Use of Renal Replacement Therapy in a Neonatal Foal with Postresuscitation Acute Renal Failure

A newborn foal was presented because it was unresponsive and in cardiopulmonary arrest. Aggressive cardiopulmonary cerebral resuscitation was administered to the foal, which revived the foal; however, acute renal failure developed. Fluid retention and azotemia occurred although the foal was alert and able to suckle. A 6‐hour renal replacement therapy session using hemodiafiltration and a continuous renal replacement therapy machine was administered to the foal at 3 days of age which lowered the foal's azotemia and facilitated removal of some of the excess body fluid. Despite therapy, the foal developed pulmonary edema and was euthanized. Although the foal in this case did not survive, this report highlights the possibility of developing postresuscitation complications such as acute renal failure and describes the use of renal replacement therapy using hemodiafiltration as a viable option in neonatal foals with acute kidney injury.     

Survey of academic veterinarians' clinical practice in cardiopulmonary–cerebral resuscitation

Objective: To document the clinical practice of cardiopulmonary–cerebral resuscitation (CPCR) among academic veterinarians. Design: Survey. Setting: Eight colleges of veterinary medicine in the United States. Subjects: Two hundred and one academic veterinarians. Interventions: The survey was distributed by hand by the authors into the mailboxes of small animal faculty, residents, and interns. Demographic variables, questions regarding number of cardiopulmonary arrests (CPA) supervised and number successful, do not attempt resuscitation discussions, and Likert‐style questions about client presence during CPCR, appropriateness of CPCR, and CPCR decision‐making were included. Multiple linear regression models were constructed to determine the effect of multiple questions on different target variables of interest. Measurements and main results: Numerous differences were noted based on institution, gender, specialty, and position. Most institutions did not have a standard resuscitation consent form. Most respondents believed the client, house officer, and senior clinician should determine whether to perform resuscitation or not. Quality of life was the most significant determinant of whether to resuscitate or not, followed by long‐term prognosis, then short‐term prognosis. Conclusions: Veterinarians differ in many aspects of their approach to CPA and resuscitation. Creating consensus within the veterinary profession would benefit client service and patient care.     

Intracardiac foreign body in a dog

A dog that was referred to the University of Florida Veterinary Medical Center was discovered to have a bamboo skewer within the right atrium and right ventricle, traversing the tricuspid valve. The skewer was ingested approximately four months prior to referral and was partially removed via gastrotomy. The presenting complaint at the time of referral included coagulopathy, anemia and leukocytosis. A linear, hyperechoic structure was identified in the right heart during an echocardiogram. The foreign body was suspected to be a portion of the skewer that the patient had previously ingested. Cardiopulmonary bypass was performed and the foreign body was removed successfully. Complications following surgery included the development of tricuspid valve and ventricular wall thrombi, atrial flutter and amiodarone toxicity. Many indications have been described in the veterinary literature for cardiopulmonary bypass. However, to the best of the authors' knowledge, successful removal of an intracardiac foreign body with cardiopulmonary bypass has not been reported in a veterinary patient. This represents a new indication for cardiopulmonary bypass in veterinary medicine.     

Successful cardiopulmonary resuscitation in an adult horse following cardiovascular collapse on recovery from general anaesthesia in the Trendelenburg position

Equine anaesthesia is associated with a high risk of perioperative morbidity and mortality, particularly in the recovery period. Cardiovascular collapse and cardiopulmonary arrest (CPA) have been reported to account for one-third of anaesthesia-related perioperative deaths in the horse. This case report describes the successful cardiopulmonary resuscitation of a healthy adult Thoroughbred mare that developed cardiovascular collapse and subsequent CPA following positioning in the recovery box after general anaesthesia in the Trendelenburg position. Cardiopulmonary resuscitation (CPR) was instigated and included thoracic compressions, intermittent positive pressure ventilation and adrenaline administered via the intravenous and intra-tracheal routes. Return of spontaneous circulation (ROSC) was detected 5 min and 50 s after the start of CPR. A stable stance was achieved approximately 100 min after ROSC. The mare was discharged from the hospital 3 days later with no known complications. To the authors’ knowledge, this is the first case report documenting CPA following general anaesthesia in the Trendelenburg position in a horse, with subsequent successful CPR. The precise cause of the CPA is unknown but a number of plausible hypothesis are discussed including hypoventilation and a Bezold-Jarisch reflex.     

The second-generation curcumin analogue RL71 elicits G2/M cell cycle arrest and apoptosis in canine osteosarcoma cells

Canine osteosarcoma is an aggressive cancer, comprising 85% of canine bone neoplasms. Current treatment practices of surgery and chemotherapy increase 1-year survival by only 45%. The curcumin analogue RL71, has demonstrated potent in vitro and in vivo efficacy in several models of human breast cancer through increased apoptosis and cell cycle arrest. Thus, the present study aimed to investigate efficacy of curcumin analogues in two canine osteosarcoma cell lines. Osteosarcoma cell viability was assessed using the sulforhodamine B assay and mechanisms of action were determined by analysing the levels of cell cycle and apoptotic regulatory proteins via Western blotting. Further evidence was obtained using flow cytometry to detect cell cycle distribution and the number of apoptotic cells. RL71 was the most potent curcumin analogue with EC₅₀ values of 0.64 ± 0.04 and 0.38 ± 0.009 μM (n = 3) in D-17 (commercial) and Gracie canine osteosarcoma cells, respectively. RL71 significantly increased the ratio of cleaved-caspase 3 to pro-caspase 3 and the level of apoptotic cells at the 2× and 5× EC₅₀ concentration (p < 0.001, n = 3). Furthermore, at the same concentration, RL71 significantly increased the number of cells in the G2/M phase. In conclusion, RL71 has potent cytotoxic activity in canine osteosarcoma cells triggering G2/M arrest and apoptosis at concentrations achievable in vivo. Future research should further investigate molecular mechanisms for these changes in other canine osteosarcoma cell lines prior to in vivo investigation.     

The clinical practice of CPCR in small animals: an internet‐based survey

Objective – To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. Design – Internet‐based survey. Setting – Academia, referral practice, and general practice. Subjects – Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board‐certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). Interventions – Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. Main Results – In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug‐dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end‐tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids. Conclusions – CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.     

Cardiopulmonary resuscitation in small animal medicine: an update

In December 2005, the American Heart Association published new guidelines for cardiopulmonary cerebral resuscitation (CPCR) in humans for the 1st time in 5 years. Many of the recommendations are based on research conducted in animal species and may be applicable to small animal veterinary patients. One important change that may impact how CPCR is performed in veterinary medicine is the recommendation to avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival. The new guidelines also emphasize the importance of providing well-executed, continuous, uninterrupted chest compressions. Interruption of chest compressions should be avoided and, if necessary, should be minimized to <10 seconds. During defibrillation, immediate resumption of chest compressions for 2 minutes after a single shock, before reassessment of the rhythm by ECG, is recommended. This recommendation replaces previous recommendations for the delivery of 3 defibrillatory shocks in rapid succession. Allowing permissive hypothermia postresuscitation has been found to be beneficial and may increase success rate. Medications utilized in cardiopulmonary resuscitation, including amiodarone, atropine, epinephrine, lidocaine, and vasopressin, along with the indications, effects, routes of administration, and dosages, are discussed. The application of the new guidelines to veterinary medicine as well as a review of cardiopulmonary resuscitation in small animals is provided.     

华蟾毒精对胃腺癌细胞MGC-803作用的研究

研究华蟾毒精（cinobufagin,CBG）体外对人胃腺癌细胞MGC-803的抑制作用,并初步探讨其抗肿瘤的作用机制。MTT法测定CBG对胃腺癌MGC-803细胞的生长抑制情况;采用光镜观察CBG对人胃腺癌细胞MGC-803形态的影响;流式细胞术检测CBG对MGC-803细胞的抑制作用、细胞周期及细胞早期凋亡的影响。一定浓度范围内CBG对MGC-803细胞的增殖有剂量、时间依赖性抑制作用;光镜下可见细胞形态明显发生变化,细胞变圆,分泌颗粒增多,细胞折光性下降,大部分细胞脱壁;流式细胞仪检测MGC-803细胞,G1期细胞减少,大量细胞停滞在G2/M期,凋亡细胞增多。CBG对MGC-803细胞的抑制作用与诱导其细胞阻滞及凋亡密切相关。     

Cardiopulmonary bypass influences the plasma levels of calcitonin gene-related peptides in dogs: effects of hemofiltration and hemodilution

Calcitonin gene-related peptides (CGRP), which are potent vasodilators, are elevated during cardiopulmonary bypass (CPB) in humans. We evaluated the plasma levels of CGRP in dogs during CPB with hemofiltration with and without hemodilution. Female beagles were divided into control (n=5) and hemodilution (n=5) groups. The CPB with hemofiltration was performed with or without hemodilution. For the measurement of CGRP, blood samples were collected pre-CPB, during CPB, and post-CPB. The concentrations of CGRP in the hemofiltration solution were measured. Although the CPB elevated the plasma CGRP levels in both groups, its elevation was significant in the hemodilution group when compared to the pre-CPB levels. CGRP levels returned to normal post-CPB. Significant differences were found between the two groups in the CGRP amount in hemofiltration. The results show that hemofiltration should be used during CPB to decrease the plasma levels of CGRP.     

Successful resuscitation from cardiac arrest associated with extradural lidocaine in a dog

BACKGROUND: Extradural lidocaine exerts several adverse effects which are seldom fatal. While cardiac arrest following extradural lidocaine injection has been reported in human beings, it has not hitherto been reported in dogs. OBSERVATIONS: The emergency management of a dog with complete urethral obstruction is described. We intended to perform vaginoscopy and cystostomy under extradural lidocaine anaesthesia, but cardiac asystole occurred a few minutes after injection. Resuscitation was successful. About 20 minutes later cardiac arrest recurred, and was treated successfully. The dog remained hypothermic for approximately 7 hours. Complete recovery without neurological deficit occurred the next day and the dog remained normal for at least 3 months. The probable cause of the problem was cranial lidocaine dispersion causing a drop in cardiac preload and cardiac arrest. The successful neurological outcome was attributed to early diagnosis and effective treatment. Hypothermia may have conferred cerebral protection during ischemia. CONCLUSIONS: Extradural local anaesthetic administration is not without risk and the technique should be tailored to individual animals. Constant monitoring is required to detect potentially fatal complications and increase the likelihood of successful outcome.