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Preoperative nuclear stress testing in the very old patient population

World Journal of Cardiology 2020年第5期12卷 210-219页

作者： amgad n makaryus John n makaryus Joseph A Diamond Department of Cardiology Northwell HealthNew Hyde ParkNY11042United States Department of Cardiology Nassau University Medical CenterEast MeadowNY 11554United States

BACKGROUnD Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing(nST)in order to evaluate their cardiovascular *** prognostic utility of such testing in the very elderly(≥85 years)has yet to be fully *** and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease,and therefore the prognostic value of nST for their preoperative risk assessment has been *** evaluation assesses the ability of nuclear stress testing to predict peri-operative cardiac outcomes in this patient *** To investigate the ability of nST to predict peri-operative cardiac outcomes in elderly patients awaiting moderate to high-risk *** Patients≥85 years undergoing pre-operative nST were retrospectively *** undergoing low-risk surgery were *** adverse cardiac events(MACE)were considered any adverse event that occurred prior to discharge and included acute heart failure,arrhythmia,acute myocardial infarction,unstable angina,or *** between patient risk factors,MACE,and the obtained results of the pre-operative stress testing,ejection fraction(nd the summed difference score(≤0,>0)were *** A total of 69 patients(mean age 88±2.6 years,31 males)underwent nuclear stress testing prior to *** were 41(60%)patients found to have an abnormal ***(23%)patients were noted to experience post-operative *** significant associations between risk factors and MACE were *** with an abnormal nST and/or a summed stress score≥9 weresignificantly(Pndicated preoperative nST is useful to assess pre-operative risk in elderly patients≥85 years undergoing moderate to high-risk surgery.

关键词： Pharmacologic nuclear stress testing Prognosis Elderly Preoperative assessment Outcomes

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Diagnostic and treatment utility of echocardiography in the management of the cardiac patient

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World Journal of Cardiology 2020年第6期12卷 262-268页

作者： Ariella Khalili Jennifer Drummond neiman Ramjattan Roman Zeltser amgad n makaryus north Shore Hebrew Academy Great NeckNY 11020United States Department of Internal Medicine Tufts Medical CenterBostonMA 10211United States Department of Cardiology Nassau University Medical CenterEast MeadowNY 11554United States Department of Cardiology Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNY 11549United States

BACKGROUnD Echocardiograms are an incredibly useful diagnostic tool due to their lack of harmful radiation,the relative ease and speed with which they can be performed,and their almost ubiquitous ***,the advantages that support the use of echocardiography can also lead to the overuse of this *** sought to evaluate the physician perceived impact echocardiography has on patient *** To evaluate the physician perceived impact echocardiography has on patient *** Surveys were distributed to the ordering physician for echocardiograms performed at our institution over a 10-wk *** transthoracic echocardiograms performed on the inpatient service were *** were distributed to either the attending physician or the resident physician listed on the echocardiogram *** information requested in the survey focused on the indication for the study and the perceived importance and effect of the *** statistical analysis was performed on all of the answers from the collected *** A total of 103 surveys were obtained and *** internal medicine(57%)and cardiology(37%)specialties ordered the most *** most common reason for ordering an echocardiogram was to rule out a diagnosis(38.2%).Only 27.5%of physicians reported that the echocardiogram significantly affected patient care,with 18.6%reporting a moderate effect,and 30.4%reporting a mild effect.A total of 19.6%of physicians stated that there was no effect on patient ***,43.1%of physicians reported that they made changes in patient management due to no change having occurred in the disease,11.8%reported that changes in management were based on the recommendation of a specialist,and only 9.8%reported that further imaging was ordered due to the results of the *** majority of physicians(67.6%)considered an echocardiogram to be“somewhat essential”in the management of adult inpat

关键词： Echocardiogram Utilization Cardiology Inpatient Survey Management

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Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident

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World Journal of Cardiology 2023年第2期15卷 56-63页

作者： Tanzim Bhuiya Sherif Roman Taner Aydin Bhakti Patel Roman Zeltser amgad n makaryus Department of Cardiology Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNY 11553United States Department of Cardiology St.Joseph’s University Medical CenterPatersonNJ 07503United States Department of Cardiology Nassau University Medical CenterEast MeadowNY 11554United States

BACKGROUnD Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare *** To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident(CVA)or transient ischemic attack(TIA)requires inpatient telemetry *** A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed *** investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these *** In our study population,63(24.5%)of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic *** the 194(75.5)patients that had a confirmed CVA/TIA,only 6(2.3%)had an arrhythmia detected during their inpatient telemetry monitoring *** with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event(3.59 vs 2.61,PnCLUSIOn Given the low percentage of inpatient arrhythmias identified,further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA.A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.

关键词： Telemetry monitoring CHA2DS2-VASc score Arrhythmia Atrial fibrillation

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Effects of energy drinks on the cardiovascular system

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World Journal of Cardiology 2017年第11期9卷 796-806页

作者： Bishoy Wassef Michelle Kohansieh amgad n makaryus Department of Family Medicine Eisenhower Medical Center Stern College for Women Yeshiva University Department of Cardiology Northwell Health/Nassau University Medical Center Hofstra northwell School of Medicine

Throughout the last decade, the use of energy drinks has been increasingly looked upon with caution as potentially dangerous due to their perceived strong concentration of caffeine aside from other substances such as taurine, guarana, and L-carnitine that are largely unknown to the general public. In addition, a large number of energy drink intoxications have been reported all over the world including cases of seizures and arrhythmias. In this paper, we focus on the effect of energy drinks on the cardiovascular system and whether the current ongoing call for the products' sales and regulation of their contents should continue.

关键词： Energy drinks Caffeine Taurine Guarana Cardiovascular effects

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Impact of cardiologist intervention on guideline-directed use of statin therapy

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World Journal of Cardiology 2020年第8期12卷 419-426页

作者： Manouchkathe Cassagnol Ofek Hai Shaqeel A Sherali Kyla D’Angelo David Bass Roman Zeltser amgad n makaryus Department of Cardiology NuHealth/Nassau University Medical CenterEast MeadowNY 11554United States Department of Clinical Health Professions College of Pharmacy and Health SciencesSt.John’s UniversityQueensNY 11430United States Donald and Barbara Zucker School of Medicine at Hofstra/northwell HempsteadNY 11549United States St.Lawrence Health System PotsdamNY 13676United States

BACKGROUnD Statins have an important and well-established role in the prevention of atherosclerotic cardiovascular disease(ASCVD).However,several studies have reported widespread underuse of statins in various practice settings and *** of relevant literature reveals opportunities for improvement in the implementation of guideline-directed statin therapy(GDST).AIM To examine the impact of cardiologist intervention on the use of GDST in the ambulatory *** Patients with at least one encounter at the adult Internal Medicine Clinic(IMC)and/or Cardiology Clinic(CC),who had an available serum cholesterol test performed,were *** 2 comparison groups were defined as:(1)Patients only seen by IMC;and(2)Patients seen by both IMC and *** were excluded if variables needed for calculation of ASCVD risk scores were lacking,and if demographic information lacked guideline-directed treatment *** were analyzed using student t-tests or χ^2,as *** of Variance was used to compare rates of adherence to *** A total of 268 patients met the inclusion criteria for this study;211 in the IMC group and 57 in the IMC-CC ***,56%of patients were female,mean age 56 years(±10.65,SD),22%Black or African American,56%Hispanic/Latino,14%had clinical ASCVD,13%current smokers,66%diabetic and 63%*** use was observed in 55%(n=147/268)of the entire patient *** the IMC-CC group,73.6%(n=42/57)of patients were prescribed statin therapy compared to 50.7%(n=107/211)of patients in the IMC group(P=0.002).In terms of appropriate statin use based on guidelines,there was no statistical difference between groups[IMC-CC group 61.4%(n=35/57)vs IMC group,55.5%(n=117/211),P=0.421].Patients in the IMC-CC group were older,had more cardiac risk factors and had higher proportions of non-white patients compared to the IMC group(PnCLUSIOn Although overall use of GDST was suboptimal,there was no statis

关键词： Statin use Guideline directed statin therapy Cardiologist Ambulatory care Adherence

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Geometric comparison of the mitral and tricuspid valve annulus:Insights from three dimensional transesophageal echocardiography

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World Journal of Cardiology 2017年第9期9卷 757-760页

作者： amgad n makaryus Haisam Ismail John n makaryus Dali Fan Hofstra northwell School of Medicine Department of CardiologyNorth Shore University HospitalManhassetNY 11030United States Department of Cardiology NuHealthNassau University Medical CenterEast MeadowNY 11554United States Department of Medicine Division of CardiologyUniversity of CaliforniaDavisCA 95616United States

AIM To apply real time three-dimensional transesophageal echocardiography(RT3D TEE) for quantitative and qualitative assessment of the mitral valve annulus(MVA) and tricuspid valve annulus(TVA) in the same *** Our retrospective cohort study examined the MVA and TVA in 49 patients by RT3 D TEE. MVA and TVA shape were examined by TEE. The MVA and TVA volume data set images were acquired in the mid esophageal 4-chamber view. The MVA and TVA were acquired separately, with optimization of each for the highest frame rate and image quality. The 3D shape of the annuli was reconstructed using the Philips~? Q lab, MVQ ver. 6.0 MVA model software. The end-systolic frame was used. The parameters measured and compared were annular area, circumference, high-low distances(height), anterolateralposterolateral(ALPM), and anteroposterior(AP) axes. RESULTS A total of 49 patients(mean age 61 ± 14 years, 45% males) were studied. The ALPM and the AP axes of the MVA and TVA are not significantly different. The ALPM axis of the MVA was 37.9 ± 6.4 mm and 38.0 ± 5.6 mm for the TVA(P = 0.70). The AP axis of the MVA was 34.8 ± 5.7 mm and 34.9 ± 6.2 mm for the TVA(P = 0.90). The MVA and the TVA had similar circumference and area. The circumference of the MVA was 127.9 ± 16.8 mm and 125.92 ± 16.12 mm for the TVA(P = 0.23). The area of the MVA was 1103.7 ± 307.8 mm^2 and 1131.7 ± 302.0 mm^2 for the TVA(P = 0.41). The MVA and TVA are similar oval structures, but with significantly different heights. The ALPM/AP ratio for the MVA was 1.08 ± 0.33 and 1.09 ± 0.28 for the TVA(P nd TVA was 9.23 ± 2.11 mm and 4.37 ± 1.48 mm, respectively(P nCLUSIOn RT3 D TEE plays an unprecedented role in the management of valvular heart disease. The specific and exclusive shape of the MVA and TVA was revealed in our study of patients studied. Moreover, the intricate codependence of the MVA and the TVA depends on their distinctive shapes. This realization seen f

关键词： Mitral valve annulus Tricuspid valve annulus Three dimensional imaging Real time three-dimensional transesophageal echocardiography

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nucleoside modified mRnA-lipid nanoparticles as a new delivery platform for the repair of the injured spinal cord

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neural Regeneration Research 2025年第8期20卷 2311-2312页

作者： Krisztián Pajer Tamás Bellák Antal nógrádi Department of Anatomy Histology and EmbryologyAlbert Szent-Györgyi Medical SchoolUniversity of SzegedSzegedHungary

Spinal cord injury and treatment opportunities:The adult mammalian spinal cord has a very limited capacity for spontaneous regeneration due to various intrinsic molecular and cellular *** the spinal cord neurons have the capacity to regenerate their axons,the expression of growth inhibitory factors,lack or suppression of proper guidance cues,and profound inflammatory responses do not permit successful regeneration(Khyeam et al.,2021).

关键词： injured capacity modified

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Impacts of PI3K/protein kinase B pathway activation in reactive astrocytes: from detrimental effects to protective functions

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neural Regeneration Research 2025年第4期20卷 1031-1041页

作者： Ramón Pérez-núñez María Fernanda González Ana María Avalos Lisette Leyton Cellular Communication Laboratory Programa de Biología Celular y MolecularCenter for Studies on ExerciseMetabolism and Cancer(CEMC)Instituto de Ciencias Biomédicas(ICBM)Facultad de MedicinaUniversidad de ChileSantiagoChile Advanced Center for Chronic Diseases(ACCDiS) Faculty of Chemical and Pharmaceutical Sciences&Faculty of MedicineUniversidad de ChileSantiagoChile Instituto de Ciencias Biomédicas Facultad de Ciencias de la SaludUniversidad Autónoma de ChileSantiagoChile

Astrocytes are the most abundant type of glial cell in the central nervous *** injury and inflammation,astrocytes become reactive and undergo morphological and functional *** on their phenotypic classification as A1 or A2,reactive astrocytes contribute to both neurotoxic and neuroprotective responses,***,this binary classification does not fully capture the diversity of astrocyte responses observed across different diseases and *** analysis has revealed that reactive astrocytes have a complex landscape of gene expression profiles,which emphasizes the heterogeneous nature of their *** actively participate in regulating central nervous system inflammation by interacting with microglia and other cell types,releasing cytokines,and influencing the immune *** phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)signaling pathway is a central player in astrocyte reactivity and impacts various aspects of astrocyte behavior,as evidenced by in silico,in vitro,and in vivo *** astrocytes,inflammatory cues trigger a cascade of molecular events,where nuclear factor-κB serves as a central mediator of the pro-inflammatory ***,we review the heterogeneity of reactive astrocytes and the molecular mechanisms underlying their *** highlight the involvement of various signaling pathways that regulate astrocyte reactivity,including the PI3K/AKT/mammalian target of rapamycin(mTOR),αvβ3 integrin/PI3K/AKT/connexin 43,and notch/PI3K/AKT *** targeting the inactivation of the PI3K/AKT cellular signaling pathway to control reactive astrocytes and prevent central nervous system damage,evidence suggests that activating this pathway could also yield beneficial *** dual function of the PI3K/AKT pathway underscores its complexity in astrocyte reactivity and brain function *** review emphasizes the importance of employing astrocyte-exclusive models to underst

关键词： inflammation integrins neuroprotective neurotoxic phosphatidylinositol 3-kinase reactive astrocytes signal transduction Thy-1(CD90)

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Astrocytes, reactive astrogliosis, and glial scar formation in traumatic brain injury

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neural Regeneration Research 2025年第4期20卷 973-989页

作者： María Belén Cieri Alberto Javier Ramos Laboratorio de neuropatología Molecular IBCN UBA-CONICETFacultad de MedicinaUniversidad de Buenos AiresBuenos AiresArgentina

Traumatic brain injury is a global health crisis,causing significant death and disability *** that follows traumatic brain injury has serious consequences for neuronal survival and cognitive impairments,with astrocytes involved in this *** traumatic brain injury,astrocytes rapidly become reactive,and astrogliosis propagates from the injury core to distant brain *** astroglial proteins are downregulated near the traumatic brain injury core,while pro-inflammatory astroglial genes are *** altered gene expression is considered a pathological remodeling of astrocytes that produces serious consequences for neuronal survival and cognitive *** addition,glial scar formed by reactive astrocytes is initially necessary to limit immune cell infiltration,but in the long term impedes axonal reconnection and functional *** therapeutic strategies for traumatic brain injury are focused on preventing acute ***,cannabinoids,progesterone,beta-blockers,and cerebrolysin demonstrate neuroprotective benefits but most of them have not been studied in the context of *** this review,we discuss the cell signaling pathways activated in reactive astrocytes following traumatic brain injury and we discuss some of the potential new strategies aimed to modulate astroglial responses in traumatic brain injury,especially using cell-targeted strategies with miRnAs or lncRnA,viral vectors,and repurposed drugs.

关键词： astrocyte glial scar innate immunity neuroinflammation stab injury Toll-like receptors

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Sex differences in aging and injured brain

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neural Regeneration Research 2025年第10期20卷 2901-2902页

作者： Jordan n.Williamson Yuan Yang University of Illinois Urbana-Champaign Grainger College of EngineeringDepartment of BioengineeringUrbanaILUSA Carle Foundation Hospital Stephenson Family Clinical Research InstituteClinical Imaging Research CenterUrbanaILUSA University of Illinois Urbana-Champaign Beckman Institute for Advanced Science and TechnologyUrbanaILUSA northwestern University Department of Physical Therapy and Human Movement SciencesChicagoILUSA

Background:The prevalence,age of onset,and symptomatology of traumatic brain injury,stroke,and neurodegenerative diseases(such as Alzheimer’s disease(AD),Parkinson’s disease,amyotrophic lateral sclerosis,and Huntington’s disease)differ substantially between males and *** higher prevalence of these brain disorders has been attributed to females having a greater longevity compared with *** one of the greatest risk factors of acquired brain injury(such as stroke,traumatic brain injury caused by fall)and neurodegenerative disease is age.

关键词： Huntington prevalence traumatic

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