Background
The enzyme extracellular superoxide dismutase (EC-SOD; SOD3) is a major antioxidant defense in lung and vasculature. A nonsynonomous single nucleotide polymorphism (SNP) in EC-SOD (rs1799895) leads to an arginine to glycine (Arg->Gly) amino acid substitution at position 213 (R213G) in the heparin-binding domain (HBD). In recent human genetic association studies, this SNP attenuates the risk of lung disease, yet paradoxically increases the risk of cardiovascular disease.
Methods and Results
Capitalizing on the complete sequence homology between human and mouse in the HBD, we created an analogous R213G SNP knockin mouse. The R213G SNP did not change enzyme activity, but shifted the distribution of EC-SOD from lung and vascular tissue to extracellular fluid (e.g. bronchoalveolar lavage fluid (BALF) and plasma). This shift reduces susceptibility to lung disease (lipopolysaccharide-induced lung injury) and increases susceptibility to cardiopulmonary disease (chronic hypoxic pulmonary hypertension).
Conclusions
We conclude that EC-SOD provides optimal protection when localized to the compartment subjected to extracellular oxidative stress: thus, the redistribution of EC-SOD from the lung and pulmonary circulation to the extracellular fluids is beneficial in alveolar lung disease but detrimental in pulmonary vascular disease. These findings account for the discrepant risk associated with R213G in humans with lung diseases compared with cardiovascular diseases.
Introduction: Point-of-care ultrasound (POCUS) is ultrasound performed by the provider at the patient's bedside to answer a specific clinical question. No guidelines exist for teaching POCUS to pediatric residents, and there are currently no pediatric-specific POCUS resources on MedEdPORTAL. To fill this gap, we designed an educational resource to introduce pediatric residents to POCUS during their pediatric intensive care unit (PICU) rotation. Methods: Our POCUS curriculum included content on ultrasound basics, lung ultrasound, and focused cardiac ultrasound. Residents completed a precourse knowledge test at the start of the PICU rotation. Self-study modules were provided to the residents for independent review. During small group, residents performed ultrasound scanning on subjects with normal anatomy. Residents also participated in weekly POCUS rounds to perform supervised ultrasound scanning on PICU patients with known abnormal ultrasound findings. After completion of the PICU rotation, residents competed a postcourse knowledge test and survey. Knowledge test scores were compared to a historical cohort of residents who had completed the PICU rotation but not the POCUS curriculum. Results: Six residents completed the curriculum, and all completed the postcourse knowledge test with significant improvement in test scores compared to a historical cohort. Residents reported increased knowledge of POCUS indications and comfort performing POCUS. All residents rated the smallgroup sessions and POCUS rounds highly. Discussion: Pediatric residents have little POCUS training and perform poorly on POCUS knowledge testing. A basic POCUS curriculum can be instituted during the PICU rotation and improve resident knowledge and comfort with POCUS.
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