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ExpertPaul Expert is an Associate Professor and Director of Research in the Department of Anesthesiology at the Employer. He has a joint appointment in physiology and is a core facultly member in the biomedical engineering institute. Prior to this, Expert worked for seven years as an Associate Professor in the Department of Anesthesiology at the Mayo Clinic. Thus, a large portion of his research has direct relevance to the fields of anesthesiology and physiology. Expert is a referee for the journals Anesthesiology, Anesthesia & Analgesia, and Acta Anesthesiologica Scandinavica. He has been a member of the American Society of Anesthesiologists since 1989.

Expert has been active in the area of biological heat transfer for over 15 years. He has worked with warming and cooling therapies related to hyperthermia, hypothermia, exercise-induced heat stress, and more recently, wound healing. These investigations have been directed at understanding the physiological basis of such therapies as well as biomedical product development. Expert is currently the director of the Employer's Biomedical Engineering course "Biomedical Aspects of Heat Transfer in Humans," in which he provides 10 hours of lectures.

A large portion of Expert's work deals with the clinical syndrome called malignant hyperthermia. This includes directing the Malignant Hyperthermia Diagnostic Center at the Employer and serving on the Board of Directors of the North American Malignant Hyperthermia Registry and the Professional Advisory Board of the Malignant Hyperthermia Association of the United States. Expert's research on this syndrome has ranged from improving diagnoses to determining if new anesthetic agents will trigger this syndrome under clinical conditions. Additional clinical conditions or disorders that Expert has performed research include: 1) treatment of essential and Parinsonian tremors, 2) treatment of clinical hyperthermia, 3) treatment of perioperative hypothermia, 4) treatment of myotonia, 5) application of lumbar traction, 6) force assessment in patients with various neuromuscular disorders, 7) wound assessment using computerized imaging, and 8) the prevention of pressure ulcers.

Expert has been investigating decubitus ulcers and chronic wounds intensively for the past three years. He has used an animal model, the swine, to investigate the thresholds for tissue (cutaneous and subcutaneous) injury at various pressures, temperatures, and duration of application. Using this model, he has gained new insight as to the differences in ischemic thresholds between epidermal, dermal, subcutaneous fat, and underlying muscle layers (with the muscle being the most susceptible layer). In a study, he has shown that focal cooling (to 25C) of cutaneous areas under the application of high-pressure (100 mmHg) could prevent the formation of pressure ulcers. Based on these results, he is currently designing biomedical devices to implement this advantage. The work has been funded in part by the National Science Foundation and by industrial support.

In several recent studies, Expert has used color and infrared imaging to investigate erythemic responses to applied pressure and temperature stimuli.

Expert has performed several investigations on the effects of exercise, some of which are ongoing. A number of physiologic parameters (heart rate, blood pressure, core temperature) were monitored throughout these studies as a means to determine the degree of stress induced by the exercise.

Expert has performed numerous studies investigating the mechanism of action of general anesthetics on muscle and nerve function, as well as their effects on the regulation of intracellular calcium in general. Several of these investigations were to determine the relative potency of such agents to induce episodes of malignant hyperthermia in susceptible swine. He has published several papers in this area.

Expert has performed numerous investigations into the pathophysiology of human skeletal muscle. As Director of the Malignant Hyperthermia Diagnostic Center, he routinely performs in vitro contracture testing of live muscle samples from patients considered at risk for this syndrome.

With a thorough knowledge of the consequences of hyperthermia and related modes of treatment, Expert lectures on these topics in the Employer's Biomedical Engineering course "Biomedical Aspects of Heat Transfer in Humans." He has experience working with a biomedical device company in developing convective-air cooling therapies to treat hyperthermia.

Expert has studied the regulation of intracellular calcium for over ten years. His doctoral thesis was on calcium transients detected with the photoprotein aequorin in single form skeletal muscle fibers. He has continued to use this indicator and other methodologies (fluorescent indicators and 45 Ca(2+) to monitor changes in intracellular calcium in a large variety of cell types (neuroblastoma, smooth muscle, fibroblasts, human and swine skeletal muscles, and hepatocytes). Expert has been publishing his work in this area since 1988.

For more than 15 years, Expert has been involved in physiological investigations of patients with various neuromuscular disorders, including myotonia, malignant hyperthermia, periodic paralyses, Parkinsonia tremor, essential tremor, clonus in paraplegics, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, and muscular dystrophy.

The majority of Expert's research has focused on motor systems (skeletal muscle and its control). In addition, he has provided 15 hours of lectures in Employer's Health Sciences course "Physiology 3053/3056/5441, covering all aspects of human neurophysiology.

Expert understands how changes in temperature will modulate cellular functions differently, depending on the type of process under investigation. A majority of his research has been thermally-related, ranging from the induction of mild hyperthermia to facility cerebral protection to the eventual fatal effects of hyperthermia initiated in humans or swine susceptible to malignant hyperthermia.

Expert has performed multiple studies to investigate muscle physiology. Such studies have been conducted on humans (in vivo and in vitro) as well as in situ and in vitro of various animal models. Mechanographic, electromyographic, electrophysiologic (microelectrode and voltage clamp), and intracellular calcium monitoring techniques have been used. He has also given numerous lectures on both research results as well as on the basic physiology of skeletal muscle.

A thorough knowledge of skin physiology is needed to perform the various ongoing studies in Expert's laboratory on wound formation, prevention, and healing. In addition, in the Employer's Biomedical Engineering course "Biomedical Aspects of Heat Transfer in Humans," Expert gives a two-hour lecture on skin physiology.

Expert has collaborated on numerous clinically relevant studies in which either the effectiveness or a currently used therapeutic or a new approach to therapy were evaluated. These studies have included: 1) treating episodes of malignant hyperthermia using the calcium modulator dantrolene, 2) minimizing essential tremor by the application of topical anesthesia, 3) determining the efficacy of lumbar traction induced using a new biomedical device, and 4) performing quantitative force measurements in patients with various neuromuscular disorders to determine the result of therapy (e.g., IgG treatment of patients with chronic inflammatory demyelinating polyneuropathy).

Thermoregulation is an area of which Expert first began investigations as an undergraduate student in 1978. His initial work in this area concerned the physiological mechanisms that control shiver, but also included thermal and cardiovascular responses to exposure to cold air environments or water immersion. More recently, his work in this area has focused on the clinical treatment of perioperative hypothermia and the induction of mild hypothermia to facilitate cerebral protection. These studies not only have employed numerous methodologies to record physiological parameters of interest, but Expert has been involved with equipment design and testing to accomplish these desired effects.

Expert has been performing electrophysiological investigations as to the electrical properties of skeletal muscle sarcolemma for more than ten years. These investigations have been performed on both human muscle and various animal models for myopathies (e.g., myotonic mice, swine susceptible to malignant hyperthermia, and more recently, transgenic mice expressing human Na+ channel mutations). The properties of voltage-gated channels have been investigated by numerous methods, for example 1) recording extracellular EMG activity, 2) resting membrane potentials, 3) miniature endplate potentials, 4) action potentials, 5) current voltage relationships using a 3-electrode technique, and 6) using various patch clamp modes.

Wound care has been an area of intensive investigation by Expert's laboratory for the past three years. He has used an animal model (the swine) to investigate the thresholds for tissue (cutaneous and subcutaneous) injury at various pressures, temperatures, and durations of application. He has evaluated the degree of wound formation and subsequent healing using numerous non-invasive methodologies that have been contrasted to histological analyses. The work has been funded in part by the National Science Foundation and by industrial support.

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