Patrick Burns

Effects of low-volume hemoglobin glutamer-200 versus normal saline and arginine vasopressin resuscitation on systemic and skeletal muscle blood flow and oxygenation in a canine hemorrhagic shock model.

Objective:To test the hypothesis that low-volume resuscitation with hemoglobin glutamer-200 improves hemodynamic function and tissue oxygenation, whereas arginine vasopressin resuscitation improves blood pressures more than low-volume saline or hemoglobin glutamer infusion but compromises systemic and muscle blood flow and oxygenation. Design:Randomized laboratory investigation. Setting:University research facility. Subjects:Nineteen dogs. Interventions:Dogs were instrumented to determine heart rate; arterial, central venous, pulmonary arterial, and pulmonary arterial occlusion pressures; cardiac output; and quadriceps muscle blood flow and oxygen tension (PMo2). Total and plasma hemoglobin, oxygen content, lactate, pH, standard base excess, and arginine vasopressin levels were determined, and systemic oxygen delivery (Do2I) and extraction ratio were calculated. Measurements were made before and 30 mins following hemorrhage. Dogs were resuscitated over 60 mins with saline (8.5 mL/kg), arginine vasopressin (0.4 IU/kg bolus plus 0.08 IU·kg−1·min−1), or 1:1 diluted hemoglobin glutamer-200. Recordings were then repeated. Subsequently, animals received 30 mL/kg shed blood (60 mL·kg−1·hr−1), and recordings were repeated immediately and 1 hr later. Measurements and Main Results:Hemorrhage (∼52 mL/kg) caused characteristic changes in hemodynamic, hematologic, systemic PMo2, and acid-base variables. Saline resuscitation increased both Do2I and muscle perfusion by 42% and 51%, while arginine vasopressin treatment reduced heart rate by 31% and increased mean arterial pressure by 22% but not cardiac output, Do2I, or muscle blood flow, resulting in a further decrease of PMo2 by 68% and worse metabolic acidosis. Hemoglobin glutamer-200 infusion caused systemic and pulmonary vasoconstriction, however, without deterioration of cardiac output, Do2I, muscle blood flow, or PMo2 despite lack of oxygen content increase. Blood transfusion restored most variables. Conclusions:Low-volume crystalloid or hemoglobin glutamer-200 resuscitation posthemorrhage may improve (but not restore) macro- and microvascular functions and tissue oxygenation, while arginine vasopressin infusion may only improve blood pressures and result in lower overall systemic perfusion compared with low-volume saline or hemoglobin glutamer-200 treatment and worsening of anaerobic conditions in skeletal muscle.

Magnetic field threshold for accurate electrocardiography in the MRI environment.

Although the electrocardiogram is known to be nondiagnostic within the bore of any high‐field magnet due to the magnetohydrodynamic effect, there are an increasing number of applications that require accurate electrocardiogram monitoring of a patient inside the MRI room but outside of the magnet bore. Magnetohydrodynamic effects on the ST segment of the electrocardiogram waveform were investigated in six subjects at magnetic field strengths ranging from 6.4 mT to 652 mT at the aortic midarch, and the electrocardiogram was found to be accurate at magnetic fields below 70 mT. This corresponds to a distance of 160 cm from the isocenter and 80 cm from the bore entrance for the 1.5‐T MRI system used in this study. These results can be translated to any MRI system, with knowledge of the fringe field. Accurate electrocardiogram monitoring is feasible in close proximity to the MRI magnet, such as during and after pharmacologic or exercise stress, or interventional or surgical procedures performed in the MRI room. Magn Reson Med, 2010.

Automated and accurate measurement of aortic pulse wave velocity using magnetic resonance imaging

Arterial stiffness is thought to be a powerful indicator of present and possible future cardiovascular risk. Accordingly, there is an increasing interest in the non-invasive clinical measurement of arterial stiffness. The commonly used non-invasive methods assess aortic pulse wave velocity (PWV) which is known to be a good indicator of aortic stiffness. These methods calculate the PWV by measuring the pressure or flow velocity at two locations along the aorta to determine the arrival time of the pulse wave; the distance between these locations is measured either on the body surface or using high resolution images. In this study, we have developed a novel method based on MRI that calculates the aortic PWV using multiple locations along the aorta. This approach is largely automatic vis-a-vis aortic segmentation that reduces user-subjectivity; the inclusion of multiple points along aorta increases the accuracy of PWV measurement by averaging.

Vehicle effects on in vitro transdermal absorption of sevoflurane in the bullfrog, Rana catesbeiana

The experimental objectives were to identify a vehicle which produces a homogenous formulation when combined with the anesthetic solution sevoflurane and understand the dermal absorption of sevoflurane in silastic membranes and amphibian skin in vitro utilizing a flow-through diffusion system. Seven vehicles were evaluated in varying ratios with 5 formulations resulting in the desired homogenous consistency for practical application. Sevoflurane diffusion across silastic membranes was influenced by pluronic/lecithin organogel (PLO), pluronic F 127 20% gel, and sterile lube. Flux and permeability across silastic membranes were significantly greater in sterile lube than in the other formulations. While no significant vehicle effects were observed in bullfrog skin, the flux-time profiles suggest that sevoflurane diffusion in bullfrog skin may be positively influenced by PLO. Future in vivo studies are required to assess sevoflurane retention after removal of these formulations to more accurately control the plane of anesthesia in amphibians.

Lipoicmethylenedioxyphenol Reduces Experimental Atherosclerosis through Activation of Nrf2 Signaling

Objective Oxidative stress is implicated in the pathogenesis of atherosclerosis, and Nrf2 is the transcriptional factor central in cellular antioxidant responses. In the present study, we investigate the effect of a dihydrolipoic acid derivative lipoicmethylenedioxyphenol (LMDP) on the progression of atherosclerosis and test whether its effect on atherosclerosis is mediated by Nrf2. Methods and Results Both magnetic resonance imaging (MRI) scanning and en face analysis reveal that 14 weeks of treatment with LMDP markedly reduced atherosclerotic burden in a rabbit balloon vascular injury model. Myograph analyses show decreased aortic contractile response to phenylephrine and increased aortic response to acetylcholine and insulin in LMDP-treated animals, suggesting that LMDP inhibits atherosclerosis through improving vascular function. A role of Nrf2 signaling in mediating the amelioration of vascular function by LMDP was supported by increased Nrf2 translocation into nuclear and increased expression of Nrf2 target genes. Furthermore, chemotaxis analysis with Boydem chamber shows that leukocytes isolated from LMDP-treated rabbits had reduced chemotaxis, and knock-down of Nrf2 significantly reduced the effect of LMDP on the chemotaxis of mouse macrophages. Conclusion Our results support that LMDP has an anti-atherosclerotic effect likely through activation of Nrf2 signaling and subsequent inhibition of macrophage chemotaxis.

Use of a novel surgical approach for treatment of complete bilateral membranous choanal atresia in an alpaca cria

CASE DESCRIPTION A 4-hour-old 6.3-kg (13.9-lb) female alpaca cria was evaluated because of severe respiratory distress and difficulty nursing since birth. CLINICAL FINDINGS The cria had open-mouth breathing and cyanotic membranes, with no airflow evident from either nostril. Supplemental oxygen was delivered, and the patient was anesthetized and intubated orotracheally; a CT evaluation of the head confirmed bilateral membranous obstruction of the nasal cavities, consistent with complete bilateral choanal atresia. TREATMENT AND OUTCOME Choanal atresia was treated with an endoscopically assisted balloon-dilation technique, and temporary tracheostomy was performed. Stenosis recurred, requiring revision of the repair and intranasal stent placement 3 days after the first surgery. The tracheostomy tube was removed the next day. Complications during hospitalization included mucoid obstruction of the tracheostomy tube, granulation tissue development in the trachea near the tracheostomy site, mucoid stent obstruction, aspiration pneumonia, and presumed partial failure of passive transfer of immunity. The stents were removed 2 weeks after admission, and the cria was discharged 3 days later. The owner was advised that the animal should not be bred. At last follow-up 3 years later, the alpaca was doing well. CLINICAL RELEVANCE Surgical treatment with a balloon-dilation technique and placement of nasal stents with endoscopic guidance were curative in this neonatal alpaca with bilateral membranous choanal atresia. Computed tomography was useful to determine the nature of the atresia and aid surgical planning. Because a genetic component is likely, owners should be advised to prevent affected animals from breeding.

NON-INVASIVE IMAGING OF THE LOCALIZATION AND TIME COURSE OF CELL DEATH IN A CANINE MODEL OF ACUTE MYOCARDIAL INFARCTION AND REPERFUSION: DEMONSTRATION OF EARLY AND LATE PHASES OF REPERFUSION CELL DEATH

Methods: The left anterior descending artery (LAD) was occluded using a 3 mm PTCA balloon catheter (n = 12). A constant gadolinium (Gd) infusion was administered during MRI to assess MI. Regional myocardial signal enhancement and function were recorded every 10 min during 90 min of ischemia followed by 120 min of R, and again at 24 and 48 hr post R. A catheter was inserted into the coronary sinus to measure creatine kinase (CK) leak across the coronary circulation.