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Morris TA, Fernandes TM, Chung J, Vintch JRE, McGuire WC, Thapamagar S, Alotaibi M, Aries S, Dakaeva K. Observational cohort study to validate SEARCH, a novel hierarchical algorithm to define long-term outcomes after pulmonary embolism. BMJ Open 2023; 13:e074470. [PMID: 37770267 PMCID: PMC10546166 DOI: 10.1136/bmjopen-2023-074470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Chronic dyspnoea and exercise impairment are common after acute pulmonary embolism (PE) but are not defined and quantified sufficiently to serve as outcomes in clinical trials. The planned project will clinically validate a novel method to determine discrete, clinically meaningful diagnoses after acute PE. The method uses an algorithm entitled SEARCH, for symptom screen, exercise testing, arterial perfusion, resting echocardiography, confirmatory imaging and haemodynamic measurements. SEARCH is a stepwise algorithm that sorts patients by a hierarchical series of dichotomous tests into discreet categories of long-term outcomes after PE: asymptomatic, post-PE deconditioning, symptoms from other causes, chronic thromboembolism with ventilatory inefficiency, chronic thromboembolism with small stroke volume augmentation, chronic thromboembolic disease and chronic thromboembolic pulmonary hypertension. METHODS The project will test the inter-rater reliability of the SEARCH algorithm by determining whether it will yield concordant post-PE diagnoses when six independent reviewers review the same diagnostic data on 150 patients evaluated at two time points after PE. The project will also determine whether the post-PE diagnoses are stable, according to the SEARCH algorithm, between the first evaluation and the subsequent one 6 months later. IMPLICATIONS Validation of the SEARCH algorithm would offer clinicians a straightforward method to diagnose post-PE conditions that are rarely distinguished clinically. Their categorisation and definition will allow post-PE conditions to be used as endpoints in clinical trials of acute PE treatment. TRIAL REGISTRATION NUMBER NCT05568927.
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Affiliation(s)
- Timothy A Morris
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Timothy M Fernandes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Jina Chung
- Division of Cardiology, The Lundquist Institute, Torrance, California, USA
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Janine R E Vintch
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute, Torrance, California, USA
- Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - W Cameron McGuire
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Suman Thapamagar
- Division of Pulmonary and Critical Care Medicine, Riverside University Health System, Moreno Valley, California, USA
- Division of Pulmonary and Critical Care Medicine, University of California Riverside, Riverside, California, USA
| | - Mona Alotaibi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Savannah Aries
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Khadizhat Dakaeva
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
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Bonenfant J, Li J, Nasouf L, Miller J, Lowe T, Jaroszewski L, Qiu X, Thapamagar S, Mittal A, Godzik A, Klein W, Nair MG. Resistin Concentration in Early Sepsis and All-Cause Mortality at a Safety-Net Hospital in Riverside County. J Inflamm Res 2022; 15:3925-3940. [PMID: 35860230 PMCID: PMC9289958 DOI: 10.2147/jir.s370788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sepsis mortality has remained unchanged for greater than a decade, and early recognition continues to be the most important factor in mortality outcome. Plasma resistin concentration is increased in sepsis, but its mechanism and clinical relevance is unclear. As one function, resistin interacts with toll-like receptor 4 in competition with lipopolysaccharide, a main component of the gram-negative bacterial cell wall. It is not known if the type of infection leading to sepsis influences resistin production. The objective of this study was to investigate whether 1) early plasma resistin concentration can predict mortality, 2) elevated plasma resistin concentration is associated with clinical disease severity scores, such as SOFA, mSOFA and APACHE II, and 3) plasma resistin concentrations differ between gram negative versus other etiologies of sepsis. Methods This was an exploratory study in the framework of a prospective observational design. Peripheral venous blood samples were obtained from subjects admitted to the intensive care unit at clinical recognition of sepsis (0 hour) and at 6 and 24 hours. Vasopressor utilization was not a requirement for inclusion. Plasma was analyzed for resistin concentration by ELISA. Cytokine concentrations including IL-6, IL-8, and IL-10 were determined by cytokine bead array. Cytokine data were evaluated against publicly available sepsis RNA expression datasets to compare protein versus RNA expression levels in predicting clinical disease state. Clinical data were collected from electronic health records for clinical severity index calculations and context for interpretation of resistin and cytokine concentrations. Subjects were followed up to 60 days, or until death, whichever came first. Statistical analysis was completed with R package and SPSS software. Results Resistin levels were elevated in subjects admitted to the intensive care unit with sepsis. Four-hundred subjects were screened with 45 subjects included in the final analysis. Thirteen of 45 patients were non-survivors. Mortality within 60 days correlated with significantly higher resistin concentrations than in survivors. A resistin concentration of >126 ng/mL at clinical recognition of sepsis and >197 ng/mL within the first 24 hours were associated with mortality within 60 days with an area under the curve of 0.82 and 0.88, respectively. Most subjects with resistin concentration greater than these threshold values were deceased prior to 30 days. Resistin concentrations correlated with SOFA, mSOFA, and APACHE II scores in addition to having association with increases in inflammatory and sepsis biomarkers. These associations were validated with analysis of RNA expression datasets. Conclusion Plasma resistin concentrations of >126 ng/mL at clinical recognition of sepsis and >197 ng/mL within the first 24 hours of clinical sepsis recognition are associated with all-cause mortality. Resistin concentration within this timeframe also has comparable mortality association to well-validated clinical severity indices of SOFA, mSOFA, and APACHE II scores.
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Affiliation(s)
- Jeffrey Bonenfant
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA.,Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jiang Li
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - Luqman Nasouf
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Joseph Miller
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - Tammy Lowe
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Lukasz Jaroszewski
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - Xinru Qiu
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - Suman Thapamagar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA.,Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Aarti Mittal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA.,Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Adam Godzik
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - Walter Klein
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA.,Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Meera G Nair
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, CA, USA
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Chen H, Joshi S, Oberle AJ, Wong AK, Shaz D, Thapamagar S, Tan L, Anholm JD, Giri PC, Henriquez C, Huang YCT. Development and Evaluation of a Small Airway Disease Index Derived From Modeling the Late-Expiratory Flattening of the Flow-Volume Loop. Front Physiol 2022; 13:914972. [PMID: 35733991 PMCID: PMC9207378 DOI: 10.3389/fphys.2022.914972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Excessive decrease in the flow of the late expiratory portion of a flow volume loop (FVL) or “flattening”, reflects small airway dysfunction. The assessment of the flattening is currently determined by visual inspection by the pulmonary function test (PFT) interpreters and is highly variable. In this study, we developed an objective measure to quantify the flattening. We downloaded 172 PFT reports in PDF format from the electronic medical records and digitized and extracted the expiratory portion of the FVL. We located point A (the point of the peak expiratory flow), point B (the point corresponding to 75% of the expiratory vital capacity), and point C (the end of the expiratory portion of the FVL intersecting with the x-axis). We did a linear fitting to the A-B segment and the B-C segment. We calculated: 1) the AB-BC angle (∠ABC), 2) BC-x-axis angle (∠BCX), and 3) the log ratio of the BC slope over the vertical distance between point A and x-axis [log (BC/A-x)]. We asked an expert pulmonologist to assess the FVLs and separated the 172 PFTs into the flattening and the non-flattening groups. We defined the cutoff value as the mean minus one standard deviation using data from the non-flattening group. ∠ABC had the best concordance rate of 80.2% with a cutoff value of 149.7°. We then asked eight pulmonologists to evaluate the flattening with and without ∠ABC in another 168 PFTs. The Fleiss’ kappa was 0.320 (lower and upper confidence intervals [CIs]: 0.293 and 0.348 respectively) without ∠ABC and increased to 0.522 (lower and upper CIs: 0.494 and 0.550) with ∠ABC. There were 147 CT scans performed within 6 months of the 172 PFTs. Twenty-six of 55 PFTs (47.3%) with ∠ABC <149.7° had CT scans showing small airway disease patterns while 44 of 92 PFTs (47.8%) with ∠ABC ≥149.7° had no CT evidence of small airway disease. We concluded that ∠ABC improved the inter-rater agreement on the presence of the late expiratory flattening in FVL. It could be a useful addition to the assessment of small airway disease in the PFT interpretation algorithm and reporting.
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Affiliation(s)
- Hengji Chen
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Sangeeta Joshi
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Amber J. Oberle
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - An-Kwok Wong
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - David Shaz
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Suman Thapamagar
- Department of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | - Laren Tan
- Department of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | - James D. Anholm
- Department of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | - Paresh C. Giri
- Department of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | - Craig Henriquez
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Yuh-Chin T. Huang
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- *Correspondence: Yuh-Chin T. Huang,
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Mak J, Zaid AH, Gnass R, Thapamagar S. AN INTERESTING CASE OF SILICONE EMBOLISM SYNDROME AFTER A COSMETIC PROCEDURE. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Simpson LL, Meah VL, Steele A, Thapamagar S, Gasho C, Anholm JD, Drane AL, Dawkins TG, Busch SA, Oliver SJ, Lawley JS, Tymko MM, Ainslie PN, Steinback CD, Stembridge M, Moore JP. Evidence for a physiological role of pulmonary arterial baroreceptors in sympathetic neural activation in healthy humans. J Physiol 2020; 598:955-965. [PMID: 31977069 DOI: 10.1113/jp278731] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS In an anaesthetised animal model, independent stimulation of baroreceptors in the pulmonary artery elicits reflex sympathoexcitation. In humans, pulmonary arterial pressure is positively related to basal muscle sympathetic nerve activity (MSNA) under conditions where elevated pulmonary pressure is evident (e.g. high altitude); however, a causal link is not established. Using a novel experimental approach, we demonstrate that reducing pulmonary arterial pressure lowers basal MSNA in healthy humans. This response is distinct from the negative feedback reflex mediated by aortic and carotid sinus baroreceptors when systemic arterial pressure is lowered. Afferent input from pulmonary arterial baroreceptors may contribute to sympathetic neural activation in healthy lowland natives exposed to high altitude. ABSTRACT In animal models, distension of baroreceptors located in the pulmonary artery induces a reflex increase in sympathetic outflow; however, this has not been examined in humans. Therefore, we investigated whether reductions in pulmonary arterial pressure influenced sympathetic outflow and baroreflex control of muscle sympathetic nerve activity (MSNA). Healthy lowlanders (n = 13; 5 females) were studied 4-8 days following arrival at high altitude (4383 m; Cerro de Pasco, Peru), a setting that increases both pulmonary arterial pressure and sympathetic outflow. MSNA (microneurography) and blood pressure (BP; photoplethysmography) were measured continuously during ambient air breathing (Amb) and a 6 min inhalation of the vasodilator nitric oxide (iNO; 40 ppm in 21% O2 ), to selectively lower pulmonary arterial pressure. A modified Oxford test was performed under both conditions. Pulmonary artery systolic pressure (PASP) was determined using Doppler echocardiography. iNO reduced PASP (24 ± 3 vs. 32 ± 5 mmHg; P < 0.001) compared to Amb, with a similar reduction in MSNA total activity (1369 ± 576 to 994 ± 474 a.u min-1 ; P = 0.01). iNO also reduced the MSNA operating point (burst incidence; 39 ± 16 to 33 ± 17 bursts·100 Hb-1 ; P = 0.01) and diastolic operating pressure (82 ± 8 to 80 ± 8 mmHg; P < 0.001) compared to Amb, without changing heart rate (P = 0.6) or vascular-sympathetic baroreflex gain (P = 0.85). In conclusion, unloading of pulmonary arterial baroreceptors reduced basal sympathetic outflow to the skeletal muscle vasculature and reset vascular-sympathetic baroreflex control of MSNA downward and leftward in healthy humans at high altitude. These data suggest the existence of a lesser-known reflex input involved in sympathetic activation in humans.
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Affiliation(s)
- Lydia L Simpson
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Wales, UK
| | - Victoria L Meah
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada
| | - Andrew Steele
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada
| | - Suman Thapamagar
- Division of Pulmonary and Critical Care, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Christopher Gasho
- Division of Pulmonary and Critical Care, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - James D Anholm
- Division of Pulmonary and Critical Care, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Aimee L Drane
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Wales, UK
| | - Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Wales, UK
| | - Stephen A Busch
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada
| | - Samuel J Oliver
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Wales, UK
| | - Justin S Lawley
- Department of Sport Science, Division of Physiology, University of Innsbruck, Austria
| | - Michael M Tymko
- Centre for Heart, Lung, and Vascular Health, University of British Columbia Okanagan, Kelowna, Canada
| | - Phillip N Ainslie
- Centre for Heart, Lung, and Vascular Health, University of British Columbia Okanagan, Kelowna, Canada
| | - Craig D Steinback
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Wales, UK
| | - Jonathan P Moore
- Extremes Research Group, School of Sport, Health and Exercise Sciences, Bangor University, Wales, UK
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Bonenfant J, Li J, Nasouf L, Thapamagar S, Mittal A, Nair M, Klein W. RESISTIN IN SEPSIS: BEYOND A BIOMARKER? Chest 2019. [DOI: 10.1016/j.chest.2019.08.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chopra S, Thompson J, Shahangian S, Thapamagar S, Moretta D, Gasho C, Cohen A, Nguyen HB. Precision and consistency of the passive leg raising maneuver for determining fluid responsiveness with bioreactance non-invasive cardiac output monitoring in critically ill patients and healthy volunteers. PLoS One 2019; 14:e0222956. [PMID: 31560711 PMCID: PMC6764744 DOI: 10.1371/journal.pone.0222956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022] Open
Abstract
Objective The passive leg raising (PLR) maneuver has become standard practice in fluid resuscitation. We aim to investigate the precision and consistency of the PLR for determining fluid responsiveness in critically ill patients and healthy volunteers using bioreactance non-invasive cardiac output monitoring (NiCOM™, Cheetah Medical, Inc., Newton Center, Massachusetts, USA). Methods This study is prospective, single-center, observational cohort with repeated measures in critically ill patients admitted to the medical intensive care unit and healthy volunteers at a tertiary academic medical center. Three cycles of PLR were performed, each at 20–30 minutes apart. Fluid responsiveness was defined as a change in stroke volume index (ΔSVI) > 10% with each PLR as determined by NiCOM™. Precision was the variability in ΔSVI after the 3 PLR’s, and determined by range, average deviation and standard deviation. Consistency was the same fluid responsiveness determination of “Yes” (ΔSVI > 10%) or “No” (ΔSVI ≤ 10%) for all 3 PLR’s. Results Seventy-five patients and 25 volunteers were enrolled. In patients, the precision was range of 17.2±13.3%, average deviation 6.5±4.0% and standard deviation 9.0±5.2%; and for volunteers, 17.4±10.3%, 6.6±3.8% and 9.0±6.7%, respectively. There was no statistical difference in the precision measurements between patients and volunteers. Forty-nine (65.3%) patients vs. twenty-four (96.0%) volunteers had consistent results, p < 0.01. Among those with consistent results, twenty-four (49.0%) patients and 24 (100%) volunteers were fluid responsive. Conclusions The precision and consistency of determining ΔSVI with NiCOM™ after PLR may have clinical implication if ΔSVI > 10% is the absolute cutoff to determine fluid responsiveness.
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Affiliation(s)
- Sahil Chopra
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Jordan Thompson
- School of Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Shahab Shahangian
- Department of Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Suman Thapamagar
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Dafne Moretta
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Chris Gasho
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - Avi Cohen
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
| | - H. Bryant Nguyen
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America
- * E-mail:
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Simpson LL, Steele A, Meah VL, Thapamagar S, Gasho C, Drane A, Oliver SJ, Tymko MM, Ainslie PN, Steinback CD, Stembridge M, Moore JP. Selective Reductions in Pulmonary Artery Pressure Lowers Sympathetic Neural Activity in Healthy Humans at High Altitude. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.562.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lydia L Simpson
- School of Sport, Health and Exercise Sciences, Bangor UniversityBangorUnited Kingdom
| | - Andrew Steele
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
| | - Victoria L Meah
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
| | - Suman Thapamagar
- Division of Pulmonary Critical CareLoma Linda UniversityLoma LindaCA
| | - Christopher Gasho
- Division of Pulmonary Critical CareLoma Linda UniversityLoma LindaCA
| | - Aimee Drane
- School of Sport and Health SciencesCardiff Metropolitan UniversityCardiffUnited Kingdom
| | - Samuel J Oliver
- School of Sport, Health and Exercise Sciences, Bangor UniversityBangorUnited Kingdom
| | - Michael M Tymko
- Centre for Heart, Lung, and Vascular Health, University of British ColumbiaKelownaBCCanada
| | - Philip N Ainslie
- Centre for Heart, Lung, and Vascular Health, University of British ColumbiaKelownaBCCanada
| | - Craig D Steinback
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonABCanada
| | - Mike Stembridge
- School of Sport and Health SciencesCardiff Metropolitan UniversityCardiffUnited Kingdom
| | - Jonathan P Moore
- School of Sport, Health and Exercise Sciences, Bangor UniversityBangorUnited Kingdom
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Affiliation(s)
- Sundeep Shenoy
- Inpatient Medicine, University of Arizona, Tucson, Ariz.
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Thapamagar S, Mallareddy R, Lantsberg I. Medical image of the week: oligemic lung field. Southwest J Pulm Crit Care 2014. [DOI: 10.13175/swjpcc163-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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