Jonathan Hu

All Publications

• Diagnostic challenges in identifying myocardial infarction due to coronary vasospasm in pregnancy complicated by partial HELLP syndrome: a case report. European heart journal. Case reports Hu, J., Higuchi, S., Tanisawa, H., Shinke, T. 2025; 9 (10): ytaf496

  Abstract

  Although a prevalence of acute myocardial infarction (AMI) is rare in young females regardless of pregnancy, coronary vasospasm (CVS) and spontaneous coronary artery dissection (SCAD) could be observed. Physiologic and hormonal changes during pregnancy, as well as inflammation and vasoreactivity secondary to autoimmune diseases could contribute to CVS or SCAD.We present a 39-year-old woman with systemic lupus erythematosus, antiphospholipid syndrome, and partial haemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome who developed chest discomfort. Initially, the on-call physicians considered that this was attributed to demand ischaemia secondary to obstetric complications. Due to non-reassuring foetal heart tracings and the development of partial HELLP syndrome, she underwent an emergency caesarean section and her chest discomfort resolved following delivery. However, she developed chest pain again. Electrocardiography showed ST-segment depression in the inferior, anterior, and lateral leads, and cardiac troponin I increased to 5452 pg/mL. Echocardiography demonstrated normal left ventricular ejection fraction of 60%. Spontaneous coronary artery dissection was excluded by coronary angiography and CVS-induced AMI was diagnosed through acetylcholine provocation testing. Following the administration of diltiazem 100 mg twice daily and enalapril 2.5 mg once daily, both of which are considered safe during breastfeeding, the patient and her newborn have done well.At the time the patient developed chest pain, identifying the cause of the symptom was challenging due to multiple concomitant underlying diseases such as HELLP syndrome and autoimmune diseases. A multidisciplinary approach, along with the timely use of diagnostic tools, is essential for accurate diagnosis and management.

  View details for DOI 10.1093/ehjcr/ytaf496

  View details for PubMedID 41141550

  View details for PubMedCentralID PMC12548568

• The Impact of Social Determinants of Health on Timely Detection in Transthyretin Cardiac Amyloidosis. JACC. Heart failure Fahed, G., Jimenez, J. I., Adrianzen Fonseca, M. I., Hu, J., Spencer-Bonilla, G., Haddad, F., Pino Moreno, J. E., Witteles, R. M., Alexander, K. M. 2025; 13 (3): 530-532

  View details for DOI 10.1016/j.jchf.2024.11.022

  View details for PubMedID 40044389

• The Impact of a Heart Health Service Learning Opportunity for First-Year Medical Students International Medical Education Lee, A. Y., Hu, J., Helaine, K. J., Dee-Ann, C. 2025; 4 (2): 16

  View details for DOI 10.3390/ime4020016

• Yield of Echocardiography with Bubble Studies Among Acute Ischemic Stroke Patients. Journal of clinical medicine Hu, J., Lee, A. Y., Nakagawa, K., Vu, K., Khan, Z. R., Tanoue, M. 2024; 13 (21)

  Abstract

  Background: Transthoracic (TTE) and transesophageal (TEE) echocardiographic studies with agitated saline, also known as "bubble studies" (BSs), are used to diagnose patent foramen ovales (PFOs) in cryptogenic strokes (CSs). Guidelines limit PFO closure recommendations to CS patients ≤ 60 but BSs are often performed as part of standard order sets, leading to inappropriate studies in older patients with already-established stroke etiologies. Methods: This retrospective single-center study included acute ischemic stroke patients between January 2021 and June 2022 and assessed the stroke etiology and number of the echocardiographic studies performed. Results: A total of 663 patients were admitted during this period with 413 (62.3%) classified as non-CS. Overall, 390 (58.8%) TTE and 40 (6.0%) TEE with BSs were conducted. Of that, non-CS patients received 252 TTE and 17 TEE with BSs. PFOs were diagnosed in 36 CS and 18 non-CS patients and 14 of the 15 PFO closures were performed in the CS patients for primary stroke prevention. The one closure in the non-CS patient was performed in conjunction with the open excision of a mitral valve mass. Conclusions: Therefore, the majority of the BSs performed in non-CS patients yielded no change in management. Our study identifies a large volume of diagnostic studies that are not supported by current clinical guidelines and instead, may contribute to healthcare waste. A new institutional protocol should be established to improve operational efficiency and reduce the downstream implications of diagnostic overuse in ischemic stroke care.

  View details for DOI 10.3390/jcm13216555

  View details for PubMedID 39518695

  View details for PubMedCentralID PMC11546412

• An Escape Room to Teach First- and Second-Year Medical Students Nephrology. Medical science educator Hu, J., Sonnleitner, M., Weldon, E., Kejriwal, S., Brown, B., Shah, A. 2024; 34 (1): 71-76

  Abstract

  An escape room is a team-based activity that requires players to solve a series of puzzles to complete a story and "break out" of a room. It has recently gained traction in medical education for its ability to interactively and effectively present learning objectives. This was a prospective educational study that describes the successful application of a nephrology themed escape room for first- and second-year medical students. Compared to pre-escape room participation, the 52 students demonstrated a statistically significant improvement in self-reported knowledge for renal physiology (p < 0.01), pharmacology (p < 0.01), pathology (p < 0.01), and relevant clinical practice guidelines (p < 0.01). A majority of the students also claimed that the escape room was "more effective" than traditional lectures (80.8%) and textbooks (73.1%) and "equally effective" as third-party board preparation resources (69.2%) and their institution's problem-based learning curriculum (51.9%). The escape room also facilitated a high-level peer-to-peer collaboration with 82.7% and 76.9% of students reporting that they worked with someone in their year and outside of their year for at least half of the game, respectively. Ninety-five percent of the first-years and 84.6% of the second-years believed that the escape room was effective at preparing them for their respective exams, and an overwhelming majority (90.4%) described the escape room as "very enjoyable." Overall, this nephrology themed escape room was an engaging and well received educational modality and may be an effective supplemental study resource for medical students. Further studies are needed to assess knowledge acquisition.The online version contains supplementary material available at 10.1007/s40670-023-01917-6.

  View details for DOI 10.1007/s40670-023-01917-6

  View details for PubMedID 38510392

  View details for PubMedCentralID PMC10948694

• The Efficacy of an Immersive Virtual Reality Exergame Incorporating an Adaptive Cable Resistance System on Fitness and Cardiometabolic Measures: A 12-Week Randomized Controlled Trial. International journal of environmental research and public health Mologne, M. S., Hu, J., Carrillo, E., Gomez, D., Yamamoto, T., Lu, S., Browne, J. D., Dolezal, B. A. 2022; 20 (1)

  Abstract

  Exergaming, combining elements of video game into the realm of exercise, has recently incorporated immersive virtual reality (IVR) with resistance training. Thirty-two participants (14 females, mean age = 24.3) were randomized to IVR or self-directed control group (SELF) and worked out thrice weekly for 12 weeks (for 36 sessions). The IVR group spent 14 fewer minutes per session (p < 0.001) while reporting the sessions “enjoyable’. Compared to SELF, the IVR group had significantly greater improvement in changes from baseline to post-training in upper-and-lower muscular strength (1-RM) and muscular endurance (85% 1-RM) (14.3 kg vs. 10.0 kg for 1-RM upper, 28.6 kg vs. 22.5 kg for 1-RM lower, 2.6 reps vs. 1.9 reps for 85% 1-RM of upper, 2.7 vs. 2.0 reps for 85% 1-RM of lower, all p < 0.001), peak leg power (1424 vs. 865 W, p < 0.001), body fat% (−3.7% vs. −1.9%, p < 0.001), heart rate variability (4.3 vs. 1.8 ms, p < 0.001), rVO2max (3.28 vs. 0.89 mL/min/kg, p < 0.001) with decreased systolic BP (−0.4 vs. −2.3 mmHg, p < 0.001), and level of perceived exertion during workouts (RPE 14 vs. 16, p < 0.001). With its high-paced and action-filled gaming coupled with superior fitness and cardiometabolic outcomes, this IVR exergaming platform should be considered as another exercise modality for performance and health-related training.

  View details for DOI 10.3390/ijerph20010210

  View details for PubMedID 36612530

  View details for PubMedCentralID PMC9819410

• Effect of Real-Time Feedback on Power Output Using a Novel Smart-Resisted Sled Push. International journal of exercise science Goldman, P., Pandit, B., Gomez, D., Lu, S., Mills, C., Kull, N., Ku, R., Aramie, A., Kim, A., Alexandru, A., Hu, J., Neufeld, E. V., Dolezal, B. A. 2022; 15 (6): 1578-1586

  Abstract

  Prior studies have demonstrated the beneficial effects of real-time data feedback (RTF) on athletic performance and motivation. Despite this evidence, the lack of practical means to implement RTF has hindered its widespread adoption. Recently, a smart-resisted sled push was developed to improve athletic power by utilizing electromagnetic motors as a resistance mechanism, coupled with an RTF display. Thirty healthy college-aged male football players were recruited in this randomized, crossover designed study to examine the efficacy of the RTF to improve power output. Participants were randomized into either group 1 (receiving RTF first then no RTF) or group 2 (receiving no RTF first then RTF) during six, 10-meter sled pushes with 3 min rest intervals. The first three pushes were set to an easier level (L1) and the last three were set to a resistance level twice that of the first three runs (L2). A one-month washout period was enforced. For trials 1-3 (L1) (p = 0.026, t = -2.34, ES = -0.428) and 4-6 (L2) (p = 0.035, t = -2.22, ES = -0.405), peak power output (the average peak power output over the course of trials 1-3 and 4-6) was greater in both groups when receiving RTF compared to no-RTF. These findings demonstrate the effectiveness of RTF in augmenting power output during performance training.

  View details for DOI 10.70252/HMXE1078

  View details for PubMedID 36582967

  View details for PubMedCentralID PMC9762164

• Muscle Activity During Immersive Virtual Reality Exergaming Incorporating an Adaptive Cable Resistance System. International journal of exercise science Gomez, D., Browne, J. D., Almalouhi, A., Abundex, M., Hu, J., Nason, S., Kull, N., Mills, C., Harris, Q., Ku, R., Neufeld, E. V., Dolezal, B. A. 2022; 15 (7): 261-275

  Abstract

  The purpose of this exploratory study was to characterize muscle activation via surface electromyography (sEMG), user-perceived exertion, and enjoyment during a 30-minute session of immersive virtual reality (IVR) cable resistance exergaming. Ten healthy, college-aged males completed a signature 30-minute exergaming session using an IVR adaptive cable resistance system that incorporated six traditional compound exercises. Muscle activation (sEMG) was captured during the session with a wearable sEMG system. Rated of Perceived Exertion (RPE) and Physical Activity Enjoyment Scale (PACES) were recorded following the session. Pectoralis major showed the highest activation during chest press, deltoids showed the highest activation on overhead press, latissimus dorsi showed the highest activation during lat pulldown and row exercises, hamstrings were the most activated muscles during Romanian deadlift, and glutes showed the highest activity during squats. RPE and PACES mean scores were 14 (1) and 4.27 (0.38), respectively. IVR exergaming with resistance cable training provides an enjoyable experience and distracts practitioners from exertion while exercising at a high intensity. Results from this study suggest similar muscle activation responses compared to traditional resistance exercises as demonstrated with prior evidence. This novel form of exercise might have important repercussions for improving health outcomes among those who find it challenging to adhere to and enjoy exercise routines, as well as with little knowledge on how to progress in their resistance training. Further investigations are needed to explore long-term adaptations and to assess if IVR exergaming has additional benefits compared to traditional resistance training.

  View details for PubMedID 36896022

• Physiological and Metabolic Requirements, and User-Perceived Exertion of Immersive Virtual Reality Exergaming Incorporating an Adaptive Cable Resistance System: An Exploratory Study. Games for health journal Hu, J., Browne, J. D., Arnold, M. T., Robinson, A., Heacock, M. F., Ku, R., Mologne, M., Baum, G. R., Ikemiya, K. A., Neufeld, E. V., Dolezal, B. A. 2021; 10 (5): 361-369

  Abstract

  Objective: To measure metabolic and physiological demand, subjective fatigue, and enjoyment during a signature 30-minute immersive virtual reality (IVR) adaptive cable resistance exergaming session. Methods: Fourteen healthy college-aged individuals (seven females) were initially acquainted with the IVR equipment and gameplay dynamics. Participants then underwent a 30-minute IVR exergaming session performing six different cable resistance exercises. A portable metabolic gas exchange analyzer concurrently assessed energy expenditure (EE) through indirect calorimetry while a chest-worn monitor captured heart rate (HR). Participants subsequently completed questionnaires, including the Borg scale for rating of perceived exertion (RPE), Physical Activity Enjoyment Scale (PACES), and Simulator Sickness Questionnaire (SSQ). Results: The mean EE, mean metabolic equivalent, and average total calories expended during the 30-minute session were 14.7 (standard deviation [SD] 2.8) kcal/minute, 12.9 (SD 0.5), and 440 (SD 84) kcals respectively. The mean HR was 176 (SD 3.1) beats per minute (bpm) with a mean max HR of 188 SD (SD 2.9) bpm. The combined training volume among all participants was 16,102 kg (SD 4137). Participants classified the IVR training session to be "somewhat hard-to-hard" with a RPE score of 14 (SD 1) while indicating the session to be "enjoyable" with a PACES score of 4.31 (SD 0.36). The participants did not report any cybersickness symptoms, demonstrating an average total SSQ score of 24.04 (SD 24.13). Conclusions: IVR exergaming incorporating cable resistance training elicits high EE and physiological demand with high enjoyment scores while attenuating perceived fatigue. The potential for IVR to elicit these acute training effects over long-term training periods warrants further investigation into its contribution to fitness and health.

  View details for DOI 10.1089/g4h.2021.0031

  View details for PubMedID 34403592

• Not All HIFT Classes Are Created Equal: Evaluating Energy Expenditure and Relative Intensity of a High-Intensity Functional Training Regimen. International journal of exercise science Browne, J. D., Carter, R., Robinson, A., Waldrup, B., Zhang, G., Carrillo, E., Dinh, M., Arnold, M. T., Hu, J., Neufeld, E. V., Dolezal, B. A. 2020; 13 (4): 1206-1216

  Abstract

  The demand for efficient and effective exercises has grown in concert with increased attention to fitness as a determinant of overall health. While past studies have examined the benefits traditional conditioning exercises, there have been few investigations of high intensity functional training (HIFT). The aim of this study was to measure the energy expenditure and relative intensity from participation in a signature, 35-minute group-based HIFT regimen. During the HIFT session, 13 volunteers (aged 23-59 years, 6 females) donned a portable breath-by-breath gas analyzer and a heart rate monitor. Mean caloric expenditure (528 ± 62 kcal), maximum heart rate (172 ± 8 bpm), and metabolic equivalents (12.2 ± 1.4 kcal/kg/h) were characterized as a vigorous-intensity activity according to the Compendium of Physical Activities guidelines. Moreover, implementing this high energy expenditure session twice weekly may comport with Physical Activity Guidelines for Americans weekly physical activity recommendations. HIFT training may provide time-efficient exercise for those seeking exercise-related health benefits.

  View details for DOI 10.70252/IUSV1063

  View details for PubMedID 33042371

  View details for PubMedCentralID PMC7523891

• Energy Expenditure and Muscular Recruitment Patterns of Riding a Novel Electrically Powered Skateboard. International journal of exercise science Robinson, A. J., Carter, R. P., Browne, J. D., Hu, J., Arnold, M. T., Baum, J. T., Neufeld, E. V., Dolezal, B. A. 2020; 13 (4): 1783-1793

  Abstract

  Analysis of metabolic gas exchange and muscular output measures have enabled researchers to index activity intensity and energy expenditure for a myriad of exercises. However, there is no current research that investigates the physiological demands of riding electrically powered skateboards. The aim of this study was to measure the energetic cost and muscular trends of riding a novel electrically powered skateboard engineered to emulate snowboarding on dry-land. While riding the skateboard, eight participants (aged 21-37 years, 1 female) donned a portable breath-by-breath gas analyzer to measure energy expenditure (mean = 12.5, SD = 2 kcal/min), maximum heart rate (mean = 158, SD = 27 bpm), and metabolic equivalent (mean = 10.5, SD = 2 kcal/kg/h). By comparison, snowboarding has a metabolic equivalent (MET) of 8.0. Per the Compendium of Physical Activities guidelines, the predicted MET values for riding an electrically powered skateboard qualifies as vigorous-intensity activity. Four participants additionally wore a surface EMG embedded garment to record the percentage of maximum voluntary contraction (%MVC) of lower limb muscle groups. The inner quadriceps had the most pronounced mean peak muscle activation of 145%MVC during frontside and 164%MVC during frontside turns. EMG recordings showed 11.7%MVC higher utilization during backside turns compared to frontside turns while riding the electrically powered skateboard, which is similar to trends observed in alpine snowboarders. Therefore, electrically powered skateboards may be a promising technology for snowboarders and non-snowboarders alike to burn calories and increase physical activity year-round.

  View details for PubMedID 33414880

• Lower Limb Graduated Compression Garments Modulate Autonomic Nervous System and Improve Post-Training Recovery Measured via Heart Rate Variability. International journal of exercise science Hu, J., Browne, J. D., Baum, J. T., Robinson, A., Arnold, M. T., Reid, S. P., Neufeld, E. V., Dolezal, B. A. 2020; 13 (7): 1794-1806

  Abstract

  Prior studies have examined the benefits of graduated compression garments (GCG) with regards to diverse exercise regimens; however, the relationship between GCG and the autonomic nervous system (ANS) has not been fully explored. The aim of this study was to examine Heart Rate Variability (HRV) trends-a proxy for ANS modulation-in response to donning GCG during a progressive overload training regimen designed to induce overtraining. Ten college-aged male novice runners were recruited for the 8-week crossover study. After three weeks of monitored free living, participants were randomized and blinded to an intervention group that donned a lower-body GCG during a two-week exercise regimen or a control group that donned a visually identical but non-compressive sham during identical training. No significant difference in HRV was calculated by the natural logarithm of the root mean square of successive RR-interval differences (lnRMSSD) between the 3-week free-living baseline and GCG intervention periods (P = 0.3040). The mean lnRMSSD was greater during the free-living phase and GCG intervention compared to the sham placebo (P < 0.001 and <0.001 respectively). With regard to the daily fluctuation of lnRMSSD, no significant differences were found between free-living and intervention (P = 1.000). Conversely, the intervention period demonstrated reduced daily fluctuation of lnRMSSD relative to the Sham placebo group (P = 0.010). These novel findings posit that post training use of a commercially available graduated compression garment in novice runners may be effective in counteracting some deleterious effects from overtraining while attenuating its effects on vagally-mediated HRV.

  View details for PubMedID 33414888