BackgroundMany patients treated with Vitamin K antagonists (VKA) for anticoagulation have concomitant vascular or valvular calcification. This meta-analysis aimed to evaluate a hypothesis that vascular and valvular calcification is a side-effect of VKA treatment.MethodsWe conducted a systematic literature search to identify studies that reported vascular or valvular calcification in patients treated with VKA. The associations between VKA use and calcification were analyzed with random-effects inverse variance models and reported as odds ratios (OR) and 95% confidence intervals (95% CI). In addition, univariate meta-regression analyses were utilized to identify any effect moderators.ResultsThirty-five studies were included (45,757 patients; 6,251 VKA users). The median follow-up was 2.3 years [interquartile range (IQR) of 1.2–4.0]; age 66.2 ± 3.6 years (mean ± SD); the majority of participants were males [77% (IQR: 72–95%)]. VKA use was associated with an increased OR for coronary artery calcification [1.21 (1.08, 1.36), p = 0.001], moderated by the duration of treatment [meta-regression coefficient B of 0.08 (0.03, 0.13), p = 0.0005]. Extra-coronary calcification affecting the aorta, carotid artery, breast artery, and arteries of lower extremities, was also increased in VKA treated patients [1.86 (1.43, 2.42), p < 0.00001] and moderated by the author-reported statistical adjustments of the effect estimates [B: −0.63 (−1.19, −0.08), p = 0.016]. The effect of VKA on the aortic valve calcification was significant [3.07 (1.90, 4.96), p < 0.00001]; however, these studies suffered from a high risk of publication bias.ConclusionVascular and valvular calcification are potential side effects of VKA. The clinical significance of these side effects on cardiovascular outcomes deserves further investigation.
Lung cancer is the leading cause of cancer-related death worldwide, with frequent metastases to the brain, liver, adrenal glands, and bone. The incidence of intraluminal small bowel metastases of the lung is extremely rare and poorly documented within the literature. Few case studies have been published since the late 1980s and early 1990s. However, little is known about this rare form of metastasis. Small bowel metastatic disease has atypical symptoms that mimic a variety of other diseases; as a result, signs and symptoms may be overlooked until the disease has progressed to a late stage. Signs of small bowel obstruction, symptomatic anemia, abdominal pain, and peritonitis are commonly reported signs and symptoms. Various modalities can be utilized for the workup of suspected small bowel metastasis, including positron emission tomography, computed tomography, and various forms of endoscopy. The prognosis for lung cancer patients with intestinal metastases is poor, with many only surviving months to a few years after diagnosis. Therefore, it is critical to consider small bowel masses as a differential diagnosis in a patient with primary lung cancer who demonstrates clinical signs consistent with symptomatic anemia secondary to gastrointestinal (GI) bleeding, peritonitis, or small bowel obstruction. We report an unusual case of intraluminal and fungating small bowel masses in a patient who had previously undergone lung resections and chemo-immunotherapy. She was diagnosed with non-small undifferentiated carcinoma with tumor necrosis over 12 years before disease recurrence in the bilateral lungs, right adrenal gland, bone, and small bowel. The discovery of the small bowel metastases occurred while undergoing treatment for advanced-stage disease. At this time, she completed chemo-immunotherapy and remained on maintenance immunotherapy. The patient also underwent a partial right adrenalectomy and radiotherapy to the right adrenal gland. Given that she was experiencing symptomatic anemia and further workup indicated that the GI masses were causing her anemia, she underwent palliative small bowel resection of the masses. The pathology results demonstrated that the masses originated from her primary lung cancer, confirming metastatic disease to the small bowel.
Applications such as sensors, batteries, and fuel cells have been improved through the use of highly porous aerogels when functional compounds are encapsulated within the aerogels. However, few reports on encapsulating proteins within sol-gels that are processed to form aerogels exist. A procedure for encapsulating cytochrome c (cyt. c) in silica (SiO 2 ) sol-gels that are supercritically processed to form bioaerogels with gas-phase activity for nitric oxide (NO) is presented. Cyt. c is added to a mixed silica sol under controlled protein concentration and buffer strength conditions. The sol mixture is then gelled and the liquid filling the gel pores is replaced through a series of solvent exchanges with liquid carbon dioxide. The carbon dioxide is brought to its critical point and vented off to form dry aerogels with cyt. c encapsulated inside. These bioaerogels are characterized with UV-visible spectroscopy and circular dichroism spectroscopy and can be used to detect the presence of gas-phase nitric oxide. The success of this procedure depends on regulating the cyt. c concentration and the buffer concentration and does not require other components such as metal nanoparticles. It may be possible to encapsulate other proteins using a similar approach making this procedure important for potential future bioanalytical device development.
Objective Cardiovascular disease (CVD) affects many individuals in the United States each year. It has many modifiable risk factors, such as hyperlipidemia and hypertension. Another risk factor is vascular calcification, which has been shown to be an independent risk factor in mortality in patients with CVD. Vascular calcification and the number of circulating low‐density lipoprotein (LDL) particles influence atherosclerotic plaque formation and progression. However, the interaction between calcification and atherosclerosis is not completely understood. Hypothesis We have previously shown that vascular calcification modifies the endothelial surface topology, thus altering the amount of wall shear stress (WSS) present against the arterial wall. Therefore, we hypothesize that more LDL particles will approximate near the arterial wall, specifically in areas exhibiting low WSS. We postulate that vascular calcification influences LDL particle accumulation near the arterial wall, hence contributing to the pathogenesis of atherosclerosis. Methods As previously reported, we created a Fluid Structure Interaction (FSI) model from abdominal aorta geometries that were reconstructed from micro‐CT images at 5.7 µm resolution. One geometry was from mico‐CT images of a mouse that were genetically modified to have microcalcifications within the subendothelial layer (affected). In contrast, a mouse that was not genetically modified served as the control aorta geometry (control). This FSI model considered a nonlinear structure and hyperplastic materials in a steady‐state phase. A Particle Tracing module was added to this model in COMSOL Multiphysics 5.6 (COMSOL Inc.). This allowed for the examination of the behavior of 2,100 LDL particles in relation to the rough and smooth surfaces of the affected and control aortas. Results The larger curvature of the affected aorta contained the greatest quantity of calcified lesions. This curvature demonstrated more LDL particles accumulating near the interior wall compared to the larger curvature of a healthy aorta. It was observed that the aorta with the calcified nodules experience a lower magnitude of WSS compared to the control aorta. It was observed that the particles clustered in areas that exhibited low WSS, ranging from less than 10 N/m2in the affected aorta. Conclusions Rougher surface topology of a calcified aorta illustrates a positive correlation with LDL particle accumulation in the areas of low WSS. This provides insight to how WSS and vascular calcification influence atherosclerotic plaque formation and progression based on the behavior of LDL particles in this model. Further work needs to be done to explore other material properties to better simulate and understand this interaction.
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