The Clement blocki Veterans Affairs Medical Center

Milwaukee, WI, United States

The Clement blocki Veterans Affairs Medical Center

Milwaukee, WI, United States

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Ebert T.J.,The Clement blocki Veterans Affairs Medical Center | Novalija J.,The Clement blocki Veterans Affairs Medical Center | Barney J.A.,The Clement blocki Veterans Affairs Medical Center | Uhrich T.D.,The Clement blocki Veterans Affairs Medical Center | And 3 more authors.
Journal of Cardiothoracic and Vascular Anesthesia | Year: 2016

Objective: Acute hyperglycemia causes endothelial dysfunction in diabetic patients, abolishes ischemic pre- and postconditioning, and is an independent predictor of adverse outcome after myocardial infarction in nondiabetic patients. Its effects on endothelial-dependent vasodilation are controversial in healthy subjects. The authors studied the effect of moderate short-term local hyperglycemia on forearm endothelium-dependent vasodilation in healthy volunteers. Design: Randomized, crossover, blinded, 2-visit, pilot design. Setting: Veterans Affairs Medical Center. Participants: Five male and 3 female healthy adult volunteers (23±4 years; height 171±13 cm; weight 66±9 kg; [mean±standard error of the mean]). Interventions: At each visit, volunteers received an infusion through a brachial artery catheter of either 0.9% saline or dextrose in the experimental, non-dominant arm, to establish mild forearm hyperglycemia. Hemodynamics and forearm blood flow (FBF; plethysmography) were measured at baseline, during brachial artery infusions of acetylcholine in consecutive increments (5, 10, and 15 μg/min), before ischemia (20 min, blood pressure cuff at 200 mmHg), and after 15 minutes of reperfusion. Blood glucose and insulin concentrations were determined from venous samples. The effect of duration of intra-arterial dextrose on FBF was examined. Measurements and Main Results: Dextrose increased steady-state blood glucose concentration in the experimental but not the control arm (dominant arm). Dextrose increased FBF compared with saline (4.5±0.5 v 2.6±0.4 mL/min/100 g of tissue, respectively). Acetylcholine caused similar increases in FBF in the absence and presence of dextrose (+239±90% v+203±75%, respectively, during 15 μg/min). The duration of dextrose did not affect this acetylcholine-induced vasodilation. Acetylcholine-stimulated increases in FBF were attenuated in dextrose-treated versus saline after reperfusion (+180±18% v+257±53%, respectively, during 10 μg/min). Interventions in the experimental arm did not affect FBF in the control arm. Conclusion: These results indicated that moderate, short-term, local hyperglycemia induced by intra-arterial administration of dextrose attenuated forearm endothelial-dependent vasodilation after ischemia-reperfusion injury in healthy volunteers. © 2016.


Pagel P.S.,The Clement blocki Veterans Affairs Medical Center | Pagel P.S.,Clement blocki Veterans Affairs Medical Center | Hudetz J.A.,The Clement blocki Veterans Affairs Medical Center
BMC Anesthesiology | Year: 2012

Background: United States anesthesia research production declined sharply from 1980-2005. Whether this trend has continued despite recent calls to improve output is unknown. We conducted an observational internet analysis to quantify American basic science and clinical anesthesia research output in 14 anesthesia journals with impact factors greater than one at three-year intervals during the past decade.Results: American investigators published 1,486 (21.7%) of the total of 6,845 research articles identified in anesthesia journals in 2001, 2004, 2007, and 2010. Approximately two-thirds of all US articles were published in Anesthesiology and Anesthesia and Analgesia. There was a significant correlation (r 2= 0.316; P = 0.036) between the number of articles published by American authors in each anesthesia journal and the corresponding journal's impact factor in 2010. Significantly (P < 0.05; Pearson's Chi-square) fewer basic science articles were published in 2007 and 2010 compared with 2001. US clinical research output also declined in 2007 (201; 15.7%) compared with 2001 (266; 19.1%) and 2004, but an increase occurred in 2010 (279; 21.8%, P < 0.05 versus 2007).Conclusions: The results indicate that US anesthesia research output continued to decrease from 2001 to 2007. An increase in clinical but not basic science research was observed in 2010 compared with 2007, suggesting that a modest recovery in clinical research production may have begun. © 2012 Pagel and Hudetz; licensee BioMed Central Ltd.


PubMed | Medical College of Wisconsin and The Clement blocki Veterans Affairs Medical Center
Type: Journal Article | Journal: Anesthesiology and pain medicine | Year: 2016

Eptifibatide is a platelet glycoprotein IIb/IIIa (GP IIb/IIIa) receptor antagonist that inhibits fibrinogen binding to the activated GP IIb/IIIa site and prevents platelet-platelet interaction and clot formation. GP IIb/IIIa inhibitors improve outcome in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Thrombocytopenia is a complication of GP IIb/IIIa inhibitors, but severe thrombocytopenia is unusual. Most reported cases of severe thrombocytopenia after eptifibatide occurred in patients with acute coronary syndrome. The authors describe a patient who developed acute profound thrombocytopenia after receiving eptifibatide before emergent coronary artery bypass graft surgery.A 67-year-old man with a normal platelet count (220 K/uL) developed atrial fibrillation, left bundle branch block, and respiratory insufficiency consistent with acute coronary syndrome two days after colectomy. He received eptifibatide during cardiac catheterization, where three-vessel coronary artery disease was encountered. Emergent coronary artery surgery was planned, but the platelet count before surgery was 2 K/uL. Eptifibatide was discontinued, surgery was postponed, and acute coronary syndrome was treated with intraaortic balloon counterpulsation.The authors describe the second reported case of eptifibatide-induced severe thrombocytopenia associated with cardiac surgery. In this case, discontinuation of eptifibatide and transfusion of apheresis platelets increased the platelet count (137 K/uL) the following day, and the patient subsequently underwent successful coronary artery surgery using cardiopulmonary bypass.


Xu H.,Childrens Research Institute | Krolikowski J.G.,Childrens Research Institute | Jones D.W.,Childrens Research Institute | Ge Z.-D.,Childrens Research Institute | And 3 more authors.
PLoS ONE | Year: 2012

The apoAI mimetic 4F was designed to inhibit atherosclerosis by improving HDL. We reported that treating tight skin (Tsk-/+) mice, a model of systemic sclerosis (SSc), with 4F decreases inflammation and restores angiogenic potential in Tsk-/+ hearts. Interferon regulating factor 5 (IRF5) is important in autoimmunity and apoptosis in immune cells. However, no studies were performed investigating IRF5 in myocardium. We hypothesize that 4F differentially modulates IRF5 expression and activation in Tsk-/+ hearts. Posterior wall thickness was significantly increased in Tsk-/+ compared to C57Bl/6J (control) and Tsk-/+ mice with 4F treatment assessed by echoradiography highlighting reduction of fibrosis in 4F treated Tsk-/+ mice. IRF5 in heart lysates from control and Tsk/+ with and without 4F treatment (sc, 1 mg/kg/d, 6-8 weeks) was determined. Phosphoserine, ubiquitin, ubiquitin K63 on IRF5 were determined on immunoprecipitates of IRF5. Immunofluorescence and TUNEL assays in heart sections were used to determine positive nuclei for IRF5 and apoptosis, respectively. Fluorescence-labeled streptavidin (SA) was used to determine endothelial cell uptake of biotinylated 4F. SA-agarose pulldown and immunoblotting for IRF5 were used to determine 4F binding IRF5 in endothelial cell cytosolic fractions and to confirm biolayer interferometry studies. IRF5 levels in Tsk-/+ hearts were similar to control. 4F treatments decrease IRF5 in Tsk-/+ hearts and decrease phosphoserine and ubiquitin K63 but increase total ubiquitin on IRF5 in Tsk-/+ compared with levels on IRF5 in control hearts. 4F binds IRF5 by mechanisms favoring association over dissociation strong enough to pull down IRF5 from a mixture of endothelial cell cytosolic proteins. IRF5 positive nuclei and apoptotic cells in Tsk-/+ hearts were increased compared with controls. 4F treatments decreased both measurements in Tsk-/+ hearts. IRF5 activation in Tsk-/+ hearts is increased. 4F treatments decrease IRF5 expression and activation in Tsk-/+ hearts by a mechanism related to 4F's ability to bind IRF5. © 2012 Xu et al.


Kallio P.J.,The Clement blocki Veterans Affairs Medical Center | Cox A.E.,The Clement blocki Veterans Affairs Medical Center | Pagel P.S.,The Clement blocki Veterans Affairs Medical Center
Anesthesiology and Pain Medicine | Year: 2014

Introduction: The authors performed videolaryngoscopy during the preoperative anesthesia clinic evaluation of a patient with chronic dyspnea, stridor, and a previous hemilaryngectomy scheduled to undergo a series of orthopedic surgery procedures for an infected knee arthroplasty. The findings proved crucial for determining airway management.Case Presentation: A 68-year-old man presented to the preoperative anesthesia clinic for work-up before anticipated removal of infected total knee arthroplasty hardware, placement of antibiotic spacers, incision and drainage procedures, and revision arthroplasty. The patient had previously undergone a hemilaryngectomy and tracheostomy (now closed) for squamous cell carcinoma of the right true vocal cord. The patient described chronic dyspnea with minimal exertion. Inspiratory and expiratory wheezes and intermittent inspiratory stridor were present. A transnasal videolaryngoscopy examination was performed using topical anesthesia and demonstrated significant supraglottic scarring, a narrowed glottis, and subglottic stenosis. A computed tomography study confirmed the presence of tracheomalacia with subglottic stenosis. A permanent tracheostomy was performed to establish a definitive airway before the knee arthroplasty was removed.Conclusions: The case illustrates that transnasal videolaryngoscopy conducted in the preoperative anesthesia clinic is capable of providing key information to guide airway management in patients with significant upper airway pathology. © 2014, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM); Published by Kowsar.


Pagel P.S.,The Clement blocki Veterans Affairs Medical Center | Hudetz J.A.,The Clement blocki Veterans Affairs Medical Center
Anesthesiology | Year: 2015

METHODS: Recipients were identified in the FAER alumni database. Each recipient's affiliation was identified using an Internet search (keyword "anesthesiology"). The duration of activity, publications, publication rate, citations, citation rate, h-index, and National Institutes of Health (NIH) funding for each recipient were obtained using the Scopus (Elsevier, USA) and NIH Research Portfolio Online Reporting Tools (National Institutes of Health, USA) databases.RESULTS: Three hundred ninety-seven individuals who received 430 FAER grants were analyzed, 79.1% of whom currently hold full-time academic appointments. Recipients published 19,647 papers with 548,563 citations and received 391 NIH grants totaling $448.44 million. Publications, citations, h-index, the number of NIH grants, and amount of support were dependent on academic rank and years of activity (P < 0.0001). Recipients who acquired NIH grants (40.3%) had greater scholarly output than those who did not. Recipients with more publications were also more likely to secure NIH grants. Women had fewer publications and lower h-index than men, but there were no gender-based differences in NIH funding. Scholarly output was similar in recipients with MD and PhD degrees versus those with MD degrees alone, but recipients with MD and PhD degrees were more likely to receive NIH funding than those with MDs alone.CONCLUSION: Most FAER alumni remain in academic anesthesiology and have established a consistent record of scholarly output that appears to exceed reported productivity for average faculty members identified in previous studies.BACKGROUND: The Foundation for Anesthesia Education and Research (FAER) grant program provides fellows and junior faculty members with grant support to stimulate their careers. The authors conducted a bibliometric analysis of recipients of FAER grants since 1987.


PubMed | the Clement blocki Veterans Affairs Medical Center
Type: Journal Article | Journal: Anaesthesia | Year: 2011

The h-index is used to evaluate scholarly productivity in academic medicine, but has not been extensively used in anaesthesia. We analysed the publications, citations, citations per publication and h-index from 1996 to date using the Scopus() database for 1630 (1120 men, 510 women) for faculty members from 24 randomly selected US academic anaesthesiology departments The median (interquartile range [range]) h-index of US academic anaesthesiologists was 1 [0-5 (0-44)] with 3 [0-18 (0-398)] total publications, 24 [0-187 (0-8515)] total citations, and 5 [0-14 (0-252)] citations per publication. Faculty members in departments with National Institutes of Health funding were more productive than colleagues in departments with little or no government funding. The h-index increased significantly between successive academic ranks concomitant with increases in the number of publications and total citations. Men had higher median h-index than women concomitant with more publications and citations, but the number of citations per publication was similar between groups. Our results suggest that h-index is a reasonable indicator of scholarly productivity in anaesthesia. The results may help comparisons of academic productivity across countries and may be used to assess whether new initiatives designed to reverse recent declines in academic anaesthetic are working. You can respond to this article at http://www.anaesthesiacorrespondence.com.


PubMed | The Clement blocki Veterans Affairs Medical Center
Type: Journal Article | Journal: Anesthesiology | Year: 2015

The Foundation for Anesthesia Education and Research (FAER) grant program provides fellows and junior faculty members with grant support to stimulate their careers. The authors conducted a bibliometric analysis of recipients of FAER grants since 1987.Recipients were identified in the FAER alumni database. Each recipients affiliation was identified using an Internet search (keyword anesthesiology). The duration of activity, publications, publication rate, citations, citation rate, h-index, and National Institutes of Health (NIH) funding for each recipient were obtained using the Scopus (Elsevier, USA) and NIH Research Portfolio Online Reporting Tools (National Institutes of Health, USA) databases.Three hundred ninety-seven individuals who received 430 FAER grants were analyzed, 79.1% of whom currently hold full-time academic appointments. Recipients published 19,647 papers with 548,563 citations and received 391 NIH grants totaling $448.44 million. Publications, citations, h-index, the number of NIH grants, and amount of support were dependent on academic rank and years of activity (P < 0.0001). Recipients who acquired NIH grants (40.3%) had greater scholarly output than those who did not. Recipients with more publications were also more likely to secure NIH grants. Women had fewer publications and lower h-index than men, but there were no gender-based differences in NIH funding. Scholarly output was similar in recipients with MD and PhD degrees versus those with MD degrees alone, but recipients with MD and PhD degrees were more likely to receive NIH funding than those with MDs alone.Most FAER alumni remain in academic anesthesiology and have established a consistent record of scholarly output that appears to exceed reported productivity for average faculty members identified in previous studies.


PubMed | The Clement blocki Veterans Affairs Medical Center
Type: Journal Article | Journal: Journal of cardiothoracic and vascular anesthesia | Year: 2014

Standard methods of quantifying aortic valve stenosis (AS), which focus entirely on the valve itself, do not adequately characterize the magnitude, predict the onset, progression, and severity of symptoms, or identify the incidence of subsequent adverse events. Valvuloarterial impedance (Z(va)) is an index of global left ventricular (LV) afterload that incorporates valvular and arterial loads. The authors tested the hypothesis that aortic valve replacement (AVR) reduces Z(va) but does not affect the arterial component of LV afterload in elderly patients with degenerative calcific trileaflet AS.Observational study.Veterans affairs medical center.Eight elderly (age, 79 4 years) men with moderate-to-severe AS and normal preoperative LV function (ejection fraction, 61% 9%) scheduled for AVR with or without coronary artery bypass graft surgery were studied after institutional review board approval.None.A comprehensive TEE examination was performed during isoflurane-fentanyl-rocuronium anesthesia. Doppler echocardiography was used to measure pressure gradients across the aortic valve, stroke volume (continuity equation), and aortic valve area using standard techniques. Z(va) was determined as (systolic arterial pressure+mean gradient)/stroke volume index. Energy loss index was calculated as (aortic area aortic valve area)/([aortic area--aortic valve area] body surface area). The stroke work loss was obtained as (mean gradient 100/[systolic arterial pressure+mean gradient]). The ratio of stroke volume index to pulse pressure was used to measure systemic arterial compliance. Z(va), energy loss index, stroke work loss, and systemic arterial compliance were assessed before and 15 minutes after cardiopulmonary bypass. Systemic and pulmonary hemodynamics (invasive catheters) were similar after versus before AVR. Aortic valve area increased significantly (p<0.05) with AVR (0.92 0.26 cm(2) to 1.94 0.35 cm(2)), concomitant with decreases in peak and mean gradients (60 17 mmHg to 15 8 mmHg and 38 11 mmHg to 8 5 mmHg, respectively) and peak blood flow velocity (3.9 0.5 m s(-1) to 1.9 0.5 m s(-1)). AVR reduced Z(va) (4.6 1.0 mmHg mL(-1) m(-2) to 3.5 0.3 mmHg mL(-1) m(-2)) and improved energy loss index (0.55 0.16 cm(2) m(-2) to 1.58 0.48 cm(2) m(-2)) concomitant with a decline in stroke work loss (25% 6% to 7% 4%), but systemic arterial compliance remained unchanged (0.63 0.13 compared with 0.70 0.12 mL mmHg(-1) m(-2)).The current results showed that AVR acutely reduced Zva, improved energy loss index, and decreased stroke work loss, but did not affect systemic arterial compliance in elderly men with degenerative calcific trileaflet AS.


PubMed | The Clement blocki Veterans Affairs Medical Center
Type: Journal Article | Journal: Anesthesiology and pain medicine | Year: 2014

The authors performed videolaryngoscopy during the preoperative anesthesia clinic evaluation of a patient with chronic dyspnea, stridor, and a previous hemilaryngectomy scheduled to undergo a series of orthopedic surgery procedures for an infected knee arthroplasty. The findings proved crucial for determining airway management.A 68-year-old man presented to the preoperative anesthesia clinic for work-up before anticipated removal of infected total knee arthroplasty hardware, placement of antibiotic spacers, incision and drainage procedures, and revision arthroplasty. The patient had previously undergone a hemilaryngectomy and tracheostomy (now closed) for squamous cell carcinoma of the right true vocal cord. The patient described chronic dyspnea with minimal exertion. Inspiratory and expiratory wheezes and intermittent inspiratory stridor were present. A transnasal videolaryngoscopy examination was performed using topical anesthesia and demonstrated significant supraglottic scarring, a narrowed glottis, and subglottic stenosis. A computed tomography study confirmed the presence of tracheomalacia with subglottic stenosis. A permanent tracheostomy was performed to establish a definitive airway before the knee arthroplasty was removed.The case illustrates that transnasal videolaryngoscopy conducted in the preoperative anesthesia clinic is capable of providing key information to guide airway management in patients with significant upper airway pathology.

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