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Acute coronary syndromes： an old age problem

Journal of Geriatric Cardiology 2012年第2期9卷 192-196页

作者： alexander d simms Philip d Batin John Kurian Nigel durham Christopher P Gale Centre for Epidemiology and Biostatistics Level 8 Worsley Building University of Leeds Clarendon Way West Yorkshire Leeds LS2 9JT UK Hull and York Medical School York Teaching Hospital NHS Foundation Trust York Y031 8HE UK department of Cardiology York Teaching Hospital NHS Foundation Trust York Y031 8HE UK department of Cardiology Mid Yorkshire NHS Trust Wakefield WF1 4DG UK department of Cardiology Bradford Teaching Hospital NHS Foundation Trust Bradford UK

The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes （ACS）. This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological tiailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.

关键词： Acute coronary syndromes Elderly patients Inequalities of care Evidenced-based treatments

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Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

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World Journal of Cardiology 2014年第8期6卷 865-872页

作者： Richard A Brogan Christopher J Malkin Philip d Batin alexander d simms James M McLenachan Christopher P Gale Leeds Institute of Cardiovascular and Metabolic Medicine Division of Epidemiology and BiostatisticsUniversity of LeedsLeeds LS2 9JTUnited Kingdom York and Hull Medical School University of YorkYorkYO10 5DDUnited Kingdom department of Cardiology Leeds Teaching Hospital NHS TrustLeeds LS2 9JTUnited Kingdom department of Cardiology Pinderfields General HospitalMid Yorkshire NHS TrustWakefield WF5 9LZUnited Kingdom department of Cardiology York Teaching Hospital NHS Foundation TrustYork YO10 5DDUnited Kingdom

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

关键词： ST segment elevation myocardial infarction Risk stratification Primary percutaneous coronary intervention Harm Risk scores

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Treating amyotrophic lateral sclerosis with allogeneic Schwann cell-derived exosomal vesicles: a case report

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Neural Regeneration Research 2025年第4期20卷 1207-1216页

作者： Pascal J.Goldschmidt-Clermont Aisha Khan George Jimsheleishvili Patricia Graham Adriana Brooks Risset Silvera alexander J.P.Goldschmidt damien d.Pearse W.dalton dietrich Allan d.Levi James d.Guest Miller School of Medicine University of MiamiMiamiFLUSA Stem Cell Institute Miller School of MedicineUniversity of MiamiMiamiFLUSA The Miami Project to Cure Paralysis Miller School of MedicineUniversity of MiamiMiamiFLUSA Alzady International LLC MiamiFLUSA Neurological Surgery Miller School of MedicineUniversity of MiamiMiamiFLUSA

Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular *** amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann cell function may also be ***,important signaling and potential trophic activities of Schwann cell-derived exosomal vesicles have been *** case report describes the treatment of a patient with advanced amyotrophic lateral sclerosis using serial intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles,marking,to our knowledge,the first instance of such *** 81-year-old male patient presented with a 1.5-year history of rapidly progressive amyotrophic lateral *** initial diagnosis,the patient underwent a combination of generic riluzole,sodium phenylbutyrate for the treatment of amyotrophic lateral sclerosis,and *** patient volunteered to participate in an FdA-approved single-patient expanded access treatment and received weekly intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles to potentially restore impaired Schwann cell and motor neuron *** confirmed that cultured Schwann cells obtained from the amyotrophic lateral sclerosis patient via sural nerve biopsy appeared impaired(senescent)and that exposure of the patient’s Schwann cells to allogeneic Schwann cell-derived exosomal vesicles,cultured expanded from a cadaver donor improved their growth capacity in *** a period of observation lasting 10 weeks,during which amyotrophic lateral sclerosis Functional Rating Scale-Revised and pulmonary function were regularly monitored,the patient received weekly consecutive infusions of 1.54×1012(×2),and then consecutive infusions of 7.5×1012(×6)allogeneic Schwann cell-derived exosomal vesicles diluted in 40 mL of dulbecco’s phosphate-buffered *** of the infusions were associated with adverse events such as infusion reactions(allergic or otherwise)or

关键词： allogeneic amyotrophic lateral sclerosis exosomes infusion neuromuscular junction Schwann cell

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Microglia:a promising therapeutic target in spinal cord injury

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Neural Regeneration Research 2025年第2期20卷 454-463页

作者： Xiaowei Zha Guoli Zheng Thomas Skutella Karl Kiening Andreas Unterberg alexander Younsi department of Neurosurgery Heidelberg University HospitalHeidelbergGermany department of Neuroanatomy Institute for Anatomy and Cell BiologyHeidelberg UniversityHeidelbergGermany

Microglia are present throughout the central nervous system and are vital in neural repair,nutrition,phagocytosis,immunological regulation,and maintaining neuronal *** a healthy spinal cord,microglia are accountable for immune surveillance,however,when a spinal cord injury occurs,the microenvironment drastically changes,leading to glial scars and failed axonal *** this context,microglia vary their gene and protein expression during activation,and proliferation in reaction to the injury,influencing injury responses both favorably and unfavorably.A dynamic and multifaceted injury response is mediated by microglia,which interact directly with neurons,astrocytes,oligodendrocytes,and neural stem/progenitor *** a clear understanding of their essential nature and origin,the mechanisms of action and new functions of microglia in spinal cord injury require extensive *** review summarizes current studies on microglial genesis,physiological function,and pathological state,highlights their crucial roles in spinal cord injury,and proposes microglia as a therapeutic target.

关键词： astrocytes cytokines functional recovery immune regulation M1/M2 activation macrophages microglia neuroinflammation spinal cord injury therapy

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Biomimetic flexible plate actuators are faster and more efficient with a passive attachment

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Acta Mechanica Sinica 2016年第6期32卷 1001-1011页

作者： Peter d.Yeh alexander Alexeev George W.Woodruff School of Mechanical Engineering Georgia Institute of Technology

Using three-dimensional computer simulations, we probe biomimetic free swimming of an internally actuated flexible plate in the regime near the first natural frequency. The plate is driven by an oscillating internal moment approximating the actuation mechanism of a piezoelectric macro fiber composite (MFC) bimorph. We show in our simulations that the addition of a passive attachment increases both swimming velocity and efficiency. Specifically, if the active and passive sections are of similar size, the overall performance is the best. We determine that this optimum is a result of two competing factors. If the passive section is too large, then the actuated portion is unable to generate substantial deflection to create sufficient thrust. On the other hand, a large actuated section leads to a bending pattern that is inefficient at generating thrust especially at higher frequencies.

关键词： Flexible plate Biomimetic Lattice Boltzmann Fluid-structure interaction Robotic fish Piezoelectric actuator

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Improved proper motion determinations for 15 open clusters based on the UCAC4 catalog

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Research in Astronomy and Astrophysics 2016年第7期16卷 39-46页

作者： alexander Kurtenkov Nadezhda dimitrova alexander Atanasov Teodor d.Aleksiev department of Astronomy University of Sofia5 James Bourchier Blvd.1164 SofiaBulgaria Institute of Astronomy and National Astronomical Observatory Bulgarian Academy of Sciences72 Tsarigradsko Shose Blvd.1784 SofiaBulgaria Anglo-American School of Sofia 1 Siyanie Str.1138 SofiaBulgaria Geo Milev High School of Mathematics Storgozia5802 PlevenBulgaria Sofia High School of Mathematics 61 Iskar Str.1000 SofiaBulgaria

The proper motions of 15 nearby（d 〈 1 kpc） open clusters（OCs） were recalculated using data from the UCAC4 catalog. Only evolved or main sequence stars inside a certain radius from the center of the cluster were used. The results significantly differ from the ones presented by dias et al.（2014）. This could be explained by a different approach in which we take the field star contamination into account. The present work aims to emphasize the importance of applying photometric criteria for the calculation of OC proper motions.

关键词： proper motions Galaxy open clusters and associations general

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Recovery of Brachiopod and Ammonoid Faunas Following the End-Permian Crisis:Additional Evidence from the Lower Triassic of the Russian Far East and Kazakhstan

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Journal of Earth Science 2014年第1期25卷 1-44页

作者： Yuri d Zakharov alexander M Popov Far Eastern Geological Institute Far Eastern BranchRussian Academy of Sciences

After the End-Permian mass extinction, ammonoids reached levels of taxonomic diver- sity higher than in the Changhsingian by the dienerian Substage of the Induan. However, brachiopods exhibit a prolonged delay in recovery, and their taxonomic diversity had not recovered to Late Permian levels even by the Olenekian. The differential patterns of recovery between these two clades may reflect fundamental differences in physiology and behavior. Brachiopods were benthic organisms that were dependent on specific trophic sources, and their general reduction in size during the Early Triassic may have been a response to a relative paucity of food resources. In contrast, ammonoids were sluggish- nektic organisms that utilized a wider range of trophic sources and that suffered no comparable size decrease during the Early Triassic. Brachiopods may have been at a disadvantage also due to vulner- abilities associated with their larval stage, during which they had to locate a suitable substrate for set- tlement. In contrast, ammonoids had no larval stage and juveniles may have been dispersed widely into favorable habitats. These factors may account for differences in the relative success of ammonoids and brachiopods at high-latitude regions following the End-Permian mass extinction： ammonoids success- fully reeolonized the Boreal region during the Early Triassic whereas brachiopods did not.

关键词： Lower Triassic South Primorye Kazakhstan brachiopod ammonoid biotic recovery.

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Is there a standardized practice for the development of international ulcerative colitis and Crohn’s disease treatment guidelines?

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Gastroenterology Report 2021年第5期9卷 408-417,I0001,I0002页

作者： alexander Goldowsky Rohan Sen Gila Hoffman Joseph d Feuerstein department of Medicine Beth Israel Deaconess Medical CenterBostonMAUSA department of Gastroenterology and Hepatology Beth Israel Deaconess Medical CenterBostonMAUSA

Background Guidelines are published by international gastroenterology societies regarding the management of ulcerative colitis(UC)and Crohn’s disease(Cd)to help clinicians to provide high-quality patient *** examined the guidelines for the quality and strength of evidence used to develop the recommendations,methods for grading evidence,differences in disease-specific recommendations,conflicts of interest,and plans for guideline *** A systematic search was performed on PubMed using“ulcerative colitis,”“Crohn’s disease,”and“guidelines”in April *** gastroenterology society websites were searched for UC-and Cd-specific *** from 12 societies were examined by two ***-squared tests were used for comparing evidence-level grades,strength of recommendations,and reported conflicts of ***-regression modeling was used to evaluate the relationship between the number of authors and the number of recommendations in a given *** Of 28 guidelines reviewed,25(89%)used a total of three different systems to grade the level of evidence and 2(7%)used an unknown ***(11%)reviewed guidelines did not provide a conflict-of-interest statement,while three(11%)provided a timeline for guideline *** 1,265 total statements examined,246(19%)reported no grade of evidence quality or explicitly stated that the recommendation was based on“expert opinion.”One hundred and thirty-five(22%)UC recommendations were noted to be“weak/conditional”and 95(16%)did not have a recommendation *** hundred and forty-two(37%)Cd recommendations were noted to be“weak/conditional”and 151(23%)did not have a recommendation *** The majority of UC and Cd guidelines are based on a low/very low quality of evidence and are further weakened due to the lack of homogeneity in specific aspects of management recommendations as well as conflicts of interest.

关键词： Crohn’s disease ulcerative colitis inflammatory bowel disease guidelines conflicts of interest

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Evaluating the Origin Intensity Factor in the Singular Boundary Method for Three-dimensional dirichlet Problems

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Advances in Applied Mathematics and Mechanics 2017年第6期9卷 1289-1311页

作者： Linlin Sun Wen Chen alexander H-d.Cheng State Key Laboratory of Hydrology-Water Resources and Hydraulic Engineering International Center for Simulation Software in Engineering and SciencesCollege of Mechanics and MaterialsHohai UniversityNanjing 210098China department of Computational Science and Statistics School of ScienceNantong UniversityNantongJiangsu 226019China School of Engineering University of MississippiUniversityMS 38677USA

In this paper,a new formulation is proposed to evaluate the origin intensity factors(OIFs)in the singular boundary method(SBM)for solving 3d potential problems with dirichlet boundary *** SBM is a strong-form boundary discretization collocation technique and is mathematically simple,easy-to-program,and free of *** crucial step in the implementation of the SBM is to determine the OIFs which isolate the singularities of the fundamental ***,the inverse interpolation technique(IIT)is adopted to calculate the OIFs on dirichlet boundary,which is time consuming for large-scale *** recent years,the new methodology has been developed to efficiently calculate the OIFs on Neumann boundary,but the dirichlet problem remains an open *** study employs the subtracting and adding-back technique based on the integration of the fundamental solution over the whole boundary to develop a new formulation of the OIFs on 3d dirichlet *** problems with varied domain shapes and boundary conditions are carried out to validate the effectiveness and feasibility of the proposed scheme in comparison with the SBM based on inverse interpolation technique,the method of fundamental solutions,and the boundary element method.

关键词： Origin intensity factors singular boundarymethod boundary-typemeshlessmethod potential problem fundamental solution

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Inequalities in care in patients with acute myocardial infarction

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World Journal of Cardiology 2015年第12期7卷 895-901页

作者： Shabnam Rashid alexander simms Phillip Batin John Kurian Chris P Gale department of Cardiology Leeds General Infirmary department of Cardiology Pinderfields General Hospital department of Cardiology Bradford Royal Infir-mary department of Cardiology University of Leeds

Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction(AMI),yet despite these,significant inequalities exist in the care of these patients. The elderly,deprived socioeconomic groups,females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI,thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group,i.e.,low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.

关键词： Coronary artery disease dual antiplatelet therapy Inequalities Guidelines Myocardial infarction

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