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1. Galantamine-Memantine Combination in the Treatment of Parkinson’s Disease Dementia

Author

Emma D. Frost, Swanny X. Shi, Vishnu V. Byroju, Jamir Pitton Rissardo, Jack Donlon, Nicholas Vigilante, Briana P. Murray, Ian M. Walker, Andrew McGarry, Thomas N. Ferraro, Khalid A. Hanafy, Valentina Echeverria, Ludmil Mitrev, Mitchel A. Kling, Balaji Krishnaiah, David B. Lovejoy, Shafiqur Rahman, Trevor W. Stone, and Maju Mathew Koola

Subjects
cognition, drug combination, galantamine, kynurenic acid, memantine, N-acetylcysteine, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects over 1% of population over age 60. It is defined by motor and nonmotor symptoms including a spectrum of cognitive impairments known as Parkinson’s disease dementia (PDD). Currently, the only US Food and Drug Administration-approved treatment for PDD is rivastigmine, which inhibits acetylcholinesterase and butyrylcholinesterase increasing the level of acetylcholine in the brain. Due to its limited efficacy and side effect profile, rivastigmine is often not prescribed, leaving patients with no treatment options. PD has several derangements in neurotransmitter pathways (dopaminergic neurons in the nigrostriatal pathway, kynurenine pathway (KP), acetylcholine, α7 nicotinic receptor, and N-methyl-D-aspartate (NMDA) receptors) and rivastigmine is only partially effective as it only targets one pathway. Kynurenic acid (KYNA), a metabolite of tryptophan metabolism, affects the pathophysiology of PDD in multiple ways. Both galantamine (α7 nicotinic receptor) and memantine (antagonist of the NMDA subtype of the glutamate receptor) are KYNA modulators. When used in combination, they target multiple pathways. While randomized controlled trials (RCTs) with each drug alone for PD have failed, the combination of galantamine and memantine has demonstrated a synergistic effect on cognitive enhancement in animal models. It has therapeutic potential that has not been adequately assessed, warranting future randomized controlled trials. In this review, we summarize the KYNA-centric model for PD pathophysiology and discuss how this treatment combination is promising in improving cognitive function in patients with PDD through its action on KYNA.

Published
2024
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2. Evaluation of vascular aging on measures of cardiac function and mechanical efficiency: insights from in-silico modeling

Author

Lawrence J. Mulligan, Julian Thrash, Ludmil Mitrev, Douglas Folk, Alyssa Exarchakis, Daniel Ewert, and Jeffrey C. Hill

Subjects
computational model, vascular aging, mechanical efficiency, pressure-volume area, aortic compliance, ventricular-vascular coupling, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

IntroductionThis study evaluated the hypothesis that vascular aging (VA) reduces ventricular contractile function and mechanical efficiency (ME) using the left ventricular pressure-volume (PV) construct.MethodsA previously published in-silico computational model (CM) was modified to evaluate the hypothesis in two phases. In phase I, the CM included five settings of aortic compliance (CA) from normal to stiff, studied at a heart rate of 80 bpm, and phase II included the normal to stiff CA settings evaluated at 60, 100, and 140 bpm. The PV construct provided steady-state and transient data through a simulated vena caval occlusion (VCO). The steady-state data included left ventricular volumes (EDV and ESV), stroke work (SW), and VCO provided the PV area (PVA) data in addition to the three measures of contractile state (CS): end-systolic pressure-volume relationship (ESPVR), dP/dtmax-EDV and preload recruitable stroke work (PRSW). Finally, ME was calculated with the SW/PVA parameter.ResultsIn phase I, EDV and ESV increased, as did SW and PVA. The impact on the CS parameters demonstrated a small decrease in ESPVR, no change in dP/dtmax-EDV, and a large increase in PRSW. ME decreased from 71.5 to 60.8%, respectively. In phase II, at the normal and stiff CA settings, across the heart rates studied, EDV and ESV decreased, ESPVR and dP/dtmax-EDV increased and PRSW decreased. ME decreased from 76.4 to 62.6% at the normal CA and 65.8 to 53.2% at the stiff CA.DiscussionThe CM generated new insights regarding how the VA process impacts the contractile state of the myocardium and ME.

Published
2024
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3. Evaluation of ventricular–vascular coupling with critical care metrics: An in silico approach

Author

Lawrence J. Mulligan, Justin Ungerleider, Adam Friedman, Benjamin Sanders, Julian Thrash, Daniel Ewert, Ludmil Mitrev, and Jeffrey C. Hill

Subjects
aortic compliance, cardiac output, computational model, Eadyn, mechanical efficiency, pulse pressure, Physiology, QP1-981
Abstract

Abstract Mean arterial pressure and cardiac output provide insufficient guidance for the management of intraoperative hypotension (IOH). In silico models offer additional insights into acute changes in hemodynamic parameters that may be encountered during IOH. A computational model (CM) generated parameters quantifying ventricular–vascular coupling, and pressure–volume construct across levels of aortic compliance (CA). We studied how a loss from normal‐to‐stiff CA impacts critical care metrics of hemodynamics during vascular occlusion. Pulse pressure (PP), end‐systolic pressure (Pes), arterial compliance (Art‐ca), arterial elastance (Art‐ea), and dynamic arterial elastance (Eadyn), along mechanical efficiency (ME) were measured at five levels of CA. A loss in CA impacted all variables. During steady‐state conditions, PP, Pes, and stroke work increased significantly as CA decreased. Art‐ca decreased and Art‐ea increased similarly; Eadyn increased and ME decreased. During a decrease in preload across all CA levels, arterial dynamics measures remained linear. The CM demonstrated that a loss in CA impacts measures of arterial dynamics during steady‐state and transient conditions and the model demonstrates that critical care metrics are sensitive to changes in CA. While Art‐ca and Art‐ea were sensitive to changes in preload, Eadyn did not change.

Published
2024
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4. Time to Post-Anesthesia Neurological Evaluation and Hemodynamic Stability in Carotid Endarterectomy Comparing Three General Anesthetic Techniques Targeted to a Preset Bispectral Index Value: A Pilot Study

Author

Rhea, Temmermand, Ludmil, Mitrev, Noud, van Helmond, Dean, Roberts, Joseph, Lombardi, and Dejan, Vuckovic

Subjects
Endarterectomy, Carotid, Piperidines, Anesthetics, General, Hemodynamics, Humans, Pilot Projects, Prospective Studies, Anesthesia, General, Propofol, Anesthetics, Intravenous
Abstract

Carotid endarterectomy (CEA) has a 1-5% risk of periprocedural stroke. The ability to emerge patients from anesthesia quickly to detect neurological abnormalities immediately after surgery is vital in this patient population. The objective of this pilot study was to assess if any of three general anesthetic techniques for CEA are associated with a shorter time to a reliable postoperative neurological exam. Secondary objectives were to assess postoperative cognitive dysfunction (POCD), postoperative delirium (POD), and hemodynamic stability. Twenty-one patients undergoing CEA were enrolled and randomized to different combinations of inhalational and intravenous anesthesia: Group A: propofol, remifentanil, and desflurane; Group B: dexmedetomidine, remifentanil, and desflurane; Group C: remifentanil and desflurane. Anesthetic depth was titrated using a bispectral index (BIS) monitor to a goal of 50-60. Time was recorded from surgery end to first meaningful neurological exam. Neurocognitive testing was completed preoperatively and up to 1 week postoperatively to assess POD (3D-CAM) and POCD (Short Blessed Test). Time to first reliable neurological exam was 2 minutes longer in group A (9 min ± 4 min) compared to group B and group C (7 min ± 3 min; 7 min ± 4 min), although this was not statistically significant. In addition, extubation time was significantly longer in group A (11 min) compared to group B and group C (5 min; 6 min) (P = 0.03). 3D -CAM and Short Blessed Test data along with hemodynamics did not differ significantly between the groups. Time to first useful neurologic exam and hemodynamics did not differ between the groups. However, extubation time was significantly prolonged in patients who received propofol, but not dexmedetomidine, as part of their anesthetic for CEA. These findings are best verified in an adequately powered prospective randomized study.

Published
2021

5. Trends in personal protective equipment use by clinicians performing airway procedures for patients with coronavirus disease 2019 in the USA from the intubateCOVID registry

Author

Sabry Ayad, May Hua, Michael F. Aziz, Guy Shochat, Cynthia A. Lien, Timothy G. Gaulton, Frederick G. Mihm, Laura Fonseca, Marian Sherman, Ahmed Salih, Danny J.N. Wong, Jill M. Mhyre, Julie K. Freed, Elizabeth Abramowicz, Richard P. Dutton, Miriam M. Treggiari, Mark Giska, Catherine Chen, Lynnette Harris, Aratara Nutcharoen, Timothy T. Houle, Matthew T. Murrell, James Dattilo, Robert B. Schonberger, Kay B. Leissner, Amy Gunnett, Kathleen N. Johnson, Michael A. Gropper, Karen B. Domino, Jochen D. Muehlschlegel, Jessica L Shanahan, Michael R. Mathis, Steven I. Bott, Laurie K. Davies, Dhanesh K. Gupta, Katherine Nowak, Jacob G. Fowler, P. M. Desai, Yatish S. Ranganath, Anoop Chhina, Yinhui Low, Benjamin H. Cloyd, Alyssa Brzenski, Meir Dashevksy, Ludmil Mitrev, Andrea J. Strathman, Mark D. Neuman, Mark I. Neuman, Aaron M. Joffe, Andrew Volio, Max W. Breidenstein, Donald H. Penning, Kariem El-Boghdadly, Richard Lee Applegate, Imran Ahmad, Timothy Gaulton, Michael B Majewski, Meghan B. Lane-Fall, J. Matthew Fisher, Lyle Gerety, Samuel A. Schechtman, Lakisha J. Gaskins, Ashish Khanna, Peter Panzica, Craig Johnstone, Matthew Wecksell, Kelsey Adair, Alexander Nagrebetsky, Jayakar Guruswamy, Andrea Olmos, Shannon Michel, Daniel Kim, Zita Sibenellar, Shanna S. Hill, Vanessa Cervantes, B. Scott Segal, J. Doug Jaffe, Alexander F. Friend, Nadir Sharawi, Howard B. Gutstein, Alexander Mittnacht, Joy Steadman, Ami R. Stuart, Steven Berstein, Jinlei Li, Michael Y. Lin, David W. Healy, Amie Hoefnagel, Alexis Skolaris, Brenda G. Fahy, and Douglas A. Colquhoun

Subjects
Adult, Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Infectious Disease Transmission, Patient-to-Professional, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Physicians, Correspondence, medicine, Intubation, Intratracheal, Humans, tracheal intubation, Personal protective equipment, business.industry, Tracheal intubation, respiratory failure, aerosol-generating procedures, COVID-19, Middle Aged, United States, Anesthesiology and Pain Medicine, Respiratory failure, Emergency medicine, personal protective equipment, Female, business, Airway
Published
2021
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6. Hereditary pseudocholinesterase deficiency discovery after electroconvulsive therapy

Author

Noud van Helmond, Angelo Andonakakis, Ludmil Mitrev, and Basant Pradhan

Subjects
Adult, Apnea, medicine.medical_treatment, Case Report, Motor function, behavioral disciplines and activities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Electroconvulsive therapy, 030202 anesthesiology, mental disorders, Pseudocholinesterase deficiency, medicine, Choline, Humans, Muscle paralysis, Electroconvulsive Therapy, Butyrylcholinesterase, Depression (differential diagnoses), Depressive Disorder, Major, business.industry, General Medicine, medicine.disease, 030227 psychiatry, chemistry, Anesthesia, Female, business, Metabolism, Inborn Errors
Abstract

Item does not contain fulltext Inherited pseudocholinesterase deficiency refers to an uncommon defect in the butyrylcholinesterase enzyme which can result in prolonged muscle paralysis due to delayed breakdown of choline ester paralytic anaesthetic agents. We describe a 25-year-old woman receiving electroconvulsive therapy (ECT) for treatment of depression in whom motor function did not recover adequately after administration of succinylcholine. Investigated post-ECT, she was found to have severe pseudocholinesterase deficiency. Implications of pseudocholinesterase deficiency for ECT treatment and anaesthetic strategies are discussed.

Published
2021

7. Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults

Author

Jennifer Hruslinski, Diane A. Menio, Robert A. Hymes, J. Douglas Jaffe, Christine Langlois, Lolita Ramsey, Lakisha J. Gaskins, Mark D. Neuman, Thomas Looke, Sandra Bent, Ariana Franco-Mora, Pamela Hedrick, Matthew Newbern, Rafik Tadros, Karen Pealer, Edward Marcantonio, Kamen Vlassakov, Carolyn Buckley, Svetlana Gorbatov, James Gosnell, Talora Steen, Avery Vafai, Jose Zeballos, Louis Cardenas, Ashley Berry, John Getchell, Nicholas Quercetti, Daniel I. Sessler, Sabry Ayad, Manal Hassan, Assad Ali, Gauasan Bajracharya, Damien Billow, Michael Bloomfield, Kavita Elliott, Robert Hampton, Linda He, Hooman Honar, Dilara Khoshknabi, Daniel Kim, Paul Minko, Adam Morris, Azfar Niazi, Tara Nutcharoen, Jeffrey Roberts, Partha Saha, Ahmed Salih, Alexis Skolaris, Taylor Stang, Victor Strimbu, Jesse Templeton, Andrew Volio, Jiayi Wang, Kelly Bolkus, Matthew DeAngelis, Gregory Dodson, Jeffrey Gerritsen, Brian McEniry, Ludmil Mitrev, Kwesi Kwofie, Flynn Bonazza, Vera Lloyd, Izabela Panek, Jared Dabiri, Chris Chavez, Jason Craig, Todd Davidson, Chad Dietrichs, Cheryl Fleetwood, Mike Foley, Chris Getto, Susie Hailes, Sarah Hermes, Andy Hooper, Greg Koener, Kate Kohls, Leslie Law, Adam Lipp, Allison Losey, William Nelson, Mario Nieto, Pam Rogers, Steve Rutman, Garrett Scales, Barbara Sebastian, Tom Stanciu, Gregg Lobel, Michelle Giampiccolo, Dara Herman, Margit Kaufman, Bryan Murphy, Clara Pau, Thomas Puzio, Marlene Veselsky, Trevor Stone, Kelly Apostle, Dory Boyer, Brenda Chen Fan, Susan Lee, Mike Lemke, Richard Merchant, Farhad Moola, Kyrsten Payne, Bertrand Perey, Darius Viskontas, Mark Poler, Patricia D'Antonio, Richard Sheppard, Amer Abdullah, Jamie Fish-Fuhrmann, Mark Giska, Christina Fidkowski, Trent Guthrie, William Hakeos, Lillian Hayes, Joseph Hoegler, Katherine Nowak, Robert Hymes, Jeffery Beck, Jaslynn Cuff, Greg Gaski, Sharon Haaser, Michael Holzman, A. Stephen Malekzadeh, Jeff Schulman, Cary Schwartzbach, Frederick Sieber, Tangwan Azefor, Charles Brown, Arman Davani, Mahmood Jaberi, Courtney Masear, Balram Sharma, Syed Basit Haider, Carolyn Chungu, Ali Ebrahimi, Karim Fikry, Kerri Gannon, Andrew Marcantonio, Meredith Pace, David Sanders, Collin Clarke, Abdel Lawendy, Gary Schwartz, Mohit Garg, Joseph Kim, Mitchell Marshall, Juan Caurci, Ekow Commeh, Randy Cuevas, Germaine Cuff, Lola Franco, David Furguiele, Matthew Giuca, Melissa Allman, Omid Barzideh, James Cossaro, Armando D'Arduini, Anita Farhi, Jason Gould, John Kafel, Anuj Patel, Abraham Peller, Hadas Reshef, Mohammed Safur, Fiore Toscano, Tiffany Tedore, Michael Akerman, Eric Brumberger, Sunday Clark, Rachel Friedlander, Anita Jegarl, Joseph Lane, John P. Lyden, Nili Mehta, Matthew T. Murrell, Nathan Painter, William Ricci, Kaitlyn Sbrollini, Rahul Sharma, Peter A.D. Steel, Michele Steinkamp, Roniel Weinberg, David Stephenson Wellman, Antoun Nader, Paul Fitzgerald, Michaela Ritz, Steven Papp, Greg Bryson, Alexandra Craig, Cassandra Farhat, Braden Gammon, Wade Gofton, Nicole Harris, Karl Lalonde, Allan Liew, Bradley Meulenkamp, Kendra Sonnenburg, Eugene Wai, Geoffrey Wilkin, Derek Donegan, Cassandra Dinh, Nabil Elkassabany, Annamarie Horan, Samir Mehta, Karen Troxell, Mary Ellen Alderfer, Jason Brannen, Christopher Cupitt, Stacy Gerhart, Renee McLin, Julie Sheidy, Katherine Yurick, Jeffrey Carson, Fei Chen, Karen Dragert, Geza Kiss, Halina Malveaux, Deborah McCloskey, Scott Mellender, Sagar S. Mungekar, Helaine Noveck, Carlos Sagebien, Barry Perlman, Luat Biby, Gail McKelvy, Anna Richards, Syed Azim, Ramon Abola, Brittney Ayala, Darcy Halper, Ana Mavarez, Stephen Choi, Imad Awad, Brendan Flynn, Patrick Henry, Richard Jenkinson, Lilia Kaustov, Elizabeth Lappin, Paul McHardy, Amara Singh, Ellen Hauck, Joanne Donnelly, Meera Gonzalez, Christopher Haydel, Jon Livelsberger, Theresa Pazionis, Bridget Slattery, Maritza Vazquez-Trejo, Eric Schwenk, Jaime Baratta, Brittany Deiling, Laura Deschamps, Michael Glick, Daniel Katz, James Krieg, Jennifer Lessin, Marc Torjman, Ki Jinn Chin, Rongyu Jin, Mary Jane Salpeter, Mark Powell, Jeffrey Simmons, Prentiss Lawson, Promil Kukreja, Shanna Graves, Adam Sturdivant, Ayesha Bryant, Sandra Joyce Crump, Derek Dillane, Michael Taylor, Michelle Verrier, Richard Applegate, Ana Arias, Natasha Pineiro, Jeffrey Uppington, Phillip Wolinsky, Joshua Sappenfield, Amy Gunnett, Jennifer Hagen, Sara Harris, Kevin Hollen, Brian Holloway, Mary Beth Horodyski, Trevor Pogue, Ramachandran Ramani, Cameron Smith, Anna Woods, Matthew Warrick, Kelly Flynn, Paul Mongan, Yatish Ranganath, Sean Fernholz, Esperanza Ingersoll-Weng, Anil Marian, Melinda Seering, Zita Sibenaller, Lori Stout, Allison Wagner, Alicia Walter, Cynthia Wong, Jay Magaziner, Denise Orwig, Trina Brown, Jim Dattilo, Susan Ellenberg, Rui Feng, Lee Fleisher, Lakisha Gaskins, Maithri Goud, Chris Helker, Lydia Mezenghie, Brittany Montgomery, Peter Preston, Alisa Stephens, J. Sanford Schwartz, Ann Tierney, Ramona Weber, Jacques Chelly, Shiv Goel, Wende Goncz, Touichi Kawabe, Sharad Khetarpal, Kevin King, Frank Kunkel, Charles Luke, Amy Monroe, Vladislav Shick, Anthony Silipo, Caroline Stehle, Katherine Szabo, Sudhakar Yennam, Mark Hoeft, Max Breidenstein, Timothy Dominick, Alexander Friend, Donald Mathews, Richard Lennertz, Helen Akere, Tyler Balweg, Amber Bo, Christopher Doro, David Goodspeed, Gerald Lang, Maggie Parker, Amy Rettammel, Mary Roth, Robert Sanders, Marissa White, Paul Whiting, Brian Allen, Tracie Baker, Debra Craven, Matt McEvoy, Teresa Turnbo, Stephen Kates, Melanie Morgan, Teresa Willoughby, Wade Weigel, David Auyong, Ellie Fox, Tina Welsh, Bruce Cusson, Sean Dobson, Christopher Edwards, Lynette Harris, Daryl Henshaw, Kathleen Johnson, Glen McKinney, Scott Miller, Jon Reynolds, Jimmy Turner, David VanEenenaam, Robert Weller, Shamsuddin Akhtar, Marcelle Blessing, Chanel Johnson, Michael Kampp, Kimberly Kunze, Jinlei Li, Mary O'Connor, and Miriam Treggiari

Subjects
medicine.medical_specialty, Canada, Research Subjects, Patient engagement, Hip fracture surgery, Patient Advocacy, Anesthesia, General, Patient advocacy, Anesthesia, Spinal, 03 medical and health sciences, 0302 clinical medicine, Nursing, 030202 anesthesiology, Fracture Fixation, Medicine, Humans, General anaesthesia, Cooperative Behavior, Geriatrics, Hip fracture, business.industry, Hip Fractures, Lived experience, Age Factors, Research process, medicine.disease, United States, Anesthesiology and Pain Medicine, Research Design, Patient Participation, business, Decision Making, Shared
Abstract

Summary Engaging patients—defined broadly as individuals with lived experience of a given condition, family members, caregivers, and the organisations that represent them—as partners in research is a priority for policymakers, funders, and the public. Nonetheless, formal efforts to engage patients are absent from most studies, and models to support meaningful patient engagement in clinical anaesthesia research have not been previously described. Here, we review our experience in developing and implementing a multifaceted patient engagement strategy within the Regional Versus General Anesthesia for Promoting Independence After Hip Fracture (REGAIN) surgery trial, an ongoing randomised trial comparing spinal vs general anaesthesia for hip fracture surgery in 1600 older adults across 45 hospitals in the USA and Canada. This strategy engaged patients and their representatives at both the level of overall trial oversight and at the level of individual recruiting sites. Activities spanned a continuum ranging from events designed to elicit patients' input on key decisions to longitudinal collaborations that empowered patients to actively participate in decision-making related to trial design and management. Engagement activities were highly acceptable to participants and led to concrete changes in the design and conduct of the REGAIN trial. The REGAIN experience offers a model for future efforts to engage patients as partners in clinical anaesthesia research, and highlights potential opportunities for investigators to increase the relevance of anaesthesia studies by incorporating patient voices and perspectives into the research process.

Published
2020

8. d -Serine is a potential biomarker for clinical response in treatment of post-traumatic stress disorder using ( R , S )-ketamine infusion and TIMBER psychotherapy: A pilot study

Author

Ludmil Mitrev, Ruin Moaddell, Basant Pradhan, and Irving W. Wainer

Subjects
Adult, Male, Oncology, medicine.medical_specialty, Mindfulness, medicine.medical_treatment, Biophysics, Pilot Projects, Biochemistry, Article, Analytical Chemistry, Stress Disorders, Post-Traumatic, 03 medical and health sciences, Basal (phylogenetics), 0302 clinical medicine, Double-Blind Method, Internal medicine, Serine, medicine, Humans, Ketamine, Molecular Biology, Traumatic stress, Extinction (psychology), Middle Aged, 030227 psychiatry, Cognitive therapy, Biomarker (medicine), Antidepressant, Female, Biomarkers, 030217 neurology & neurosurgery, medicine.drug
Abstract

Post-traumatic stress disorder (PTSD) is a chronic and debilitating condition that is often refractory to standard frontline antidepressant therapy. A promising new approach to PTSD therapy is administration of a single sub-anesthetic dose of (R,S)-ketamine (Ket). The treatment produces rapid and significant therapeutic response, which lasts for only 4–7 days. In one of our studies, the mean duration of response was increased to 33 days when Ket administration was combined with a mindfulness-based cognitive therapy, Trauma Interventions using Mindfulness Based Extinction and Reconsolidation (TIMBER). We now report the results from a 20-patient study, which examined the duration of sustained response with combined TIMBER-Ket therapy, TIMBER-K arm, relative to the response observed in a placebo-controlled arm, TIMBER-P. A significant difference in the duration of response was observed between TIMBER-K and TIMBER-P arms: 34.44 ± 19.12 days and 16.50 ± 11.39 days, respectively (p = 0.022). Previous studies identified a negative correlation between antidepressant response to Ket and basal plasma concentrations of d -serine (DSR). In this study, the basal DSR levels positively correlated with the pre-treatment severity of PTSD symptoms (Pearson's r = 0.42, p = 0.07) and patients with basal DSR level ≥ 3.5 μM displayed not only higher PTSD severity but also shorter duration of response. The data indicate that basal DSR levels may serve as a biomarker of the severity of PTSD symptoms and as a predictor of clinical response. This article is part of a Special Issue entitled: d -Amino acids: biology in the mirror, edited by Dr. Loredano Pollegioni, Dr. Jean-Pierre Mothet and Dr. Molla Gianluca.

Published
2018
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9. Interventional Echocardiography of the MV: What the Interventionalist Wants to Know

Author

Sajjad Sabir, Nayan Desai, Ludmil Mitrev, and Ahmed Awad

Subjects
medicine.medical_specialty, Percutaneous, Rheumatic mitral stenosis, Mitral ring, 030204 cardiovascular system & hematology, Balloon, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Mitral valve, medicine, Humans, Mitral Valve Stenosis, Ultrasonography, Interventional, Heart Valve Prosthesis Implantation, Mitral regurgitation, business.industry, Patient Selection, MitraClip, Mitral Valve Insufficiency, Anesthesiology and Pain Medicine, medicine.anatomical_structure, 030228 respiratory system, Echocardiography, Cardiology, Mitral Valve, Cardiology and Cardiovascular Medicine, Commissurotomy, business, Angioplasty, Balloon, Echocardiography, Transesophageal
Abstract

The past 2 decades have seen a proliferation of transcatheter mitral valve (MV) therapies, which are less invasive and distinct from surgical MV repair or replacement. The commonly used MV transcatheter therapies include (1) percutaneous mitral balloon commissurotomy (PMBC) for rheumatic mitral stenosis; (2) edge-to-edge repair with the MitraClip for mitral regurgitation; (3) valve-in-valve implantation in bioprosthetic MV, native MV, or mitral ring; and (4) closure of paravalvular leaks (PVLs). This article will focus on the use of echocardiography in the diagnosis, patient selection, procedural guidance, and postprocedural follow-up for PMBC, with notes on the role of transesophageal echocardiography in transcatheter interventions for prosthetic valve degeneration and PVL closure.

Published
2018
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10. Electronic medical record registration of ventilatory parameters during critical stages of anesthesia: Does the data reflect reality?

Author

Keyur Trivedi, Noud van Helmond, Ludmil Mitrev, Erin W. Pukenas, John F. Julian, Patrick J. Gilhooley, Kinjal M. Patel, and Ronak G. Desai

Subjects
medicine.medical_specialty, Anesthesiology and Pain Medicine, Anesthesiology, business.industry, Anesthesia, medicine, Electronic medical record, MEDLINE, Electronic Health Records, business, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Contains fulltext : 221583.pdf (Publisher’s version ) (Closed access) 01 augustus 2020

Published
2020

11. A Pilot Study Comparing Aortic Valve Area Estimates Derived from Fick Cardiac Output with Estimates Based on Cheetah-NICOM Cardiac Output

Author

Kinjal M. Patel, Vineeth Nagubandi, Janah Aji, Zahi Rafeq, Jeffrey Ogbara, John P. Gaughan, Debbie Orr, Noud van Helmond, Michael Rosenbloom, Georges Kaddissi, Ahmed Awad, and Ludmil Mitrev

Subjects
Male, medicine.medical_specialty, Cardiac output, medicine.medical_treatment, Cardiology, lcsh:Medicine, Pilot Projects, Fick method, 030204 cardiovascular system & hematology, Article, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Internal medicine, medicine, Humans, In patient, Cardiac Output, lcsh:Science, Cardiac catheterization, Aged, Aged, 80 and over, Multidisciplinary, business.industry, Limits of agreement, lcsh:R, Middle Aged, medicine.disease, Confidence interval, Stenosis, Aortic valve area, Aortic Valve, lcsh:Q, Female, business, Interventional cardiology
Abstract

Cardiac output during cardiac catheterization is often estimated using the modified Fick method (COFick). In this proof-of-concept, prospective non-randomized study carried out in a single academic healthcare centre, we examined whether replacing COFick in the Gorlin formula with Cheetah-NICOM monitor cardiac output (COCheetah) could produce an accurate and precise estimate of aortic valve area in patients with severe aortic stenosis. In twenty-six subjects, COFick and COCheetah were obtained concurrently. A spot and 3-minute running average of COCheetah was used. Bland and Altman analysis was used to derive bias, 95% limits of agreement (LOA) and confidence intervals (CI). The mean difference (bias) between AVACheetah (average) and AVAFick was 0.11 cm2 and the 95% LOA were ±0.42 cm2. The 95% CI of the bias was 0.02–0.2 cm2. The bias and 95% LOA of AVACheetah (spot value) were 0.14 ± 0.42cm2, with a 95% CI of 0.06–0.23 cm2. No proportional bias was present. AVACheetah thus appears to be a reasonably accurate measure of AVA in patients with severe aortic stenosis compared to AVAFick measured using a modified Fick CO. However, the limits of agreement were not narrow enough to consider AVACheetah and AVAFick interchangeable.

Published
2019

12. Videolaryngoscopic intubation may have a higher risk of severe oropharyngeal injury than intubation under direct laryngoscopy: A review of 30,633 intubations

Author

Lauren K. Young, Jonathan A. Rost, Ludmil Mitrev, John P. Gaughan, Thomas Timmerman, Noud van Helmond, and Yekaterina Koshkareva

Subjects
Anesthesiology and Pain Medicine, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Anesthesia, Laryngoscopy, Medicine, Intubation, business, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Contains fulltext : 215229.pdf (Publisher’s version ) (Closed access)

Published
2019

13. Continuous Use of Intrathoracic Pressure Regulation Device Improved Cardiac Output in Porcine Peritonitis

Author

Purnachandra Jasti, Roy D. Goldfarb, Anja Metzger, R. Phillip Dellinger, Keith G. Lurie, Joseph E. Parrillo, Christopher R. Knob, Ludmil Mitrev, Marc C. Torjman, and J. Douglas Jaffe

Subjects
Cardiac output, medicine.medical_specialty, business.industry, Peritonitis, medicine.disease, Biochemistry, Continuous use, Internal medicine, Genetics, medicine, Cardiology, business, Molecular Biology, Biotechnology
Published
2012
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