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Bentin JM, Heegaard S, Jørgensen NR, Grahnemo L, Hamann S. Optic disc drusen: Dystrophic calcification, a potential target for treatment. Eye (Lond) 2024:10.1038/s41433-024-03138-6. [PMID: 38778137 DOI: 10.1038/s41433-024-03138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Optic disc drusen (ODD) are calcified, acellular bodies, seen in the optic nerve head of up to 2% of the population. Although seldomly affecting visual acuity, visual field defects are common, and severe, ischemic complications causing irreversible vision loss are known to occur. Different treatment strategies for ODD have been explored, but so far without success. This review focuses on the unique, calcified property of ODD, describing what we know about ODD pathogenesis and previously tried treatment strategies. In this context, we discuss current knowledge about calcium and pathological calcifications, including intracranial and ocular calcifications. We also explore some of the obstacles that must be addressed to develop a therapy centred on the concept of calcification, should calcification be identified as a pathogenic factor contributing to vision loss.
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Affiliation(s)
- Josephine Mejdahl Bentin
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Translational Research Centre, Rigshospitalet, Copenhagen, Denmark
| | - Louise Grahnemo
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Tiffany L, Lim LJ. Hearts of stone: Rapidly progressive left ventricular myocardial calcifications in severe sepsis: Case series. J Med Imaging Radiat Oncol 2024; 68:265-268. [PMID: 38346165 DOI: 10.1111/1754-9485.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/01/2024] [Indexed: 04/26/2024]
Abstract
Rapidly progressive left ventricular myocardial calcification (RPLVMC) is a rare phenomenon of severe sepsis which is associated with long-term complications like irreversible cardiomyopathy and arrhythmias. To date, only 19 cases have been reported in literature. We present a case series of two patients with RPLVMC which manifested within a period of days in the setting of severe sepsis. Unique to previous case reports, the patients in the current case series had no pre-existing systemic risk factors such as end-stage kidney disease or endocrinological dysfunction. This case series aims to increase awareness of RPLVMC in severe sepsis, improve its opportunistic detection on routine medical imaging (namely chest x-ray and computed tomography), and spur future research to develop potential prevention strategies.
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Affiliation(s)
- Lea Tiffany
- Department of Medical Imaging, Western Health, Melbourne, Victoria, Australia
| | - Lincoln J Lim
- Department of Medical Imaging, Western Health, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Wilkinson ZA, Krywanczyk A. Myocardial Calcification: An Unusual Complication of Remote Trauma With Coidentified Amyloidosis. Acad Forensic Pathol 2024; 14:39-46. [PMID: 38505636 PMCID: PMC10947706 DOI: 10.1177/19253621231217775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/12/2023] [Indexed: 03/21/2024]
Abstract
We present the heart of a 38-year-old man with paraplegia due to a remote traumatic spinal cord injury. In the 20 years following his injury, he experienced chronic decubitus ulcers, osteomyelitis, neurogenic bladder, malnutrition, and urinary tract infections. He was admitted to the hospital with septic shock secondary to multiple decubitus ulcers and osteomyelitis and expired after a two-month hospitalization. At autopsy, there was marked replacement of left ventricle and interventricular septal myocardium by gritty, firm, yellow-white tissue. Microscopic examination demonstrated a remote infarct with marked dystrophic calcification and unexpected amyloid deposition. This example demonstrates the extraordinary extent to which dystrophic calcifications can replace myocardium and highlights multiple potential etiologies of myocardial calcifications. Of note, this is the first report documenting myocardial calcification as a complication of remote, non-iatrogenic trauma. The role of the amyloidosis in the development of calcification is unclear, but a contributory effect cannot be excluded.
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Affiliation(s)
- Zachary Alan Wilkinson
- Zachary Alan Wilkinson, MD, Department of Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195,
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Rafiee MJ, Bandegi P, Taylor JL. Extensive myocardial calcifications in a dialysis patient: A porcelain heart manifesting with abdominal pain. Radiol Case Rep 2024; 19:523-530. [PMID: 38044898 PMCID: PMC10686893 DOI: 10.1016/j.radcr.2023.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
This case report describes a 41-year-old male patient with chronic kidney disease on peritoneal dialysis presenting with upper abdominal pain and mild thigh numbness. CT chest demonstrated extensive myocardial calcifications and left atrial thrombus. This case emphasizes the clinical relevance of myocardial calcifications, especially in patients with end-stage renal disease. It also highlights the potential association between these calcifications and complications such as atrial fibrillation and thromboembolic events. The findings emphasize the need for diagnostic vigilance and an improved understanding of the pathophysiology of myocardial calcifications in the context of renal disease.
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Affiliation(s)
- Moezedin Javad Rafiee
- Department of Diagnostic Radiology, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
- Research Institute, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
| | - Pouya Bandegi
- Department of Diagnostic Radiology, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
| | - Jana Lyn Taylor
- Research Institute, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
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Deng Y, Li G, Liu J, Wan X, Li L, Lv J, Li Q, Zhou F, Chang D. Case report: Catheter ablation for persistent atrial fibrillation in a patient with heart of stone. Front Cardiovasc Med 2023; 10:1207064. [PMID: 37849940 PMCID: PMC10577284 DOI: 10.3389/fcvm.2023.1207064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
Myocardial calcification is a rare condition, with only a few reports in the literature. For the first time, we report a case of diffuse myocardial calcification who underwent successful catheter ablation for persistent atrial fibrillation (AF). In this case, catheter ablation was recommended due to repeated hospitalization for palpitation and heart failure, but preoperative computed tomography showed massive myocardial calcification. Electroanatomic mapping of the atrium was performed with a Pentaray catheter before ablation, which showed areas of low voltage in the calcified region. As the persistent AF was terminated after circumferential pulmonary vein isolation and posterior wall isolation, and no further ablation was performed. The patient recovered well, with no recurrence of palpitation or heart failure during the one-year follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Faguang Zhou
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Dong Chang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Koo CW, Chan JCK, Bois MC. Fulminant Giant Cell Myocarditis-induced Myocardial Calcification. Radiol Cardiothorac Imaging 2023; 5:e220305. [PMID: 36860840 PMCID: PMC9969210 DOI: 10.1148/ryct.220305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Chi Wan Koo
- From the Department of Radiology (C.W.K.) and Department of Laboratory Medicine and Pathology (J.C.K.C., M.C.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jackie Cheuk Ki Chan
- From the Department of Radiology (C.W.K.) and Department of Laboratory Medicine and Pathology (J.C.K.C., M.C.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Melanie C. Bois
- From the Department of Radiology (C.W.K.) and Department of Laboratory Medicine and Pathology (J.C.K.C., M.C.B.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Li B, Liu Q, Chen X, Chen T, Dang W, Zhao J, Cui G, Chen K, Wu Y. A Novel Idiopathic Atrial Calcification: Pathologic Manifestations and Potential Mechanism. Front Cardiovasc Med 2022; 9:788958. [PMID: 35387434 PMCID: PMC8978529 DOI: 10.3389/fcvm.2022.788958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac calcification is a type of ectopic pathologic calcification of unknown etiology and mechanisms. Once diagnosed, the location, extent and morphology of the calcified lesions, as well as their functional significance in the heart, are usually the focus of case reports. Calcification is mostly distributed in myocardium, but rarely reported in atrium. In addition, because of limited sampling and complex pathological mechanisms, the etiology underlying the formation of these calcified lesions also remains unclear. Methods Two cardiac calcifications were found in a patient, died of trauma-induced subarachnoid hemorrhage after slightly drinking, during a standard autopsy. The location and morphological characteristics of the calcified lesions were determined by computed tomography (CT) and CT-based 3D reconstruction. The specific histopathological characteristics of the lesions were determined by multi-staining. The concentration of free calcium and inorganic pyrophosphate (PPi) in plasma reflected the change of calcium metabolism. The expression and membranal localization of the ATP Binding Cassette Subfamily C Member 6 (ABCC6) in hepatocytes were detected by immunofluorescence. The variants of the ABCC6 were detected by Sanger sequencing and potential pathogenic variants were further identified by in silico analysis. Results The present study describes a patient with idiopathic calcification with two pear-shaped and irregularly hollow lesions symmetrically distributed in the patient's atrium. Massive accumulation of calcium salts was identified by multi-staining. For this patient, the plasma concentration of free calcium was higher than the control, indicating that calcium metabolism was disturbed. Furthermore, the plasma PPi of the patient was lower than the normal. By using immunofluorescence, the expression and membranal localization of ABCC6 was decreased and impaired in hepatocytes, respectively. Combined with Sanger sequencing and in silico analysis, 7 variants were identified. Conclusions This study described a novel patient with symmetrically distributed idiopathic atrial calcifications. Furthermore, all the results indicated that these pathologic calcifications may be secondary to reduced plasma PPi content due to ABCC6 dysfunction in hepatocytes. Moreover, these findings provided novel clues to the pathogenesis, clinical diagnosis and treatment of idiopathic atrial calcification in future.
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Affiliation(s)
- Bowen Li
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Qingbo Liu
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Xihui Chen
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Tangdong Chen
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Wenhui Dang
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Jing Zhao
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Guangbin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, China
- Guangbin Cui
| | - Kun Chen
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Centre, Air Force Medical University, Xi'an, China
- Kun Chen
| | - Yuanming Wu
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
- *Correspondence: Yuanming Wu
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Li J, Chelala L, Hossain R, Jeudy J, White C. Rapid Onset Development of Myocardial Calcifications in the Setting of Renal Failure and Sepsis. Radiol Cardiothorac Imaging 2021; 3:e200549. [PMID: 33969311 DOI: 10.1148/ryct.2021200549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/27/2020] [Accepted: 01/13/2021] [Indexed: 11/11/2022]
Abstract
Myocardial calcifications can arise following damage to myocardial tissue or in the setting of disturbances in the calcium and phosphorus balance. They are associated with a number of cardiac sequelae, as well as higher mortality. Three cases of rapid-onset myocardial calcifications that developed within the course of 5 to 13 weeks in patients who had a history of sepsis and renal failure while undergoing hemodialysis are described. Baseline imaging from several weeks prior without myocardial calcification are shown for each of the three patients, demonstrating the rapid onset of these calcifications. The clinical significance of these findings is discussed. © RSNA, 2021.
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Affiliation(s)
- Joy Li
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Lydia Chelala
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Rydhwana Hossain
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Jean Jeudy
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Charles White
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
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Lippolis A, Buzzi MP, Romano IJ, Dadone V, Gentile F. Stone heart: An unusual case of heart failure with preserved ejection fraction due to massive myocardial calcification. J Cardiol Cases 2021; 23:145-148. [PMID: 33841589 DOI: 10.1016/j.jccase.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/10/2023] Open
Abstract
We report an unusual case of heart failure due to massive myocardial calcification related to a rare combination of idiopathic mitral annular calcification, myocardial calcification of the left ventricular septum and the inferior wall without other predisposing factors, such as previous myocardial infarction, ventricular aneurysms, myocarditis, rheumatic heart disease, tuberculosis, chronic renal failure, or systemic metabolic disease (sarcoidosis or primary hyperoxaluria). The related restrictive pattern of diastolic filling of the left ventricle could explain this unusual case of heart failure with preserved ejection fraction. <Learning objective: The prevalence of heart failure with preserved ejection fraction has increased with an increasing prevalence of risk factors. For patients presenting with heart failure and normal left ventricular (LV) ejection fraction, many causes should be excluded. We make the argument that massive myocardial calcification related to a combination of idiopathic mitral annular calcification, myocardial calcification of the LV septum and the inferior wall without other predisposing factors may serve as an uncommon mechanism of heart failure with preserved ejection fraction.>.
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Affiliation(s)
- Antonio Lippolis
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
| | - Maria Paola Buzzi
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
| | - Ilaria Jane Romano
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
| | - Viola Dadone
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
| | - Francesco Gentile
- Cardiology Department, ASST Nord Milano, Ospedale E. Bassini, Cinisello Balsamo, Milano, Italy
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Kimura Y, Seguchi O, K Kono A, Matsumoto M, Kumai Y, Kuroda K, Nakajima S, Watanabe T, Matsumoto Y, Fukushima S, Yanase M, Fujita T, Ishibashi-Ueda H, Kobayashi J, Fukushima N. Massive Biventricular Myocardial Calcification in a Patient with Fulminant Myocarditis Requiring Ventricular Assist Device Support. Intern Med 2019; 58:1283-1286. [PMID: 30568151 PMCID: PMC6543210 DOI: 10.2169/internalmedicine.2039-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The natural course of myocardial calcification is unclear. We herein report a case of massive biventricular myocardial calcification associated with fulminant myocarditis and present its natural course. The patient was a 15-year-old boy. Massive calcification was detected in both ventricles on computed tomography several months after left ventricular assist device placement. Although the calcification gradually regressed, the patient's cardiac function did not recover, and he underwent heart transplantation after a waiting period of 3 years. A histological examination revealed severe fibrosis in both ventricles of the original heart. Myocardial calcification might suggest severe myocardial inflammation and injury in cases of fulminant myocarditis.
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Affiliation(s)
- Yuki Kimura
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Atsushi K Kono
- Department of Radiology, National Cerebral and Cardiovascular Center, Japan
| | - Manabu Matsumoto
- Department of Pathology, National Cerebral and Cardiovascular Center, Japan
| | - Yuto Kumai
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Kensuke Kuroda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Seiko Nakajima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | | | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
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Manole CG, Marinescu BG, Marta D, Nicolescu MI. Areas of Cartilaginous and Osseous Metaplasia After Experimental Myocardial Infarction in Rats. Anat Rec (Hoboken) 2018; 302:947-953. [DOI: 10.1002/ar.24010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 09/03/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Catalin Gabriel Manole
- Animal Facility Department, “Victor Babeş” National Institute of Pathology 99‐101 Splaiul Independeţei, 050096 Bucharest Romania
- Histology Department, “Carol Davila” University of Medicine and Pharmacy 8 Eroilor Sanitari Blvd., 050474 Bucharest Romania
| | - Bogdan Gabriel Marinescu
- Animal Facility Department, “Victor Babeş” National Institute of Pathology 99‐101 Splaiul Independeţei, 050096 Bucharest Romania
- Faculty of Veterinary MedicineUniversity of Agronomic Sciences 59 Mărăşti Blvd., 011464 Bucharest Romania
| | - Daciana Marta
- Ultrastructural Pathology Department“Victor Babeş” National Institute of Pathology 99‐101 Splaiul Independenţei, 050096 Bucharest Romania
| | - Mihnea Ioan Nicolescu
- Histology Department, “Carol Davila” University of Medicine and Pharmacy 8 Eroilor Sanitari Blvd., 050474 Bucharest Romania
- Radiobiology Department“Victor Babeş” National Institute of Pathology 99‐101 Splaiul Independenţei, 050096 Bucharest Romania
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Baracho SF, Pinheiro DJLL, Godoy CMGD, Coelho RC. A segmentation method for myocardial ischemia/infarction applicable in heart photos. Comput Biol Med 2017. [DOI: 10.1016/j.compbiomed.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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