Bezold-Jarisch Reflex Induced by Dopamine during Isoflurane Anesthesia in Small Dogs

Background: Unlike other major reflexes contributing to hemodynamic homeostasis, the Bezold-Jarisch reflex (BJR) paradoxically decreases heart rate (HR) and mean arterial pressure (MAP) despite hypotension. In the veterinary field, there are few reported cases of BJR induced by dopamine, which is often used to manage hypotension. Herein, 2 cases involving small dogs exhibiting BJR due to dopamine infusion during general anesthesia are described.Cases: Case 1: A 7-year-old, 7 kg, mongrel was referred for external skeletal fixator removal. The patient was premedicated with 0.3 mg/kg midazolam and 0.2 mg/kg butorphanol intravenously (IV). General anesthesia was induced with 6 mg/kg propofol and maintained with 1.6% isoflurane in oxygen. The patient was given 5 mL/kg/h of Hartmann’s solution IV. The respiratory rate (RR) was set to 9 breaths/min with a ventilator. The HR and MAP values were initially 120 bpm and 76 mmHg and gradually decreased to 70 bpm and 40 mmHg, respectively. The end-tidal CO2 partial pressure (ETCO2) was 39 mmHg, and the patient was administered 2.5 μg/kg glycopyrrolate IV. Then, 5 μg/kg/min dopamine was administered IV since the MAP did not improve. The HR, MAP, and ETCO2 increased to 113 bpm, 72 mmHg, and 47 mmHg, respectively. Subsequently, HR and MAP dramatically decreased to 50 bpm and 43 mmHg, respectively. A second-degree atrioventricular block was detected, prompting dopamine infusion discontinuation, and 2.5 μg/kg glycopyrrolate was again administered IV. Within 5 min, HR and MAP values normalized, and postoperative patient recovery was typical. Case 2: A 2-year-old, 8.6 kg, mongrel underwent surgery to correct a medial luxating patella of the right leg. The patient was premedicated with 0.3 mg/kg midazolam and 0.2 mg/kg butorphanol IV. Anesthesia was induced with 4 mg/kg propofol IV and maintained with 3% isoflurane in oxygen; 10 mL/kg/h of Hartmann’s solution was administered IV. Within 15 min, the patient’s HR and MAP values decreased from 120 to 107 bpm and 73 to 50 mmHg, respectively. The ETCO2remained approximately 39 mmHg, and RR decreased from 20 to 17 breaths/min. Dopamine was infused at a rate of 5 µg/kg/min. After 10 min, the MAP slightly increased from 50 to 57 mmHg, but the HR dramatically decreased from 107 to 62 bpm and the RR also dropped to 12 breaths/min. Further, a second-degree atrioventricular block was observed. Dopamine infusion was immediately discontinued, and 2.5 μg/kg glycopyrrolate was injected IV. As the HR returned to 94 bpm, the atrioventricular block disappeared, and the RR increased to 15 breaths/min. After general anesthesia was terminated, the patient recovered well.Discussion: Among drugs used for anesthesia, propofol and isoflurane may lower the MAP and HR. Therefore, HR or MAP decreases at the beginning of anesthesia are likely due to the drugs. Considering half-life, it is unlikely that propofol provoked sudden HR or MAP decreases at about 25 min post-induction. Isoflurane may also be ruled out since the hemodynamic disorder depended on dopamine injection. Sudden decreases in the HR, MAP, or RR after dopamine injection are not generally expected dopaminergic or adrenergic responses, which likely occur due to the vagal cardiopulmonary reflex suggesting the BJR resulting from activation of cardiac mechano- or chemoreceptors. To the best of our knowledge, there have been no reports of dopamine-mediated BJR in young or middle-aged, small dogs. The BJR has been observed in older, larger dogs and humans. In the patients described, body condition score may be considered when estimating the cause of the BJR. Since they scored 8/9, it is possible that obesity increased the risk of the BJR. This report described the clinical features and treatment outcomes in young or middle-aged, obese, small-sized dogs, whose hypotension or bradycardia was exacerbated by dopamine.Keywords: Bezold-Jarisch reflex, dopamine, hypotension, bradycardia, canine.

Retrieval of NO2 Column Amounts from Ground-Based Hyperspectral Imaging Sensor Measurements

Total column amounts of NO2 (TCN) were estimated from ground-based hyperspectral imaging sensor (HIS) measurements in a polluted urban area (Seoul, Korea) by applying the radiance ratio fitting method with five wavelength pairs from 400 to 460 nm. We quantified the uncertainty of the retrieved TCN based on several factors. The estimated TCN uncertainty was up to 0.09 Dobson unit (DU), equivalent to 2.687 ?? 1020 molecules m???2) given a 1?? error for the observation geometries, including the solar zenith angle, viewing zenith angle, and relative azimuth angle. About 0.1 DU (6.8%) was estimated for an aerosol optical depth (AOD) uncertainty of 0.01. In addition, the uncertainty due to the NO2 vertical profile was 14% to 22%. Compared with the co-located Pandora spectrophotometer measurements, the HIS captured the temporal variation of the TCN during the intensive observation period. The correlation between the TCN from the HIS and Pandora also showed good agreement, with a slight positive bias (bias: 0.6 DU, root mean square error: 0.7 DU)

A Zero Velocity Detection Algorithm Using Inertial Sensors for Pedestrian Navigation Systems

In pedestrian navigation systems, the position of a pedestrian is computed using an inertial navigation algorithm. In the algorithm, the zero velocity updating plays an important role, where zero velocity intervals are detected and the velocity error is reset. To use the zero velocity updating, it is necessary to detect zero velocity intervals reliably. A new zero detection algorithm is proposed in the paper, where only one gyroscope value is used. A Markov model is constructed using segmentation of gyroscope outputs instead of using gyroscope outputs directly, which makes the zero velocity detection more reliable

Lower extremity edema in patients with early ovarian cancer

BACKGROUND: The objective of this study was to investigate clinical manifestations of lower extremity edema (LEE) in early ovarian cancer. METHODS: Patients with early ovarian cancer who underwent staging surgery between January 2001 and December 2010. Medical records for LEE and/or responses to the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) were evaluated. RESULTS: Patients had a median age of 46 years. Twenty-nine patients (40.8%) had past (13 patients, 44.8%) and/or current patient-reported LEE (16 patients, 55.2%). Symptoms reported on the GCLQ in over 20% of respondents were numbness, firmness/tightness, swelling, heaviness, limited movement of knee, and aching. GCLQ total symptoms score was significantly higher in patients with current LEE. Most of the LEE (25/29, 86.2%) developed within 12 months after surgery and LEE lasted more than 6 months in approximately two-thirds of the patients (18/29, 62.1%). Only half of the patients (52.1%) indicated knowledge of lymphedema: 86.2% of LEE patients and 28.6% of patients with no LEE. CONCLUSIONS: Although a significant proportion of patients with ovarian cancer have LEE after surgery, most are not aware of lymphedema until they develop. Education and analyses for LEE and lymphedema are needed in patients with ovarian cancer

Dual Therapy with Cidofovir and Mirtazapine for Progressive Multifocal Leukoencephalopathy in a Sarcoidosis Patient

Background: Progressive multifocal leukoencephalopathy (PML) is a demyelinating central nervous system disease caused by JC virus (JCV) reactivation in immunocompromised patients. The disease course of PML is often progressive, fatal and at present, there are few reports on successful treatment outcomes. Case Report: A 45-year-old man with systemic sarcoidosis presented with rapidly progressive dementia and right hemiparesis. The patient was diagnosed with PML as confirmed via brain biopsy and JCV PCR. With a combination treatment of cidofovir and mirtazapine, there was significant improvement of neurological symptoms without measurable functional deficit. Conclusion: This case suggests that dual therapy with cidofovir and mirtazapine might be an effective treatment option in PML patients with sarcoidosis

Induction of inflammatory cytokines and toll-like receptors in chickens infected with avian H9N2 influenza virus

H9N2 influenza virus is endemic in many Asian countries and is regarded as a candidate for the next human pandemic. Knowledge of the induction of inflammatory responses and toll-like receptors (TLRs) in chickens infected with H9N2 is limited. Here, we show that H9N2 induces pro-inflammatory cytokines such as transforming growth factor-beta 3; tumor necrosis factor-alpha; interferon-alpha, -beta, and gamma; and TLR 1, 2, 3, 4, 5, 7, and 15 in trachea, lung, and intestine of infected chickens. In the lung, TLR-15 was dominantly induced. Taken together, it seems that H9N2 infections efficiently induce inflammatory cytokines and TLRs in trachea, lung and intestine of chickens

Aldosterone-Producing Adrenocortical Carcinoma without Hypertension

Although adrenocortical tumors are common, adrenocortical carcinomas are rare. Moreover, aldosterone-producing adrenocortical carcinomas without hypertension are exceedingly rare, with only two previously reported cases

Combined Dust Detection Algorithm by Using MODIS Infrared Channels over East Asia

A new dust detection algorithm is developed by combining the results of multiple dust detectionmethods using IR channels onboard the MODerate resolution Imaging Spectroradiometer (MODIS). Brightness Temperature Difference (BTD) between two wavelength channels has been used widely in previous dust detection methods. However, BTDmethods have limitations in identifying the offset values of the BTDto discriminate clear-sky areas. The current algorithm overcomes the disadvantages of previous dust detection methods by considering the Brightness Temperature Ratio (BTR) values of the dual wavelength channels with 30-day composite, the optical properties of the dust particles, the variability of surface properties, and the cloud contamination. Therefore, the current algorithm shows improvements in detecting the dust loaded region over land during daytime. Finally, the confidence index of the current dust algorithm is shown in 10 10 pixels of the MODIS observations. From January to June, 2006, the results of the current algorithm are within 64 to 81% of those found using the fine mode fraction (FMF) and aerosol index (AI) from the MODIS and Ozone Monitoring Instrument (OMI). The agreement between the results of the current algorithm and the OMI AI over the non-polluted land also ranges from 60 to 67% to avoid errors due to the anthropogenic aerosol. In addition, the developed algorithm shows statistically significant results at four AErosol RObotic NETwork (AERONET) sites in East Asia