Total Synthesis of Dragocins A-C through Electrochemical Cyclization

The first total synthesis of dragocins A-C, remarkable natural products containing an unusual C4' oxidized ribose architecture bridged by a polyhydroxylated pyrrolidine, is presented through a route featuring a number of uncommon maneuvers. Several generations towards the target molecules are presented, including the spectacular failure of a key C-H oxidation on a late-stage intermediate. The final route features rapid, stereocontrolled access to a densely functionalized pyrrolidine and an unprecedented diastereoselective oxidative electrochemical cyclization to forge the hallmark 9-membered ring. Preliminary studies suggest this electrochemical oxidation protocol is generally useful.

A Lewis Acid-Controlled Enantiodivergent Epoxidation of Aldehydes

Two epoxidation catalysts, one of which consists of two VANOL ligands and an aluminum and the other that consists of two VANOL ligands and a boron, were compared. Both catalysts are highly effective in the catalytic asymmetric epoxidation of a variety of aromatic and aliphatic aldehydes with diazoacetamides, giving high yields and excellent asymmetric inductions. The aluminum catalyst is effective at 0 °C and the boron catalyst at -40 °C. Although both the aluminum and boron catalysts of (R)-VANOL give very high asymmetric inductions (up to 99% ee), they give opposite enantiomers of the epoxide. The mechanism, rate- and enantioselectivity-determining step, and origin of enantiodivergence are evaluated using density functional theory calculations.

Sickle cell disease and complex congenital cardiac surgery: a case report and review of the pathophysiology and perioperative management

Sickle cell anemia and thalassemia are hemoglobinopathies rarely encountered in the United States. Compounded with congenital heart disease, patients with sickle cell disease (SCD) requiring cardiopulmonary bypass and open-heart surgery represent the proverbial “needle in the haystack”. As such, there is some trepidation on the part of clinicians when these patients present for complex cardiac surgery.

SCD is an autosomal, recessive condition that results from a single nucleotide polymorphism in the β-globin gene. Hemoglobin SS molecules (HgbSS) with this point mutation can polymerize under the right conditions, stiffening the erythrocyte membrane and distorting the cellular structure to the characteristic sickle shape. This shape change alters cellular transit through the microvasculature. As a result, circumstances such as hypoxia, hypothermia, acidosis or diminished blood flow can lead to aggregation, vascular occlusion and thrombosis. Chronically, SCD can give rise to multiorgan damage secondary to hemolysis and vascular obstruction.

This review and case study details an 11-year-old African-American male with known SCD who presented to the cardiothoracic surgical service with congenital heart disease consisting of an anomalous, intramural right coronary artery arising from the left coronary sinus for surgical consultation and subsequent surgical correction. This case report will include a review of the pathophysiology and current literature regarding preoperative, intraoperative and postoperative management of SCD patients.

Total artificial heart in the pediatric patient with biventricular heart failure

Mechanical circulatory support emerged for the pediatric population in the late 1980s as a bridge to cardiac transplantation. The Total Artificial Heart (TAH-t) (SynCardia Systems Inc., Tuscon, AZ) has been approved for compassionate use by the Food and Drug Administration for patients with end-stage biventricular heart failure as a bridge to heart transplantation since 1985 and has had FDA approval since 2004. However, of the 1,061 patients placed on the TAH-t, only 21 (2%) were under the age 18. SynCardia Systems, Inc. recommends a minimum patient body surface area (BSA) of 1.7 m(2), thus, limiting pediatric application of this device. This unique case report shares this pediatric institution's first experience with the TAH-t. A 14-year-old male was admitted with dilated cardiomyopathy and severe biventricular heart failure. The patient rapidly decompensated, requiring extracorporeal life support. An echocardiogram revealed severe biventricular dysfunction and diffuse clot formation in the left ventricle and outflow tract. The decision was made to transition to biventricular assist device. The biventricular failure and clot formation helped guide the team to the TAH-t, in spite of a BSA (1.5 m(2)) below the recommendation of 1.7 m(2). A computed tomography (CT) scan of the thorax, in conjunction with a novel three-dimensional (3D) modeling system and team, assisted in determining appropriate fit. Chest CT and 3D modeling following implantation were utilized to determine all major vascular structures were unobstructed and the bronchi were open. The virtual 3D model confirmed appropriate device fit with no evidence of compression to the left pulmonary veins. The postoperative course was complicated by a left lung opacification. The left lung anomalies proved to be atelectasis and improved with aggressive recruitment maneuvers. The patient was supported for 11 days prior to transplantation. Chest CT and 3D modeling were crucial in assessing whether the device would fit, as well as postoperative complications in this smaller pediatric patient.

Motor cortical functional geometry in cerebral palsy and its relationship to disability

OBJECTIVE

To investigate motor cortical map patterns in children with diplegic and hemiplegic cerebral palsy (CP), and the relationships between motor cortical geometry and motor function in CP.

METHODS

Transcranial magnetic stimulation (TMS) was used to map motor cortical representations of the first dorsal interosseus (FDI) and tibialis anterior (TA) muscles in 13 children with CP (age 9-16 years, 6 males.) The Gross Motor Function Measure (GMFM) and Melbourne upper extremity function were used to quantify motor ability.

RESULTS

In the hemiplegic participants (N = 7), the affected (right) FDI cortical representation was mapped on the ipsilateral (N = 4), contralateral (N = 2), or bilateral (N = 1) cortex. Participants with diplegia (N = 6) showed either bilateral (N = 2) or contralateral (N = 4) cortical hand maps. The FDI and TA motor map center-of-gravity mediolateral location ranged from 2-8 cm and 3-6 cm from the midline, respectively. Among diplegics, more lateral FDI representation locations were associated with lower Melbourne scores, i.e. worse hand motor function (Spearman's rho = -0.841, p = 0.036).

CONCLUSIONS

Abnormalities in TMS-derived motor maps cut across the clinical classifications of hemiplegic and diplegic CP. The lateralization of the upper and lower extremity motor representation demonstrates reorganization after insults to the affected hemispheres of both diplegic and hemiplegic children.

SIGNIFICANCE

The current study is a step towards defining the relationship between changes in motor maps and functional impairments in CP. These results suggest the need for further work to develop improved classification schemes that integrate clinical, radiologic, and neurophysiologic measures in CP.

Inbreeding depression in two seed-feeding beetles, Callosobruchus maculatus and Stator limbatus (Coleoptera: Chrysomelidae)

Inbreeding depression is well documented in insects but the degree to which inbreeding depression varies among populations within species, and among traits within populations, is poorly studied in insects other than Drosophila. Inbreeding depression was examined in two long-term laboratory colonies of the seed beetle, Callosobruchus maculatus (Fabricius), which are used frequently as models for experiments in ecology, evolution and behaviour. Inbreeding depression in these laboratory colonies are compared with one recently field-collected population of a different seed beetle, Stator limbatus Horn. Inbreeding reduced embryogenesis, egg hatch and larval survival in both species, such that eggs produced by sib matings were >17% less likely to produce an adult offspring. Inbred larvae also took 4-6% longer to develop to emergence in both species. Inbreeding depression varied among the measured traits but did not differ between the two populations of C. maculatus for any trait, despite the large geographic distance between source populations (western Africa vs. southern India). Inbreeding depression was similar in magnitude between C. maculatus and S. limbatus. This study demonstrates that these laboratory populations of C. maculatus harbour substantial genetic loads, similar to the genetic load of populations of S. limbatus recently collected from the field.

Complications associated with traction on the hip during arthroscopy

We studied 16 hips (eight cadaver specimens) using arthrography, arthroscopy and anatomical dissection, under incremental traction of up to a maximum of 64 kg, to determine the relationship of the portals to nearby neurovascular structures.

The distance of each arthroscopic portal (anterior, anterolateral, and posterolateral) to the associated neurovascular structures was measured after the application of 23 kg of traction.

Traction of up to 64 kg on the lower limb failed to produce evidence of labral or capsular injury. Furthermore, traction of 23 kg resulted in little change in the position of adjacent neurovascular structures relative to the standard arthroscopic portals.

Evidence for biosynthesis of pseudophrynamine alkaloids by an Australian myobatrachid frog (pseudophryne) and for sequestration of dietary pumiliotoxins

Australian myobatrachid frogs of the genus Pseudophryne have only two classes of alkaloids in skin extracts, pseudophrynamines (PSs) and pumiliotoxins (PTXs). The former are unique to such Australian frogs, while the PTXs occur worldwide in all other genera of frogs/toads that contain lipophilic alkaloids. The major alkaloid of wild-caught frogs from one population of Pseudophryne semimarmorata was PTX 267C, while PSs were only minor or trace alkaloids. Captive-raised frogs from the same parental stock had no PTXs, but had larger amounts of PSs. A PTX fed to captive-raised frogs accumulated into skin along with dihydro and hydroxy metabolites. Thus, Pseudophryne frogs appear to biosynthesize PSs, but to sequester into skin dietary PTXs. In addition, biosynthesis of PSs appears reduced when high levels of dietary PTXs have accumulated into skin. This is the first evidence indicating that certain frogs are capable of synthesizing rather than merely sequestering alkaloids. A wide range of PSs, including many with molecular weights >500, were detected using both GC-mass spectral and LC-mass spectral analysis.

Evaluation of an autogenous Salmonella bacterin and a modified live Salmonella serotype Choleraesuis vaccine on a commercial dairy farm

OBJECTIVE

To compare the efficacy of a Salmonella bacterin and a modified live Salmonella ser. Choleraesuis vaccine on a commercial dairy.

ANIMALS

450 cows in late gestation and 80 calves.

PROCEDURE

Group-1 cows (n = 150) were vaccinated once with a modified live S. Choleraesuis (serogroup C1) strain 54 (SC54) vaccine, group-2 cows (150) were vaccinated on enrollment and 30 days later with a Salmonella ser. Montevideo (serogroup C1) bacterin, and group-3 cows (150) served as unvaccinated controls. One gallon of colostrum harvested from the first 80 cows to calve was fed to each calf. Outcome assessments included fecal shedding of Salmonella spp for the first 10 days after parturition (cows) or birth (calves), milk production, involuntary culling rate, mastitis incidence, antimicrobial use, and mortality rate.

RESULTS

Salmonellae were isolated from 306 of 309 (99%) cows and 64 of 74 (86.5%) calves. Shedding frequency was less in SC54-vaccinated cows and calves that received colostrum from those cows, compared with the other groups, and vaccination was specifically associated with less shedding of serogroup C1 salmonellae. Production data were similar among groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Vaccination of pregnant cows with an autogenous Salmonella bacterin had no effect on fecal shedding of salmonellae, whereas vaccination with a modified live S. Choleraesuis vaccine reduced the frequency of fecal shedding of serogroup C1 salmonellae during the peripartum period. A commercial S. Choleraesuis vaccine licensed for use in swine may be more efficacious than autogenous Salmonella bacterins on dairies infected with serogroup C1 salmonellae.

Botulinum toxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial

BACKGROUND

Focal spasticity of the gastrocnemius-soleus muscles causes equinus gait in children with cerebral palsy (CP). Botulinum toxin type A (BTX-A), a neuromuscular blocking agent, reduces muscle tone/overactivity in dystonia, stroke, and CP.

OBJECTIVE

A prospective, open-label, multicenter clinical trial evaluated the long-term safety and efficacy of repeated intramuscular injections of BTX-A on equinus gait in CP children.

METHODS

Nine centers enrolled 207 children. BTX-A injections (4 U/Kg) were given approximately every 3 months (maximum dose 200 U per treatment). Outcome measures included a Physician Rating Scale of gait, ankle range of motion measurements, and the incidence and profile of adverse events.

RESULTS

One hundred fifty-five (75%) of 207 children completed at least 1 year with a total of 302 patient years of BTX-A treatment. The mean duration of BTX-A exposure was 1.46 years per patient. Dynamic gait pattern on the Physician Rating Scale improved in 46% of patients (86/185) at first follow-up. The response was maintained in 41% to 58% of patients for 2 years. Both gait pattern and ankle position improved at every visit. The most common treatment-related adverse events included increased stumbling, leg cramps, leg weakness, and calf atrophy in 1% to 11% of patients. No treatment-related serious adverse events were reported. Only 6% (7/117) of patients with pre- and postantibody samples had both detectable antibodies and a subsequent treatment failure.

CONCLUSION

BTX-A proved both safe and effective in the chronic management of focal muscle spasticity in children with equinus gait.

Serological distinction of bovine Salmonella carriers from vaccinated and acutely infected cows

Identification of Salmonella carriers using lipopolysaccharide (LPS) ELISA serology in a Salmonella-infected herd requires distinction of chronically infected cattle from convalescent and vaccinated cows. Cows responding to Salmonella infection and vaccination produce titers to Salmonella LPS that overlap with the lower titers of some Salmonella carriers. The objective of this study was to determine if the LPS antigen specificity of the bovine humoral immune response to Salmonella LPS antigens differs following vaccination and acute and chronic Salmonella infection. The study focused on the nondiscriminatory area of Salmonella ELISA serology, specifically, peak-titered sera from Salmonella bacterin-vaccinated and experimentally infected cows and low-titered sera from Salmonella carriers. The LPS serogroup specificity of the IgG1 and IgG2 response following acute and chronic Salmonella serotype Dublin infection and Salmonella bacterin vaccination was evaluated using 5 Salmonella serogroup (B, D, E1, C3, and C1) LPS ELISA assays. IgG, titers of carriers, vaccinated, and acutely infected cows were predominantly O antigen specific. Similarly, the IgG2 titers of acutely infected cows were also O antigen specific. In contrast, Salmonella carriers produced an IgG2 response to each of the heterologous LPS antigens (B, E1, C3, and C1) examined. The results of this study indicate that the bovine IgG1 isotype response to Salmonella LPS is serogroup specific. Conversely, production of IgG2 antibodies to core Salmonella LPS antigens shared across Salmonella serogroups is a feature of chronic Salmonella infections.

Monitoring biogenic volatile compounds emitted by Eucalyptus citriodora using SPME

A procedure to monitor BVOC emitted by living plants using SPME technique is presented. For this purpose, a glass sampling chamber was designed. This device was employed for the characterization of biogenic volatile compounds emitted by leaves of Eucalyptus citriodora. After extraction with SPME fibers coated with PDMS/ DVB, it was possible to identify or detect 33 compounds emitted by this plant. A semiquantitative approach was applied to monitor the behavior of the emitted BVOC during 9 days. Circadian profiles of the variation in the concentration of isoprene were plotted. Using diffusion-based SPME quantitation, a recently introduced analytical approach, with extraction times as short as 15 s, it was possible to quantify subparts-per-billion amounts of isoprene emitted by this plant.

Conventional and surrogate light chains differentially regulate Ig mu and Dmu heavy chain maturation and surface expression

Positive selection of precursor (pre-) B cells by Ig membrane mu H chains (mum HC) and counterselection mediated by the truncated HC Dmu depend on the ability of each HC to form a pre-B cell receptor (pre-BCR) signaling complex with the surrogate L chain (SLC) components lambda5 and Vpre-B. To better understand how pre-BCR signaling output is determined by its Ig components and the SLC, we investigated the regulation of pre-BCR surface expression and HC secretory maturation in a new nonlymphoid system. We took this approach as a means to distinguish B-lineage-specific effects from pre-BCR-intrinsic properties that may influence these aspects of pre-BCR homeostasis necessary for signaling. As in pre-B cells, the SLC in nonlymphoid cells supported only a limited degree of mum HC maturation and low pre-BCR surface expression levels compared with conventional LCs, indicating that this was due to an intrinsic property of the SLC. We identified the non-Ig region of lambda5 as harboring the restrictive activity responsible for this phenotype. This property of lambda5 was also evident with Dmu, but the overall SLC- and L chain-dependent requirements for Dmu maturation and surface expression were markedly different from those for mum. Surprisingly, Dmu was modified in an unusual manner that was only dependent on Vpre-B. These results establish a novel function of lambda5 in limiting surface pre-BCR levels and reveal biochemical properties of Ig molecules that may underlie the diverse consequences of pre-BCR signaling in vivo by different HCs.

On understanding variation in immune expression of the damselflies Lestes spp

Immune ability and immune expression have been viewed as life-history traits that are influenced by such factors as the likelihood of being parasitized, intensity and costs of parasitism, and trade-offs associated with immune expression. In this paper we show that different patterns of infestation by a generalist ectoparasite, Arrenurus planus Marshall (Arrenuridae: Hydrachnida), do not fully explain the variation in immune expression across four species of sympatric damselflies (Lestidae: Zygoptera). Within species, no gender biases in immune expression were evident. Whereas both males and females of one oft-exploited species did not mount immune responses against attending larval mites, males and females of three other species showed similar immune responses, with variable expression. The immune response was melanotic encapsulation of mite feeding tubes, and was associated with dead mites. Of the three species showing immune expression, the species with the highest prevalence and intensity of infestation had a significantly higher proportion of individuals responding immunologically to mites. In conclusion, current infestation levels only partially predict immune investment; consideration of the timing of emergence of different species suggests that season may be an important predictor of immune investment.

A simple transport system for radiation treatment of specific pathogen-free mice in lifetime studies

To prevent the introduction of pathogens, specific pathogen-free (SPF) facilities generally have a "once out, never back" policy with respect to animals and materials. In a lifetime study of the long-term effects of ionizing radiation exposure in mice, large numbers of SPF mice needed to be transported from clean-animal barrier labs to a multiuser conventional building for radiation treatment and then back into the animal facility. The conventional building is known to harbor wild mice as well as insects, spiders, and mites, and this situation might potentiate the transfer of wild mouse pathogens to laboratory animals. Introduction of pathogens into the mouse population would jeopardize the entire study, but the radiation treatments were an essential component of the study. These considerations prompted development of a system for transporting individual animals out of and back into the facility without exposure to pathogens. The system consists of reusable transport/treatment vessels and transport protocols designed to minimize the potential for pathogen exposure.

Isotype-specific antibody responses of cattle to Salmonella Dublin lipopolysaccharide and porin following Salmonella Dublin vaccination and acute and chronic infection

Stimulation of different T-cell subsets during antigen presentation influences the antibody isotype response to an antigen. Salmonella infection and Salmonella bacterin vaccination are likely to stimulate different T-cell subtypes. The objective of this study was to determine whether there are differences in the isotype response of cattle to Salmonella antigens following Salmonella infection and Salmonella bacterin vaccination. Sera from Salmonella bacterin-vaccinated, experimentally infected, and chronically infected (carrier) adult cattle collected during previous studies was used to evaluate the IgG1, IgG2, and IgM isotype responses of cows to Salmonella serotype Dublin lipopolysaccharide (LPS) and porin. Following vaccination and experimental oral infection, IgG1 titers to LPS and porin rose more quickly and persisted longer than did IgG2 titers. In contrast to Salmonella infection, bacterin vaccination stimulated a weak response to Salmonella porin. Salmonella infection also induced a higher IgG2:IgG1 titer ratio to LPS than did bacterin vaccination. Chronic Salmonella infection induced the highest LPS and porin IgG2:IgG1 titer ratios and the highest correlation between LPS and porin titers. Response operating characteristic curves for each isotype-specific enzyme-linked immunosorbent assay (ELISA) were determined to evaluate the effect of isotype on the sensitivity and specificity of Salmonella ELISA serology for distinguishing sera of Salmonella carriers from those of vaccinated and acutely infected cows. IgG2 titers to LPS and porin provide a more specific indicator of chronic Salmonella infection status than do IgG1 titers to the same antigens with little to no loss in sensitivity.

Arthroscopic and open management of dynamic scaphoid instability

This article focuses on the pathophysiology and treatment of dynamic scaphoid instability. Cadaver studies suggest that dynamic instability results from isolated injury to the scapholunate interosseous ligament without damage to the dorsal intercarpal and dorsal radial lunotriquetral ligaments. The diagnosis may be made by dynamic fluoroscopic examination, including stress and load views. The role of arthroscopy is twofold: (1) it enables the surgeon to distinguish between a complete, grossly unstable scapholunate interosseous space that requires open treatment and (2) it permits direct visualization of the reduction and percutaneous pinning of the articulation in an effort to stabilize the joint. Operative indications, open and arthroscopic techniques, and results are discussed.

Congenital dislocation of the knee: overview of management options

Congenital dislocation of the knee (CDK) is rare and includes a spectrum of hyperextension disorders of the knee. Early recognition of CDK is important, and careful evaluation is required to rule out associated hip deformity. Early manipulation, combined with splinting and casting, is the mainstay of initial treatment. Patients with seemingly fixed contractures may respond rapidly to serial casting and then can be placed in a Pavlik harness. Severe recalcitrant deformities or late presentation of the deformity may require surgical release. We highlight the importance of diagnostic categorization, show management options, and provide an overview of this rare but clinically significant problem. We present two case reports that illustrate the full range of management options.

Management of spasticity in cerebral palsy with botulinum-A toxin: report of a preliminary, randomized, double-blind trial

In order to evaluate further the efficacy of local intramuscular injections of botulinum-A toxin (BAT-A) in the management of dynamic equinus deformity associated with cerebral palsy, a randomized, double-blind, placebo-controlled study was undertaken. When evaluated using our Physician Rating Scale, 83% (five of six) of patients receiving toxin showed improvement, versus 33% (two of six) receiving placebo. There were no major complications. BAT-A injections appear to be safe and effective in children, and merit further prospective study.

Virulence factors in Escherichia coli isolated from the blood of bacteremic neonatal calves

Twenty-five Escherichia coli isolates from the blood of critically ill bacteremic calves sampled in two separate studies on a calf-rearing farm housing over 15,000 calves, in the San Joaquin Valley, California were studied. Isolates were characterized for O serogroups and for pathotypes as determined by the presence of specific virulence factors including heat-labile enterotoxin (LT), heat-stable enterotoxins a and b (STa, STb), verotoxins 1 and 2 (VT1, VT2), cytotoxic necrotizing factor (CNF), aerobactin, intimin Eae and P, F17 and CS31A fimbrial adhesins, and resistance to bactericidal effects of serum. These isolates constituted a heterogeneous group. However, isolates were mostly aerobactin positive and often resistant to the bactericidal effects of serum. Isolates of pathotypes O78 (n=6), O119:CS31a (n=3), and P positive but O non-typeable (n=3) were associated with a high mortality rate. The remaining isolates belonged to diverse pathotypes, often possessing the adhesins P, F17, CS31A and Eae but belonging to O serogroups other than O78 and O119, and were less frequently associated with mortality. Although no virulence factor common to all isolates was identified, the capacity to use iron by the presence of aerobactin which is important to the capture of iron was a predominant factor. Moreover, certain pathotypes appear to be associated with primary colisepticemia whereas other pathotypes may cause a bacteremia without necessarily leading to septicemia.

Confidence interval criteria for assessment of dose proportionality

PURPOSE

The aim of this work was a pragmatic, statistically sound and clinically relevant approach to dose-proportionality analyses that is compatible with common study designs.

METHODS

Statistical estimation is used to derive a (1-alpha)% confidence interval (CI) for the ratio of dose-normalized, geometric mean values (Rdnm) of a pharmacokinetic variable (PK). An acceptance interval for Rdnm defining the clinically relevant, dose-proportional region is established a priori. Proportionality is declared if the CI for Rdnm is completely contained within the critical region. The approach is illustrated with mixed-effects models based on a power function of the form PK = beta0 x Dose(beta1); however, the logic holds for other functional forms.

RESULTS

It was observed that the dose-proportional region delineated by a power model depends only on the dose ratio. Furthermore, a dose ratio (rho1) can be calculated such that the CI lies entirely within the pre-specified critical region. A larger ratio (rho2) may exist such that the CI lies completely outside that region. The approach supports inferences about the PK response that are not constrained to the exact dose levels studied.

CONCLUSION

The proposed method enhances the information from a clinical dose-proportionality study and helps to standardize decision rules.

Prevalence of Salmonella in beef feeder steers as determined by bacterial culture and ELISA serology

Results are presented for monitoring Salmonella infection by bacteriological culture and immune response (enzyme linked immunosorbent assay (ELISA) and haptoglobin) testing of samples collected from beef cattle at a single feedyard sampled over time. A total of 120 beef steers were examined on entry to the feedyard and at days 30, 60, and at time of slaughter (120-150 days). Isolations of Salmonella decreased over time from 40% of the steers sampled at day 0 to 0% at slaughter, whereas serological results varied by serogroup. Seropositivity increased for Salmonella group B up to day 60, and subsequently decreased to about half of the 60-day positivity rate at the time of slaughter. No significant changes in seropositivity were detected during the course of the study for the four other Salmonella serogroups (C1, C3, D1, and E1). Haptoglobin measurements were not a good indicator of Salmonella infection status. Sequential Salmonella testing either by culture, ELISA, or both could be used to monitor pathogen control practices.

Effects of peripheral sympathectomy on thermoregulatory vascular control in the rabbit ear

A rabbit ear model of the human digit was utilized to determine the vascular response to peripheral sympathectomy. Vascular responses were evaluated by subjecting chronically instrumented rabbits to a cold stress before and after sympathectomy surgery. The typical response to cold stress is for ear temperatures and auricular cutaneous perfusion to decrease during the cooling phase of the test and to increase toward baseline levels during the rewarming phase after cold exposure. Following peripheral sympathectomy, ear temperatures were significantly increased during both the cooling and rewarming phase of the cold stress test although overall ear perfusion and skin perfusion were not different from sham-operated rabbits. The responses observed in the rabbit ear following peripheral sympathectomy appear to mimic those noted in patients receiving digital peripheral sympathectomies for the treatment of refractory pain and ulceration. Peripheral sympathectomy may result in clinical improvements in patients because it improves both total digital and nutritional cutaneous blood flow. Peripheral sympathectomy in normal rabbit ears does not result in altered perfusion patterns with cold exposure although ear temperature is significantly higher. This pattern of changes suggests that the distribution of extremity perfusion is altered even though overall extremity perfusion and cutaneous perfusion per se are not significantly different from sham-operated controls. Complete sympathectomy was accompanied by a persistent increase in ear temperature and a dissociation between conductance and microvascular perfusion. Auricular conductance was transiently increased and then decreased to levels below preoperative control values. Microvascular perfusion is decreased immediately following amputation/replantation and thereafter increases.

Anatomic and physiologic evaluation of upper extremity ischemia

This study assessed the accuracy of arteriography and laser Doppler perfusion imaging (LDPI) as predictors of digital ischemia and correlated upper extremity symptoms, function, and nutritional flow with arteriographic and laser Doppler assessments. Multiple-level occlusive disease was documented in 25 hands (23 patients) by arteriography. LDPI demonstrated one or more hypoperfused digits in 17 hands. Patient questionnaires were used to assess upper extremity symptoms, pain, cold sensitivity, and function. Spearman correlation coefficients indicated that arteriography is a poor indicator of nutritional perfusion as measured by LDPI. Neither arteriography or laser Doppler perfusion imaging served as an indicator of the severity of cold intolerance. However, upper extremity symptoms and functional status correlated with both laser Doppler measurements and the level of cold sensitivity. Laser Doppler perfusion imaging and arteriographic analysis provide complimentary data in the evaluation of upper extremity ischemia.

PhRMA perspective on population and individual bioequivalence

The Food and Drug Administration (FDA) issued a second-draft guidance in August 1999 on the subject of in vivo bioequivalence, which is based on the concepts of individual and population bioequivalence (IBE and PBE, respectively). The intention of this guidance is to replace the 1992 guidance that requires that in vivo bioequivalence be demonstrated by average bioequivalence (ABE). Although the concepts of population and individual bioequivalence are intuitively reasonable, a detailed review of the literature has not uncovered clinical evidence to justify the additional burden to the innovator and generic companies as well as the consumer that the new guidelines would impose. The criteria for bioequivalence described in the draft guidance employ aggregate statistics that combine information about differences in bioavailability between formulation means and differences in bioavailability variation of formulations between and within subjects. The purely technical aspects of the statistical approach are reasonably sound. However, PhRMA believes that important operational issues remain that need to be resolved before any changes to current practice are implemented. PhRMA believes that the ideals of prescribability and switchability are intuitively reasonable, but it is uncertain of the extent to which the proposed guidance can achieve these goals. It is not clear whether the attainment of such goals is necessary in the evaluation of bioequivalence given the role this plays in drug development, and the lack of clinical evidence argues against a pressing need to change current practice. PhRMA is concerned that the trade-off offered by the aggregate criteria may ultimately represent more harm than good to the public interest. PhRMA recommends more rigorous evaluation of methods based on two-way crossover designs before moving to methods that require more complex designs. One such method is identified herein and contains procedures for estimating prescribability and switchability. The possibility of a phase-in or trial period to collect replicate crossover data to further evaluate IBE and PBE and possibly allow market access based on these criteria as they are being evaluated has been proposed. PhRMA believes this is unprecedented and will offer little additional information beyond that which can be obtained by simulation or has already been collected by the FDA. Simulation studies have the advantage of allowing evaluation of the sensitivity of various procedures to represent the data patterns as created within the simulation. Operating characteristics by which proposed criteria can be adequately judged have not yet been defined. The limitations of ABE for highly variable drugs and narrow therapeutic drugs are well appreciated and may be addressed by means other than a wholesale change in the current criteria.

Arterial reconstruction for radial artery occlusion

This study was designed to detail the history and symptoms of symptomatic radial artery vaso-occlusive disease and to evaluate the results of radial artery reconstruction. Thirteen patients with symptomatic vaso-occlusive disease of the radial artery unresponsive to management by nonoperative modalities were managed with arterial reconstruction. All cases were treated with reversed interpositional vein grafting from the radial artery in the forearm (end-to-side) to the deep arch distally (end-to-end). Patients completed preoperative and postoperative assessments of symptoms and function, cold sensitivity (cold intolerance), and digital microvascular perfusion (isolated cold stress test evaluation with laser Doppler fluxmetry). At the follow-up examination all vascular grafts were patent, as determined by Allen's testing and Doppler ultrasound. The patients reported symptoms and functional status that demonstrated significant improvement following reconstruction. Microvascular evaluations demonstrated a significant improvement in digital microvascular perfusion as assessed by laser Doppler fluxmetry and digital temperature recordings with a resultant resolution of ischemic pain, numbness, and ulceration.

Differences in the skin peptides of the male and female Australian tree frog Litoria splendida. The discovery of the aquatic male sex pheromone splendipherin, together with phe8 caerulein and a new antibiotic peptide caerin 1.10

The skin secretions of female and male Litoria splendida have been monitored monthly over a three-year period using HPLC and electrospray mass spectrometry. Two minor peptides are present only in the skin secretion of the male. The first of these is the female-attracting aquatic male sex pheromone that we have named splendipherin, a 25 amino acid peptide (GLVSSIGKALGGLLADVVKSKGQPA-OH). This pheromone constitutes about 1% of the total skin peptides during the breeding season (January to March), dropping to about 0.1% during the period June to November. Splendipherin attracts the female in water at a concentration of 10-11-10-9 M, and is species specific. The second peptide is a wide-spectrum antibiotic of the caerin 1 group, a 25 residue peptide (GLLSVLGSVAKHVLPHVVPVIAEKL-NH2) named caerin 1.10. The neuropeptides of L. splendida are also seasonally variable, the change identical for both the female and male. During the period October to March, the sole neuropeptide present in skin secretions is caerulein [pEQDY(SO3)TGWMDF-NH2]; this is active on smooth muscle and is also an analgaesic. During the southern winter (June to September), more than half of the caerulein is hydrolysed to [pEQDYTGWMDF-NH2], a peptide that shows no smooth muscle activity. In place of caerulein, a new peptide, Phe8 caerulein [pEQDY(SO3)TGWFDF-NH2], becomes a major component of the skin secretion. Perhaps this seasonal change is involved in thermoregulation, that is, with the initiation and maintenance of the inactive (hibernation) phase of the animal.

Two pathways for the induction of apoptosis in human lymphocytes

PURPOSE

To assess the roles of cell membranes and DNA as targets in radiation-induced apoptosis.

MATERIALS AND METHODS

Peripheral blood lymphocytes from normal human donors were exposed to different types of apoptosis-inducing agents. Several measures of apoptosis were used to compare the kinetics of the processes induced, as well as to correlate the processes with DNA damage and membrane oxidation.

RESULTS

Two kinetically distinct processes were observed. DNA-damaging agents, such as ionizing radiation, bleomycin, cisplatin and the topoisomerase inhibitor m-amsacrine, induced apoptosis by a kinetically slow process initiated by DNA damage and dependent on protein synthesis, but which did not correlate with membrane oxidation. Conversely, the agents t-butyl hydroperoxide and cumene hydroperoxide induced apoptosis by a kinetically fast process independent of protein synthesis and which did correlate with membrane oxidation.

CONCLUSIONS

Slowly repaired or unrepairable DNA lesions, such as some of those produced by ionizing radiation exposure, trigger apoptosis by a kinetically slow process. This slow apoptotic pathway is distinct from a fast process not induced by radiation but which is induced by membrane-oxidizing agents.

Isolation of Salmonella organisms from the mesenteric lymph nodes of horses at necropsy

OBJECTIVES

To determine the prevalence of Salmonella infections in horses at necropsy.

DESIGN

Cross-sectional prevalence survey.

ANIMALS

102 horses.

PROCEDURE

Mesenteric lymph nodes were collected from horses that were necropsied. Horses had died or were euthanatized because of severe disease or at the request of the owner. Twenty-eight of the horses were racehorses euthantized following acute catastrophic injuries on the racetrack. Mesenteric lymph nodes were submitted for Salmonella culture via direct plating of tissue specimens on MacConkey agar and by use of 4 enrichment culture techniques that used tetrathionate and selenite enrichment broth and brilliant green and Salmonella-Shigella selective plating media.

RESULTS

Salmonella typhimurium was isolated from the mesenteric lymph nodes of 2 foals (2/102, 1.96% of the horses). Salmonella organisms were not isolated from the mesenteric lymph nodes of adult horses.

CONCLUSIONS AND CLINICAL RELEVANCE

Prevalence of Salmonella infections in horses of our study (1.96%) suggests that the results of cross-sectional surveys, using bacteriologic culture to determine prevalence of Salmonella infection, should be interpreted with caution. Prevalence of Salmonella infections determined in a single facility may not reflect the prevalence of Salmonella-infected horses in the general population; furthermore, obtaining a Salmonella isolate from a horse does not establish that the horse is a chronic Salmonella carrier.

Parasitism of Sympetrum dragonflies by Arrenurus planus mites: maintenance of resistance particular to one species

Using field surveys and histological methods, we show that a dragonfly species (Sympetrum internum) has an effective resistance, not seen previously in other odonates, to a mite parasite (Arrenurus planus). This mite is a generalist parasite known to effectively engorge on several other odonate species. We argue that selection is likely weak, favouring counter adaptations of Arrenurus planus to Sympetrum internum, in part because other host species are available. We further argue that this pattern is possibly linked to the fact that the mode of resistance is relatively novel, and because Sympetrum internum is rare compared to another host species, Sympetrum obtrusum, at our study site. Although resistance of Sympetrum internum is quite effective against Arrenurus planus, Arrenurus planus larvae still attach to this species, but less often than they attach to Sympetrum obtrusum. Attachment to unsuitable hosts may reflect constraints operating on Arrenurus planus larvae during host discovery. Such factors influencing the evolution of resistance, when several potential host species exist, have not received much attention.

Effect of injected versus iontophoretic corticosteroid on the rabbit tendon

BACKGROUND

The etiologic role of corticosteroid therapy in tendon rupture is controversial. This study compared the effects of injected versus iontophoretically delivered corticosteroid on the normal rabbit Achilles tendon.

METHODS

Rabbits were divided into three treatment groups: (1) corticosteroid injections, (2) iontophoretically delivered corticosteroid, and (3) no treatment. One tendon of each rabbit in the treatment groups was treated with either drug injection or iontophoresis; the tendon of the other leg served as a control. Some tendons were used for testing elastic modulus, ultimate load, and ultimate stress, while the remaining tendons were evaluated histologically.

RESULTS

Injections of either corticosteroid or saline into the tendon sheath resulted in short-term changes in tendon biomechanical characteristics and somewhat higher histologic severity scores; however, iontophoretic delivery of corticosteroid or saline did not affect either significantly.

CONCLUSIONS

Iontophoresis using sterile water or corticosteroid resulted in minimal or no biochemical and histologic changes in the tendon compared with injection of either substance. The method of corticosteroid delivery may be as important as the actual drug effects on the biomechanical and histologic properties of tendons.

Risk factors for nosocomial Salmonella infection among hospitalized horses

OBJECTIVE

To identify risk factors for nosocomial Salmonella infections among hospitalized horses.

DESIGN

Longitudinal study.

ANIMALS

1,583 horses hospitalized in an intensive care unit between January 1992 and June 1996.

PROCEDURE

Survivor functions were used to estimate time to shedding salmonellae for various Salmonella serotypes. Survival analysis was then used to determine how variables associated with patient management, environmental conditions, hospital conditions, and other disease processes affected the risk of nosocomial Salmonella infection.

RESULTS

78 horses shed Salmonella organisms: 35 shed Salmonella krefeld, 26 shed S typhimurium, and 17 shed other Salmonella serotypes. Mean time from admission to shedding was significantly longer for horses shedding S krefeld or S typhimurium than for horses shedding other Salmonella serotypes. Therefore, infection with S krefeld or S typhimurium was considered nosocomial. Seven variables were found to be significantly associated with risk of nosocomial Salmonella infection: mean number of horses in the hospital shedding S krefeld during the 4 days prior to and the day of admission, mean number of horses shedding S typhimurium during this period, a diagnosis of large colon impaction, withholding feed, number of days fed bran mash, duration of treatment with potassium penicillin G, and mean daily ambient temperature.

CLINICAL IMPLICATIONS

Results suggest that risk of nosocomial Salmonella infections is greater for horses with large colon impactions. In addition to implementing hospital protocols that minimize cross contamination between patients, strategies to reduce the risk of nosocomial Salmonella infection should include minimizing use of potassium penicillin G and regulation of environmental temperature in the hospital.

Treatment of hypernatremia in an acidotic neonatal calf

A 7-day-old Jersey calf was evaluated because of diarrhea and pneumonia. The calf was hypernatremic, hypoproteinemic, and acidemic, and was treated initially with i.v. administration of fluids with sodium concentration (175 mEq/L) similar to the calf's serum sodium concentration. Sodium concentration of the administered fluids was gradually decreased over the following days, but the calf's serum sodium concentration decreased too rapidly, and the calf developed neurologic signs attributed to cerebral edema. Treatment with mannitol and i.v. administration of fluids with a higher concentration of sodium resulted in abatement of clinical signs. In calves, hypernatremia may develop over several days. Prescribing traditional isotonic or hypotonic fluids in such cases will be harmful, because during chronic hypernatremia, the brain's adaptive mechanisms involve accumulation of organic osmoles that may take several days to equilibrate across cell membranes, and cerebral edema may result. Administration of fluids containing sodium concentration approximately equal to the patient's measured serum sodium concentration is required to decrease serum sodium concentration more slowly than is possible with traditional isotonic fluids.

Innervation density of the base of the palm

Cutaneous nerves of the palm were localized and quantitated by longitudinal axis, proximity to the distal palmar crease, and tissue layer to identify an incision that would avoid injury to the palmar branches of cutaneous nerves. Cadaveric palms (n = 10) harvested en bloc were fixed at physiologic tension and prepared using the celloidin method and hematoxylin-eosin staining. The cutaneous nerves of the palm were counted and classified by their size and location within each tissue layer and longitudinal axis as well as by proximal, middle, and distal locations within each axis. The mean number of large nerves identified within regions of the palm differed by tissue layer and longitudinal axis but not by longitudinal location within axes. The long/ring finger web space was characterized by the lowest innervation density; the index/long finger web space and ring finger axis were characterized by the greatest innervation density. An incision in the long/ring finger web space 2 cm proximal to Kaplan's cardinal line should result in injury to fewer nerves and reduce the incidence of painful neuromas during open carpal tunnel release.

Significance of cold intolerance in upper extremity disorders

After upper extremity injury, pain on exposure to cold (cold sensitivity) is a significant problem. This cross-sectional observational study (1) assesses the incidence and prevalence of cold intolerance, (2) evaluates the relationship between functional status and degree of cold intolerance, and (3) correlates health-related quality of life (HRQL) with symptoms of cold intolerance. Patients in a tertiary care center completed questionnaires to document (1) cold sensitivity, (2) upper extremity pain, symptoms, and function, and (3) HRQL. Cold sensitivity was found to be associated with more functional limitations, greater pain, and reduced HRQL. As the severity of cold intolerance increased, functional limitations and pain increased and HRQL decreased. Cold intolerance has a profound effect on HRQL.

Influence of fecal shedding of Salmonella organisms on mortality in hospitalized horses

OBJECTIVES

To predict mortality of horses by use of clinical data from the first day of hospitalization, to determine whether fecal shedding of Salmonella organisms is related to severity of clinical disease, and to determine the impact of fecal shedding of Salmonella organisms on mortality.

DESIGN

Prospective study.

ANIMALS

1,446 hospitalized horses.

PROCEDURE

Medical information was obtained from horses hospitalized in an intensive care unit or isolation facility during a 4.5-year period. A model was created to predict mortality, using covariates determined on the day of admission. Predicted mortality provided a measure of clinical condition. Predicted mortality was compared between horses that were and were not shedding Salmonella organisms in their feces to determine whether shedding was associated with severity of disease. Predicted and observed mortality between horses were also compared to evaluate the association between fecal shedding of Salmonella organisms and mortality.

RESULTS

92 horses were identified as shedding Salmonella organisms. In a multivariable model, 4 variables (heart rate, respiratory rate, rectal temperature, and clinical management) were associated with mortality. A higher predicted probability of death was observed in horses that shed Salmonella krefeld or more than 1 serotype. Relative risk (RR) of mortality was high for horses shedding S typhimurium (RR, 1.94; 95% confidence interval, 1.04 to 3.59) and multiple serotypes (RR, 4.75; 95% confidence interval, 2.29 to 9.84). When the clinical condition (i.e., prior predicted probability of death) was taken into consideration, fecal shedding of Salmonella organisms was not significantly associated with mortality.

CLINICAL IMPLICATIONS

In this horse population, fecal shedding of S krefeld was associated with more severe clinical conditions at the time of admission; however, fecal shedding of Salmonella organisms during hospitalization did not alter predicted mortality.

Arterial reconstruction in the ischemic hand and wrist: effects on microvascular physiology and health-related quality of life

Patients were evaluated before and after arterial reconstruction surgery (1) to define the physiology of the digital microcirculation in chronic subcritical ischemia, (2) to demonstrate the short-term effects of successful arterial reconstruction on microvascular flow, and (3) to document the effects of surgery on symptoms, function, and health-related quality of life. Arterial insufficiency was the result of a proximal reconstructible occlusive lesion, 1 or more distal unreconstructible occlusions, and secondary reactive vasospasm. Microvascular physiology was evaluated by monitoring digital temperatures, microvascular perfusion (laser Doppler fluxmetry) and perfusion patterns (laser Doppler perfusion patterns (laser Doppler perfusion imaging). Following successful vascular reconstruction, digital temperatures and microvascular perfusion improved significantly, approaching control levels. Although cold sensitivity was unchanged, symptoms decreased and upper extremity function and health-related quality of life improved after successful proximal reconstruction in patients with 2-level arterial occlusion.

The effect of transdermal nicotine on digital perfusion in reformed habitual smokers

The effects of transdermal nicotine-assisted smoking cessation on digital perfusion and health-related quality of life were assessed in 10 chronic smokers. Components of digital blood flow were evaluated by digital temperature and laser Doppler fluxmetry before, during, and after a standardized cold challenge. Nutritional flow was measured by vital capillaroscopy; a quantitative perfusion profile was obtained by laser Doppler perfusion imaging. A battery of validated measures were used to evaluate health-related quality of life. The microvascular response of smokers was evaluated before smoking cessation and at 2 and 7 days after smoking cessation and was compared with the response of nonsmoking controls. Results demonstrated that a (1) cutaneous microvascular perfusion was lower in smokers than nonsmokers, (2) the acute administration of transdermal nicotine did not decrease cutaneous perfusion, (3) smoking cessation and transdermal nicotine normalized digital microvascular perfusion by 7 days, and (4) transdermal nicotine and smoking cessation did not negatively impact health-related quality of life.

Endogenous nitric oxide influences arteriovenous anastomosis adrenergic tone in the conscious rabbit ear

The role of nitric oxide (NO) in the control of arteriovenous anastomoses (AVAs) has not been studied in vivo in a thermoregulatory end organ. In this study, the effect of local inhibition of NO synthesis by NG-nitro-L-arginine methyl ester (L-NAME) on the microvasculature in the rabbit ear (n=12) was observed in vivo through a chronically implanted ear microvascular chamber. Ear cutaneous blood perfusion (CBP), total auricular arterial flow (TAF), and ear temperature were monitored simultaneously with the direct microvascular observations. Results revealed that intrafacial artery infusion of L-NAME produced significant vasoconstriction of arterioles, AVAs, and venules (p < 0.05). A decrease of ear blood perfusion also was demonstrated by changes of CBP, TAF, and surface temperature. The data provide evidence that basal generation of NO influences the vascular resistance in the thermoregulatory end organ. Moreover, endogenous NO production may be more important in regulating the AVA flow than is flow in other parts of the rabbit ear microvasculature. The effects of NO inhibition on ear microvasculature were not abolished by superior cervical ganglionectomy, indicating that NO production in the rabbit ear is not a neurally mediated mechanism. Further study with a short-term rabbit ear preparation showed that inhibition of NO production with L-NAME enhanced microvascular constrictive responses to extraluminal application of norepinephrine. NO thus appears to play a role of basal vasodilator in opposition to the basal adrenergic vasoconstrictor tone in the rabbit ear.

Prediction of anticoagulation during hemodialysis by population kinetics and an artificial neural network

All systems currently used for routine hemodialysis require heparin administration to prevent blood clotting in the extracorporeal circuit. We tested the hypothesis that population-based statistical techniques can be used to predict heparin concentrations during routine hemodialysis. Two predictive models were developed, one based on nonlinear mixed effects modeling (NONMEM) and the other on a multilayer perceptron neural network. Serial clotting time data were obtained from forty-nine patients and used to develop the models. The models were used to predict the clotting times of 70 patients in a prospective test. We determined that the neural network provided greater precision, had fewer outliers in its predictions, and did not have the model misspecification in bolus administration that the NONMEM predictions demonstrated. A final NONMEM model was developed using all data from 119 patients to identify important covariates for predicting the heparin pharmacodynamic parameters, volume of distribution, and clearance. Both the volume of distribution and clearance increased following the initiation of dialysis and as the patient's baseline clotting time increased. The volume of distribution also increased as the patient's weight increased but was decreased by smoking and diabetes. Population-based statistical techniques may provide a useful alternative to existing methods for prescribing heparin.

Alpha adrenoceptors in the rabbit ear thermoregulatory microcirculation

The rabbit ear microcirculation was analyzed in a chronic unanesthetized model to evaluate alpha adrenergic microvascular control in a thermoregulatory end organ. This model allowed direct measurement of microcirculatory responses without the effects of anesthetics or inflammatory responses induced by acute surgical intervention. The ipsilateral facial artery was catheterized for drug injections into the experimental ear. Microvascular diameter changes following stimulation or blockade of adrenoceptor (AR) subtypes were observed directly through a chronic microvascular chamber implanted in the rabbit ear. Vascular alpha1- and alpha2-ARs appear to be distributed differently across the arterioles and AVAs of the rabbit ear. Both alpha1- and alpha2-ARs appear to contribute to vasoconstriction of AVAs in the conscious rabbit ear. In contrast, alpha1-AR's (vs alpha2-ARs) appear to predominate in adrenergically mediated sympathetic vasoconstriction of arterioles.

Effect of cooling on cutaneous microvascular adrenoceptors in vivo in the rabbit ear

Previous studies have suggested that moderate cooling increases the responsiveness of vascular alpha2-adrenoceptors. However, limited information is available documenting the influence of temperature changes on adrenoceptor responses in the microvasculature of thermoregulatory organs (e.g., the human digit and the rabbit ear) subjected to a wide range of temperatures. In the present study, the effect of local cooling (24 degrees C) on cutaneous microvascular adrenoceptors in the ear was observed in vivo in male New Zealand White rabbits (total: 66 ears). The rabbit ear was studied in a temperature-controlled tissue bath; the ear preparation was pretreated with terazosin (an alpha1-adrenoceptor antagonist) (10(-5) M) or a combination of terazosin (10(-5) M) and propranolol (a beta-adrenoceptor antagonist) (10(-6) M). The microvascular diameter responses of the ear to norepinephrine (10(-11)-10(-4) M) then were determined at 24 or 34 degrees C, respectively, to determine the influences of low temperature on adrenoceptor responses to norepinephrine stimulation. The results demonstrated that low concentrations of norepinephrine induced vasodilation in arterioles and arteriovenous anastomoses. This vasodilation was followed by vasoconstriction with an increased concentration of norepinephrine in animals with alpha1-adrenergic blockade at 34 degrees C. Moderate tissue cooling increased the microvascular maximal response of the rabbit ear to norepinephrine and abolished the vasodilatation induced by a low concentration of norepinephrine. There was no significant difference in the microvascular response to norepinephrine between the two temperature conditions after simultaneous blockade of alpha1-adrenoceptors and beta-adrenoceptors. Data from the present study indicate that moderate cooling does not enhance the responsiveness of alpha2-adrenoceptors to norepinephrine. In contrast, cooling reduced the beta-adrenergic activity of arterioles and arteriovenous anastomoses after norepinephrine stimulation.