Renal responses of normal and preascitic broilers to systemic hypotension induced by unilateral pulmonary artery occlusion

Exogenous creatinine clearence indexed to body surface area allows estimation of GFR and across species comparison

The assessment of renal function in birds is difficult because sensitive biomarkers are lacking. Previous studies have demonstrated the feasibility of measuring the exogenous creatinine clearance in pigeons, indicating the potential use of this technique for the assessment of renal function in birds. The aim of the study was to index the exogenous creatinine elimination rate by body surface area, enabling comparison between different species. Exploratory data on common buzzards (Buteo buteo), Eurasian eagle-owls (Bubo bubo), domestic goose (Anser anser domesticus) and racing pigeons (Columba livia) were collected and indexed by body surface area. A sterile creatinine solution was administered at a dose D_M = 50 mg kg^-1 i.m. into the deep pectoral muscle of 52 clinically healthy birds of the four species with different body masses. The time course of the plasma creatinine concentration was measured and analyzed by a parametric pharmacokinetic Bateman model, followed by indexing the exogenous creatinine clearance (ECC) by body surface area. The exploratory ECC values for birds with a mean body mass ranging from 0.42 kg (pigeon) to 8.2 kg (goose) were between 0.4261 mL min^-1 dm^-2 (CI 0.3882-0.4672) and 0.8717 mL min^-1 dm^-2 (CI 0.8091-0.9362). ECC indexed by body surface area turned out to be independent from body mass. Resulting exploratory data covering species with different body masses are comparable with published data from very complex studies of avian renal function.

Altered Expression of Zinc Transporter ZIP12 in Broilers of Ascites Syndrome Induced by Intravenous Cellulose Microparticle Injection

Ascites syndrome (AS) is a harmful disease in fast-growing broilers characterized by heart failure and serious fluid accumulation in the abdominal cavity. One of the known functions of zinc transporter ZIP12 is an important regulator in pulmonary hypertension (PH) in rat. Whether chicken ZIP12 is involved in the process of AS need to be explored. Here, chicken ZIP12 was sequenced and expression pattern and histological distribution were detected in broilers of AS induced by intravenous cellulose microparticle injection. Phylogenetic analysis showed that ZIP12 was significantly different between chicken and mammalian. The relative mRNA expression level of ZIP12 in the liver and lung in AS and pre-ascites (PAS) groups were significantly higher (P < 0.01) than that in control. The immunohistological staining using rabbit anti-chicken ZIP12 IgG and integrated optical density analysis showed the positive cells of ZIP12 distributed in detected tissues and the expression level of ZIP12 protein increased in AS and PAS groups compared to control. The results will provide the basic data of ZIP12 in the pathological process of AS in broiler chickens and offer an important reference for prevention and control of the disease.

Pulmonary arterial hypertension (ascites syndrome) in broilers: a review

Pulmonary arterial hypertension (PAH) syndrome in broilers (also known as ascites syndrome and pulmonary hypertension syndrome) can be attributed to imbalances between cardiac output and the anatomical capacity of the pulmonary vasculature to accommodate ever-increasing rates of blood flow, as well as to an inappropriately elevated tone (degree of constriction) maintained by the pulmonary arterioles. Comparisons of PAH-susceptible and PAH-resistant broilers do not consistently reveal differences in cardiac output, but PAH-susceptible broilers consistently have higher pulmonary arterial pressures and pulmonary vascular resistances compared with PAH-resistant broilers. Efforts clarify the causes of excessive pulmonary vascular resistance have focused on evaluating the roles of chemical mediators of vasoconstriction and vasodilation, as well as on pathological (structural) changes occurring within the pulmonary arterioles (e.g., vascular remodeling and pathology) during the pathogenesis of PAH. The objectives of this review are to (1) summarize the pathophysiological progression initiated by the onset of pulmonary hypertension and culminating in terminal ascites; (2) review recent information regarding the factors contributing to excessively elevated resistance to blood flow through the lungs; (3) assess the role of the immune system during the pathogenesis of PAH; and (4) present new insights into the genetic basis of PAH. The cumulative evidence attributes the elevated pulmonary vascular resistance in PAH-susceptible broilers to an anatomically inadequate pulmonary vascular capacity, to excessive vascular tone reflecting the dominance of pulmonary vasoconstrictors over vasodilators, and to vascular pathology elicited by excessive hemodynamic stress. Emerging evidence also demonstrates that the pathogenesis of PAH includes characteristics of an inflammatory/autoimmune disease involving multifactorial genetic, environmental, and immune system components. Pulmonary arterial hypertension susceptibility appears to be multigenic and may be manifested in aberrant stress sensitivity, function, and regulation of pulmonary vascular tissue components, as well as aberrant activities of innate and adaptive immune system components. Major genetic influences and high heritabilities for PAH susceptibility have been demonstrated by numerous investigators. Selection pressures rigorously focused to challenge the pulmonary vascular capacity readily expose the genetic basis for spontaneous PAH in broilers. Chromosomal mapping continues to identify regions associated with ascites susceptibility, and candidate genes have been identified. Ongoing immunological and genomic investigations are likely to continue generating important new knowledge regarding the fundamental biological bases for the PAH/ascites syndrome.

An inadequate pulmonary vascular capacity and susceptibility to pulmonary arterial hypertension in broilers

Broilers are susceptible to pulmonary hypertension syndrome (PHS; ascites syndrome) when their pulmonary vascular capacity is anatomically or functionally inadequate to accommodate the requisite cardiac output without an excessive elevation in pulmonary arterial pressure. The consequences of an inadequate pulmonary vascular capacity have been demonstrated experimentally and include elevated pulmonary vascular resistance (PVR) attributable to noncompliant, fully engorged vascular channels; sustained pulmonary arterial hypertension (PAH); systemic hypoxemia and hypercapnia; specific right ventricular hypertrophy, and right atrioventricular valve failure (regurgitation), leading to central venous hypertension and hepatic cirrhosis. Pulmonary vascular capacity is broadly defined to encompass anatomical constraints related to the compliance and effective volume of blood vessels, as well as functional limitations related to the tone (degree of constriction) maintained by the primary resistance vessels (arterioles) within the lungs. Surgical occlusion of 1 pulmonary artery halves the anatomical pulmonary vascular capacity, doubles the PVR, triggers PAH, eliminates PHS-susceptible broilers, and reveals PHS-resistant survivors whose lungs are innately capable of handling sustained increases in pulmonary arterial pressure and cardiac output. We currently are using i.v. microparticle injections to increase the PVR and trigger PAH sufficient in magnitude to eliminate PHS-susceptible individuals while allowing PHS-resistant individuals to survive as progenitors of robust broiler lines. The microparticles obstruct pulmonary arterioles and cause local tissues and responding leukocytes to release vasoactive substances, including the vasodilator NO and the highly effective vasoconstrictors thromboxane A(2) and serotonin [5-hydroxytryptamine (5-HT)]. Nitric oxide is the principal vasodilator responsible for modulating (attenuating) the PAH response and ensuing mortality triggered by i.v. microparticle injections, whereas microparticle-induced increases in PVR can be attributed principally to 5-HT. Our observations support the hypothesis that susceptibility to PHS is a consequence of anatomically inadequate pulmonary vascular capacity combined with the functional predominance of the vasoconstrictor 5-HT over the vasodilator NO. The contribution of TxA(2) remains to be determined. Selecting broiler lines for resistance to PHS depends upon improving both anatomical and functional components of pulmonary vascular capacity.

Types of renal disease in avian species

Renal disease in birds is frequently encountered. Like most other animals, birds are susceptible to a full spectrum of renal insults,such as toxins, tumors, infections, and degenerative conditions. Accurate diagnosis of renal disease is based on a complete history,physical examination, and laboratory evaluation of the patient. Because it is often required for a more definitive diagnosis, special attention is given to histopathologic evaluation of renal tissue,whether through a premortem biopsy or collection at gross necropsy.

Nω-nitro-L-arginine methyl ester (L-NAME) amplifies the pulmonary hypertensive response to microparticle injections in broilers

We tested the hypothesis that microparticles entrapped within the pulmonary vasculature elicit the production of nitric oxide (NO) in quantities sufficient to modulate the combined impact of physical occlusion plus contemporaneously released vasoconstrictors. In experiment 1, male broilers were given an injection of the NO synthase (NOS) inhibitor Nomega-nitro-L-arginine methyl ester (L-NAME), followed by an intravenous injection of cellulose microparticles while the pulmonary arterial pressure (PAP) and cardiac output (CO) were recorded. When L-NAME was used to block NO synthesis induced by the microparticles, an early peak of pulmonary hypertension was revealed that rarely developed in the absence of L-NAME. The subsequent more prolonged increases in PAP and pulmonary vascular resistance (PVR) were greater in amplitude and duration in broilers pretreated with L-NAME than in broilers in the control group. These amplified responses occurred in spite of a simultaneous reduction in CO, thereby conclusively demonstrating that inhibiting NOS permitted the development of a much more profound increase in the PVR. In experiment 2 the mortality triggered within 48 h after injecting microparticles was evaluated in the presence and absence of L-NAME. The 48 h postinjection mortality more than doubled when L-NAME was combined with microparticle injection doses that otherwise caused relatively low mortality in the absence of L-NAME. Experiment 3 was conducted to determine whether NO contributes to the systemic hypoxemia that develops after microparticles are injected. L-NAME administration had no impact on the magnitude and duration of the microparticle induced decline in the percentage saturation of hemoglobin with oxygen (%HbO2). Evidently hypoxemia per se contributes relatively little to the amplified pulmonary vasoconstriction and 48 h postinjection mortality triggered by microparticle injections in broilers pretreated with L-NAME. These observations indicate that NO modulates the responses to vasoconstrictors released when microparticles become entrapped in the pulmonary vasculature. Inhibition of NOS by L-NAME exposed a more dramatic increase in PVR and pulmonary hypertension leading to enhanced mortality in response to microparticle injections.

Major histocompatibility (B) complex control of responses against Rous sarcomas

The chicken major histocompatibility (B) complex (MHC) affects disease outcome significantly. One of the best characterized systems of MHC control is the response to the oncogenic retrovirus, Rous sarcoma virus (RSV). Genetic selection altered the tumor growth pattern, either regressively or progressively, with the data suggesting control by one or a few loci. Particular MHC genotypes determine RSV tumor regression or progression indicating the crucial B complex role in Rous sarcoma outcome. Analysis of inbred lines, their crosses, congenic lines, and noninbred populations has revealed the anti-RSV response of many B complex haplotypes. Tumor growth disparity among lines identical at the MHC but differing in their background genes suggested a non-MHC gene contribution to tumor fate. Genetic complementation in tumor growth has also been demonstrated for MHC and non-MHC genes. RSV tumor expansion reflects both tumor cell proliferation and viral replication generating new tumor cells. In addition, the B complex controls tumor growth induced by a subviral DNA construct encoding only the RSV v-src oncogene. Immunity to subsequent tumors and metastasis also exhibit MHC control. Genotypes that regressed either RSV or v-src DNA primary tumors had enhanced protection against subsequent homologous challenge. Regressor B genotypes had lower tumor metastasis compared with progressor types. Together, the data indicate that B complex control of RSV tumor fate is strongly defined by the response to a v-src-determined function. Differential RSV tumor outcomes among various B genotypes may include immune recognition of a tumor-specific antigen or immune system influences on viral replication.

Dietary sodium bicarbonate, cool temperatures, and feed withdrawal: impact on arterial and venous blood-gas values in broilers

Sodium bicarbonate (NaHCO3) has been used successfully in mammals and birds to alleviate pulmonary hypertension. Experiment 1 was designed to provide measurements of arterial and venous blood-gas values from unanesthetized male broilers subjected to a cool temperature (16 degrees C) challenge and fed either a control diet or the same diet alkalinized by dilution with 1% NaHCO3. The incidences of pulmonary hypertension syndrome (PHS, ascites) for broilers fed the control or bicarbonate diets were 15.5 and 10.5%, respectively (P = 0.36, NS). Non-ascitic broilers fed the control diet were heavier than those fed the bicarbonate diet on d 49 (2,671 vs. 2,484 g, respectively); however, other comparisons failed to reveal diet-related differences in heart weight, pulse oximetry values, electrocardiogram amplitudes, or blood-gas values (P > 0.05). When the data were resorted into categories based on right:total ventricular weight ratios (RV:TV) indicative of normal (RV:TV < 0.28) or elevated (RV:TV > or = 0.28) pulmonary arterial pressures, broilers with elevated RV:TV ratios had poorly oxygenated arterial blood that was more acidic, had high partial pressure of CO2 (PCO2), and had higher HCO3 concentrations when compared with broilers with normal RV:TV ratios. Experiment 2 was conducted to determine if metabolic variations associated with differences in feed intake or environmental temperature potentially could mask an impact of diet composition on blood-gas values. Male broilers maintained at thermoneutral temperature (24 degrees C) either received feed ad libitum or had the feed withdrawn > or = 12 h prior to blood sampling. Broilers fed ad libitum had lower venous saturation of hemoglobin with O2, higher venous PCO2, and higher arterial HCO3 concentrations than broilers subjected to feed withdrawal. Broilers in experiment 2 fed ad libitum and exposed to cool temperatures (16 degrees C) had lower arterial partial pressure of O2 and higher venous PCO2 than broilers fed ad libitum and maintained at 24 degrees C. Overall, these results demonstrate that changes in diet composition (control vs. 1% NaHCO3 diets) had minimal impact on arterial and venous blood-gas variables when compared with the more dramatic differences associated with feed intake (ad libitum vs. > or = 12 h withdrawal), environmental temperature (24 vs. 16 degrees C), and the pathogenesis associated with PHS (RV:TV < 0.28 vs. > or = 0.28).

Intravenous micro-particle injection and pulmonary hypertension in broiler chickens: cardio-pulmonary hemodynamic responses

Experiments were conducted to determine whether intravenous injections of micro-particles, having a size suitable to be trapped by the pulmonary precapillary arterioles, could be used to increase the pulmonary vascular resistance and thereby trigger an acute increase in the pulmonary arterial pressure (pulmonary hypertension). Anesthetized male broilers injected intravenously with inorganic (silica gel, polystyrene) or organic (cellulose, Sephadex) micro-particles developed an immediate pulmonary hypertension in proportion to the cumulative quantities of micro-particles injected. Micro-particle occlusion of a portion of the pulmonary arterioles forced the cardiac output to flow at a higher rate through the remaining vascular channels, thereby exposing a diffusion limitation characterized by undersaturation of the systemic arterial blood with oxygen (hypoxemia). The concurrent onset of systemic hypotension (reduced systemic arterial blood pressure) was not due to a reduction in cardiac output but rather was attributed to hypoxemic vasodilation of the systemic vasculature (reduced total peripheral resistance). Preliminary histological evaluations revealed micro-particles lodged in inter- and intraparabronchial arterioles, surrounded by aggregates of thrombocytes and mononuclear leukocytes within 30 min post-injection. These observations infer that intravenously injected micro-particles are carried to the lungs by the returning venous blood, where trapping of the micro-particles by the pulmonary vasculature triggers acute responses (increased pulmonary vascular resistance, pulmonary hypertension, systemic hypoxemia, systemic hypotension) that mirror those previously observed following acute occlusion of one pulmonary artery. Additional studies will be required to determine the extent to which the focal immune response to trapped micro-particles promotes local vasoconstriction that amplifies the pulmonary hypertension attributable to direct physical obstruction of precapillary arterioles.

Taurine, cardiopulmonary hemodynamics, and pulmonary hypertension syndrome in broilers

Previous studies have suggested cardiac taurine is released into the plasma in response to hypoxemia (low blood oxygen levels) during the pathogenesis of pulmonary hypertension syndrome (PHS, ascites). In the present study, broilers reared under cool temperature conditions (16 C) were provided tap water (control group), tap water supplemented with taurine, or tap water supplemented with the taurine transport antagonist beta-alanine. When compared with control values, taurine supplementation consistently elevated free taurine concentrations in the plasma but not in cardiac tissues, whereas beta-alanine supplementation consistently reduced free taurine concentrations in cardiac tissues but not in the plasma. Neither the incidence of PHS nor specific predictors of PHS susceptibility (electrocardiogram Lead II S-wave amplitude, % saturation of hemoglobin with oxygen, heart rate, right to total ventricular weight ratio) were affected by taurine or beta-alanine supplementation. Cardiopulmonary hemodynamic evaluations were conducted to compare control and beta-alanine supplemented broilers breathing room air or air containing 12% oxygen (low oxygen challenge). While breathing room air, the betaalanine-supplemented broilers had higher baseline values for cardiac output (186.2 vs. 146.9 mL/min/kg BW) and pulmonary arterial pressure (27.4 vs. 22.4 mm Hg), similar values for mean systemic arterial pressure (100 vs. 104 mm Hg) and pulmonary vascular resistance (0.062 vs. 0.064 resistance units), and lower values for total peripheral resistance (0.228 vs. 0.296 resistance units) when compared with control broilers breathing room air. During low oxygen challenges, the beta-alanine-supplemented broilers exhibited larger reductions in cardiac output, mean systemic arterial pressure, and pulmonary arterial pressure and greater increases in pulmonary vascular resistance than control broilers. These observations indicate that beta-alanine-supplemented broilers breathing room air had a higher systemic demand for oxygen as evidenced by their lower total peripheral resistance (systemic vasodilation) and had a capacity sufficient to pump a higher cardiac output and, thereby, maintain a similar mean systemic arterial pressure when compared with control broilers. However, cardiac function rapidly deteriorated in beta-alanine-supplemented broilers during low oxygen challenges, leading to substantially greater reductions in cardiac output, stroke volume, and mean systemic arterial pressure when compared with control broilers. Concurrent changes in pulmonary arterial pressure within the beta-alanine group reflect interactions between cardiac output and pulmonary vascular resistance. Overall, depleting cardiac taurine did not appear to initiate PHS, but systemic hypoxemia developing during the mid- to late-pathogenesis of PHS may expose and incipient cardiac weakness attributable to depleted taurine reserves.

Furosemide does not facilitate pulmonary vasodilation in broilers during chronic or acute unilateral pulmonary arterial occlusion

Furosemide (FURO) is a diuretic and a putative pulmonary vasodilator that, when added to broiler diets, previously has been shown to reduce the cumulative pulmonary hypertension syndrome (PHS) mortality induced by cold temperatures. The objective of the present study was to evaluate the influence of dietary FURO on the pulmonary vasculature in broilers undergoing chronic or acute unilateral pulmonary arterial occlusion. Broilers were fed a standard ration throughout the entire experiment (Control group) or the same ration supplemented with 0.015% (wt/wt) FURO from Day 14 to 42 (FURO group). In the present study chicks were chosen at random at 16 to 18 d of age to undergo sham surgery or a chronic unilateral pulmonary artery clamp (PAC) procedure. Diet and surgical treatments resulted in Control-Sham, FURO-Sham, Control-PAC, and FURO-PAC groups. The Control-PAC and FURO-PAC groups did not differ in body weight or right:total ventricular weight ratios (RV:TV). The postsurgical mortality, ascites mortality, and mortality due to other causes did not differ between the Control-PAC and FURO-PAC groups. Plasma Na+ (P < or = 0.05) was lower in the FURO-Sham group than in the Control-Sham group. Broilers from the same hatch were fed Control or FURO diets and surgically prepared for acute unilateral pulmonary arterial occlusion by using a snare. Tightening of the snare triggered characteristic increases in pulmonary blood flow, pulmonary arterial pressure, and pulmonary vascular resistance. Across all of these variables, the Control and FURO groups did not differ during any sample interval. Dietary FURO did not affect body weight, hematocrit, or RV:TV. Dietary FURO at 0.015% (wt/wt) does not appear to influence the pulmonary vasculature in broilers, but it may prolong the survival of broilers during the pathophysiological progression of PHS.

Measurements of pulmonary arterial pressure in anesthetized male broilers at two to seven weeks of age

Pulmonary hypertension (an elevated pulmonary arterial pressure) is the defining symptom of the pathophysiological progression leading to pulmonary hypertension syndrome (ascites) in broilers. Previously, closed-thorax techniques had not been reported for measuring the pulmonary arterial pressure in young (<5 wk of age) broilers. The objective of this research was to evaluate continuous pulmonary arterial pressure in anesthetized male broilers at weekly intervals (2 to 7 wk of age) by inserting a cannula directly into the pulmonary artery. Body weights, heart rates, and the right:total ventricular weight ratio were also recorded. Clinically healthy individuals were selected from two separate hatches without prior assessment of electrocardiograms or the percentage of saturation of hemoglobin with oxygen. The pulmonary arterial pressure increased (P < or = 0.05) from 20 to 25 mm Hg between Weeks 2 and 3, remained at approximately 25 mm Hg during Weeks 4 and 5, and then returned to 19 mm Hg during Weeks 6 to 7. Body weight increased with age, the heart rate and body weight-normalized right and total ventricular weights remained constant through Week 5, and the right:total ventricular weight ratio remained constant through Week 7. This technique is useful for determining age-related changes in pulmonary arterial pressure that may contribute to a mismatch between pulmonary vascular capacity and cardiac output in apparently healthy broilers during the pathogenesis of pulmonary hypertension syndrome.

Cardio-pulmonary function in preascitic (hypoxemic) or normal broilers inhaling ambient air or 100% oxygen

We evaluated the influence of the percentage saturation of hemoglobin with oxygen (HbO2) on the pulmonary arterial pressure in normal and preascitic (hypoxemic) broilers breathing ambient air or 100% O2. In Experiment 1, unanesthetized preascitic broilers (right:total ventricular weight ratios [RV:TV] = 0.32+/-0.02) breathing ambient air had initial values of 67% for HbO2 and 32 mm Hg for pulmonary arterial pressure. The HbO2 increased to > or =96.6% during inhalation of 100% O2; however, pulmonary arterial pressure was not reduced. In Experiment 2, anesthetized normal (RV:TV = 0.23; HbO2 = 88%) and preascitic broilers (RV:TV = 0.28; HbO2 = 76%) were compared. The groups did not differ in body weight or respiratory rate, but preascitic broilers had lower values for mean arterial pressure, total peripheral resistance, and partial pressure of O2 in arterial blood and had higher values for pulmonary arterial pressure. Inhaling 100% O2 increased HbO2 to 99.9% in both groups; however, pulmonary arterial pressure remained higher in preascitic than in normal broilers, and the pulmonary vascular resistance was not reduced during 100% O2 inhalation. Cardiac output was higher in preascitic than in normal broilers before and after, but not during, 100% O2 inhalation. Mean arterial pressure and total peripheral resistance increased in the preascitic but not in the normal group during 100% O2 inhalation. Low coefficients of determination (R2) were obtained for linear regression comparisons of HbO2 vs. pulmonary arterial pressure in both experiments. Overall, acute reversal of the systemic hypoxemia in preascitic broilers had little direct impact on pulmonary hypertension, providing no evidence of hypoxemic or hypoxic pulmonary vasoconstriction. Instead, acute reversal of the systemic hypoxemia primarily increased the total peripheral resistance and normalized the mean arterial pressure and cardiac output. A sustained reduction in cardiac output theoretically should attenuate pulmonary hypertension, but this was not observed because of the overriding influence of sustained pulmonary vascular resistance.

Cardio-pulmonary function in broilers reared at warm or cool temperatures: effect of acute inhalation of 100% oxygen

Fast growth and cool temperatures are the primary triggers for pulmonary hypertension syndrome (PHS, ascites) during commercial broiler growout. We evaluated cardio-pulmonary function in male broilers that initially were reared together at normal brooding temperatures and then were randomly assigned to chambers maintained at 28 C (warm group) or 16 C (cool group). Cardio-pulmonary evaluations were conducted between 35 and 42 d of age. The groups initially did not differ in body weight, right:total ventricular weight ratio, respiratory rate, heart rate, total peripheral resistance, or pulmonary vascular resistance, nor did their arterial blood gas values differ for the partial pressure of carbon dioxide, bicarbonate concentration, or hydrogen ion concentration. When compared with the warm group, the cool group had heavier total ventricular weights and higher values for pulmonary arterial pressure, cardiac output, stroke volume, mean systemic arterial pressure, and hematocrit and a marginally lower (P = 0.06) partial pressure of oxygen. Inhaling 100% O2 for 20 min caused equivalent increases in the arterial partial pressure of oxygen (> or =388 mm Hg) and the percentage saturation of hemoglobin with oxygen (99.9%) in both groups. The respiratory rate was reduced and total peripheral resistance in both groups was increased; the pulmonary arterial pressure, cardiac output, and heart rate in the cool group were also reduced. Cool temperatures contributed to the increase in pulmonary arterial pressure primarily by increasing the metabolic demand for oxygen, as reflected by incipient hypoxemia (reduced blood oxygen and elevated hematocrit), generalized ventricular hypertrophy, and an elevated cardiac output. It was the elevated cardiac output rather than hypoxemic pulmonary vasoconstriction that increased the pulmonary arterial pressure in the cool group when compared with the warm group.