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Jiang Y, Li Y, Zhang Y, Hu D, Zhang S, Wang C, Huang S, Zhang A, Jia Z, You R. NSC228155 alleviates septic cardiomyopathy via protecting mitochondria and inhibiting inflammation. Int Immunopharmacol 2023; 116:109847. [PMID: 36774857 DOI: 10.1016/j.intimp.2023.109847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
Septic cardiomyopathy is a lethal symptom of sepsis. Discovery of effective therapy that prevents cardiac injury in sepsis is critical in the clinical management of sepsis. NSC228155 is a novel compound with therapeutic potential on acute kidney injury by preventing apoptosis and protecting mitochondria. Whether NSC228155 protects against septic cardiomyopathy is unclear. In the present study, adult C57BL/6J mice were i.p injected with 5 mg/kg/day NSC228155 for 2 days before 10 mg/kg lipopolysaccharide (LPS) injection. Cardiac functional testing and sampling for serum and tissue were performed 12 and 24 h post LPS injection, respectively. NSC228155 significantly improved cardiac function examined by echocardiography, decreased the serum lactate dehydrogenase (LDH) and creatine kinase-MB, and pathologically alleviated cardiac injury in LPS mice. Accordingly, NSC228155 attenuated cardiomyocytes' mitochondrial damage as shown by decreased damaged mitochondrial ratio and activated signals for mitochondrial biogenesis, dynamics and mitophagy in LPS mice model. Metabolomics analysis demonstrated that NSC228155 corrected the metabolic disturbance involved in oxidative stress and energy metabolism, and decreased tissue injury metabolites in LPS-stimulated cardiac tissue. In the LPS-stimulated cardiac cell culture derived from human induced pluripotent stem cells, NSC228155 effectively restored the beating frequency, decreased LDH release, and protected mitochondria. NSC228155 also inhibited inflammation shown by decreased pro-inflammatory mediators in both serum and cardiac tissue in LPS model. Taken together, NSC228155 significantly improved cardiac function by directly preventing against cardiac cell injury and inhibiting inflammation in LPS model, hence may be a potential novel therapy against septic cardiomyopathy.
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Affiliation(s)
- Yuteng Jiang
- School of Medicine, Southeast University, Nanjing, China; Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Yanwei Li
- School of Medicine, Southeast University, Nanjing, China; Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Yiyuan Zhang
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China; Department of Nephrology, Huai'an Hospital Affiliated to Xuzhou Medical University, Huai'an, Jiangsu, China
| | - Dandan Hu
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Shengnan Zhang
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Chunli Wang
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Songming Huang
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Aihua Zhang
- School of Medicine, Southeast University, Nanjing, China; Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China.
| | - Zhanjun Jia
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China.
| | - Ran You
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Pediatrics, Nanjing Medical University, Nanjing, China.
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Garcia-Cardenas M, Jimenez-Santos M, Cabello-Ganem A, Solorzano-Pinot E, Serrano-Roman J, Fernandez-Badillo V, Espejel-Guzman A, Aparicio-Ortiz AD, Canseco-Leon N, Espinola-Zavaleta N. Single-Photon Emission Computed Tomography Assessment of Sepsis-Related Myocardial Calcification. Heart Lung Circ 2023; 32:e19-e20. [PMID: 36813593 DOI: 10.1016/j.hlc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Mauricio Garcia-Cardenas
- Department of Cardiac Computed Tomography, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Moises Jimenez-Santos
- Department of Cardiac Computed Tomography, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Enrique Solorzano-Pinot
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Javier Serrano-Roman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Valente Fernandez-Badillo
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Adrian Espejel-Guzman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | - Nadia Canseco-Leon
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico; Department of Echocardiography, ABC Medical Center IAP, Mexico City, Mexico.
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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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Early detection and progression of sepsis-related myocardial calcification with subsequent left ventricular systolic dysfunction: a case report. J Cardiol Cases 2022; 25:130-132. [DOI: 10.1016/j.jccase.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
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Samanta J, Mondal A, Das S, Chakraborty S, Sengupta A. Induction of cardiomyocyte calcification is dependent on FoxO1/NFATc3/Runx2 signaling. In Vitro Cell Dev Biol Anim 2021; 57:973-986. [PMID: 34845564 DOI: 10.1007/s11626-021-00623-0] [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: 07/06/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
Cardiovascular disorders (CAVDs) being a major concern over the past several years due to the huge number of morbidity and mortality worldwide, a number of studies have been done on the various aspects of cardiac problems. One of the various CAVDs is cardiovascular calcification. A number of investigations and research work have been done previously on the molecular mechanism of vascular and heart valve calcification but the mechanism of myocardial and cardiomyocyte calcification has remained uninvestigated. A number of case studies have shown the presence of calcific deposits in the myocardial/ventricular region of the heart in fetal condition as well as in individuals of different ages but no detailed studies have been done yet. In this study, we have mainly investigated the role of Forkhead box transcription factor FoxO1 and nuclear factor of activated T-cells NFATc3 in cardiomyocyte calcification. Our studies in H9c2 cardiomyocytes show that calcific deposition in cardiomyocytes does not occur in 15 d but upon osteogenic induction for 1 mo where FoxO1 expression gets reduced thereby increasing the expression of its downstream target NFATc3, thus increasing the expression of the osteogenic marker Runx2. Detailed studies on the molecular mechanism of cardiomyocyte calcification will help in finding out therapeutic strategies in the treatment of cardiac calcification.
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Affiliation(s)
- Jayeeta Samanta
- Department of Life Science and Biotechnology, Jadavpur University, 188, Raja S. C. Mallick Road, Kolkata, 700032, West Bengal, India
| | - Arunima Mondal
- Department of Life Science and Biotechnology, Jadavpur University, 188, Raja S. C. Mallick Road, Kolkata, 700032, West Bengal, India
| | - Shreya Das
- Department of Life Science and Biotechnology, Jadavpur University, 188, Raja S. C. Mallick Road, Kolkata, 700032, West Bengal, India
| | - Santanu Chakraborty
- Department of Life Sciences, Presidency University, 86/1, College Street, Kolkata, 700073, India
| | - Arunima Sengupta
- Department of Life Science and Biotechnology, Jadavpur University, 188, Raja S. C. Mallick Road, Kolkata, 700032, West Bengal, India.
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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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Cappelletti S, Piacentino D, Ciallella C. A systematic review of radiological and histological findings of septic myocardial calcifications. J Forensic Leg Med 2020; 74:102026. [PMID: 32755766 DOI: 10.1016/j.jflm.2020.102026] [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: 05/20/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Myocardial calcification is a life-threatening condition that is a recognised complication of ischaemic heart disease, cardiac surgery, rheumatic fever, myocarditis and sepsis. Only sparse data, reporting the clinical symptoms, the anatomo-pathological findings, the imaging findings have been published and no exhaustive analysis of all these factors exists in literature. To date, there have been 26 published cases in the medical literature in which myocardial calcifications is the consequence of a septic status. In this review, we will describe the main imaging and histological findings, with particular attention to the known and hypothesized mechanisms of myocardial calcifications. The results of this study may help clinicians and forensic pathologists to identify possible unrecognized cases and inspire the development of an international registry by which to coordinate further research.
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Affiliation(s)
- Simone Cappelletti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy; State Police Health Service Department, Ministry of Interior, Rome, Italy.
| | - Daria Piacentino
- Department of Psychiatry, Central Hospital, Sanitary Agency of South Tyrol, Bolzano-Bozen, Italy
| | - Costantino Ciallella
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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Abstract
OBJECTIVES To describe an unusual complication on extracorporeal membrane oxygenation. DATA SOURCES Clinical observation. STUDY SELECTION Case report. DATA EXTRACTION Relevant clinical information. DATA SYNTHESIS We report the cases of three young patients who developed extensive myocardial calcifications on prolonged extracorporeal membrane oxygenation support for severe acute respiratory distress syndrome with septic cardiomyopathy, postresuscitation cardiogenic shock, and septic shock complicating severe acute respiratory distress syndrome, respectively. Extensive myocardial calcifications were confirmed by echocardiography, CT, and cardiac biopsy. The combination of multiple factors, for example, prolonged hemodynamic failure, profound acidosis, high vasopressor doses, and renal failure, may lead to this unusual and severe complication. CONCLUSIONS Intensivists should be aware of this rare but rapid complication on extracorporeal membrane oxygenation support that may directly impact outcome. The precise role of extracorporeal membrane oxygenation support in the timing and frequency of new-onset diffuse myocardial calcification deserves further investigation.
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Maiese A, Manetti F, La Russa R, Di Fazio N, De Matteis A, Frati P, Fineschi V. Septic myocardial calcification: A case report. J Forensic Leg Med 2019; 65:45-47. [PMID: 31100653 DOI: 10.1016/j.jflm.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/30/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
The histological findings in the heart in cases of fatal sepsis can show myocytolysis, interstitial fibrosis, necrotic contraction band, mononuclear infiltrates, and interstitial edema, which can be used in post mortem diagnosis of sepsis. Septic myocardial calcification is a very rare condition, and only a few cases have been reported in the literature. In general, the pathogenesis of the myocardial calcification has not been well clarified, but two pathogenic mechanisms have been universally recognized: metastatic or dystrophic. We present a rare case of sepsis-related myocardial calcification. Here we report a case involving a 72-year-old white male who was admitted to a hospital for a polytrauma caused by a motorbike accident. On the 110th day of hospitalization, the patient was diagnosed with a septic process and a subsequent transesophageal echocardiogram revealed the presence of a calcification on the right atrial wall. According to the medical history of the patient there were no systemic factors predisposing to calcium crystals deposition in tissues. Patient died due to multi-organ failure in the course of multimicrobial septic shock during the 149th day. The autopsy revealed both the presence of a greenish-brown formation and a greater consistency of the right atrial wall. The histological investigation of the right atrium wall showed a wide calcification area localized at subendocardial level, which contained fibrin deposition and was surrounded by fibrotic tissue.
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Affiliation(s)
- Aniello Maiese
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Federico Manetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy
| | - Raffaele La Russa
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Nicola Di Fazio
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy
| | - Alessandra De Matteis
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy
| | - Paola Frati
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy
| | - Vittorio Fineschi
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Viale Regina Elena 336, 00161, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077, Italy.
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Ahmed T, Inayat F, Haq M, Ahmed T. Myocardial calcification secondary to toxic shock syndrome: a comparative review of 17 cases. BMJ Case Rep 2019; 12:12/1/bcr-2018-228054. [PMID: 30635313 DOI: 10.1136/bcr-2018-228054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Myocardial calcification is a rare and life-threatening condition. It has been associated with a myriad of causes, including ischaemic heart disease, cardiac surgery, rheumatic fever, and myocarditis. However, this entity is less well recognised in the setting of toxic shock syndrome. Published medical literature is scarce with regard to the pathogenesis and clinical implications of this potential association. We chronicle here the case of a patient with myocardial calcification secondary to toxic shock syndrome from our clinical experience. Furthermore, a systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 17 cases fulfilled the inclusion criteria. The data on patients' characteristics, epidemiology, clinical features, comorbid conditions, diagnosis, clinical course and outcome were collected and analysed. The present review outlines our current understanding of the epidemiology of and risk factors for sepsis-related myocardial calcification, the pathophysiology of this condition and currently available approaches to diagnosis.
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Affiliation(s)
- Talha Ahmed
- University of Maryland Medical Center - Midtown Campus, Baltimore, Maryland, USA
| | | | - Muhammad Haq
- University of Maryland Medical Center - Midtown Campus, Baltimore, Maryland, USA
| | - Taha Ahmed
- Cleveland Clinic - Fairview Hospital, Cleveland, Ohio, USA
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Hibi A, Mizuguchi K, Yoneyama A, Kasugai T, Kamiya K, Kamiya K, Ito C, Kominato S, Miura T, Koyama K. Severe refractory TAFRO syndrome requiring continuous renal replacement therapy complicated with Trichosporon asahii infection in the lungs and myocardial infarction: an autopsy case report and literature review. RENAL REPLACEMENT THERAPY 2018; 4:16. [PMID: 34171004 PMCID: PMC7149248 DOI: 10.1186/s41100-018-0157-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/22/2018] [Indexed: 01/09/2023] Open
Abstract
Background TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal failure, and organomegaly) syndrome is a systemic inflammatory disorder and unique clinicopathological variant of idiopathic multicentric Castleman disease that was proposed in Japan. Prompt diagnosis is critical because TAFRO syndrome is a progressive and life threating disease. Some cases are refractory to immunosuppressive treatments. Renal impairment is frequently observed in patients with TAFRO syndrome, and some severe cases require hemodialysis. Histological evaluation is important to understand the pathophysiology of TAFRO syndrome. However, systemic histopathological evaluation through autopsy in TAFRO syndrome has been rarely reported previously. Case presentation A 46-year-old Japanese man with chief complaints of fever and abdominal distension was diagnosed with TAFRO syndrome through imaging studies, laboratory findings, and pathological findings on cervical lymph node and bone marrow biopsies. Interleukin (IL)-6 and vascular endothelial growth factor (VEGF) levels were remarkably elevated in both blood and ascites. Methylprednisolone (mPSL) pulse therapy was initiated on day 10, followed by combination therapy with PSL and cyclosporine A. However, the amount of ascites did not respond to the treatment. The patient became anuric, and continuous renal replacement therapy was initiated from day 50. However, the patient suddenly experienced cardiac arrest associated with myocardial infarction (MI) on the same day. Although the emergent percutaneous coronary intervention was successfully performed, the patient died on day 52, despite intensive care. Autopsy was performed to ascertain the cause of MI and to identify the histopathological characteristics of TAFRO syndrome. Conclusions Bacterial peritonitis, systemic cytomegalovirus infection, and Trichosporon asahii infection in the lungs were observed on autopsy. In addition, sepsis-related myocardial calcification was suspected. Management of infectious diseases is critical to reduce mortality in patients with TAFRO syndrome. Although the exact cause of MI could not be identified on autopsy, we considered embolization by fungal hyphae as a possible cause. Endothelial injury possibly caused by excessive secretion of IL-6 and VEGF contributed to renal impairment. Fibrotic changes in anterior mediastinal fat tissue could be a characteristic pathological finding in patients with TAFRO syndrome.
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Affiliation(s)
- Arata Hibi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Ken Mizuguchi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Akiko Yoneyama
- Deaprtment of Pathology, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Takahisa Kasugai
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Chiharu Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Satoru Kominato
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Toshiyuki Miura
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Katsushi Koyama
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
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Hortells L, Sur S, St Hilaire C. Cell Phenotype Transitions in Cardiovascular Calcification. Front Cardiovasc Med 2018; 5:27. [PMID: 29632866 PMCID: PMC5879740 DOI: 10.3389/fcvm.2018.00027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/14/2018] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular calcification was originally considered a passive, degenerative process, however with the advance of cellular and molecular biology techniques it is now appreciated that ectopic calcification is an active biological process. Vascular calcification is the most common form of ectopic calcification, and aging as well as specific disease states such as atherosclerosis, diabetes, and genetic mutations, exhibit this pathology. In the vessels and valves, endothelial cells, smooth muscle cells, and fibroblast-like cells contribute to the formation of extracellular calcified nodules. Research suggests that these vascular cells undergo a phenotypic switch whereby they acquire osteoblast-like characteristics, however the mechanisms driving the early aspects of these cell transitions are not fully understood. Osteoblasts are true bone-forming cells and differentiate from their pluripotent precursor, the mesenchymal stem cell (MSC); vascular cells that acquire the ability to calcify share aspects of the transcriptional programs exhibited by MSCs differentiating into osteoblasts. What is unknown is whether a fully-differentiated vascular cell directly acquires the ability to calcify by the upregulation of osteogenic genes or, whether these vascular cells first de-differentiate into an MSC-like state before obtaining a “second hit” that induces them to re-differentiate down an osteogenic lineage. Addressing these questions will enable progress in preventative and regenerative medicine strategies to combat vascular calcification pathologies. In this review, we will summarize what is known about the phenotypic switching of vascular endothelial, smooth muscle, and valvular cells.
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Affiliation(s)
- Luis Hortells
- Division of Cardiology, Department of Medicine, and the Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Swastika Sur
- Division of Cardiology, Department of Medicine, and the Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cynthia St Hilaire
- Division of Cardiology, Department of Medicine, and the Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
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Bower G, Ashrafian H, Cappelletti S, Lee LM, Harling L, Ciallella C, Aromatario M, Athanasiou T. A proposed role for sepsis in the pathogenesis of myocardial calcification. Acta Cardiol 2017. [PMID: 28636521 DOI: 10.1080/00015385.2017.1305163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Guy Bower
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Simone Cappelletti
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Liang Mei Lee
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Costantino Ciallella
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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Torracchi Carrasco AM. Calcificación miocárdica: una complicación excepcional de la neumonía y la sepsis. Arch Bronconeumol 2017; 53:270. [DOI: 10.1016/j.arbres.2016.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
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Peter AK, Bradford WH, Dalton ND, Gu Y, Chao CJ, Peterson KL, Knowlton KU. Increased Echogenicity and Radiodense Foci on Echocardiogram and MicroCT in Murine Myocarditis. PLoS One 2016; 11:e0159971. [PMID: 27486657 PMCID: PMC4972301 DOI: 10.1371/journal.pone.0159971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/11/2016] [Indexed: 01/12/2023] Open
Abstract
Objectives To address the question as to whether echocardiographic and/or microcomputed tomography (microCT) analysis can be utilized to assess the extent of Coxsackie B virus (CVB) induced myocarditis in the absence of left ventricular dysfunction in the mouse. Background Viral myocarditis is a significant clinical problem with associated inflammation of the myocardium and myocardial injury. Murine models of myocarditis are commonly used to study the pathophysiology of the disease, but methods for imaging the mouse myocardium have been limited to echocardiographic assessment of ventricular dysfunction and, to a lesser extent, MRI imaging. Methods Using a murine model of myocarditis, we used both echocardiography and microCT to assess the extent of myocardial involvement in murine myocarditis using both wild-type mice and CVB cleavage-resistant dystrophin knock-in mice. Results Areas of increased echogenicity were only observed in the myocardium of Coxsackie B virus infected mice. These echocardiographic abnormalities correlated with the extent of von Kossa staining (a marker of membrane permeability), inflammation, and fibrosis. Given that calcium phosphate uptake as imaged by von Kossa staining might also be visualized using microCT, we utilized microCT imaging which allowed for high-resolution, 3-dimensional images of radiodensities that likely represent calcium phosphate uptake. As with echocardiography, only mice infected with Coxsackie B virus displayed abnormal accumulation of calcium within individual myocytes indicating increased membrane permeability only upon exposure to virus. Conclusions These studies demonstrate new, quantitative, and semi-quantitative imaging approaches for the assessment of myocardial involvement in the setting of viral myocarditis in the commonly utilized mouse model of viral myocarditis.
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Affiliation(s)
- Angela K. Peter
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
- BioFrontiers, University of Colorado, Boulder, Colorado, United States of America
| | - William H. Bradford
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Nancy D. Dalton
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Yusu Gu
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Chieh-Ju Chao
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
- Department of Internal Medicine, Mayo Clinic College of Medicine, Phoenix, Arizona, United States of America
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, United States of America
| | - Kirk L. Peterson
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Kirk U. Knowlton
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, United States of America
- * E-mail:
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Torfs M, Salgado R, Van Herck P, Corthouts B, Robert D, Parizel PM. A Curious Case of Acute Myocardial Calcifications. Circulation 2016; 133:e426-7. [PMID: 26951826 DOI: 10.1161/circulationaha.115.019178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michaël Torfs
- From Departments of Radiology (M.T., R.S., B.C., P.M.P.), Cardiology (P.V.H.), and Intensive Care (D.R.), Antwerp University Hospital, Belgium.
| | - Rodrigo Salgado
- From Departments of Radiology (M.T., R.S., B.C., P.M.P.), Cardiology (P.V.H.), and Intensive Care (D.R.), Antwerp University Hospital, Belgium
| | - Paul Van Herck
- From Departments of Radiology (M.T., R.S., B.C., P.M.P.), Cardiology (P.V.H.), and Intensive Care (D.R.), Antwerp University Hospital, Belgium
| | - Bob Corthouts
- From Departments of Radiology (M.T., R.S., B.C., P.M.P.), Cardiology (P.V.H.), and Intensive Care (D.R.), Antwerp University Hospital, Belgium
| | - Dominique Robert
- From Departments of Radiology (M.T., R.S., B.C., P.M.P.), Cardiology (P.V.H.), and Intensive Care (D.R.), Antwerp University Hospital, Belgium
| | - Paul M Parizel
- From Departments of Radiology (M.T., R.S., B.C., P.M.P.), Cardiology (P.V.H.), and Intensive Care (D.R.), Antwerp University Hospital, Belgium
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Marciniak A, Marciniak M, Chiribiri A, Claridge S, Ramos V, Rajani R. Multimodality imaging of extensive caseating intramyocardial calcification secondary to lymphoma. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002750. [PMID: 25784724 DOI: 10.1161/circimaging.114.002750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anna Marciniak
- From the Department of Cardiology (A.M., M.M., R.R.) and Cardiovascular Division, Division of Imaging Sciences and Biomedical Engineering, King's College London British Heart Foundation Centre of Excellence, National Institute of Health Research Biomedical Research Centre (A.C., S.C., V.R., R.R.), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Maciej Marciniak
- From the Department of Cardiology (A.M., M.M., R.R.) and Cardiovascular Division, Division of Imaging Sciences and Biomedical Engineering, King's College London British Heart Foundation Centre of Excellence, National Institute of Health Research Biomedical Research Centre (A.C., S.C., V.R., R.R.), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amedeo Chiribiri
- From the Department of Cardiology (A.M., M.M., R.R.) and Cardiovascular Division, Division of Imaging Sciences and Biomedical Engineering, King's College London British Heart Foundation Centre of Excellence, National Institute of Health Research Biomedical Research Centre (A.C., S.C., V.R., R.R.), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- From the Department of Cardiology (A.M., M.M., R.R.) and Cardiovascular Division, Division of Imaging Sciences and Biomedical Engineering, King's College London British Heart Foundation Centre of Excellence, National Institute of Health Research Biomedical Research Centre (A.C., S.C., V.R., R.R.), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vitor Ramos
- From the Department of Cardiology (A.M., M.M., R.R.) and Cardiovascular Division, Division of Imaging Sciences and Biomedical Engineering, King's College London British Heart Foundation Centre of Excellence, National Institute of Health Research Biomedical Research Centre (A.C., S.C., V.R., R.R.), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- From the Department of Cardiology (A.M., M.M., R.R.) and Cardiovascular Division, Division of Imaging Sciences and Biomedical Engineering, King's College London British Heart Foundation Centre of Excellence, National Institute of Health Research Biomedical Research Centre (A.C., S.C., V.R., R.R.), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Gan XT, Taniai S, Zhao G, Huang CX, Velenosi TJ, Xue J, Urquhart BL, Karmazyn M. CD73-TNAP crosstalk regulates the hypertrophic response and cardiomyocyte calcification due to α1 adrenoceptor activation. Mol Cell Biochem 2014; 394:237-46. [PMID: 24894822 DOI: 10.1007/s11010-014-2100-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
Cluster of differentiation 73 (CD73) is an ecto-5' nucleotidase which catalyzes the conversion of AMP to adenosine. One of the many functions of adenosine is to suppress the activity of tissue nonspecific alkaline phosphatase (TNAP), an enzyme important in regulating intracellular calcification. Since myocardial calcification is associated with various cardiac disease states, we studied the individual roles and crosstalk between CD73 and TNAP in regulating myocyte responses to the α1 adrenoceptor agonist phenylephrine in terms of calcification and hypertrophy. Cultured neonatal rat cardiomyocytes were treated with 10 µM phenylephrine for 24 h in the absence or presence of the stable adenosine analog 2-chloro-adenosine, the TNAP inhibitor tetramisole or the CD73 inhibitor α,β-methylene ADP. Phenylephrine produced marked hypertrophy as evidenced by significant increases in myocyte surface area and ANP gene expression, as well as calcification determined by Alizarin Red S staining. These responses were associated with reduced CD73 gene and protein expression and CD73 activity. Conversely, TNAP expression and activity were significantly increased although both were suppressed by 2-chloro-adenosine. CD73 inhibition alone significantly reduced myocyte-derived adenosine levels by >50 %, and directly induced hypertrophy and calcification in the absence of phenylephrine. These responses and those to phenylephrine were abrogated by TNAP inhibition. We conclude that TNAP contributes to the hypertrophic effect of phenylephrine, as well as its ability to produce cardiomyocyte calcification. These responses are minimized by CD73-dependent endogenously produced adenosine.
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Affiliation(s)
- Xiaohong Tracey Gan
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
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Roberts WC, Rosenblatt RL, Ko JM, Grayburn PA, Kuiper JJ, Guileyardo JM. Cardiac restriction secondary to massive calcific deposits in the left ventricular cavity. Am J Cardiol 2014; 113:1442-6. [PMID: 24576543 DOI: 10.1016/j.amjcard.2013.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 12/26/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
Described herein are clinical and necropsy findings in a 61-year-old woman with fatal left ventricular diastolic failure secondary to massive calcific deposits primarily within the left ventricular cavity. At age 3, an isthmic aortic coarctation was resected, and at age 44, a stenotic congenitally bicuspid aortic valve was replaced. The cause of the intracavitary calcific deposits remains unclear, but surgical resection of the deposits has been an effective form of therapy.
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Ghatak T, Singh RK, Azim A, Gurjar M, Baronia AK, Hiralal. A case of extensive cardiac calcification. Saudi J Anaesth 2013; 7:220-2. [PMID: 23956734 PMCID: PMC3737710 DOI: 10.4103/1658-354x.114066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tanmoy Ghatak
- Department of Critical Care Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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