暂无摘要。

BACKGROUND: To perform a detailed morphological analysis of the inorganic portion of two different clinical presentations of calcium-based deposits retrieved from subjects with SSc and identify a chemical dissolution of these deposits suitable for clinical use.
METHODS: Chemical analysis using Fourier Transform IR spectroscopy (\'FTIR\'), Raman microscopy, Powder X-Ray Diffraction (\'PXRD\'), and Transmission Electron Microscopy (\'TEM\') was undertaken of two distinct types of calcinosis deposits: paste and stone. Calcinosis sample titration with ethylenediaminetetraacetic acid (\'EDTA\') assessed the concentration at which the EDTA dissolved the calcinosis deposits in vitro.
RESULTS: FTIR spectra of the samples displayed peaks characteristic of hydroxyapatite, where signals attributable to the phosphate and carbonate ions were all identified. Polymorph characterization using Raman spectra were identical to a hydroxyapatite reference while the PXRD and electron diffraction patterns conclusively identified the mineral present as hydroxyapatite. TEM analysis showed differences of morphology between the samples. Rounded particles from stone samples were up to a few micron in size, while needle-like crystals from paste samples reached up to 0.5 µm in length. Calcium phosphate deposits were effectively dissolved with 3% aqueous solutions of EDTA, in vitro. Complete dissolution of both types of deposit was achieved in approximately 30 min using a molar ratio of EDTA/HAp of ≈ 300.
CONCLUSIONS: Stone and paste calcium-based deposits both comprise hydroxyapatite, but the constituent crystals vary in size and morphology. Hydroxyapatite is the only crystalline polymorph present in the SSc-related calcinosis deposits. Hydroxyapatite can be dissolved in vitro using a dosage of EDTA considered safe for clinical application. Further research is required to establish the optimal medium to develop the medical product, determine the protocol for clinical application, and to assess the effectiveness of EDTA for local treatment of dystrophic calcinosis.

Idiopathic basal ganglia calcification (IBGC), also known as Fahr\'s disease, is a rare neurological disorder characterized by metabolic, biochemical, neuroradiological, and neuropsychiatric alterations resulting from symmetrical and bilateral intracranial calcifications. In most cases, an autosomal dominant pattern of inheritance and genetic heterogeneity is observed. Neuropsychiatric symptoms with movement disorders account for 55% of the manifestations of this disease. In this report, we present the case of a 42-year-old Pakistani male who presented to the emergency department with a sudden onset of generalized tonic muscle contractions. His medical history revealed progressive cognitive impairment, and he had a history of taking oral calcium supplements. Initial laboratory investigations showed hypocalcemia with normal magnesium and phosphate levels, while his parathyroid hormone levels were low. The interictal electroencephalogram was normal, and CT imaging of the brain without contrast revealed bilateral symmetrical dense calcifications in the basal ganglia, thalami, periventricular area, corona radiata, centrum semiovale, and dentate nucleus of the cerebellum, suggestive of Fahr disease. Intravenous calcium gluconate was administered in the emergency department, leading to an improvement in the patient\'s symptoms. The diagnosis of IBGC with relevant symptoms was confirmed through laboratory values and characteristic features observed in the CT examination.

The neem tree (Azadirachta indica A.Juss.) contains a range of biologically active compounds-mainly triterpenoids produced in single secretory cells, which are distributed among all plant parts. Neem secretions are toxic to animal cells, triggering autolytic mechanisms that culminate in cell disruption. However, little is known about the self-toxicity of these secretions to the cells that produce them. We carried out an anatomical, histochemical, and ultrastructural investigation of neem\'s single secretory cells in the shoot apex and in young leaves. We evaluated the morphological changes as possible evidences of stress reactions to their own secretions. The subcellular apparatus involved in synthesis and compartmentation was consistent with hydrophilic and lipophilic secretions. Polymorphic plastids devoid of thylakoids and abundant smooth endoplasmic reticulum in the later stages of differentiation are comparable with previous reports on neem cotyledons with regard to terpenoid synthesis. However, secretions were compartmentalized within autophagic vacuoles and periplasmic spaces instead of in terpenoid vesicles. Cellular swelling, increased vesiculation, dilatation of endoplasmic reticulum cisternae, mitochondrial hypertrophy in the cristolysis process, autolytic vacuoles, and vacuolar degeneration culminating in protoplast autolysis are all consistent with early indications of autotoxicity. The signaling stress reaction mechanism was expressed as cytoplasmic deposits of calcium salt and by the expression of a 70-kDa heat-shock protein. The morphological and histochemical changes in the secreting cells are comparable with those described in animal cells exposed to neem oil. Our data provide evidence of cell damage and signaling reactions linked to these cells\' own secretions before autolysis.

The purpose of this case study is to describe the surgical treatment of idiopathic ulcerative cutaneous calcinosis or calcinosis cutis of the lower extremity. A 77-year-old Latin American female who reported no significant past medical history presented to our hospital\'s emergency department from her home complaining of worsening right lower extremity erythema, edema, increased temperature, and pain. It was noted that the patient presented with multiple cutaneous calcified nodules to bilateral lower extremities, which she stated has been present for approximately 40 years. At the time of evaluation, 1 of the nodules on the lateral aspect of the right lower extremity ulcerated and became infected with unknown etiology, which lead to cellulitis of this limb. Radiographic imaging studies of the bilateral lower extremities showed extensive sheetlike soft tissue calcification overlying the middle to distal lower extremities. Serology reports showed the patient was positive for rheumatoid factor, antinuclear antibodies, SS-A/Ro antibody, and SS-B/La antibody. Because of the evidence of frank purulence and cellulitic changes to the infected nodule, the patient was taken to surgery the following day for sharp debridement and biopsy of the site. Postoperatively, there were minimal signs of improved healing to the wound base, although there was evidence of decreased erythema and edema to the extremity after the initial debridement and biopsy. Four days after the initial surgical invention, the patient was taken for a second operative procedure, which included a wide excisional biopsy with application of acellular dermal matrix and negative-pressure therapy. It was during this secondary debridement that further calcified deposits were encountered and specimens were submitted to pathology. Pathologic examination diagnosed the submitted specimen as cutaneous calcinosis. At this time, the patient is currently undergoing local wound care of the soft tissue deficient to her right lower extremity with the assistance of negative-pressure wound therapy with biweekly clinical follow-up.

Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.

Calcinosis cutis is a rare presentation and not many cases have been reported especially of idiopathic type. We are reporting a case of idiopathic calcinosis cutis of lower limbs in a 33-year old female who presented to our clinic for multiple painless swellings over her lower limbs for the past six months, without any history of trauma or infection. We have decided to observe her condition on regular follow-up and conservative management.

We describe the bone scan and single-photon emission computed tomography/computed tomography findings in calcific tendinitis of the gluteus maximus and discuss its pathophysiology. Although this tendinopathy is mostly self-limiting, awareness of this disease is important for 2 reasons. First, it may explain acute hip symptoms in patients in the resorptive phase of the calcifications. Second, it should be considered as a differential diagnosis for bone scan hot spots in the vicinity of the gluteus maximus tendon and for cortical erosion seen in that region on X-rays or CT.

Cartilage growth plate is a natural template from both a biochemical and structural point of view and allows osteoblasts migration, proliferation, differentiation, and ultimately, bone formation. It is evolutionary adjusted to support bone formation within strictly defined spatial framework serving as an interesting model for studying more mechanistically aspects which might be important for specific scaffold-based bone tissue engineering strategies. Surprisingly little is known about the geometric features of this physiological template. To this purpose we analyzed cartilage growth plate from rat, mouse, and human costochondral junction and tibia. High-resolution X-ray tomography showed that pore size in the zone of provisional calcification was within 20 to 30 µm range and in the metaphysis in 35 to 50 µm range. The thickness of calcified longitudinal septa in zone of provisional calcification was 3 to 5 µm and in metaphysis 7 to 12 µm. The porosity varied from 84 to 88%. We observed that numerical values characteristic for cartilage growth plate were not significantly influenced by the species of origin, by the type of bone, or by age. In addition, electron microscopy of calcified fragments of longitudinal septa showed that the calcium aggregates were globular, connected with each other, and formed a shell covering cartilage matrix located within longitudinal septa.

The clinical and autopsy findings of a 66-year-old man with myocardial infarction complicated by reperfusion injury are described, highlighting the presence of large myocardium calcium deposits.