVS.Managing SBP in hypertensive patients with CCBs may prevent CAVS.ARBs might exert protective effects on CAVS independent of blood pressure reduction.The relationship between diuretics and CAVS is complex,with opposite effects through different mechanisms.展开更多
A simplified CaO-V_(2)O_(5)-MnO_(2) system was established to qualitatively and quantitatively investigate the transformation behavior of vanadates.The results demonstrated dynamic transformations between calcium vana...A simplified CaO-V_(2)O_(5)-MnO_(2) system was established to qualitatively and quantitatively investigate the transformation behavior of vanadates.The results demonstrated dynamic transformations between calcium vanadate and manganese vanadate as n(CaO)/n(V_(2)O_(5))/n(MnO_(2))ratios and roasting temperatures varied.When MnO_(2) was incrementally added with n(CaO)/n(V_(2)O_(5))of 2,some Ca_(2)V_(2)O_(7) converted to Mn_(2)V_(2)O_(7).The mass of vanadium as calcium vanadate consistently exceeded that as manganese vanadate.Conversely,when CaO was gradually added with n(MnO_(2))/n(V_(2)O_(5))of 2,Mn_(2)V_(2)O_(7) tended to transform into Ca_(2)V_(2)O_(7) and Ca3V2O8.The affinity of vanadium for calcium was higher compared that of vanadium for manganese.The specific type of calcium vanadate formed depended on both n(CaO)/n(V_(2)O_(5))/n(MnO_(2))values and roasting temperatures,while manganese vanadate remained predominantly as Mn_(2)V_(2)O_(7).The influence of roasting temperature on the conversion between calcium vanadate and manganese vanadate was minimal.At n(CaO)/n(V_(2)O_(5))/n(MnO_(2))of 2/1/2 and temperatures ranging from 650 to 850°C,the mass ratio of vanadium present as calcium vanadate to manganese vanadate stabilized at approximately 2.展开更多
Brain calcification is frequently detected by neuroimaging in patients with hereditary and nonhereditary disorders or in normal individuals with aging.Its prevalence ranges from approximately 1%in young people to over...Brain calcification is frequently detected by neuroimaging in patients with hereditary and nonhereditary disorders or in normal individuals with aging.Its prevalence ranges from approximately 1%in young people to over 20%in the elderly(Yamada et al.,2013),yet the underlying mechanisms of brain calcification remain poorly understood.Specifically,calcification in the basal ganglia is detected in approximately 5.5%-20%of CT scans in patients over 50 years old(Auffray-Calvier et al.,2020).展开更多
Objective:Methylmalonic acid(MMA)buildup has recently been suggested to contribute to the onset of both age-related conditions and cardiovascular disorders.This research was aimed at examining the link between MMA and...Objective:Methylmalonic acid(MMA)buildup has recently been suggested to contribute to the onset of both age-related conditions and cardiovascular disorders.This research was aimed at examining the link between MMA and abdominal aortic calcification(AAC).Methods:Data from the 2013–2014 National Health and Nutrition Examination Survey(NHANES)were analyzed.Serum MMA levels were determined through LC-MS/MS,and MMA levels 250 nmol/L or above were considered high.Dual-energy X-ray absorptiometry was used to assess the presence of AAC.Logistic regression analysis was performed after propensity score matching(PSM)to study the relationship between MMA and AAC.Results:A total of 2483 participants were involved in this study.To eliminate large differences between the AAC and non-AAC groups,1:1 PSM was performed.Logistic regression analysis indicated that participants with high MMA levels had a significantly greater likelihood of experiencing AAC than those with low MMA levels(OR:1.38,95%CI:1.01–1.90,P=0.046).No statistically interaction effects between AAC and BMI or the estimated glomerular filtration rate(eGFR)were observed in subgroup analyses.Conclusion:Our study indicated a significant association between high serum MMA levels and AAC incidence.展开更多
Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined ...Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of fol- low-up, 620 patients were treated by coronary stenting and 153 （7%） adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score 〈 400, AoAC showed an additive predictive value in detecting significant coronary artery disease （CAD）. A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.展开更多
Cardiac valve calcification is a common disease,especially among the elderly.Calcification can affect valve function and cause heart failure and sudden death(Adler et al.,2002).Aortic valve calcification is alsorelate...Cardiac valve calcification is a common disease,especially among the elderly.Calcification can affect valve function and cause heart failure and sudden death(Adler et al.,2002).Aortic valve calcification is alsorelated to arteriosclerosis and coronary heart disease(Rashedi et al.,2015).However,the origin of valve calcification is still unclear.This study characterized the展开更多
Aortic valve calcification disease (CAVD) is the most prevalent degenerative valve disease in humans, leading to significant morbidity and mortality. Despite its common occurrence, our understanding of the underlying ...Aortic valve calcification disease (CAVD) is the most prevalent degenerative valve disease in humans, leading to significant morbidity and mortality. Despite its common occurrence, our understanding of the underlying mechanisms remains incomplete, and available treatment options are limited and risky. A more comprehensive understanding of the biology of CAVD is essential to identify new therapeutic strategies. Animal models have played a crucial role in advancing our knowledge of CAVD and exploring potential treatments. However, these models have inherent limitations as they cannot fully replicate the complex physiological mechanisms of human CAVD. In this review, we examine various CAVD models ranging from pigs to mice, highlighting the unique characteristics of each model to enhance our understanding of CAVD. While these models offer valuable insights, they also have limitations and shortcomings. We propose that the guide wire model shows promise for future CAVD research, and streamlining the methodology could enhance our understanding and expand the research scope in this field.展开更多
Resource utilization of metallurgical solid waste is vital for the sustainable development of the steel industry in the context of“dual carbon.”The calcification-carbothermal reduction method was employed to extract...Resource utilization of metallurgical solid waste is vital for the sustainable development of the steel industry in the context of“dual carbon.”The calcification-carbothermal reduction method was employed to extract zinc and iron from electric furnace dust effectively.In this process,calcium oxide reacts with zinc ferrite to form dicalcium ferrite and zinc oxide,which further promotes the effective separation of zinc and iron.However,the addition of pure calcium oxide increases production costs for steel companies.Herein,a new process for dust removal and zinc recovery in electric furnaces has been developed,using electric furnace slag as a calcium agent and mineral trough ash as a reducing agent.Large amounts of dicalcium ferrate phases were detected in the carbothermal reduction products by steel slag synergistic calcification.The reaction mechanism was determined as ZnFe_(2)O_(4)+CaO→Ca_(2)Fe_(2)O_(5)+ZnO→Ca_(2)Fe_(2)O_(5)+Zn(g).Such a two-step reaction path indicated that steel slag can effectively promote the reduction and volatilization of zinc.The experimental optimal roasting parameters were determined as roasting temperature of 1150℃,roasting time of 45 min,calcium to zinc molar ratio of 1.1,and carbon to oxygen molar ratio of 0.8.The mass percentage of added steel slag was recorded as 21.83%,while that of mineral trough ash was 21.85%.Under these conditions,the zinc removal rate above 99%and the metallization rate of pellets of about 75.31%were achieved.Overall,the proposed method looks promising for future efficient separation of zinc and iron in industrial steel slag.展开更多
Background Coronary artery calcification(CAC),a hallmark of atherosclerosis,paradoxically associates with reduced cardiovascular risk under statin therapy despite accelerated calcification progression,prompting this s...Background Coronary artery calcification(CAC),a hallmark of atherosclerosis,paradoxically associates with reduced cardiovascular risk under statin therapy despite accelerated calcification progression,prompting this study to explore CAC metrics as potential mediators between statin use and major adverse cardiovascular events(MACE).Methods Clinical data of 246 hospitalized patients who underwent coronary computed tomography angiography(CCTA)at Guangdong Provincial People's Hospital from January 2023 to June 2023 were retrospectively analyzed.Linear regression was used to evaluate the relationship between statin use and CAC parameters.Multivariable Poisson regression models were applied to explore the associations of statin use and CAC parameters with MACE risk.A mediation analysis was performed to assess the role of CAC parameters in the statin-MACE relationship.Results Statin use was independently associated with increased calcification score(β=0.648,P<0.001),CAC volume(β=0.623,P<0.001),and calcified plaque proportion(β=0.606,P=0.002).Multivariable Poisson regression indicated that statin use significantly reduced MACE risk[incidence rate ratio(IRR):0.33,P=0.018],whereas calcification score(IRR:2.63,P=0.026)and CACvolume(IRR:2.66,P=0.044)were associated with elevated MACE risk;Calcified plaque proportion showed no significant association.Mediation analysis revealed that calcification score(β=0.035,P=0.021)and CAC volume(β=0.023,P=0.018)exerted masking effects,while calcified plaque proportion had no mediating role.Conclusions Calcification score and CACvolume demonstrated limited masking effects in the association between statin use and MACE.展开更多
Objective: To investigate the relationship between the expression levels of sKL and BSP and the calcification and prognosis of abdominal aorta in patients with HD. Methods: 130 patients with HD admitted to our hospita...Objective: To investigate the relationship between the expression levels of sKL and BSP and the calcification and prognosis of abdominal aorta in patients with HD. Methods: 130 patients with HD admitted to our hospital between January 2015 and June 2017 were selected as the research subjects;all patients were treated with Fresenius hemodialysis machine for intervention treatment;the expression levels of sKL and BSP in the patients' blood were monitored, and 30 mmonths were followed up The extent of calcification of the abdominal aorta and the quality of the prognosis of the patients were evaluated and the relationship between the expression levels of sKL and BSP and the calcification and prognosis of the abdominal aorta were analyzed. Results: The levels of sKL and BSP in the blood of patients with different degrees of abdominal aortic calcification were significantly different, and the differences were statistically significant (P <0.05). Among the patients with mild or no calcification, the levels of sKL and BSP were the highest in the blood and those in the death group were the lowest. The sKL level was significantly lower than the survival group, and the BSP level was significantly higher than the survival group, and the differences were statistically significant (P <0.05);the survival rate of patients with high sKL expression was significantly better than that of patients with low sKL expression, and the survival rate of low BSP expression was significantly better High expression in BSP;high sKL and low BSP are independent protective factors affecting abdominal aortic calcification and prognostic quality in HD patients (P <0.05);combined use of sKL and BSP in predicting the prognostic quality of HD patients is sensitive and specific Both are greater than 90%, and AUC> 0.90. Conclusions:High sKL and low BSP in the blood of HD patients are independent protective factors affecting abdominal aortic calcification and prognostic quality. The combined application of sKL and BSP can effectively predict the prognostic quality value of patients.展开更多
BACKGROUND Transarterial chemoembolization(TACE)is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma(HCC).Although it is rarely curative,complete radiological response can be achi...BACKGROUND Transarterial chemoembolization(TACE)is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma(HCC).Although it is rarely curative,complete radiological response can be achieved in selected patients,leading to prolonged survival.Post-treatment tumoral calcification is an uncom-mon imaging finding in HCC and is rarely reported after drug-eluting beads TACE(DEB-TACE).CASE SUMMARY Two patients with large,solitary HCCs(>5 cm)were treated with DEB-TACE,and both achieved complete radiological response after two treatment sessions.Approximately 1 year after DEB-TACE,imaging demonstrated progressive peripheral tumoral calcification.Over 6 years of follow-up,both patients remained in remission with preserved liver function.CONCLUSION These two cases highlight the potential for complete remission and long-term survival in selected patients with large HCC following DEB-TACE.The appearance of peripheral calcification may represent a late imaging marker of effective tumor necrosis and durable treatment response although prospective studies are warranted to clarify its prognostic value.展开更多
Vascular calcification is closely associated with cardiovascular-related mortality,particularly high-risk of occurring this disease is in patients suffering from hypertension.Vascular calcification involves the active...Vascular calcification is closely associated with cardiovascular-related mortality,particularly high-risk of occurring this disease is in patients suffering from hypertension.Vascular calcification involves the active deposition of calcium and other mineral substances in the vascular wall.In blood vessels,intimal calcification is related to atherosclerosis,whereas medial calcification is a non-occlusive process that increases vascular stiffness and reduces vascular compliance.In the valves,calcification of the leaflets can change the mechanical properties of the tissue and result in stenosis.Cardiovascular diseases are being lead significant health risk worldwide and its estimated 30%of deaths.Synthetic drugs can help in the treatment of cardiovascular disease but they have limited efficacy and carry substantial risks.High risk and narrow margin of safety of synthetic drugs growing our interest to explore the different plants with specific medicinal properties in treatment of different cardiovascular disorders including hypertension,atherosclerosis,cardiac arrest and heart failure.Plants like Daucus carota,Nerium oleander,Amaranthus,Terminalia arjuna,and Picrorhiza kurroa contain phytochemicals like tea flavonoids,polyphenols,plant sterols,and terpenoids that can prevent low density lipoprotein cholesterol oxidation,inhibit cholesterol synthesis and promote vasodilation.Researchers has identified many medicinal herbs and their chemical components that show potential in alleviating vascular calcification via antioxidant mechanisms.In this study,we briefly discuss the role of vascular calcification in the pathophysiology of cardiac diseases.Utilizing the efficacy of these natural molecules will lead to the development of new treatment methods for chronic heart disease associated with vascular calcification.展开更多
BACKGROUND Pathological calcification is a common feature of many diseases.Calcifying nanoparticles(CNPs)are considered potential inducers of this abnormal calcification,but their specific effects on bone marrow mesen...BACKGROUND Pathological calcification is a common feature of many diseases.Calcifying nanoparticles(CNPs)are considered potential inducers of this abnormal calcification,but their specific effects on bone marrow mesenchymal stem cells(BMSCs)remain unclear.BMSCs are key cells in bone formation and repair,and their aberrant apoptosis and calcification are closely related to disease progression.AIM To explore whether CNPs can induce apoptosis and calcification in BMSCs and analyzed the relationship between these processes.The differential effects of CNPs and nanoscale hydroxyapatites(nHAPs)in inducing apoptosis and calcification in BMSCs were also compared.METHODS CNPs obtained in the early stage were identified by electron microscopy and particle size analysis.BMSCs were cultured with various treatments,including different concentrations of nHAPs,CNPs[2 McFarland(MCF)turbidity,4 MCF,6 MCF],and a transforming growth factor(TGF)-βinhibitor(SB431542)for 72 hours.The isolated CNPs exhibited the expected sizes and shapes.RESULTS Exposure to CNPs and nHAPs suppressed cell proliferation and promoted apoptosis in a concentration-dependent manner,with CNPs exhibiting significantly stronger effects.Alizarin Red staining indicated an increase in calcium deposition with exposure to increasing concentrations of nHAPs and CNPs.Quantitative reverse-transcription polymerase chain reaction results indicated that medium concentrations of nHAPs and CNPs significantly enhanced the expression of pro-apoptotic and pro-calcification markers,whereas the expression of anti-apoptotic Bcl-2 was reduced compared with untreated controls.Western blotting results showed that medium concentrations of CNPs and nHAPs increased the expression of osteopontin,bone morphogenetic protein-2,TGF-β/Smad,Bax,and caspase-3 and decreased Bcl-2 expression compared with controls.CONCLUSION CNPs and nHAPs induced apoptosis and calcification in BMSCs,with CNPs being the most potent.Additionally,the TGF-βinhibitor SB431542 significantly reduced the occurrence of apoptosis and calcification.A correlation was found between apoptosis and calcification,which is likely mediated through the TGF-β/Smad signaling pathway.展开更多
Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances ...Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances in imaging and surgical techniques,ASE has high morbidity and mortality rates,particularly when diagnosis or intervention is delayed.Here,we report two patients admitted to our center to increase awareness among emergency physicians.展开更多
基金supported by the Scientific Program of Tianjin Municipal Education Commission(Natural Science,Grant No.2022KJ254)Science Foundation of the Second Hospital of Tianjin Medical University(Grant No.2021ydey05)Tianjin Municipal Health Commission Integrated Traditional Chinese and Western Medicine Project(Grant No.2021173).
文摘Arteriovenous fistula(AVF)calcification is a common complication in hemodialysis patients that leads to AVF dysfunction and decreases the AVF survival,but the mechanisms of AVF calcification,especially the role of hemodynamic changes in AVF calcification have not been fully investigated.In this study,a computational fluid dynamics(CFD)model was carried out based on AVF,at the distal anastomosis of the cephalic vein and radial artery,generated from a patient-specific computed tomography(CT)angiography and Doppler ultrasound image.Hemodynamic factors were considered to explore the mechanisms responsible for the initiation and progression of AVF calcification.Five stages in one cardiac cycle were chosen to be studied for the velocity field,pressure,time-averaged wall shear stress(TAWSS),and oscillatory shear index(OSI).Blood pressure was higher in the arteriovenous anastomosis,and variations of great amplitude of pressure were examined during the cardiac cycle.Blood pressure,transient shear stress,TAWSS,and OSI were higher in the arteriovenous anastomosis and at the bottom of expanded outflow vein,and these sites were highly consistent with the calcified areas shown on CT angiography.On the contrary,no calcification was found in sites where streamline was stable,blood pressure did not change dramatically,as well as TAWSS and OSI were lower.It was shown that AVF calcification was correlated with hemodynamic changes,which may contribute to further understanding the mechanisms of AVF calcification and providing scientific evidence to inform the optimization of surgical strategies and the development of personalized interventional measures in clinical contexts.
文摘The effect of atorvastatin on warfarin-induced aortic medial calcification and systolic blood pressure （SBP） of rats induced by warfarin was studied. Thirty healthy and adult rats were randomly divided into Warfarin group （n=10）, Atorvastatin group （n=10） and normal control group （n=10）. Caudal arterial pressure of rats was measured once a week, and 4 weeks later, aorta was obtained. Elastic fiber, collagen fiber and calcium accumulation in tunica media of cells were measured by Von Kossa staining. The results showed that warfarin treatment led to elevation of systolic blood pressure and aortic medial calcification. The chronic treatment also increased collagen, but decreased elastin in the aorta. However, the atorvastatin treatment had adverse effects. It was concluded that treatment with atorvastatin presented evidence of blood pressure lowing and calcification reducing. These data demonstrate that atorvastatin protected aortic media from warfarin-induced calcification and elevation of systolic blood pressure.
基金supported by the National Natural Science Foundation of China(No.81070190)
文摘Aortic valve calcification is a common disease in the elderly, but its cellular and molecular mechanisms are not clear. In order to verify the hypothesis that Wnt/β-catenin signaling pathway is involved in the process of calcification of aortic valve, porcine aortic valve interstitial cells（VICs） were isolated, cultured and stimulated with oxidized low density lipoprotein（ox-LDL） for 48 h to induce the differentiation of VICs into osteoblast-like cells. The key proteins and genes of Wnt/β-catenin signaling pathway, such as glycogen synthase kinase 3β（GSK-3β） and β-catenin, were detected by using Western blotting and real-time polymerase chain reaction（PCR）. The results showed that the VICs managed to differentiate into osteoblast-like cells after the stimulation with ox-LDL and the levels of proteins and genes of GSK-3β and β-catenin were increased significantly in VICs after stimulation for 48 h（P0.05）. It is suggested that Wnt/β-catenin signaling pathway may play a key role in the differentiation of VICs into osteoblast-like cells and make great contribution to aortic valve calcification.
文摘Background: Arterial calcification is a predictive marker in patient on hemodialysis (HD), but the relationship between arterial calcification and calciprotein particles (CPPs) is unclear. Methods: We examined the effects of ferric citrate hydrate (JTT-751) on CPP level and evaluated changes in aortic arch calcification (AoAC) grade in patients on maintenance HD (MHD). In total, 70 MHD patients were enrolled in the study and followed for 24 months. We measured serum CPP levels and fibroblast growth factor 23 (FGF 23) among propensity score-matched MHD patients. One group (n = 35) was treated with CaCO3 and the other (n = 35) was treated with ferric citrate hydrate (JTT-751). AoAC was assessed on chest-X rays. Eligible patients continued the same treatment. Results: All 70 patients completed the study. Serum CPP levels reduced in the JTT-751 group, but were not significantly different in the CaCO3 group. Among patients whose baseline AoAC score (AoACS) was ≤ 4 (median), median AoACS increased from 0 (0 - 3) to 3 (2 - 4) (p 3 group, median AoACS increased from 2 (0 - 2) to 3 (0 - 4) (p Conclusion: These results indicate that the administration of JTT-751 decreased serum CPP levels but did not inhibit AoAC progression in patients on MHD.
文摘OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturb-ances after transcatheter aortic valve implantation(TAVI).METHODS We retrospectively analyzed the preoperative clinical characteristics,electrocardiograms,contrast-enhanced mul-tidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017.Quantification of calcium volume was performed for each aortic cusp above(aortic valve)and below(left ventricular outflow tract,LVOT)the basal plane.Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block(BBB),transient and permanent atrioventricular block(tAVB,pAVB).RESULTS A total of 569 patients were included in the study.Six different prostheses were implanted(Edwards Sapien XT,n=162;Edwards Sapien 3,n=240;Medtronic CoreValve,n=27;Medtronic CoreValve Evolut R,n=21;Symetis Acurate,n=56;Sy-metis Acurate neo,n=63).The logistic regression analysis for BBB showed association with baseline left anterior hemiblock.The logistic regression for tAVB,found the prior valvuloplasty and the balloon post-dilatation associated with the outcome.Baseline left and right BBB,degree of oversizing,and LVOT calcification beneath the non-coronary cusp were associated with pAVB.Neither the prosthesis model,nor the use of a self-expandable prosthesis showed statistical significance with the above-men-tioned outcomes on univariate analysis.CONCLUSIONS LVOT calcification beneath the non-coronary cusp,baseline left anterior hemiblock,right BBB,balloon post-dilatation,prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI.Use of a self-expandable prosthesis may show a lower incidence of AVB,if applied in lower calcified aortic valves.
基金supported by the National Natural Science Foundation of China(82170375,U23A20395)1.3.5 project for disciplines of excellence from West China Hospital of Sichuan University(ZYGD23021,23HXF-H009)Sichuan Science and Technology Program 2023NSFSC1645。
文摘Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benefit of antihypertensive drugs for CAVS.Methods Using genome-wide association studies(GWAS)summary statistics,we performed bidirectional two-sample univariable mendelian randomization(UVMR)to assess the causal associations of systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)with CAVS.Multivariable mendelian randomization(MVMR)was conducted to evaluate the direct effect of hypertension on CAVS,adjusting for confounders.Drug target mendelian randomization(MR)and summary-level MR(SMR)were used to estimate the effects of 12 classes of antihypertensive drugs and their target genes on CAVS risk.Inverse variance weighting was the primary MR method,with sensitivity analyses to validate results.Results UVMR showed SBP,DBP,and PP have causal effects on CAVS,with no significant reverse causality.MVMR confirmed the causality between hypertension and CAVS after adjusting for confounders.Drug-target MR analyses indicated that calcium channel blockers(CCBs),loop diuretics,and thiazide diuretics via SBP lowering exerted protective effects on CAVS risk.SMR analysis showed that the CCBs target gene CACNA2D2 and ARBs target gene AGTR1 were positively associated with CAVS risk,while diuretics target genes SLC12A5 and SLC12A1 were negatively associated with aortic stenosis risk.Conclusions Hypertension has a causal relationship with CAVS.Managing SBP in hypertensive patients with CCBs may prevent CAVS.ARBs might exert protective effects on CAVS independent of blood pressure reduction.The relationship between diuretics and CAVS is complex,with opposite effects through different mechanisms.
基金finally supported by the National Natural Science Foundation of China (Nos.52204309,52174277,52374300)。
文摘A simplified CaO-V_(2)O_(5)-MnO_(2) system was established to qualitatively and quantitatively investigate the transformation behavior of vanadates.The results demonstrated dynamic transformations between calcium vanadate and manganese vanadate as n(CaO)/n(V_(2)O_(5))/n(MnO_(2))ratios and roasting temperatures varied.When MnO_(2) was incrementally added with n(CaO)/n(V_(2)O_(5))of 2,some Ca_(2)V_(2)O_(7) converted to Mn_(2)V_(2)O_(7).The mass of vanadium as calcium vanadate consistently exceeded that as manganese vanadate.Conversely,when CaO was gradually added with n(MnO_(2))/n(V_(2)O_(5))of 2,Mn_(2)V_(2)O_(7) tended to transform into Ca_(2)V_(2)O_(7) and Ca3V2O8.The affinity of vanadium for calcium was higher compared that of vanadium for manganese.The specific type of calcium vanadate formed depended on both n(CaO)/n(V_(2)O_(5))/n(MnO_(2))values and roasting temperatures,while manganese vanadate remained predominantly as Mn_(2)V_(2)O_(7).The influence of roasting temperature on the conversion between calcium vanadate and manganese vanadate was minimal.At n(CaO)/n(V_(2)O_(5))/n(MnO_(2))of 2/1/2 and temperatures ranging from 650 to 850°C,the mass ratio of vanadium present as calcium vanadate to manganese vanadate stabilized at approximately 2.
基金supported by the Natural Science Foundation of China(32270663 and 31230045 to J.Y.L.)China Postdoctoral Science Foundation(2024M762007 and GZB20240453 to J.L.)Shanghai Municipal Science and Technology Major Project(2018SHZDZX05 to J.Y.L.).
文摘Brain calcification is frequently detected by neuroimaging in patients with hereditary and nonhereditary disorders or in normal individuals with aging.Its prevalence ranges from approximately 1%in young people to over 20%in the elderly(Yamada et al.,2013),yet the underlying mechanisms of brain calcification remain poorly understood.Specifically,calcification in the basal ganglia is detected in approximately 5.5%-20%of CT scans in patients over 50 years old(Auffray-Calvier et al.,2020).
文摘Objective:Methylmalonic acid(MMA)buildup has recently been suggested to contribute to the onset of both age-related conditions and cardiovascular disorders.This research was aimed at examining the link between MMA and abdominal aortic calcification(AAC).Methods:Data from the 2013–2014 National Health and Nutrition Examination Survey(NHANES)were analyzed.Serum MMA levels were determined through LC-MS/MS,and MMA levels 250 nmol/L or above were considered high.Dual-energy X-ray absorptiometry was used to assess the presence of AAC.Logistic regression analysis was performed after propensity score matching(PSM)to study the relationship between MMA and AAC.Results:A total of 2483 participants were involved in this study.To eliminate large differences between the AAC and non-AAC groups,1:1 PSM was performed.Logistic regression analysis indicated that participants with high MMA levels had a significantly greater likelihood of experiencing AAC than those with low MMA levels(OR:1.38,95%CI:1.01–1.90,P=0.046).No statistically interaction effects between AAC and BMI or the estimated glomerular filtration rate(eGFR)were observed in subgroup analyses.Conclusion:Our study indicated a significant association between high serum MMA levels and AAC incidence.
文摘Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of fol- low-up, 620 patients were treated by coronary stenting and 153 （7%） adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score 〈 400, AoAC showed an additive predictive value in detecting significant coronary artery disease （CAD）. A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.
基金supported by the National Natural Science Foundation of China(Grant NO.40972210,41272048)
文摘Cardiac valve calcification is a common disease,especially among the elderly.Calcification can affect valve function and cause heart failure and sudden death(Adler et al.,2002).Aortic valve calcification is alsorelated to arteriosclerosis and coronary heart disease(Rashedi et al.,2015).However,the origin of valve calcification is still unclear.This study characterized the
文摘Aortic valve calcification disease (CAVD) is the most prevalent degenerative valve disease in humans, leading to significant morbidity and mortality. Despite its common occurrence, our understanding of the underlying mechanisms remains incomplete, and available treatment options are limited and risky. A more comprehensive understanding of the biology of CAVD is essential to identify new therapeutic strategies. Animal models have played a crucial role in advancing our knowledge of CAVD and exploring potential treatments. However, these models have inherent limitations as they cannot fully replicate the complex physiological mechanisms of human CAVD. In this review, we examine various CAVD models ranging from pigs to mice, highlighting the unique characteristics of each model to enhance our understanding of CAVD. While these models offer valuable insights, they also have limitations and shortcomings. We propose that the guide wire model shows promise for future CAVD research, and streamlining the methodology could enhance our understanding and expand the research scope in this field.
基金the support from Graduate Student Scientific Research Innovation Projects in Jiangsu Province(KYCX22_3804)Natural Science Foundation of Jiangsu Province(No.BK20210888).
文摘Resource utilization of metallurgical solid waste is vital for the sustainable development of the steel industry in the context of“dual carbon.”The calcification-carbothermal reduction method was employed to extract zinc and iron from electric furnace dust effectively.In this process,calcium oxide reacts with zinc ferrite to form dicalcium ferrite and zinc oxide,which further promotes the effective separation of zinc and iron.However,the addition of pure calcium oxide increases production costs for steel companies.Herein,a new process for dust removal and zinc recovery in electric furnaces has been developed,using electric furnace slag as a calcium agent and mineral trough ash as a reducing agent.Large amounts of dicalcium ferrate phases were detected in the carbothermal reduction products by steel slag synergistic calcification.The reaction mechanism was determined as ZnFe_(2)O_(4)+CaO→Ca_(2)Fe_(2)O_(5)+ZnO→Ca_(2)Fe_(2)O_(5)+Zn(g).Such a two-step reaction path indicated that steel slag can effectively promote the reduction and volatilization of zinc.The experimental optimal roasting parameters were determined as roasting temperature of 1150℃,roasting time of 45 min,calcium to zinc molar ratio of 1.1,and carbon to oxygen molar ratio of 0.8.The mass percentage of added steel slag was recorded as 21.83%,while that of mineral trough ash was 21.85%.Under these conditions,the zinc removal rate above 99%and the metallization rate of pellets of about 75.31%were achieved.Overall,the proposed method looks promising for future efficient separation of zinc and iron in industrial steel slag.
文摘Background Coronary artery calcification(CAC),a hallmark of atherosclerosis,paradoxically associates with reduced cardiovascular risk under statin therapy despite accelerated calcification progression,prompting this study to explore CAC metrics as potential mediators between statin use and major adverse cardiovascular events(MACE).Methods Clinical data of 246 hospitalized patients who underwent coronary computed tomography angiography(CCTA)at Guangdong Provincial People's Hospital from January 2023 to June 2023 were retrospectively analyzed.Linear regression was used to evaluate the relationship between statin use and CAC parameters.Multivariable Poisson regression models were applied to explore the associations of statin use and CAC parameters with MACE risk.A mediation analysis was performed to assess the role of CAC parameters in the statin-MACE relationship.Results Statin use was independently associated with increased calcification score(β=0.648,P<0.001),CAC volume(β=0.623,P<0.001),and calcified plaque proportion(β=0.606,P=0.002).Multivariable Poisson regression indicated that statin use significantly reduced MACE risk[incidence rate ratio(IRR):0.33,P=0.018],whereas calcification score(IRR:2.63,P=0.026)and CACvolume(IRR:2.66,P=0.044)were associated with elevated MACE risk;Calcified plaque proportion showed no significant association.Mediation analysis revealed that calcification score(β=0.035,P=0.021)and CAC volume(β=0.023,P=0.018)exerted masking effects,while calcified plaque proportion had no mediating role.Conclusions Calcification score and CACvolume demonstrated limited masking effects in the association between statin use and MACE.
文摘Objective: To investigate the relationship between the expression levels of sKL and BSP and the calcification and prognosis of abdominal aorta in patients with HD. Methods: 130 patients with HD admitted to our hospital between January 2015 and June 2017 were selected as the research subjects;all patients were treated with Fresenius hemodialysis machine for intervention treatment;the expression levels of sKL and BSP in the patients' blood were monitored, and 30 mmonths were followed up The extent of calcification of the abdominal aorta and the quality of the prognosis of the patients were evaluated and the relationship between the expression levels of sKL and BSP and the calcification and prognosis of the abdominal aorta were analyzed. Results: The levels of sKL and BSP in the blood of patients with different degrees of abdominal aortic calcification were significantly different, and the differences were statistically significant (P <0.05). Among the patients with mild or no calcification, the levels of sKL and BSP were the highest in the blood and those in the death group were the lowest. The sKL level was significantly lower than the survival group, and the BSP level was significantly higher than the survival group, and the differences were statistically significant (P <0.05);the survival rate of patients with high sKL expression was significantly better than that of patients with low sKL expression, and the survival rate of low BSP expression was significantly better High expression in BSP;high sKL and low BSP are independent protective factors affecting abdominal aortic calcification and prognostic quality in HD patients (P <0.05);combined use of sKL and BSP in predicting the prognostic quality of HD patients is sensitive and specific Both are greater than 90%, and AUC> 0.90. Conclusions:High sKL and low BSP in the blood of HD patients are independent protective factors affecting abdominal aortic calcification and prognostic quality. The combined application of sKL and BSP can effectively predict the prognostic quality value of patients.
文摘BACKGROUND Transarterial chemoembolization(TACE)is a widely accepted palliative therapy modality for unresectable hepatocellular carcinoma(HCC).Although it is rarely curative,complete radiological response can be achieved in selected patients,leading to prolonged survival.Post-treatment tumoral calcification is an uncom-mon imaging finding in HCC and is rarely reported after drug-eluting beads TACE(DEB-TACE).CASE SUMMARY Two patients with large,solitary HCCs(>5 cm)were treated with DEB-TACE,and both achieved complete radiological response after two treatment sessions.Approximately 1 year after DEB-TACE,imaging demonstrated progressive peripheral tumoral calcification.Over 6 years of follow-up,both patients remained in remission with preserved liver function.CONCLUSION These two cases highlight the potential for complete remission and long-term survival in selected patients with large HCC following DEB-TACE.The appearance of peripheral calcification may represent a late imaging marker of effective tumor necrosis and durable treatment response although prospective studies are warranted to clarify its prognostic value.
文摘Vascular calcification is closely associated with cardiovascular-related mortality,particularly high-risk of occurring this disease is in patients suffering from hypertension.Vascular calcification involves the active deposition of calcium and other mineral substances in the vascular wall.In blood vessels,intimal calcification is related to atherosclerosis,whereas medial calcification is a non-occlusive process that increases vascular stiffness and reduces vascular compliance.In the valves,calcification of the leaflets can change the mechanical properties of the tissue and result in stenosis.Cardiovascular diseases are being lead significant health risk worldwide and its estimated 30%of deaths.Synthetic drugs can help in the treatment of cardiovascular disease but they have limited efficacy and carry substantial risks.High risk and narrow margin of safety of synthetic drugs growing our interest to explore the different plants with specific medicinal properties in treatment of different cardiovascular disorders including hypertension,atherosclerosis,cardiac arrest and heart failure.Plants like Daucus carota,Nerium oleander,Amaranthus,Terminalia arjuna,and Picrorhiza kurroa contain phytochemicals like tea flavonoids,polyphenols,plant sterols,and terpenoids that can prevent low density lipoprotein cholesterol oxidation,inhibit cholesterol synthesis and promote vasodilation.Researchers has identified many medicinal herbs and their chemical components that show potential in alleviating vascular calcification via antioxidant mechanisms.In this study,we briefly discuss the role of vascular calcification in the pathophysiology of cardiac diseases.Utilizing the efficacy of these natural molecules will lead to the development of new treatment methods for chronic heart disease associated with vascular calcification.
基金Supported by the Project of Xinjiang Production and Construction Corps,No.2022ZD090the Project of Xinjiang Production and Construction Corps-Young Science and Technology Innovation Talents,No.2023CB008-31+2 种基金The First Affiliated Hospital of Shihezi University Medical College,Doctoral Fund Project,No.BS202207Talent Development Fund-Tianshan Talents,No.CZ0012192024 National Health Commission Central Asian High-Incidence Prevention and Control Key Laboratory,No.KF202405.
文摘BACKGROUND Pathological calcification is a common feature of many diseases.Calcifying nanoparticles(CNPs)are considered potential inducers of this abnormal calcification,but their specific effects on bone marrow mesenchymal stem cells(BMSCs)remain unclear.BMSCs are key cells in bone formation and repair,and their aberrant apoptosis and calcification are closely related to disease progression.AIM To explore whether CNPs can induce apoptosis and calcification in BMSCs and analyzed the relationship between these processes.The differential effects of CNPs and nanoscale hydroxyapatites(nHAPs)in inducing apoptosis and calcification in BMSCs were also compared.METHODS CNPs obtained in the early stage were identified by electron microscopy and particle size analysis.BMSCs were cultured with various treatments,including different concentrations of nHAPs,CNPs[2 McFarland(MCF)turbidity,4 MCF,6 MCF],and a transforming growth factor(TGF)-βinhibitor(SB431542)for 72 hours.The isolated CNPs exhibited the expected sizes and shapes.RESULTS Exposure to CNPs and nHAPs suppressed cell proliferation and promoted apoptosis in a concentration-dependent manner,with CNPs exhibiting significantly stronger effects.Alizarin Red staining indicated an increase in calcium deposition with exposure to increasing concentrations of nHAPs and CNPs.Quantitative reverse-transcription polymerase chain reaction results indicated that medium concentrations of nHAPs and CNPs significantly enhanced the expression of pro-apoptotic and pro-calcification markers,whereas the expression of anti-apoptotic Bcl-2 was reduced compared with untreated controls.Western blotting results showed that medium concentrations of CNPs and nHAPs increased the expression of osteopontin,bone morphogenetic protein-2,TGF-β/Smad,Bax,and caspase-3 and decreased Bcl-2 expression compared with controls.CONCLUSION CNPs and nHAPs induced apoptosis and calcification in BMSCs,with CNPs being the most potent.Additionally,the TGF-βinhibitor SB431542 significantly reduced the occurrence of apoptosis and calcification.A correlation was found between apoptosis and calcification,which is likely mediated through the TGF-β/Smad signaling pathway.
文摘Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances in imaging and surgical techniques,ASE has high morbidity and mortality rates,particularly when diagnosis or intervention is delayed.Here,we report two patients admitted to our center to increase awareness among emergency physicians.
