Surgical Specialist
22 years of experience
Video profile
West View
Front Range Internal Medicine
499 E Hampden Ave
Ste 380
Englewood, CO 80113
303-788-5300
Locations and availability (3)

Education ?

Medical School Score
George Washington University (1988)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Associations
American Board of Surgery

Affiliations ?

Dr. Slone is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • Swedish Medical Center
    501 E Hampden Ave, Englewood, CO 80113
    • Currently 4 of 4 crosses
    Top 25%
  • Sky Ridge Medical Center
    10101 Ridgegate Pkwy, Lone Tree, CO 80124
    • Currently 4 of 4 crosses
    Top 25%
  • Spalding Rehabilitation Hospital
    900 Potomac St, Aurora, CO 80011
  • Conroe Regional Medical Center
  • Publications & Research

    Dr. Slone has contributed to 14 publications.
    Title Phthalate Esters Used As Plasticizers in Packed Red Blood Cell Storage Bags May Lead to Progressive Toxin Exposure and the Release of Pro-inflammatory Cytokines.
    Date January 2011
    Journal Oxidative Medicine and Cellular Longevity
    Excerpt

    Phthalate esters (PE's) are plasticizers used to soften PVC-based medical devices. PE's are the most abundant man-made pollutants and increase the risk of developing an allergic respiratory disease or a malignancy. The leaching of PE's in donated packed red blood cells (PRBC) during storage was assessed. PRBC transfusion bags containing CPD/AS-1 (ADSOL) buffer were analyzed. Samples were collected on storage day 1 and day 42. Two PE's, di-(2-ethylhexyl) phthalate (DEHP) and mono-(2-ethylhexyl) phthalate (MEHP), were measured by liquid chromatography coupled to mass spectrometry (LCMS). Interleukin-8 (IL-8) was measured by standard ELISA techniques. DEHP significantly increased from 34.3 microM (+/-20.0 SD) on day 1 to 433.2 microM (+/-131.2 SD) on day 42, a 12.6-fold increase. Similarly, MEHP significantly increased from 3.7 microM (+/-2.8 SD) on day 1 to 74.0 microM (+/-19.1 SD) on day 42, a 20.2-fold increase. Also, DEHP and MEHP increased the release of IL-8 from human umbilical vein endothelial cells (HUVEC). The transfusion of older units of PRBC could lead to an accumulation of PE's possibly resulting in inflammation and other effects. This accumulation could be exacerbated due to the decreased metabolism of PE's since trauma patients have a lower esterase activity, the enzymes responsible for metabolizing PE's. The effect of oxidative stress caused by PE's is discussed as a potential mechanism for increases in inflammation caused by older units of PRBC.

    Title Plasma Oxidation-reduction Potential and Protein Oxidation in Traumatic Brain Injury.
    Date September 2010
    Journal Journal of Neurotrauma
    Excerpt

    The amount of oxidative stress in patients with an isolated traumatic brain injury (ITBI) can be estimated by measuring several biochemical parameters, such as total antioxidants, lipid peroxidation, protein oxidation, and others. Unfortunately, measuring these parameters is time-consuming, impractical in a clinical setting, and may miss important factors contributing to the overall redox balance. Here we suggest that the overall oxidative status in ITBI patients can be assessed by measuring plasma oxidation-reduction potential (ORP). Daily whole blood samples were obtained from severe ITBI patients (abbreviated injury score [AIS] >or=3, n = 32), and demographically similar non-head injury traumatized patients (n = 26) until discharge. Whole blood was also collected from patients with minor to moderate ITBI (AIS <or= 2, n = 18) and healthy volunteers (n = 22). Admission plasma ORP was significantly elevated in all traumatized patients compared to controls. Maximum ORP was detected on day 6 for severe ITBI and non-head injury traumatized patients. However, maximum ORP values were significantly higher (p < 0.05) in the severe ITBI group (+8.5 mV +/- 3.4 SEM) compared to the non-head injury group (-5.2 mV +/- 2.9 SEM). Additionally, a significantly higher oxidation of human serum albumin (HSA) was measured in all trauma patients compared to controls. These results demonstrate the presence of an oxidative environment in the plasma of traumatized patients, specifically in severe ITBI patients. Therefore monitoring ORP is a potentially useful tool for assessing the degree of oxidative stress, inflammation, severity of injury, and potential efficacy of treatment in ITBI patients.

    Title Potential Dysregulation of the Pyruvate Dehydrogenase Complex by Bacterial Toxins and Insulin.
    Date September 2009
    Journal The Journal of Trauma
    Excerpt

    The pyruvate dehydrogenase complex (PDC) catalyzes the conversion of pyruvate to acetyl CoA, effectively controlling the entrance of glycolysis products into aerobic metabolism. Because hyperlactatemia is one of the hallmarks of sepsis, we hyphothesized that gram-positive and negative bacterial toxin treatment will interfere with mRNA levels of regulatory enzymes of the PDC and overall enzyme activity in hepatocytes.

    Title Current Utilization and Radiation Dose from Computed Tomography in Patients with Trauma.
    Date May 2009
    Journal Critical Care Medicine
    Excerpt

    To quantify the cumulative effective dose of radiation received during hospitalization after traumatic injury and to compare the computed tomography (CT) utilization practices for two time periods in patients with trauma.

    Title The Effect of Storage on the Accumulation of Oxidative Biomarkers in Donated Packed Red Blood Cells.
    Date February 2009
    Journal The Journal of Trauma
    Excerpt

    Transfusion-related acute lung injury (TRALI) is a life-threatening condition characterized by oxidative stress. Longer storage times of packed red blood cells (PRBC) and other blood products have been implicated with an increased risk in developing TRALI in transfused patients.

    Title Mechanisms of Delayed Wound Healing by Commonly Used Antiseptics.
    Date February 2009
    Journal The Journal of Trauma
    Excerpt

    The cytotoxic effects of antiseptics on pivotal cell types of the healing process have been well documented. The purpose of our investigation was to explore the ability of subcytotoxic levels of antiseptics to interfere with fibroblast function.

    Title Reduced Mortality at a Community Hospital Trauma Center: the Impact of Changing Trauma Level Designation From Ii to I.
    Date February 2008
    Journal Archives of Surgery (chicago, Ill. : 1960)
    Excerpt

    OBJECTIVE: To determine if a change in trauma designation from level II (L2) to level I (L1) in the same institution reduces mortality. Design, Setting, and PATIENTS: A retrospective cohort study of all patients consecutively admitted to a community hospital trauma center. INTERVENTION: The upgrade to trauma L1 designation (January 1, 2003-March 31, 2007) (n = 7902) from trauma L2 designation (January 1, 1998-December 31, 2002) (n = 9511). MAIN OUTCOME MEASURES: Adjusted overall mortality and adjusted mortality for severely injured patients, patients with complications, and patients with severe sites of injury. RESULTS: After adjusting for age, sex, Injury Severity Score, mechanism of injury, hypotension on admission, respirations, and comorbidities, there was a significant decrease in overall mortality during L1 designation compared with L2 designation (2.50% vs 3.48%; P = .001). Severely injured patients (Injury Severity Score of >/= 15) admitted during an L1 trauma designation had a significant reduction in mortality compared with patients admitted during an L2 designation (8.99% vs 14.11%; P < .001). Patients admitted during an L1 designation with a severe head, chest, or abdominal or pelvic injury diagnosis had a significant decrease in mortality (9.96% vs 14.51% [P = .005], 7.14% vs 11.27% [P = .01], and 6.76% vs 17.05% [P = .002], respectively), as did patients who developed acute respiratory distress syndrome during their hospital stay (9.51% vs 26.87%; P = .02). CONCLUSION: The significant reduction in mortality of trauma patients with severe or specific injuries after the change to a higher trauma level designation may justify direct triage of these patients to L1 facilities, when available.

    Title The Cobalt-albumin Binding Assay: Insights into Its Mode of Action.
    Date January 2008
    Journal Clinica Chimica Acta; International Journal of Clinical Chemistry
    Excerpt

    BACKGROUND: We previously hypothesized that the N-terminus of human serum albumin (HSA) is altered during ischemic events, thus establishing the foundation for the cobalt-HSA binding assay phenomenon. In this investigation, we attempt to clarify the mode of action of the cobalt-HSA binding assay by direct observations of cobalt binding to HSA. METHODS: High pressure liquid chromatography coupled to positive electrospray ionization mass spectrometry (HPLC/MS) was used to study cobalt binding to HSA in the plasma of patients with and without evidence of myocardial ischemia. RESULTS: Strong binding of cobalt to the N-terminus of HSA occurs at pH>7.0. No differences in cobalt binding to the N-terminus of HSA are observed in ischemic versus non-ischemic patients' plasma despite differences in the cobalt-HSA binding assay. Plasma free cysteine/cystine ratio appears to play a role in the quantitative response of the cobalt-HSA binding assay. CONCLUSIONS: The main determinants of the cobalt-HSA binding assay mechanism of action include but are not limited to: the proportion of intact N-terminus of HSA, HSA concentration, plasma cysteine/cystine ratio, plasma pH, and the state of oxidation of cys34 of HSA. Assay improvements that consider and take these factors into account could lead to an improved cobalt-HSA binding assay with greater clinical utility.

    Title A Diketopiperazine Fragment of Human Serum Albumin Modulates T-lymphocyte Cytokine Production Through Rap1.
    Date January 2008
    Journal The Journal of Trauma
    Excerpt

    BACKGROUND: Aspartyl-alanyl- diketopiperazine (DA-DKP) is generated by cleavage and cyclization from the N-terminus of human albumin during the preparation of commercial serum albumin product. Antigen-stimulated human T lymphocytes produce significantly lower quantities of interferon-gamma and tumor necrosis factor-alpha after stimulation in vitro in the presence of DA-DKP. METHODS: T lymphocytes activated in the presence of DA-DKP were analyzed by pull-down western blot assay for the activation of the guanosine triphosphatase Rap1 and by quantitative immunoassay for the phosphorylated transcription factors ATF-2 (activating transcription factor-2) and c-jun, which regulate the production of interferon-gamma and tumor necrosis factor-alpha. RESULTS: Exposure of human T lymphocytes to DA-DKP resulted in increased levels of active Rap1 and decreased activation factors relevant to the T-cell receptor signal transduction pathway and subsequently, decreased phosphorylated ATF-2 and c-jun expression. CONCLUSION: The cyclized N- terminal fragment of human serum albumin, DA-DKP, can modulate the inflammatory immune response through a molecular pathway implicated in T- lymphocyte anergy.

    Title Oxidation-reduction Potential and Paraoxonase-arylesterase Activity in Trauma Patients.
    Date September 2007
    Journal Biochemical and Biophysical Research Communications
    Excerpt

    The amount of oxidative stress in severely traumatized patients is usually based on various individual parameters such as total antioxidants and lipid peroxidation. Serial measurements of plasma oxidation-reduction potential (ORP) in severely traumatized patients as a simple mean of assessing overall oxidative stress is described. Serial whole blood samples were obtained from multi-trauma patients (N=39) and healthy individuals (N=10). Plasma ORP in multi-trauma patients increased during the first few days of hospitalization and approached normal ORP levels upon discharge. On the ORP maxima day (5.8 days+/-0.5 SEM), a statistically significant decrease (p<0.05) was observed for negative acute phase reactants such as plasma paraoxonase-arylesterase (PON-AE) activity and total plasma protein in comparison with admission plasma levels. Monitoring ORP could be a useful tool for assessing the degree of oxidative stress, inflammation, severity of injury, and potential efficacy of treatment.

    Title Severe Systemic Immune Response Syndrome, Low Plasma Paraoxonase Activity, and a New Albumin Species in a Traumatized Patient with Gaucher's Disease.
    Date March 2007
    Journal Clinica Chimica Acta; International Journal of Clinical Chemistry
    Excerpt

    INTRODUCTION: Gaucher's disease (GD) is an inborn error, autosomal recessive lysosomal lipid storage disorder characterized by the lack of the enzyme glucocerebrosidase. We observed some abnormalities in the plasma of a traumatized patient with GD. CASE REPORT: We report of a traumatized patient with GD that developed a severe systemic immune response during the course of an extended hospital stay. Plasma paraoxonase (PON) activity was assayed and found to be extremely low possibly due to the existence of GD in this particular patient. Also, a potentially novel post-translational modification (PTM) of albumin was noticed in the patient's plasma that coincided with enzyme replacement therapy (ERT) with Cerezyme. CONCLUSIONS: The decreased plasma PON activity measured might be a contributive factor in the development of an accentuated systemic immune response in a traumatized patient with GD. A modified albumin species could serve as a biomarker for ERT in Gaucher patients.

    Title The Formation and Rapid Clearance of a Truncated Albumin Species in a Critically Ill Patient.
    Date June 2006
    Journal Clinica Chimica Acta; International Journal of Clinical Chemistry
    Excerpt

    INTRODUCTION: Hypoalbuminemia is known to occur in critically ill patients and is associated with increased mortality. We observed a potentially novel, partial explanation for the hypoalbuminemia noticed in a severely traumatized patient. CASE REPORT: We report of a severely, multi-system traumatized patient in whom hypoalbuminemia was present (1-2 g/dl). The plasma albumin (HSA) was analyzed by liquid chromatography/positive electrospray ionization mass spectrometry. A high percentage of a truncated albumin that lost its carboxy terminal amino acid leucine (HSA-L) associated with a 10-fold increase in plasma carboxypeptidase A (CPA) activity (R(2)=0.994) were found. We estimated the half life of this truncated albumin species to be <80 h. CONCLUSIONS: The increased CPA activity encountered following a traumatic event and subsequent rapid clearance of the resulting HSA-L from plasma might be a contributing factor to the hypoalbuminemia observed in the critically ill patients.

    Title Heterogeneity and Oxidation Status of Commercial Human Albumin Preparations in Clinical Use.
    Date August 2005
    Journal Critical Care Medicine
    Excerpt

    OBJECTIVE: Human serum albumin is indicated for the treatment of shock, acute restoration of blood volume, and in hypoalbuminemia. Conflicting reports are found in the literature for the clinical safety and efficacy of human serum albumin administration to critically ill patients. We sought to analyze various commercially available albumin preparations for common, posttranslational modifications. DESIGN: Analysis of six commercially available albumin preparations for clinical use. SETTING: Trauma research laboratory. SUBJECTS: Commercially available human serum albumin preparations and healthy volunteers. INTERVENTIONS: Six commercially available human serum albumin preparations were analyzed by high-performance liquid chromatography. The presence of various posttranslational modifications was identified by positive electrospray ionization, time-of-flight mass spectrometry. Three different lots from three preparations were also analyzed to assess variability within lots from the same manufacturer. Also, for the purpose of comparison, human serum albumin was analyzed in the plasma of healthy volunteers. MEASUREMENTS AND MAIN RESULTS: The six human serum albumin preparations analyzed contained a high percentage (57.2 +/- 3.3%) of bound Cys34 (oxidation of cysteine in position 34 on the human serum albumin molecule) in comparison to the plasma human serum albumin from healthy volunteers (22.9 +/- 4.8%). Lot-to-lot variability in native human serum albumin ranged between 4.8% and 11.2% in three separate commercial albumins. Significant differences existed among the various commercial preparations in other posttranslational modifications of albumin. CONCLUSIONS: Human serum albumin species with a bound Cys34 account for a large percentage of the composition of human serum albumin preparations used for the treatment of critically ill patients. Also, the variability within lots from the same manufacturer is significant. Consequences of the administration of these oxidized forms of human serum albumin to critically ill patients warrants further investigation.

    Title Nutritional Support of the Critically Ill and Injured Patient.
    Date March 2004
    Journal Critical Care Clinics
    Excerpt

    The understanding of the importance of nutrition, particularly in the critically ill patient, is based on the known physiologic consequences of malnutrition. It includes respiratory muscle function, cardiac function, the coagulation cascade balance, electrolyte and hormonal balance, and renal function. Nutrition affects emotional and behavioral responses, functional recovery, and the overall cost of health care. The need to identify and treat the malnourished or potentially malnourished patient is a critical aspect of patient management. Much is known of catabolic and hypermetabolic state caused by trauma and burns. The response to injury needs to be mediated. There is much to learn about the intervention of that response through adjuvant nutritional therapy.


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