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Oh L, Linden JA, Zeidan A, Salhi B, Lema PC, Pierce AE, Greene AL, Werner SL, Heron SL, Lall, MD, Finnell JT, Franks N, Battaglioli NJ, Haber J, Sampson C, Fisher J, Pillow MT, Doshi AA, Lo B. Overcoming barriers to promotion for women and underrepresented in medicine faculty in academic emergency medicine. J Am Coll Emerg Physicians Open 2021; 2:e12552. [PMID: 34984414 PMCID: PMC8692182 DOI: 10.1002/emp2.12552] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/06/2021] [Accepted: 08/19/2021] [Indexed: 11/12/2022] Open
Abstract
Equity in the promotion of women and underrepresented minorities (URiM) is essential for the advancement of academic emergency medicine and the specialty as a whole. Forward-thinking healthcare organizations can best position themselves to optimally care for an increasingly diverse patient population and mentor trainees by championing increased diversity in senior faculty ranks, leadership, and governance roles. This article explores several potential solutions to addressing inequities that hinder the advancement of women and URiM faculty. It is intended to complement the recently approved American College of Emergency Physicians (ACEP) policy statement aimed at overcoming barriers to promotion of women and URiM faculty in academic emergency medicine. This policy statement was jointly released and supported by the Society for Academic Emergency Medicine (SAEM), American Academy of Emergency Medicine (AAEM), and the Association of Academic Chairs of Emergency Medicine (AACEM).
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Affiliation(s)
- Laura Oh
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Judith A. Linden
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Amy Zeidan
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Bisan Salhi
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Penelope C. Lema
- Department of Emergency MedicineColumbia University Valegos College of Physicians and SurgeonsNew York CityNew YorkUSA
| | - Ava E. Pierce
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Andrea L. Greene
- Department of Emergency MedicineUniversity Medical CenterEl PasoTexasUSA
| | - Sandra L. Werner
- Department of Emergency MedicineMetroHealth Medical Center/Case Western Reserve UniversityClevelandOhioUSA
| | - Sheryl L. Heron
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | | | - John T. Finnell
- Department of Emergency MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Nicole Franks
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | | | - Jordana Haber
- Department of Emergency MedicineUNLV School of MedicineLas VegasNevadaUSA
| | - Christopher Sampson
- Department of Emergency MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Jonathan Fisher
- Department of Emergency MedicineUNTHSC‐TCU School of MedicineFort WorthTexasUSA
| | - M. Tyson Pillow
- Department of Emergency MedicineBaylor College of MedicineDallasTexasUSA
| | - Ankur A. Doshi
- Department of Emergency MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Bruce Lo
- Department of Emergency MedicineSentara Norfolk General Hospital/Eastern Virginia Medical SchoolNorfolkVirginiaUSA
- Department of Emergency MedicineUT Southwestern Medical CenterDallasTexasUSA
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Clemency BM, Bola A, Schlader ZJ, Hostler D, Lin H, St James E, Lema PC, Johnson BD. Ultrasonographic Inferior Vena Cava Measurement is More Sensitive Than Vital Sign Abnormalities for Identifying Moderate and Severe Hemorrhage. J Emerg Med 2021; 62:64-71. [PMID: 34544622 DOI: 10.1016/j.jemermed.2021.07.049] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasound inferior vena cava (IVC) diameter has been shown to decrease in response to hemorrhage. IVC diameter cut points to identify moderate and severe blood loss have not been established. OBJECTIVES This study sought to find ultrasound IVC diameter cut points to identify moderate and severe hemorrhage and assess the performance of these cut points vs. vital sign abnormalities. METHODS This is a secondary analysis of data from a study that described changes in vital signs and sonographic measurements of the IVC during a lower body negative pressure model of hemorrhage. Using receiver operator curve analyses, optimal cut points for identifying moderate and severe hemorrhage were identified. The ability of these cut points to identify hemorrhage in patients with no vital sign abnormalities was then assessed. RESULTS In both long- and short-axis views, maximum and minimum IVC diameters (IVCmax and IVCmin) were significantly lower than baseline in severe blood loss. The optimal cut point for IVCmax in both axes was found to be ≤ 0.8 cm. This cut point is able to distinguish between no blood loss vs. moderate blood loss, and no blood loss vs. severe blood loss. The optimal cut point for IVCmin was variable between axes and blood loss severity. IVC diameter cut points obtained were able to identify hemorrhage in patients with no vital sign abnormalities. CONCLUSION An ultrasound IVCmax of ≤ 0.8 cm may be useful in identifying moderate and severe hemorrhage before vital sign abnormalities are evident.
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Affiliation(s)
- Brian M Clemency
- Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Aaron Bola
- Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Zachary J Schlader
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana
| | - David Hostler
- Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Howard Lin
- Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Erika St James
- Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Penelope C Lema
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Blair D Johnson
- Department of Kinesiology, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana
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Zaidi SR, Sharma VK, Tsai S, Flores S, Lema PC, Castillo J. Emergency Department Well-being Initiatives During the COVID-19 Pandemic: An After-action Review. AEM Educ Train 2020; 4:411-414. [PMID: 33150284 PMCID: PMC7592823 DOI: 10.1002/aet2.10490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
The COVID-19 pandemic has significantly impacted the well-being of our health care professionals, particularly frontline providers in the emergency department (ED). Our ED, located in New York City, was severely affected, exposing the staff to a combination of unique stressors. Our ED Wellness Committee responded by implementing various initiatives focusing on the physical, mental, and social needs of our providers to support them through this difficult time. The initiatives we describe offer a framework that may help other departments understand the importance of provider well-being during a pandemic.
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Affiliation(s)
- Sara R. Zaidi
- Department of Emergency MedicineNew York Presbyterian–Columbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
- Department of Emergency MedicineNew York Presbyterian–Weill Cornell MedicineNew YorkNYUSA
| | - Vineet K. Sharma
- Department of Emergency MedicineNew York Presbyterian–Columbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
- Department of Emergency MedicineNew York Presbyterian–Weill Cornell MedicineNew YorkNYUSA
| | - Shiu‐Lin Tsai
- Department of Emergency MedicineNew York Presbyterian–Columbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
| | - Stefan Flores
- Department of Emergency MedicineNew York Presbyterian–Columbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
| | - Penelope C. Lema
- Department of Emergency MedicineNew York Presbyterian–Columbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
| | - Jenny Castillo
- Department of Emergency MedicineNew York Presbyterian–Columbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
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4
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Panebianco NL, Liu RB, Alerhand S, Au AK, Bailitz J, Chiem AT, Damewood SC, Friedman L, Gottlieb M, Lema PC, Lewiss RE, Lin J, Lin M, Liang Liu E, Magee MA, Nelson MJ, Sajed D, Situ‐LaCasse EH, Stolz L. Joint Recommendations and Resources for Clinical Ultrasound Education Amidst the COVID-19 Era. AEM Educ Train 2020; 4:438-442. [PMID: 33150291 PMCID: PMC7592817 DOI: 10.1002/aet2.10506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 05/28/2023]
Affiliation(s)
- Nova L. Panebianco
- From theDepartment of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Rachel B. Liu
- theDepartment of Emergency MedicineYale School of MedicineNew HavenCTUSA
| | - Stephen Alerhand
- theDepartment of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNJUSA
| | - Arthur K. Au
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - John Bailitz
- theDepartment of Emergency MedicineNorthwestern UniversityChicagoILUSA
| | - Alan T. Chiem
- theDepartment of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Sara C. Damewood
- theDepartment of Emergency MedicineUniversity of WisconsinMadisonWIUSA
| | - Lucas Friedman
- theDepartment of Emergency MedicineUniversity of California at Riverside School of MedicineRiversideCAUSA
| | - Michael Gottlieb
- theDepartment of Emergency MedicineRush University Medical CenterChicagoILUSA
| | - Penelope C. Lema
- theDepartment of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNYUSA
| | - Resa E. Lewiss
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Judy Lin
- theDepartment of Emergency MedicineMaimonides Medical CenterBrooklynNYUSA
| | - Maya Lin
- theDepartment of Emergency MedicineNew York Presbyterian–Brooklyn Methodist HospitalBrooklynNYUSA
| | - E. Liang Liu
- theDepartment of Emergency MedicineEmory UniversityAtlantaGAUSA
| | - Mark A. Magee
- theDepartment of Emergency MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaPAUSA
| | - Mathew J. Nelson
- theDepartment of Emergency MedicineNorth Shore University HospitalManhassetNYUSA
| | - Dana Sajed
- theDepartment of Emergency MedicineLA County + USC Medical CenterLos AngelesCAUSA
| | - Elaine H. Situ‐LaCasse
- theDepartment of Emergency MedicineUniversity of Arizona/Banner University Medical Center–TucsonTucsonAZUSA
| | - Lori Stolz
- and theDepartment of Emergency MedicineUniversity of CincinnatiCincinnatiOHUSA
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Gavin N, Romney MLS, Lema PC, Babineau J, Chang B, Egan DJ, Tedeschi C, Mills AM, Kessler DO. Organisational crisis resource management: leading an academic department of emergency medicine through the COVID-19 pandemic. leader 2020. [DOI: 10.1136/leader-2020-000310] [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: 11/03/2022]
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6
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Johnson BD, Schlader ZJ, Schaake MW, O'Leary MC, Hostler D, Lin H, St James E, Lema PC, Bola A, Clemency BM. Inferior Vena Cava Diameter is an Early Marker of Central Hypovolemia during Simulated Blood Loss. PREHOSP EMERG CARE 2020; 25:341-346. [PMID: 32628063 DOI: 10.1080/10903127.2020.1778823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Inferior vena cava (IVC) diameter decreases under conditions of hypovolemia. Point-of-care ultrasound (POCUS) may be useful to emergently assess IVC diameter. This study tested the hypothesis that ultrasound measurements of IVC diameter decreases during severe simulated blood loss. METHODS Blood loss was simulated in 14 healthy men (22 ± 2 years) using lower body negative pressure (LBNP). Pressure within the LBNP chamber was reduced 10 mmHg of LBNP every four minutes until participants experienced pre-syncopal symptoms or until 80 mmHg of LBNP was completed. IVC diameter was imaged with POCUS using B-mode in the long and short axis views between minutes two and four of each stage. RESULTS Maximum IVC diameter in the long axis view was lower than baseline (1.5 ± 0.4 cm) starting at -20 mmHg of LBNP (1.0 ± 0.3 cm; p < 0.01) and throughout LBNP (p < 0.01). The minimum IVC diameter in the long axis view was lower than baseline (0.9 ± 0.3 cm) at -20 mmHg of LBNP (0.5 ± 0.3 cm; p < 0.01) and throughout LBNP (p < 0.01). Maximum IVC diameter in the short axis view was lower than baseline (0.9 ± 0.2 cm) at 40 mmHg of LBNP (0.6 ± 0.2; p = 0.01) and the final LBNP stage (0.6 ± 0.2 cm; p < 0.01). IVC minimum diameter in the short axis view was lower than baseline (0.5 ± 0.2 cm) at the final LBNP stage (0.3 ± 0.2 cm; p = 0.01). CONCLUSION These data demonstrate that IVC diameter decreases prior to changes in traditional vital signs during simulated blood loss. Further study is needed to determine the view and diameter threshold that most accurate for identifying hemorrhage requiring emergent intervention.
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Chapman CL, Johnson BD, Hostler D, Lema PC, Schlader ZJ. Reliability and agreement of human renal and segmental artery hemodynamics measured using Doppler ultrasound. J Appl Physiol (1985) 2020; 128:627-636. [PMID: 32027544 DOI: 10.1152/japplphysiol.00813.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
To optimize study design and data interpretation, there is a need to understand the reliability of Doppler ultrasound-derived measures of blood velocity (BV) measured in the renal and segmental arteries. Thus, this study tested the following two hypotheses: 1) renal and segmental artery BV measured over the current standard of three cardiac cycles have good agreement with measurements over nine cardiac cycles (study 1); and 2) renal and segmental artery BV measurements have relatively poor day-to-day reliability (study 2). In study 1, there was excellent agreement between measurements over three and nine cardiac cycles for BV in both the renal and segmental arteries, as evidenced by BV measurements that were not statistically different (P ≥ 0.68), were highly consistent (r ≥ 0.99, P < 0.01), had a coefficient of variation ≤2.5 ± 1.8%, and 97% (renal artery) and 92% (segmental artery) of the individual differences fell within the 95% limits of agreement. In study 2, there was relatively good day-to-day reliability in renal artery BV as evidenced by no differences between three separate days (P ≥ 0.30), an intraclass correlation coefficient (ICC) of 0.92 (0.78, 0.98), and 7.4 ± 5.5% coefficient of variation. The day-to-day reliability was relatively poor in the segmental artery with an ICC of 0.77 (0.41, 0.93) and 9.0 ± 5.6% coefficient of variation. These findings support measuring renal and segmental artery hemodynamics over three cardiac cycles and the utility in reporting renal BV across days. However, because of the variation across days, hemodynamic responses in the segmental arteries should be reported as changes from baseline when making comparisons across multiple days.NEW & NOTEWORTHY The present study indicates that Doppler ultrasound-derived measures of renal and segmental artery hemodynamics over three cardiac cycles have excellent agreement with those over nine cardiac cycles. These findings support the current practice of measuring renal and segmental artery blood velocity over three cardiac cycles. This study also demonstrates that there is excellent day-to-day reliability for measures of renal artery blood velocity, which supports reporting absolute values of renal artery blood velocity across days. However, it was also found that the day-to-day reliability of segmental artery measurements is relatively poor. Thus, to account for this variability, we suggest that segmental artery hemodynamics be compared as relative changes from baseline across separate days.
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Affiliation(s)
- Christopher L Chapman
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York
| | - Blair D Johnson
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York
| | - David Hostler
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York
| | - Penelope C Lema
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Zachary J Schlader
- Department of Exercise and Nutrition Sciences, Center for Research and Education in Special Environments, University at Buffalo, Buffalo, New York.,Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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Chapman CL, Benati JM, Johnson BD, Vargas NT, Lema PC, Schlader ZJ. Renal and segmental artery hemodynamics during whole body passive heating and cooling recovery. J Appl Physiol (1985) 2019; 127:974-983. [DOI: 10.1152/japplphysiol.00403.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
High environmental temperatures are associated with increased risk of acute kidney injury, which may be related to reductions in renal blood flow. The susceptibility of the kidneys may be increased because of heat stress-induced changes in renal vascular resistance (RVR) to sympathetic activation. We tested the hypotheses that, compared with normothermia, increases in RVR during the cold pressor test (CPT, a sympathoexcitatory maneuver) are attenuated during passive heating and exacerbated after cooling recovery. Twenty-four healthy adults (22 ± 2 yr; 12 women, 12 men) completed CPTs at normothermic baseline, after passive heating to a rise in core temperature of ~1.2°C, and after cooling recovery when core temperature returned to ~0.2°C above normothermic baseline. Blood velocity was measured by Doppler ultrasound in the distal segment of the right renal artery (Renal, n = 24 during thermal stress, n = 12 during CPTs) or the middle portion of a segmental artery (Segmental, n = 12). RVR was calculated as mean arterial pressure divided by renal or segmental blood velocity. RVR increased at the end of CPT during normothermic baseline in both arteries (Renal: by 1.0 ± 1.0 mmHg·cm−1·s, Segmental: by 2.2 ± 1.2 mmHg·cm−1·s, P ≤ 0.03), and these increases were abolished with passive heating ( P ≥ 0.76). At the end of cooling recovery, RVR in both arteries to the CPT was restored to that of normothermic baseline ( P ≤ 0.17). These data show that increases in RVR to sympathetic activation during passive heating are attenuated and return to that of normothermic baseline after cooling recovery. NEW & NOTEWORTHY Our data indicate that increases in renal vascular resistance to the cold pressor test (i.e., sympathetic activation) are attenuated during passive heating, but at the end of cooling recovery this response returns to that of normothermic baseline. Importantly, hemodynamic responses were assessed in arteries going to (renal artery) and within (segmental artery) the kidney, which has not been previously examined in the same study during thermal and/or sympathetic stressors.
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Affiliation(s)
- Christopher L. Chapman
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Julia M. Benati
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Blair D. Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Nicole T. Vargas
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Penelope C. Lema
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Zachary J. Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
- Department of Kinesiology, School of Public Health–Bloomington, Indiana University, Bloomington, Indiana
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Chapman CL, Benati JM, Vargas NT, Johnson BD, Lema PC, Schlader ZJ. Extra- And Intra- Renal Vascular Responses To Sympathetic Activation Are Not Modified Following Cooling Recovery. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560902.91629.61] [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: 11/21/2022]
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10
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Schlader ZJ, Chapman CL, Benati JM, Gideon EA, Vargas NT, Lema PC, Johnson BD. Renal Hemodynamics During Sympathetic Activation Following Aerobic and Anaerobic Exercise. Front Physiol 2019; 9:1928. [PMID: 30687130 PMCID: PMC6335335 DOI: 10.3389/fphys.2018.01928] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/27/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022] Open
Abstract
We tested the hypotheses that prior aerobic (Study 1) or anaerobic (Study 2) exercise attenuates the increase in renal vascular resistance (RVR) during sympathetic stimulation. Ten healthy young adults (5 females) participated in both Study 1 (aerobic exercise) and Study 2 (anaerobic exercise). In Study 1, subjects completed three minutes of face cooling pre- and post- 30 min of moderate intensity aerobic exercise (68 ± 1% estimate maximal heart rate). In Study 2, subjects completed two minutes of the cold pressor test pre- and post- the completion of a 30 s maximal effort cycling test (Wingate Anaerobic Test). Both face cooling and the cold pressor test stimulate the sympathetic nervous system and elevate RVR. The primary dependent variable in both Studies was renal blood velocity, which was measured at baseline and every minute during sympathetic stimulation. Renal blood velocity was measured via the coronal approach at the distal segment of the right renal artery with pulsed wave Doppler ultrasound. RVR was calculated from the quotient of mean arterial pressure and renal blood velocity. In Study 1, renal blood velocity and RVR did not differ between pre- and post- aerobic exercise (P ≥ 0.24). Face cooling decreased renal blood velocity (P < 0.01) and the magnitude of this decrease did not differ between pre- and post- aerobic exercise (P = 0.52). RVR increased with face cooling (P < 0.01) and the extent of these increases did not differ between pre- and post- aerobic exercise (P = 0.74). In Study 2, renal blood velocity was 2 ± 2 cm/s lower post- anaerobic exercise (P = 0.02), but RVR did not differ (P = 0.08). The cold pressor test decreased renal blood velocity (P < 0.01) and the magnitude of this decrease did not differ between pre- and post- anaerobic exercise (P = 0.26). RVR increased with the cold pressor test (P < 0.01) and the extent of these increases did not differ between pre- and post- anaerobic exercise (P = 0.12). These data indicate that 30 min of moderate intensity aerobic exercise or 30 s of maximal effort anaerobic exercise does not affect the capacity to increase RVR during sympathetic stimulation following exercise.
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Affiliation(s)
- Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, United States
| | - Christopher L Chapman
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, United States
| | - Julia M Benati
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, United States
| | - Elizabeth A Gideon
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, United States
| | - Nicole T Vargas
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, United States
| | - Penelope C Lema
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, United States
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11
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O’Leary MC, Schlader ZJ, Schaake MW, Sackett JR, Lin H, James ES, Lema PC, Clemency BM, Johnson BD. Inferior Vena Cava Diameter Reductions Precede Changes in Traditional Vital Signs during Simulated Blood Loss. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535685.86751.a3] [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: 11/21/2022]
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12
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Benati JM, Chapman CL, Johnson BD, Lema PC, Gideon EA, Abdul‐Rashed JL, Solis FE, Schlader ZJ. Measurement of Renal Hemodynamics by Doppler Ultrasound during Sympathetic Activation while Heat Stressed. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.lb254] [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)
- Julia M Benati
- Department of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNY
| | | | - Blair D Johnson
- Department of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNY
| | - Penelope C Lema
- Department of Emergency MedicineUniversity at BuffaloBuffaloNY
| | - Elizabeth A Gideon
- Department of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNY
| | | | - Fernando E Solis
- Department of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNY
| | - Zachary J Schlader
- Department of Exercise and Nutrition SciencesUniversity at BuffaloBuffaloNY
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13
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Lema PC, Mantuani D, Nagdev A, Adhikari S. Asteroid Hyalosis Masquerading as Vitreous Hemorrhage on Point-of-Care Sonography. J Ultrasound Med 2018; 37:281-284. [PMID: 28715155 DOI: 10.1002/jum.14317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
Point-of-care ocular sonography is frequently used in the emergency department to evaluate patients with vision disorders. We describe a case series of 3 patients who ultimately had a diagnosis of asteroid hyalosis, a lesser-known condition that on point-of-care sonography may be mistaken for vitreous hemorrhage. Asteroid hyalosis is considered a benign degenerative condition. In contrast, vitreous hemorrhage may be an ocular emergency that warrants an urgent ophthalmologic consultation if there is an underlying retinal tear or detachment. Although similar in appearance on sonography, recognition of the subtle pathognomonic sonographic features along with their clinical presentations can differentiate these diseases, with vastly different management strategies and dispositions.
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Affiliation(s)
- Penelope C Lema
- Department of Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Daniel Mantuani
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California, USA
| | - Arun Nagdev
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California, USA
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
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