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PurposeT50 is a novel serum-based marker that assesses the propensity of calcification in serum. Shorter T50 indicates greater propensity to calcify and it has been associated to cardiovascular disease (CVD) and mortality among patients with kidney disease. In the general population, neither the correlates of T50 nor the relationships of T50 with bone mineral density (BMD) are known.MethodsWe performed a nested cross-sectional study selecting 150 individuals at random among participants from the Osteoporotic Fractures in Men (MrOS) Study, a study of community-living older men. We categorized individuals into tertiles of T50 and compared demographics and disease indicators across tertiles. We utilized linear regression to evaluate the cross-sectional association between T50 and hip and spine BMD in multivariable models.ResultsOlder age was associated with shorter T50. Kidney function tended to be lower in those with shorter T50 and the prevalence of CVD and peripheral arterial disease in those with shorter T50, albeit these findings did not achieve statistical significance. We found no statistically significant associations between T50 and total hip or total spine BMD in either unadjusted or multivariable adjusted models.ConclusionsT50, a novel indicator of serum calcification propensity, is not associated with BMD in community-living older men. Future larger studies should determine if T50 may give insights to CVD in the general population above and beyond traditional risk factors.

Background Cardiovascular complications are common in kidney transplant patients and calcification propensity of blood, measured as T 50 , is associated with cardiovascular outcomes. Paricalcitol supplementation affects calcium/phosphate homeostasis and may affect calcification propensity. To assess this hypothesis we measured T 50 in kidney transplant recipients participating in a randomized study comparing paricalcitol versus no treatment during the first year after kidney transplantation. Methods Stored serum samples from 76 kidney transplant recipients (paricalcitol n  = 37, no treatment n  = 39) were analyzed. Analyses were performed at inclusion (8 weeks after transplantation) and repeated one year after transplantation. Results There were no statistically significant differences in T 50 between the paricalcitol and placebo groups, neither at baseline ( p  = 0.56) nor at 1 year ( p  = 0.61). Also, there were no significant changes in T 50 over time in either group or when pooling all data ( p  <  0.20). In multivariate regression analysis, out of 16 potentially relevant covariates, comprising clinical and biochemical parameters, only plasma PTH and T 50 at baseline were significantly correlated to T 50 after one year. ( p  <  0.03 and p  < 0.01, respectively). Conclusions Calcium propensity measured as T 50 score remained unchanged with paricalcitol treatment in kidney transplant recipients, and was not changed over time during the study period of one year. Trial registration ClinicalTrials.gov, NCT01694160 , registered 23 September 2012.

This study aimed to compare the mid-term clinical outcomes of intravascular ultrasound (IVUS)-calcified nodules between percutaneous coronary intervention (PCI) with and without rotational atherectomy (RA). There has been a debate whether to use RA for the revascularization of calcified nodule. Although RA can ablate the calcified structure within calcified nodule and may facilitate adequate stent expansion, RA may provoke severe coronary perforation, because calcified nodule typically shows eccentric calcification. We included 204 lesions with IVUS-calcified nodule, and divided into 73 lesions treated with RA (RA group) and 131 lesions without RA (non-RA group). After propensity-score matching, 42 lesions with RA (matched RA group) and 42 lesions without RA (matched non-RA group) were selected. We compared the clinical characteristics and outcomes between the 2 groups before and after propensity-score matching. The primary endpoint was ischemia-driven target vessel revascularization (TVR) within 1 year. Acute lumen area gain on IVUS was comparable between the matched RA group and matched non-RA group (3.9 ± 2.1 mm2 vs. 3.4 ± 1.6 mm2, p = 0.18). The stent malapposition at calcified nodules was frequently observed in both groups. The ischemia-driven TVR was not different between the 2 groups before (p = 0.82) and after propensity score-matching (p = 0.87). The use of RA could not reduce the incidence of ischemia-driven TVR in lesions with IVUS-calcified nodule. Our results do not support the routine use of RA for lesions with IVUS-calcified nodule.

Coronary arteries in patients with chronic kidney disease (CKD) have been shown to exhibit more extensive atherosclerosis and calcium. We aimed to assess characteristics of coronary plaque in hemodialysis (HD)-dependent patients using optical coherence tomography (OCT). This was a multicenter, retrospective study of 124 patients with stable angina who underwent OCT imaging. Sixty-two HD-dependent patients who underwent pre-intervention OCT for coronary artery disease were compared 1:1 with a cohort of patients without CKD, matched for age, diabetes mellitus, gender, and culprit vessel. Baseline characteristics were comparable. Pre-intervention OCT imaging identified 62 paired culprit, 53 paired non-culprit, and 19 paired distal vessel lesions. Lesion length, minimum lumen area, and area stenosis were similar between groups. The HD-dependent group had greater mean calcium arcs in culprit (54.3° vs 26.4°, p = 0.004) and non-culprit lesions (34.3° vs 24.5°, p = 0.02) and greater maximum calcium arc in distal vessel segments (101.6° vs 0°, p = 0.03). There were no differences in lipid arcs between groups. There was a higher prevalence of thin intimal calcium, defined as an arc of calcium >30° within intima <0.5 mm thick, in patients in the HD-dependent group (41.9% vs 4.8%, p <0.001). There was a higher prevalence of calcified nodules in the HD-dependent group (24.2% vs 9.7%, p = 0.049) but no differences in medial calcification or thin-cap fibroatheroma. In conclusion, in this OCT study, HD-dependent patients, compared with matched patients without CKD, had more extensively distributed coronary calcium and uniquely, a higher prevalence of non-atherosclerotic thin intimal calcium. This thin intimal calcium may cause an overestimation of calcium burden by intravascular ultrasound and may contribute to the lack of correlation between increased coronary artery calcification scores with long-term outcomes in patients with CKD.

The association between aortic valve calcification (AVC) and cardiovascular (CV) events across diverse populations including patients with chronic kidney disease (CKD) remains controversial. This study aimed to determine whether AVC is associated with CV events in patients with CKD. In this prospective study, 1,279 participants with CKD were enrolled. A Cox proportional hazard model was applied to determine the association between AVC and CV events. The participants were divided into the following groups according to the number of calcified aortic cusps (CACs): no CACs ( n  = 922), one CAC ( n  = 209), and two to three CACs ( n  = 148). During a median follow-up of 2.9 years, CV events occurred in 185 participants. In multivariable Cox analyses, the hazard ratios (95% confidence intervals) of one CAC and two to three CACs for CV events compared with no CACs were 1.94 (1.32, 2.83) and 2.21 (1.46, 3.33), respectively. In a propensity score-matched cohort, participants with AVC ( n  = 284) had a significantly higher risk of CV events than those without AVC ( n  = 284). In CKD, the presence of AVC appears to be an independent risk factor for CV events, and the assessment of AVC is useful in predicting the prognosis.

This study aimed to compare the early and long-term postoperative outcomes of valve-sparing and Bio-Glue–reinforced non-valve-sparing aortic root replacement surgeries in patients diagnosed with aortic root aneurysms and/or aortic dissection. A total of 107 patients, aged 15 to 84, diagnosed with aortic root aneurysm and/or aortic dissection, underwent aortic root replacement using either the David procedure ( n  = 30) or the Bio-Glue–reinforced modified Bentall procedure ( n  = 77). All surgeries were performed by the same surgical team at a tertiary university hospital’s cardiovascular surgery clinic between April 2007 and April 2018. The patients’ preoperative characteristics, early postoperative outcomes, and long-term results were retrospectively reviewed. Further analyses were conducted after propensity-score matching to evaluate survival outcomes. Among the 30 patients who underwent the David procedure, 4 required reoperation due to aortic insufficiency (13.3%). In contrast, no reoperation was required in the Bentall group due to aortic valve pathology ( p  = 0.001). Survival analysis showed similar 30-day survival rates between the groups; however, after propensity-score matching, the Bentall group demonstrated significantly higher long-term survival compared to the David group (96.7 vs. 76.7%, p  = 0.005). Valve-sparing techniques, such as the David procedure, have a higher reoperation rate compared to non-valve-sparing techniques like the modified Bentall procedure. While the valve-sparing David procedure achieves good outcomes, the Bio-Glue–reinforced modified Bentall procedure should be recognized for its comparable and potentially superior long-term survival outcomes.

Since beta-2 microglobulin (B2M) is a surrogate marker for middle molecular weight uremic toxins and the major protein component in dialysis-related amyloidosis, it has been frequently studied in dialysis patients. It is not known, however, whether B2M has an impact in patients with chronic kidney disease (CKD) not yet on dialysis. Here we studied the relationship of plasma B2M levels to clinical and cardiovascular outcomes in 142 patients (mean age of 67 years) at different stages of CKD. B2M levels increased with CKD stage and thus were highest in hemodialysis patients. Baseline B2M levels were associated with vascular calcification but not with arterial stiffness or bone density. During a mean follow-up of 969 days, 44 patients died and 49 suffered a cardiovascular event. Higher B2M levels were independently associated with overall and cardiovascular mortality and cardiovascular events in the whole cohort and with cardiovascular events in the predialysis cohort. Moreover, B2M appeared to be a better predictor than well-established factors associated with outcomes in this population, such as estimated glomerular filtration rate ((eGFR), only for predialysis patients), inflammation biomarkers, and other factors included in a propensity score. Thus, we confirm the strong relationship between B2M levels and eGFR and confirm the power of B2M to predict overall and cardiovascular mortality and cardiovascular events in patients at different stages of CKD.

Purpose Abdominal aortic calcification (AAC) is a well-known risk marker for cardiovascular disease. However, its clinical effect on patients who underwent radical surgery for colorectal cancer (CRC) stages II–III is unclear. This study aimed to analyze the associations between AAC and prognosis of patients with stage II–III CRC. Methods To evaluate the effect of AAC on clinical outcomes, prognosis, and metastatic patterns of CRC, we analyzed 362 patients who underwent radical surgery for stage II–III CRC between 2010 and 2018. Results The high AAC group had significantly worse overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) after propensity score matching to adjust for differences in baseline characteristics of patients and tumors. In the multivariate Cox regression analyses, a high AAC was an independent risk factor for poor OS (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.23–4.59; p  = 0.01), poor CSS (HR, 5.22; 95% CI, 1.74–15.6; p  < 0.01), and poor RFS (HR, 1.83; 95% CI, 1.19–2.83; p  < 0.01). A high AAC was not associated with a risk of lung metastasis or local or peritoneal recurrence, but a risk for liver metastasis of CRC. Conclusion A high AAC showed a strong relationship with poor OS, CSS, and RFS after curative resection for stage II–III CRC. A high AAC was also associated with a risk for liver metastasis, which may worsen the prognosis in stage II–III CRC. AAC could be a new clinical tool for predicting the prognosis for patients in stage II–III CRC.

Objective The effect of Type 2 diabetes mellitus (T2DM) on lumbar disc herniation (LDH) remains controversial. This retrospective cohort study aims to investigate the effect of T2DM on the LDH patients underwent percutaneous endoscopic lumbar discectomy (PELD) throughout pre, peri and post operation. Methods : This study included patients underwent PELD surgery from October 2021 to January 2024. General data including age, gender and body mass index (BMI), hemoglobin, hypertension and coronary heart disease (CHD) were collected. Clinical data including Visual Analogue Scale (VAS) score, surgical time, blood loss, length of hospital stay, recurrence ratio and reoperation ratio were recorded. Imaging data include L1-5 cobb angle, lumbar range of motion (ROM), relative cross-sectional area (CSA) and fat infiltration ratio (FIR) of the paraspinal muscles, abdominal aorta calcification (AAC), disc Pfirrmann grading, herniated disc Michigan State University (MSU) classification and Lee Zoning et al. were measured. Propensity score-matched (PSM) analysis with 1:1 ratio was performed to eliminate the influence of confounding factors using a multi-variable logistic regression model before analysis. Results 728 patients were eligible in this study, and significant difference was detected in age, hypertension and CHD between the T2DM group and Control group. After PSM analysis and matching, 56 pairs of patients generated and were included for further analysis. The patients in the T2DM possessed significantly higher grades of Pfirrmann score and AAC ratio (48.21% vs. 25.00%) than control group. Postoperative VAS of the T2DM group was 2(IQR = 1), which was significantly higher than the Control group, which was 1(IQR = 2). The recurrence and reoperation ratio were 21.43% and 16.07% respectively in the T2DM group, both of which were notably higher than the Control group (5.36% and 1.79%). Conclusion T2DM may aggravate disc degeneration, impede postoperative symptom relief, and increase recurrence and reoperation rates after PELD.