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12. No effect of patent foramen ovale on acute mountain sickness and pulmonary pressure in normobaric hypoxia

Author

DiMarco, Kaitlyn G., primary, Beasley, Kara M., additional, Shah, Karina, additional, Speros, Julia P., additional, Elliott, Jonathan E., additional, Laurie, Steven S., additional, Duke, Joseph W., additional, Goodman, Randall D., additional, Futral, Joel Eben, additional, Hawn, Jerold A., additional, Roach, Robert C., additional, and Lovering, Andrew T., additional

Published
2022
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19. Role of Circulating Inflammation in Regulating Pulmonary Pressure at Altitude

Author

DiMarco, Kaitlyn, primary, Beasley, Kara, additional, Shah, Karina, additional, Speros, Julia, additional, Elliott, Jonathan, additional, Laurie, Steven, additional, Duke, Joseph, additional, Goodman, Randall, additional, Futral, Eben, additional, Hawn, Jerold, additional, Hetrick, Byron, additional, McCurdy, Carrie, additional, Roach, Robert, additional, and Lovering, Andrew, additional

Published
2021
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26. Nutrition Practices in Hematopoietic Stem Cell Transplantation (HSCT): A Comparison between Guidelines and Clinical Practice

Author

Lowder, Yen P, primary, Moyers, Meredith, additional, Seckar, Jenna, additional, Gorecki, Elisabeth, additional, Oldham, Kelli, additional, Frutchey, Jennifer, additional, Beasley, Kara, additional, Guy, Anya, additional, Proch, Christina, additional, Lightbourne, Teisha, additional, Verne, Samuel Del, additional, Stockmann, Kathleen, additional, Horwitz, Mitchell E., additional, Chao, Nelson J., additional, and Sung, Anthony D., additional

Published
2019
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28. AltitudeOmics: effect of reduced barometric pressure on detection of intrapulmonary shunt, pulmonary gas exchange efficiency, and total pulmonary resistance

Author

Petrassi, Frank A., primary, Davis, James T., additional, Beasley, Kara M., additional, Evero, Oghenero, additional, Elliott, Jonathan E., additional, Goodman, Randall D., additional, Futral, Joel E., additional, Subudhi, Andrew, additional, Solano-Altamirano, J. Manuel, additional, Goldman, Saul, additional, Roach, Robert C., additional, and Lovering, Andrew T., additional

Published
2018
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29. Decreased arterial PO2, not O2 content, increases blood flow through intrapulmonary arteriovenous anastomoses at rest

Author

Duke, Joseph W., Davis, James T., Ryan, Benjamin J., Elliott, Jonathan E., Beasley, Kara M., Hawn, Jerold A., Byrnes, William C., and Lovering, Andrew T.

Subjects
Adult, Male, Oxygen, Young Adult, Blood Volume Determination, Arteriovenous Anastomosis, Iron, Ferritins, Respiratory, Humans, Female, Hypoxia, Respiratory Function Tests
Abstract

The mechanism(s) that regulate hypoxia-induced blood flow through intrapulmonary arteriovenous anastomoses (QIPAVA ) are currently unknown. Our previous work has demonstrated that the mechanism of hypoxia-induced QIPAVA is not simply increased cardiac output, pulmonary artery systolic pressure or sympathetic nervous system activity and, instead, it may be a result of hypoxaemia directly. To determine whether it is reduced arterial PO2 (PaO2) or O2 content (CaO2) that causes hypoxia-induced QIPAVA , individuals were instructed to breathe room air and three levels of hypoxic gas at rest before (control) and after CaO2 was reduced by 10% by lowering the haemoglobin concentration (isovolaemic haemodilution; Low [Hb]). QIPAVA , assessed by transthoracic saline contrast echocardiography, significantly increased as PaO2 decreased and, despite reduced CaO2 (via isovolaemic haemodilution), was similar at iso-PaO2. These data suggest that, with alveolar hypoxia, low PaO2 causes the hypoxia-induced increase in QIPAVA , although where and how this is detected remains unknown.Alveolar hypoxia causes increased blood flow through intrapulmonary arteriovenous anastomoses (QIPAVA ) in healthy humans at rest. However, it is unknown whether the stimulus regulating hypoxia-induced QIPAVA is decreased arterial PO2 (PaO2) or O2 content (CaO2). CaO2 is known to regulate blood flow in the systemic circulation and it is suggested that IPAVA may be regulated similar to the systemic vasculature. Thus, we hypothesized that reduced CaO2 would be the stimulus for hypoxia-induced QIPAVA . Blood volume (BV) was measured using the optimized carbon monoxide rebreathing method in 10 individuals. Less than 5 days later, subjects breathed room air, as well as 18%, 14% and 12.5% O2 , for 30 min each, in a randomized order, before (CON) and after isovolaemic haemodilution (10% of BV withdrawn and replaced with an equal volume of 5% human serum albumin-saline mixture) to reduce [Hb] (Low [Hb]). PaO2 was measured at the end of each condition and QIPAVA was assessed using transthoracic saline contrast echocardiography. [Hb] was reduced from 14.2 ± 0.8 to 12.8 ± 0.7 g dl(-1) (10 ± 2% reduction) from CON to Low [Hb] conditions. PaO2 was no different between CON and Low [Hb], although CaO2 was 10.4%, 9.2% and 9.8% lower at 18%, 14% and 12.5% O2 , respectively. QIPAVA significantly increased as PaO2 decreased and, despite reduced CaO2, was similar at iso-PaO2. These data suggest that, with alveolar hypoxia, low PaO2 causes the hypoxia-induced increase in QIPAVA . Whether the low PO2 is detected at the carotid body, airway and/or the vasculature remains unknown.

Published
2016

30. Intrapulmonary arteriovenous anastomoses in humans with chronic obstructive pulmonary disease: implications for cryptogenic stroke?

Author

Norris, H. Cameron, Mangum, Tyler S., Kern, Julia P., Elliott, Jonathan E., Beasley, Kara M., Goodman, Randy D., Mladinov, Suzana, Barak, Otto F., Bakovic, Darija, Dujic, Zeljko, and Lovering, Andrew T.

Subjects
intrapulmonary arteriovenous anastomoses, chronic obstructive pulmonary disease
Abstract

What is the central question of this study? Do individuals with chronic obstructive pulmonary disease have blood flow through intrapulmonary arteriovenous anastomoses at rest or during exercise? What is the main finding and its importance? Individuals with chronic obstructive pulmonary disease have a greater prevalence of blood flow through intrapulmonary arteriovenous anastomoses at rest than age- matched control subjects. Given that the intrapulmonary arteriovenous anastomoses are large enough to permit venous emboli to pass into the arterial circulation, patients with chronic obstructive pulmonary disease and an elevated risk of thrombus formation may be at risk of intrapulmonary arteriovenous anastomosis-facilitated embolic injury (e.g. stroke or transient ischaemic attack). The pulmonary capillaries prevent stroke by filtering venous emboli from the circulation. Intrapulmonary arteriovenous anastomoses are large-diameter (≥50 μm) vascular connections in the lung that may compromise the integrity of the pulmonary capillary filter and have recently been linked to cryptogenic stroke and transient ischaemic attack. Prothrombotic populations, such as individuals with chronic obstructive pulmonary disease (COPD), may be at increased risk of stroke and transient ischaemic attack facilitated by intrapulmonary arteriovenous anastomoses, but the prevalence and degree of blood flow through intrapulmonary arteriovenous anastomoses in this population has not been fully examined and compared with age-matched healthy control subjects. We used saline contrast echocardiography to assess blood flow through intrapulmonary arteriovenous anastomoses at rest (n = 29 COPD and 19 control subjects) and during exercise (n = 10 COPD and 10 control subjects) in subjects with COPD and age-matched healthy control subjects. Blood flow through intrapulmonary arteriovenous anastomoses was detected in 23% of subjects with COPD at rest and was significantly higher compared with age-matched healthy control subjects. Blood flow through intrapulmonary arteriovenous anastomoses at rest was reduced or eliminated in subjects with COPD after breathing hyperoxic gas. Sixty per cent of subjects with COPD who did not have blood flow through the intrapulmonary arteriovenous anastomoses at rest had blood flow through them during exercise. The combination of blood flow through intrapulmonary arteriovenous anastomoses and potential for thrombus formation in individuals with COPD may permit venous emboli to pass into the arterial circulation and cause stroke and transient ischaemic attack. Breathing supplemental oxygen may reduce this risk in COPD. The link between blood flow through intrapulmonary arteriovenous anastomoses, stroke and transient ischaemic attack is worthy of future investigation in COPD and other populations.

Published
2016

32. Intrapulmonary arteriovenous anastomoses in humans with chronic obstructive pulmonary disease: implications for cryptogenic stroke?

Author

Norris, H. Cameron, primary, Mangum, Tyler S., additional, Kern, Julia P., additional, Elliott, Jonathan E., additional, Beasley, Kara M., additional, Goodman, Randy D., additional, Mladinov, Suzana, additional, Barak, Otto F., additional, Bakovic, Darija, additional, Dujic, Zeljko, additional, and Lovering, Andrew T., additional

Published
2016
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33. Bilateral deep brain stimulation of the fornix for Alzheimer's disease: surgical safety in the ADvance trial

Author

Ponce, Francisco A., primary, Asaad, Wael F., additional, Foote, Kelly D., additional, Anderson, William S., additional, Rees Cosgrove, G., additional, Baltuch, Gordon H., additional, Beasley, Kara, additional, Reymers, Donald E., additional, Oh, Esther S., additional, Targum, Steven D., additional, Smith, Gwenn S., additional, Lyketsos, Constantine G., additional, and Lozano, Andres M., additional

Published
2016
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35. Medical complications and mortality in octogenarians undergoing elective spinal fusion surgeries.

Author

Rajpal, Sharad, Lee Nelson, E., Villavicencio, Alan T., Telang, Jayratna, Kantha, Roshan, Beasley, Kara, and Burneikiene, Sigita

Subjects
SURGICAL complications, SPINAL surgery, SPINE diseases, LUMBAR vertebrae diseases, THROMBOEMBOLISM
Abstract

Background: The consequences of suffering postoperative complications in elderly undergoing spinal surgeries may be different compared to younger patients. The primary objective of this study was to identify the types and frequency of medical complications and mortality rates in patients 80 years of age or older undergoing elective spinal fusion surgeries for degenerative spinal disease. Methods: A prospective observational study with a retrospective chart review was performed, which included all consecutive patients ≥80 years old undergoing elective spinal fusion surgeries from May 2012 to August 2015. We identified a total of 95 patients, of which 39 cervical and 56 lumbar surgeries were performed. There were 41 female and 54 male patients with the mean age of 82.8 years (range, 80-91). The perioperative complications were allocated into the following categories: infection, pulmonary, cardiac, gastrointestinal, hematologic, urologic, neurovascular, thromboembolic, and other. Baseline and postoperative clinical outcome scores were compared to evaluate efficacy. Results: The mean follow-up time was 14.8 months (range, 5 days to 37 months) with an overall mortality rate of 8.4%. The 30-day, 90-day, and 1-year mortality rates were 2.1, 2.1, and 4.2%, respectively. There were 53.9 and 71.4% patients with complications in the cervical and lumbar patient groups, respectively. The presence of general comorbidities and the number of intervertebral levels predicted the occurrence of perioperative complications. Also, longer OR times were associated with a higher number of complications per patient and the occurrence of a UTI. Dysphagia was a significant predictor in developing pneumonia and atelectasis. Conclusions: The incidence of perioperative medical complications and mortality rates in octogenarians undergoing elective spinal surgeries are quite high. The benefits of having surgery must be weighed against the risks of not only surgical but also adverse medical events. An informed decision-making process should include discussion of potential postoperative morbidity specific to this patient population in order to guide patient's acceptance of higher risks and expectations postoperatively. It is also important to identify potential complications and adapt preventive measures in order to help minimize them in this patient population. [ABSTRACT FROM AUTHOR]

Published
2018
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36. 130 Bilateral Fornix Deep Brain Stimulation for Alzheimer Disease

Author

Ponce, Francisco A., primary, Asaad, Wael, additional, Foote, Kelly D., additional, Anderson, William S., additional, Cosgrove, Rees, additional, Baltuch, Gordon H., additional, Beasley, Kara D., additional, Reymers, Donald E., additional, Oh, Esther S., additional, Targum, Steven D., additional, Smith, Gwenn, additional, lyketsos, Constantine G., additional, and Lozano, Andres M., additional

Published
2015
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48. Decreased arterial.

Author

Duke, Joseph W., Davis, James T., Ryan, Benjamin J., Elliott, Jonathan E., Beasley, Kara M., Hawn, Jerold A., Byrnes, William C., and Lovering, Andrew T.

Subjects
HYPOXIA-inducible factors, SYMPATHETIC nervous system, SYSTOLIC blood pressure, CARDIAC output, BLOOD flow measurement
Abstract

Key points The mechanism(s) that regulate hypoxia-induced blood flow through intrapulmonary arteriovenous anastomoses ( QIPAVA) are currently unknown., Our previous work has demonstrated that the mechanism of hypoxia-induced QIPAVA is not simply increased cardiac output, pulmonary artery systolic pressure or sympathetic nervous system activity and, instead, it may be a result of hypoxaemia directly., To determine whether it is reduced arterial [ABSTRACT FROM AUTHOR]

Published
2016
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