Papers by Yuriy Bronshteyn
International Journal of Obstetric Anesthesia, Feb 1, 2020
Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limit... more Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limited regions in Africa has become a main initiative for global health services in recent years. In this article, we present lessons learned from introducing POCUS as part of the Global Health Service Partnership (GHSP), a collaboration started in 2012 between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Peace Corps and Seed Global Health to provide health care work force education and training in resource-limited countries. A cross-sectional survey of GHSP clinical educators trained to use POCUS and provided with hand-held ultrasound during their 1-y deployment during the period 2013À2017. The survey consisted of 35 questions on the adequacy of the training program and how useful POCUS was to their overall clinical and educational mission. Clinical educators engaged in a series of ultrasound educational initiatives including pre-departure training, bedside training in the host institutions, online educational modules, educational feedback on transmitted images and training of local counterparts. In this study 63 GHSP clinical educators who participated in the POCUS trainings were identified, and 49 were included at the study (78% response rate). They were assigned to academic institutions in Tanzania (n = 24), Malawi (n = 21) and Uganda (n = 18). More than 75% reported use of POCUS in clinical diagnoses and 50% in determining treatment, and 18% reported procedural application of ultrasound in their practice. The top indications for POCUS were cardiac exams, second-and third-trimester obstetric exams, lung and pleura, liver and spleen and gynecology/first-trimester obstetrics. The largest perceived barriers were lack of ultrasound knowledge by the clinical educators, lack of time, equipment security, difficulty accessing the Internet and equipment problems. We concluded that our multiphase POCUS training program has increased the utility, acceptability and usage of POCUS in resource-limited settings.
Journal of Visualized Experiments, Mar 3, 2023
Journal of Visualized Experiments, Feb 10, 2023
Journal of Visualized Experiments, Jan 13, 2023
Anesthesiology, Apr 1, 2017
<zdoi;10.1097/ALN.0000000000001487> Anesthesiology, V 126 • No 4 716 April 2017 T HESE two ... more <zdoi;10.1097/ALN.0000000000001487> Anesthesiology, V 126 • No 4 716 April 2017 T HESE two images were obtained 4 days apart around the site of a quadruple-lumen central venous catheter placed in the subclavian vein of a patient with septic shock. The proximal port of the line is believed to have migrated extravascularly, permitting extravasation of vesicants with resulting tissue injury. Agents and solutions that can cause tissue destruction with extravasation are called vesicants.1 Vesicants can induce necrosis by multiple mechanisms, including direct cytotoxicity (e.g., chemotherapies), hyperosmolarity (e.g., mannitol), deviation from physiologic pH (e.g., most vasopressors), vasoconstriction (e.g., concentrated electrolytes and α-agonists), and inflammation caused by the drug diluent (e.g., benzyl alcohol).1,2 Central line extravasation with vesicants presents special challenges.1 Unlike with peripheral lines, the site of extravasation may remain hidden by layers of tissue, leaving only surface stigmata like the rim of erythema seen in the early image. Furthermore, vesicants do not reliably cause severe pain after extravasation. To evaluate for potential extravascular line migration, the most proximal and distal ports could be aspirated regularly during line use (e.g., once per nursing shift if feasible). The distance between the proximal and distal ports can vary from 5.4 cm in triple-lumen catheters to 8.75 cm in quintuple-lumen catheters, so the increasing lumen number may increase the risk of extravascular positioning of the proximal port.1 When extravasation is suspected, early intervention may decrease the extent of injury. One study found a lower incidence of tissue necrosis when the affected area was opened and irrigated with normal saline within 24 h of the extravasation event.3
Neuropsychopharmacology reports, Jun 27, 2023
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Nov 16, 2022
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Mar 30, 2022
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature
50 Studies Every Intensivist Should Know
Patients with severe acute kidney injury who require renal replacement therapy have high mortalit... more Patients with severe acute kidney injury who require renal replacement therapy have high mortality rates. Controversy exists over whether a mortality benefit occurs with use of a more intensive renal replacement therapy regimen. In this multicenter, prospective study, 1124 patients requiring renal replacement therapy for severe acute kidney injury were randomized to a more and a less intensive renal replacement therapy regimen and were followed for 60 days. There was no statistical difference in mortality at 60 days (53.6% intensive, 51.5% less intensive, P = 0.47) and no difference in kidney recovery or non-renal organ failure. Hypotension and electrolyte abnormalities were more common in the intensive renal replacement regimen. A less intensive renal replacement regimen (intermittent hemodialysis 3 times a week or continuous venovenous hemodiafiltration at 20ml/kg/hour) was found noninferior to a more intensive renal replacement strategy (dialysis 6 times per week or continuous ve...
International Anesthesiology Clinics
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, 2021
Anesthesiology, 2020
in each group: analgesic pathway 39 (26%) versus 32 (22%) in placebo. In a robust double-blind ra... more in each group: analgesic pathway 39 (26%) versus 32 (22%) in placebo. In a robust double-blind randomized trial (n = 299), there is no reason to expect substantive differences between treatment and placebo groups. Meier et al. write that “measuring the Quality of Recovery score 3 days after surgery, as well as other postsurgical pain measures, is confounded when both the experimental and control groups received multimodal analgesics during and after surgery.” Confounding—by definition—is restricted to factors that influence both exposure and outcome. Randomization usually prevents confounding; but in any case, an intervention after a blinded exposure cannot be a confounder. What Meier et al. presumably mean is that postrandomization treatments might influence outcomes. We agree, but the fact that patients in each group consumed nearly the same amounts of various analgesics during the initial postoperative days is not a limitation; instead, it confirms that the four combined treatmen...
Regional Anesthesia & Pain Medicine, 2021
Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain ... more Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA. In part II of this two-part series, learning goals and objectives were identified and outlined for achieving competency in the use of POCUS, specifically, airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma exam, and focused cardiac ultrasound, in the perioperative and chronic pain setting. It als...
Journal of the American Chemical Society, 2007
The active site metal ion of superoxide dismutase (SOD) is reduced and reoxidized as it dispropor... more The active site metal ion of superoxide dismutase (SOD) is reduced and reoxidized as it disproportionates superoxide to dioxygen and hydrogen peroxide. Thus, the reduction midpoint potential (Em) is a critical determinant of catalytic activity. In E. coli Fe-containing SOD (FeSOD), reduction of Fe 3+ is accompanied by protonation of a coordinated OH-, to produce Fe 2+ coordinated by H2O. The coordinated solvent's only contact with the protein beyond the active site is a conserved Gln residue. Mutation of this Gln to His or Glu resulted in elevation of the Em by 220 mV and more than 660 mV, respectively [Yikilmaz et al., Biochemistry 2006, 45, 1151-1161], despite the fact that overall protein structure was preserved, His is a chemically conservative replacement for Gln, and neutral Glu is isostructural and isoelectronic with Gln. Therefore, we have investigated several possible bases for the elevated Em's, including altered Fe electronic structure, altered active site electrostatics, altered H-bonding and altered redox-coupled proton transfer. Using EPR, MCD, and NMR spectroscopies, we find that the active site electronic structures of the two mutants resemble that of the WT enzyme, for both oxidation states, and Q69E-FeSOD's apparent deviation from WT-like Fe 3+ coordination in the oxidized state can be explained by increased affinity for a small anion. Spontaneous coordination of an exogenous anion can only stabilize oxidized Q69E-Fe 3+ SOD and, therefore, cannot account for the increased Em of Q69E FeSOD. WT-like anion binding affinities and active site pK's indicate that His69 of Q69H-FeSOD is neutral in both oxidation states, like Gln69 of WT-FeSOD, whereas Glu69 appears to be neutral in the oxidized state but ionized in the reduced state of Q69E-FeSOD. A 1.1 Å resolution crystal structure of Q69E-Fe 2+ SOD indicates that Glu69 accepts a strong H-bond from coordinated solvent in the reduced state, in contrast to the case in WT-FeSOD where Gln69 donates an H-bond. These data and DFT calculations lead to the proposal that the elevated Em of Q69E-FeSOD can be substantially explained by (1) relief from enforced H-bond donation in the reduced state, (2) Glu69's capacity to provide a proton for proton-coupled Fe 3+ reduction, and (3) strong hydrogen bond acceptance in the reduced state, which stabilizes coordinated H2O. Our results thus support the hypothesis that the protein matrix can apply significant redox tuning via its influence over redox-coupled proton transfer and the energy associated with it.
Critical Care Medicine, 2013
Editorials and hemodynamics, making these results interesting, but not necessarily clinically rel... more Editorials and hemodynamics, making these results interesting, but not necessarily clinically relevant? We don't have that data. Finally, adding strength to the argument that NO bioavailability was the problem (and not reduced substrate), simultaneous measurement of L-arginine would have been valuable. Going forward, continued investigation into a more-directed pharmacotherapy for PE patients failing therapy is a worthwhile effort. Finding an adequate sample size, as well as timing of interventions and measurements, will be key to trial success. These are not easily studied patients. I would also encourage not only following short-term outcomes most relevant in the acute setting but also long-term outcomes, given the role of PE in the development of chronic pulmonary hypertension, as well as the role of NO in the vascular remodeling and proliferation associated with pulmonary hypertension. In the meantime, I thank the authors for their interesting scientiflc contribution.
l am a second-year chemistry major and biology rrtinor in the College of Arts and Sciences. I am ... more l am a second-year chemistry major and biology rrtinor in the College of Arts and Sciences. I am a first year Gaines Fellow, a National Merit Scholar, and a Singletary Scholar. I am employed by the Thomas D. Clark Study as a tutor of the biological, chemical, and physical sciences. I am also a member of Phi Beta Kappa honor society and Phi Delta Theta social fraternity. In the summer of 2004, I was granted a Neuroengineering Summer Research Program fel-lowship by the National Science Foundation to work at UCLA's Brain Mapping Institute. This paper is a summary of my work with Dr. Mark Cohen and Jennifer Bramen whose endless patience and supportive mentoring made it possible for me to jump into an otherwise highly special-ized fie ld. I have presented the findings at UCLA's Summer Program for Undergraduate Research and to the Bluegrass
Regional Anesthesia & Pain Medicine, 2021
Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain ... more Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA. In part II of this two-part series, learning goals and objectives were identified and outlined for achieving competency in the use of POCUS, specifically, airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma exam, and focused cardiac ultrasound, in the perioperative and chronic pain setting. It als...
Journal of Cardiothoracic and Vascular Anesthesia
This article is the fifth of an annual series reviewing the research highlights of the year perta... more This article is the fifth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank Editor-in-Chief Dr. Kaplan and the editorial board for the opportunity to continue this series. In most cases, these will be research articles that are targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but in some cases, these articles will target the use of perioperative echocardiography in general.
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Papers by Yuriy Bronshteyn