Bio

Clinical Focus


  • Critical Care Medicine
  • Intensive Care, Pediatric

Academic Appointments


Honors & Awards


  • REAC Research Award, UCSF Medical Center (2004)

Professional Education


  • Fellowship:Univ of California San Francisco (2002) CA
  • Residency:Northwestern Children's Memorial Hospital (1998) IL
  • Internship:Northwestern Children's Memorial Hospital (1996) IL
  • Medical Education:University of Texas Medical School at Houston (1995) TX
  • MD, UCSF Medical Center, Critical Care Fellowship (2002)
  • MD, Children's Memorial Hospital, Chief Resident (1999)
  • MD, Children's Memorial Hospital, Resident (1998)
  • MD, University of Texas - Houston, Medicine (1995)
  • BA, Southern Methodist University, English (1988)

Community and International Work


  • Pediatric Cardiothoracic Surgery, Managua, Nicaragua

    Topic

    repair of congenital heart defects

    Partnering Organization(s)

    International Children's Heart Foundation

    Populations Served

    Nicaraguan children

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Pediatric acute lung injury following cardiopulmonary bypass surgery for repair of congenital heart defects.

Publications

Journal Articles


  • Inhaled nitric oxide decreases pulmonary soluble guanylate cyclase protein levels in 1-month-old lambs JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Thelitz, S., Bekker, J. M., Ovadia, B., Stuart, R. B., Johengen, M. J., Black, S. M., Fineman, J. R. 2004; 127 (5): 1285-1292

    Abstract

    Inhaled nitric oxide produces potent pulmonary vasodilation by activating soluble guanylate cyclase and increasing smooth muscle cell concentrations of cyclic guanosine monophosphate. However, responses are often nonsustained, and clinically significant increases in pulmonary vascular resistance have been noted on its acute withdrawal. In vitro and in vivo data suggest that inhaled nitric oxide decreases endogenous nitric oxide synthase activity. The effects of inhaled nitric oxide on the downstream mediators of the nitric oxide/cyclic guanosine monophosphate cascade, soluble guanylate cyclase and phosphodiesterase 5, have not been investigated. We sought to determine the effects of inhaled nitric oxide on endogenous cyclic guanosine monophosphate levels, soluble guanylate cyclase, and phosphodiesterase 5 protein levels in the intact lamb.Eleven 1-month-old lambs were mechanically ventilated. In 7 lambs, inhaled nitric oxide (40 ppm) was administered for 24 hours and then acutely withdrawn. Intermittent lung biopsy samples were obtained for cyclic guanosine monophosphate concentrations and soluble guanylate cyclase and phosphodiesterase 5 protein levels (Western blot analysis).Initiation of nitric oxide decreased left pulmonary vascular resistance by 26.2%, and withdrawal rapidly increased pulmonary vascular resistance by 77.8% (P <.05). Tissue cyclic guanosine monophosphate concentrations initially increased during nitric oxide therapy but were not maintained during the 24-hour exposure. In addition, cyclic guanosine monophosphate concentrations rapidly decreased after nitric oxide withdrawal (P <.05). The alpha soluble guanylate cyclase (-45.7%) and beta soluble guanylate cyclase (-48.4%) protein levels decreased during nitric oxide therapy (P <.05), whereas phosphodiesterase 5 proteins levels were unchanged.These data suggest a role for decreased soluble guanylate cyclase and its resulting decrease in cyclic guanosine monophosphate concentrations in the nonsustained response to nitric oxide and the rebound pulmonary hypertension noted on its acute withdrawal. Phosphodiesterase 5 inhibitors may be a useful adjunct therapy during inhaled nitric oxide to preserve cyclic guanosine monophosphate levels and thereby preserve nitric oxide responsiveness and prevent rebound pulmonary hypertension.

    View details for DOI 10.1016/j.jtcvs.2003.07.024

    View details for Web of Science ID 000221134600009

    View details for PubMedID 15115984

  • Inhaled nitric oxide increases surfactant protein gene expression in the intact lamb AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY Stuart, R. B., Ovadia, B., Suzara, V. V., Ross, P. A., Thelitz, S., Fineman, J. R., Gutierrez, J. A. 2003; 285 (3): L628-L633

    Abstract

    Inhaled nitric oxide (iNO) is used to treat a number of disease processes. Although in vitro data suggest that nitric oxide (NO) alters surfactant protein gene expression, the effects in vivo have not been studied. The objective of this study was to evaluate the effects of iNO on surfactant protein (SP)-A, -B, and -C gene expression in the intact lamb. Thirteen 4-wk-old lambs were mechanically ventilated with 21% oxygen and received iNO at 40 ppm (n = 7) or vehicle gas (n = 6) for 24 h. Peripheral lung biopsies were obtained at 0, 12, and 24 h and analyzed for surfactant mRNA, protein, and total DNA content. Inhaled NO increased SP-A and SP-B mRNA content by 80% from 0 to 12 h and by 78 and 71%, respectively, from 0 to 24 h. There was an increase in SP-A and SP-B protein content by 45% from 0 to 12 h, and a decrease by 70 and 65%, respectively, from 0 to 24 h. DNA content was unchanged. The mechanisms and physiological effects of these findings warrant further investigation.

    View details for DOI 10.1152/ajplung.00264.2002

    View details for Web of Science ID 000184565600016

    View details for PubMedID 12765879

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