Marked reductions in cardiovascular mortality in women have occurred for the first time this decade as a result of advances in medical treatment, improvement in medical technology, and a greater focus on women and their cardiovascular risk. 1 Nonetheless, cardiovascular disease remains the No. 1 cause of death for women in the United States, and more women die from cardiovascular disease than men every year. 2 In addition, women with coronary artery disease (CAD) are more likely to have a poorer prognosis than men. 1,3,4 Women who have an acute myocardial infarction have a higher mortality than their male counterparts, and women who have symptoms of angina or an abnormal stress test are less likely to be referred for further diagnostic testing. 2,[5][6][7] Given these gender differences in the evaluation of possible CAD symptoms and the higher mortality due to CAD in women, critical steps should be taken to identify women at the earliest stage of presentation so that appropriate therapeutic strategies can be implemented. Nonetheless, identifying women with coronary disease can be a diagnostic challenge. The prevalence of CAD in younger women is low, and women tend to present with symptoms and CAD at older ages as compared with men. In addition, women may present with more atypical symptoms. 8 Women also have a lower prevalence of obstructive coronary disease, making diagnostic testing designed to detect focal areas of coronary stenosis less sensitive and specific in this population. 9 Currently, exercise stress testing is the most commonly used method of diagnosing CAD in women, 10 -12 Historically, exercise stress testing in women has been thought to have a decreased diagnostic accuracy because of a lower prevalence of CAD in women, but most early studies evaluating stress testing as a diagnostic tool were performed in almost exclusively male cohorts. [15][16][17][18][19][20][21][22][23][24][25] Until recently, the representation of women in published studies was too small to determine any gender differences in test accuracy. The underrepresentation of women, as well as the bias in selection of women when included, may be the reason for the misconceptions regarding the value of exercise stress testing in women. Nonetheless, research on exercise stress testing in women has increased in the past decade, improving our understanding of the diagnostic and prognostic value of this modality in women.The purpose of this article is to review the literature regarding exercise stress testing in women, with a focus beyond ST-segment depression alone. It addition to interpretation of ECG changes with exercise, evaluation of exercise capacity, chronotropic index, heart rate (HR) recovery (HRR), blood pressure response, and Duke Treadmill Score (DTS) can be used to enhance the utility of exercise testing. The diagnostic and prognostic value of these non-ECG variables in women is reviewed, with a goal of highlighting the importance of exercise stress testing in women on the basis of the research available to date. ST-Segment...

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Men caregivers face caregiving burden, have weak support networks and are less likely to seek out programs which increase their caregiving capabilities and help them cope with this burden. Using the 2011 and 2015 National Study of Caregiving (NSOC) database and hierarchical regressions, we studied the emotional, financial, and physical burden of male caregivers as spouses, sons, and other caregivers by assessing the impact of caregiver characteristics, tasks and resources for each subgroup. We highlighted the importance of using a nationally representative database for men caregivers only and emphasized that these caregivers are not a monolithic group. We found that all caregivers experienced these three burden types, particularly elevated emotional stress, with sons reporting the highest emotional and financial strain levels. Assisting with personal care was the most stressful task and caregivers vastly under-utilized support and training. Our results suggest that burden suppressants included having family and friends help with caregiving, having time to decompress, and feeling appreciated by the care recipient. These findings offer insight for devising future policies that intentionally include relationship and burden type to encourage improved and more caregiving from men while supporting their well-being.

Cell transplantation offers a potential new treatment for stroke. Animal studies using models that produce ischemic damage in both the striatum and the frontal cortex have shown beneficial effects when hNT cells (postmitotic immature neurons) were transplanted into the ischemic striatum. In this study, we investigated the effect of hNT cells in a model of stroke in which the striatum remains intact and damage is restricted to the cortex. hNT cells were transplanted into the ischemic cortex 1 week after stroke induced by distal middle cerebral artery occlusion (dMCAo). The cells exhibited robust survival at 4 weeks posttransplant even at the lesion border. hNT cells did not migrate, but they did extend long neurites into the surrounding parenchyma mainly through the white matter. Neurite extension was predominantly toward the lesion in ischemic animals but was bidirectional in uninjured animals. Extension of neurites through the cortex toward the lesion was also seen when there was some surviving cortical tissue between the graft and the infarct. Prolonged deficits were obtained in four tests of sensory-motor function. hNT-transplanted animals showed a significant improvement in functional recovery on one motor test, but there was no effect on the other three tests relative to control animals. Thus, despite clear evidence of graft survival and neurite extension, the functional benefit of hNT cells after ischemia is not guaranteed. Functional benefit could depend on other variables, such as infarct location, whether the cells mature, the behavioral tests employed, rehabilitation training, or as yet unidentified factors.