Sympathetic, sensory, and nonneuronal contributions to the cutaneous vasoconstrictor response to local cooling

Novel cryotherapy technique for pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis- a randomized controlled trial

OBJECTIVES

To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis.

MATERIALS AND METHODS

The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.50C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72 h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test.

RESULTS

The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48 h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05).

CONCLUSIONS

Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis.

CLINICAL RELEVANCE

The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.

Cooling-induced cutaneous vasodilatation is mediated by small-conductance, calcium-activated potassium channels in tail arteries from male mice

Cooling causes cutaneous dilatation to restrain cold-induced constriction and prevent tissue injury. Cooling increases communication through myoendothelial gap junctions (MEGJs), thereby increasing endothelium-derived hyperpolarization (EDH)-type dilatation. EDH is initiated by calcium-activated potassium channels (KCa ) activated by endothelial stimuli or muscle-derived mediators traversing MEGJs (myoendothelial feedback). The goal of this study was to determine the individual roles of KCa with small (SK3) and intermediate (IK1) conductance in cooling-induced dilatation. Vasomotor responses of mice isolated cutaneous tail arteries were analyzed by pressure myography at 37°C and 28°C. Cooling increased acetylcholine-induced EDH-type dilatation during inhibition of NO and prostacyclin production. IK1 inhibition did not affect dilatations to acetylcholine, whereas SK3 inhibition inhibited dilatation at both temperatures. Cooling uncovered myoendothelial feedback to inhibit constrictions in U46619. IK1 inhibition did not affect U46619 constrictions, whereas SK3 inhibition abolished the inhibitory effect of cooling without affecting U46619 constriction at 37°C. Immunoblots confirmed SK3 expression, which was localized (immunofluorescence) to holes in the internal elastic lamina consistent with myoendothelial projections. Immunoblots and Immunofluorescence did not detect IK1. Studies in non-cutaneous arteries have highlighted the predominant role of IK1 in EDH-type dilatation. Cutaneous arteries are distinctly reliant on SK3, which may enable EDH-type dilation to be amplified by cooling.

Targeting temperature-sensitive transient receptor potential channels in hypertension: far beyond the perception of hot and cold

Transient receptor potential (TRP) channels are nonselective cation channels and participate in various physiological roles. Thus, changes in TRP channel function or expression have been linked to several disorders. Among the many TRP channel subtypes, the TRP ankyrin type 1 (TRPA1), TRP melastatin type 8 (TRPM8), and TRP vanilloid type 1 (TRPV1) channels are temperature-sensitive and recognized as thermo-TRPs, which are expressed in the primary afferent nerve. Thermal stimuli are converted into neuronal activity. Several studies have described the expression of TRPA1, TRPM8, and TRPV1 in the cardiovascular system, where these channels can modulate physiological and pathological conditions, including hypertension. This review provides a complete understanding of the functional role of the opposing thermo-receptors TRPA1/TRPM8/TRPV1 in hypertension and a more comprehensive appreciation of TRPA1/TRPM8/TRPV1-dependent mechanisms involved in hypertension. These channels varied activation and inactivation have revealed a signaling pathway that may lead to innovative future treatment options for hypertension and correlated vascular diseases.

Hesperetin-7-O-glucoside/β-cyclodextrin Inclusion Complex Induces Acute Vasodilator Effect to Inhibit the Cold Sensation Response during Localized Cold-Stimulate Stress in Healthy Human Subjects: A Randomized, Double-Blind, Crossover, and Placebo-Controlled Study

Hesperetin, a citrus flavonoid, exerts vasodilation and is expected to improve endothelial function and alleviate cold sensation by activating nervous system thermal transduction pathways. In this randomized, double-blind, crossover, and placebo-controlled study, the purpose was to assess the effect of an orally administered highly bioavailable soluble inclusion complex of hesperetine-7-O-glucoside with β-cyclodextrin (HEPT7G/βCD; SunActive® HES/HCD) on cold sensation response during localized cold-stimulated stress in healthy humans. A significant (p ≤ 0.05) dose-dependent increase in skin cutaneous blood flow following relatively small doses of HEPT7G/βCD inclusion complex ingestion was confirmed, which led to a relatively effective recovery of peripheral skin temperature. The time delay of an increase in blood flow during rewarming varied significantly between low- and high-dose HEPT7G/βCD inclusion complex consumption (e.g., 150 mg and 300 mg contain 19.5 mg and 39 mg of HEPT7G, respectively). In conclusion, the substantial alteration in peripheral skin blood flow observed during local cooling stress compared to placebo suggested that deconjugated hesperetin metabolites may have a distinct capacity for thermoregulatory control of human skin blood flow to maintain a constant body temperature during cold stress exposure via cutaneous vasodilation and vasoconstriction systems.

Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience

With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain.

Sex differences during a cold-stress test in normobaric and hypobaric hypoxia: A randomized controlled crossover study

Cold and hypoxia are two stressors that are frequently combined and investigated in the scientific literature. Despite the growing literature regarding normobaric hypoxia (NH) and hypobaric hypoxia (HH), responses between females and males are less often evaluated. Therefore, this study aims to investigate the physiological sex differences following a cold-stress test under normoxia, normobaric- and hypobaric hypoxia. A total of n = 10 females (24.8 ± 5.1 years) and n = 10 males (30.3 ± 6.3 years) from a university population volunteered for this study. The cold-stress test (CST) of the right hand (15°C for 2 min) was performed using a randomised crossover design in normobaric normoxia, NH and HH. The change (∆) from baseline to post-CST up to 15 min was analysed for cutaneous vascular conductance (CVC) and the hands’ skin temperature, whilst the mean values across time (post-CST up to 15 min) were assessed for peripheral oxygen saturation (SpO₂), thermal sensation- and comfort. Pressure pain threshold (PPT) was assessed after the post-CST 15 min period. The hands’ skin temperature drop was higher (p = 0.01) in the female group (∆3.3 ± 1.5°C) compared to the male group (∆1.9 ± 0.9°C) only in NH. Females (−0.9 ± 0.5) rated this temperature drop in NH to feel significantly colder (p = 0.02) compared to the males (−0.2 ± 0.7). No differences were observed between sexes in NN, NH, and HH for ∆CVC, SpO₂, thermal comfort and PPT. In conclusion, females and males show similar reactions after a CST under normoxia and hypoxia. Sex differences were observed in the local skin temperature response and thermal sensation only in NH.

Influence of Local Muscle Cooling on Mitochondrial-Related Gene Expression at Rest

The purpose of this study was to determine the impact of localized cooling of the skeletal muscle during rest on mitochondrial related gene expression. Thermal wraps were applied to the vastus lateralis of each limb of 12 participants. One limb received a cold application (randomized) (COLD), while the other did not (RT). Wraps were removed at the 4 h time point and measurements of skin temperature, blood flow, and intramuscular temperature were taken prior to a muscle biopsy. RT-qPCR was used to measure expression of genes associated with mitochondrial development. Skin and muscle temperatures were lower in COLD than RT (p < 0.05). Femoral artery diameter was lower in COLD after 4 h (0.62 ± 0.05 cm, to 0.60 ± 0.05 cm, p = 0.018). Blood flow was not different in COLD compared to RT (259 ± 69 mL·min^-1 vs. 275 ± 54 mL·min^-1, p = 0.20). PGC-1α B and GABPA expression was higher in COLD relative to RT (1.57-fold, p = 0.037 and 1.34-fold, p = 0.006, respectively). There was no difference (p > 0.05) in the expression of PGC-1α, NT-PGC-1α, PGC-1α A, TFAM, ESRRα, NRF1, GABPA, VEGF, PINK1, PARK 2, or BNIP3-L. The impact of this small magnitude of difference in gene expression of PGC-1α B and GABPA without alterations in other genes are unknown. There appears to be only limited impact of local muscle cooling on the transcriptional response related to mitochondrial development.

Effects of sensory nerve blockade on cutaneous microvascular responses to ischemia-reperfusion injury

OBJECTIVE

Examine the effects of sensory nerve blockade on cutaneous post-occlusive reactive hyperemia (PORH) and local thermal hyperemia (LTH) following prolonged upper limb ischemia.

MATERIALS AND METHODS

In nine males [28 years (standard deviation:6)], volar forearm skin blood flux normalized to maximum vasodilation (%SkBF_max) was assessed at control (CTRL) and sensory nerve blockade (EMLA) treated sites during the PORH response following 20-min of complete arm ischemia and during rapid LTH (33-42 °C, 1 °C·20 s^-1, held for ~30-min + 20-min at 44 °C) before and after ischemia-reperfusion (IR) injury.

RESULTS

EMLA increased mean [95 % confidence-interval] PORH amplitude by 21%SkBF_max ([9,33]; p = 0.003), delayed time to peak by 111 s ([40,182]; p = 0.007) and increased area under the curve by 19,462%SkBF_max·s ([11,346,27,579]; p < 0.001) compared to CTRL. For LTH, EMLA delayed onset time by 76 s ([46,106]; p < 0.001) Pre-IR and by 46 s ([27,65]; p < 0.001) Post-IR compared to CTRL. Post-IR onset time was delayed for CTRL by 26 s ([8,43]; p = 0.007), but was not different for EMLA (p > 0.050) compared to Pre-IR. EMLA delayed time to initial peak by 24 s ([4,43]; p = 0.022, Main time effect) and it attenuated the initial peak by 27%SkBF_max ([12,43]; p = 0.002) Pre-IR and by 16%SkBF_max ([3,29]; p = 0.020) post-IR compared to CTRL. Post-IR, the initial peak was not different for CTRL (p > 0.050), but it was increased by 16%SkBF_max ([5,26]; p = 0.005) for EMLA compared to Pre-IR. Neither EMLA nor IR altered the steady-state heating plateau (all p > 0.050).

CONCLUSION

For the current model of IR injury, sensory nerves appear to have a negligible influence on the LTH response in non-glabrous forearm skin once vasodilation has been initiated.

Current Insights Into the Role of Neuropeptide Y in Skin Physiology and Pathology

Neuropeptide Y is widely distributed within the body and has long been implicated as a contributor to skin disease based on the correlative clinical data. However, until recently, there have been few empirical investigations to determine whether NPY has a pathophysiological role in the skin. Due to appearance-altering phenotypes of atopic dermatitis, psoriasis, and vitiligo, those suffering from these diseases often face multiple forms of negative social attention. This often results in psychological stress, which has been shown to exacerbate inflammatory skin diseases - creating a vicious cycle that perpetuates disease. This has been shown to drive severe depression, which has resulted in suicidal ideation being a comorbidity of these diseases. Herein, we review what is currently known about the associations of NPY with skin diseases and stress. We also review and provide educated guessing what the effects NPY can have in the skin. Inflammatory skin diseases can affect physical appearance to have significant, negative impacts on quality of life. No cure exists for these conditions, highlighting the need for identification of novel proteins/neuropetides, like NPY, that can be targeted therapeutically. This review sets the stage for future investigations into the role of NPY in skin biology and pathology to stimulate research on therapeutic targeting NPY signaling in order to combat inflammatory skin diseases.

Dysfunctional TRPM8 signalling in the vascular response to environmental cold in ageing

Ageing is associated with increased vulnerability to environmental cold exposure. Previously, we identified the role of the cold-sensitive transient receptor potential (TRP) A1, M8 receptors as vascular cold sensors in mouse skin. We hypothesised that this dynamic cold-sensor system may become dysfunctional in ageing. We show that behavioural and vascular responses to skin local environmental cooling are impaired with even moderate ageing, with reduced TRPM8 gene/protein expression especially. Pharmacological blockade of the residual TRPA1/TRPM8 component substantially diminished the response in aged, compared with young mice. This implies the reliance of the already reduced cold-induced vascular response in ageing mice on remaining TRP receptor activity. Moreover, sympathetic-induced vasoconstriction was reduced with downregulation of the α_2c adrenoceptor expression in ageing. The cold-induced vascular response is important for sensing cold and retaining body heat and health. These findings reveal that cold sensors, essential for this neurovascular pathway, decline as ageing onsets.

Assessment of the Dynamics of Temperature Changes in the Knee Joint Area in Response to Selected Cooling Agents in Thermographic Tests

Although local cryotherapy (LC) is performed with various cooling agents (C_Ag) such as ice, water, and gasses, in clinical practice, it is mostly performed with cooling gasses. Presently, LC with cooling gasses is very popular but the inference about the thermal (stimulus) effect on the tissues is mainly based on research carried out using ice packs. The proposed objective of the study was to evaluate the dynamics of temperature changes in the knee joint area in response to a 3-min exposure to liquid nitrogen vapors (LNVs), cold air (CA) and ice bag (IB). The study group included 23 healthy volunteers with an average age of 26.67 ± 4.56. The exposed (ROI_E) and contralateral (ROI_NE) areas of the knee joint after exposure to C_Ag were observed. Immediately after 3 min of LC, the ROI_E temperature dropped by 10.11 ± 0.91 °C after LNV, 7.59 ± 0.14 °C after IB and 6.76 ± 1.3 °C after CA. Significant tissue cooling was maintained up to 15 min after LNV (p < 0.01), 10 min after IB (p < 0.05) and 5 min after CA (p < 0.05). LC causes significant temperature changes both in ROI_E and ROI_NE. The greatest cooling potential was demonstrated for LNV and the lowest for CA.

Objective Improvements in Peripheral Arterial Disease from Dorsal Root Ganglion Stimulation: A Case Series

BACKGROUND

The sympathetic nervous system (SNS) is important in the regulation of perfusion. Dorsal root ganglion stimulation (DRG-S) modulates sympathetic tone and is approved to treat complex regional pain syndrome, a disorder related to SNS dysfunction. We herein present 3 cases of DRG-S therapy to improve blood flow and symptoms of ischemia in peripheral arterial disease (PAD).

METHODS

Patient 1 is a 44-year-old female with dry gangrene of the third and fourth digits of her right hand due to Raynaud's syndrome who was scheduled for amputation of the affected digits. DRG-S leads were placed at the right C6, 7, and 8 DRG. Pulse volume recordings (PVR) were measured at baseline and after DRG-S. Patient 2 is a 55-year-old female with a non-healing ulcer of her left foot secondary to PAD scheduled for a below the knee amputation who underwent a DRG-S trial with leads placed at the left L4 and L5 DRG followed by a spinal cord stimulation trial with leads placed at the T9-T10 spinal levels for comparison. Transcutaneous oximetry (TcPO2) was measured at baseline and after 3 days of each therapy. Patient 3 is a 69-year-old female with persistent left foot pain at rest secondary to PAD with DRG-S leads placed at the left L4 and S1 levels.

RESULTS

All 3 patients experienced a significant reduction in pain with DRG-S, along with improvements in blood flow of the involved extremities, avoiding or limiting amputation. PVR improved dramatically with DRG-S in patient 1. A greater improvement in TcPO2 was seen with the DRG-S trial compared to spinal cord stimulation trial in patient 2. Patient 3 experienced an increase in walking distance and demonstrated long term efficacy and limb salvage at 32 months postimplantation.

CONCLUSIONS

Modulation of SNS output from DRG-S through orthodromic and antidromic autonomic pathways is likely responsible for improving blood flow. DRG-S may be a treatment option for PAD.

Cooling-induced dilatation of cutaneous arteries is mediated by increased myoendothelial communication

Cold exposure causes cutaneous vasoconstriction via a reflex increase in sympathetic activity and a local effect to augment adrenergic constriction. Local cooling also initiates cutaneous dilatation, which may function to restrain cold-induced constriction. However, the underlying mechanisms and physiological role of cold-induced dilatation have not been defined. Experiments were performed to assess the role of endothelial-derived mediators in this response. In isolated pressurized cutaneous mouse tail arteries, cooling (28°C) did not affect the magnitude of dilatation to acetylcholine in preconstricted arteries. However, inhibition of nitric oxide (NO) [N^G-nitro-l-arginine methyl ester (l-NAME)] and prostacyclin (PGI₂) (indomethacin) reduced acetylcholine-induced dilatation at 37°C but not at 28°C, suggesting that cooling increased NO/PGI₂-independent dilatation. This NO/PGI₂-independent dilatation was reduced by inhibition of endothelial SK (UCL1684) and IK (TRAM34) Ca²⁺-activated K⁺-channels (K_Ca), consistent with endothelium-derived hyperpolarization (EDH). Cooling also increased dilatation to direct activation of K_Ca channels (SKA31, CyPPA) but did not affect dilatation to exogenous NO (DEA-NONOate). This cooling-induced increase in EDH-type dilatations was associated with divergent effects on potential downstream EDH mechanisms: cooling reduced dilatation to K⁺, which mimics an intercellular K⁺ cloud, but increased direct communication between endothelial and smooth muscle cells (myoendothelial coupling), assessed by cellular transfer of biocytin. Indeed, inhibition of gap junctions (carbenoxolone) abolished the EDH-type component of dilatation to acetylcholine during cooling but did affect NO-dominated dilatation at 37°C. Cooling also inhibited U46619 constriction that was prevented by inhibition of IK and SK K_Ca channels or inhibition of gap junctions. The results suggest that cooling dilates cutaneous arteries by increasing myoendothelial communication and amplifying EDH-type dilatation.NEW & NOTEWORTHY Cold causes cutaneous vasoconstriction to restrict heat loss. Although cold also initiates cutaneous dilatation, the mechanisms and role of this dilatation have not been clearly defined. This study demonstrates that cooling increases myoendothelial coupling between smooth muscle and endothelial cells in cutaneous arteries, which is associated with increased endothelium-derived hyperpolarization (EDH)-type dilatation. Dysfunction in this process may contribute to excessive cold-induced constriction and tissue injury.

Historical reviews of the assessment of human cardiovascular function: interrogation and understanding of the control of skin blood flow

Several techniques exist for the determination of skin blood flow that have historically been used in the investigation of thermoregulatory control of skin blood flow, and more recently, in clinical assessments or as an index of global vascular function. Skin blood flow measurement techniques differ in their methodology and their strengths and limitations. To examine the historical development of techniques for assessing skin blood flow by describing the origin, basic principles, and important aspects of each procedure and to provide recommendations for best practise. Venous occlusion plethysmography was one of the earliest techniques to intermittently index a limb’s skin blood flow under conditions in which local muscle blood flow does not change. The introduction of laser Doppler flowmetry provided a method that continuously records an index of skin blood flow (red cell flux) (albeit from a relatively small skin area) that requires normalisation due to high site-to-site variability. The subsequent development of laser Doppler and laser speckle imaging techniques allows the mapping of skin blood flow from larger surface areas and the visualisation of capillary filling from the dermal plexus in two dimensions. The use of iontophoresis or intradermal microdialysis in conjunction with laser Doppler methods allows for the local delivery of pharmacological agents to interrogate the local and neural control of skin blood flow. The recent development of optical coherence tomography promises further advances in assessment of the skin circulation via three-dimensional imaging of the skin microvasculature for quantification of vessel diameter and vessel recruitment.

Changes of Endothelin-1 and Nitric Oxide Systems in Brain Tissue During Mild Hypothermia in a Porcine Model of Cardiac Arrest

BACKGROUND

Our previous study found that mild hypothermia (MH) after resuscitation reduced cerebral microcirculation, but the mechanism was not elucidated. The aim of this study was to clarify changes of endothelin-1 (ET-1) and nitric oxide (NO) systems in brain tissue during hypothermia after resuscitation.

METHODS

Twenty-six domestic male Beijing Landrace pigs were used in this study. MH was intravascularly induced 1 h after resuscitation from 8-min ventricular fibrillation. Core temperature was reduced to 33 °C and maintained until 8 h after resuscitation, and then animals were euthanized. ET-1 and NO levels in brain tissue and peripheral plasma were measured. Expression of endothelin-converting enzyme-1 (ECE-1), endothelin A receptor (ET-AR), endothelin-B receptor, and nitric oxide synthase (NOS) in brain tissue was determined by Western blot analysis.

RESULTS

Compared with non-hypothermia (NH) treatment, MH after resuscitation significantly increased the level of endothelin-1 and reduced the level of NO in peripheral blood and brain tissue. Cerebral expression of ECE-1 and ET-AR was significantly increased during MH after resuscitation. Moreover, MH significantly decreased inducible NOS expression compared with the NH group.

CONCLUSIONS

The ET-1 system is activated, while inducible NOS is inhibited in brain tissue during MH after resuscitation.

A Human Sensory Pathway Connecting the Foot to Ipsilateral Face That Partially Bypasses the Spinal Cord

Human sensory transmission from limbs to brain crosses and ascends through the spinal cord. Yet, descriptions exist of ipsilateral sensory transmission as well as transmission after spinal cord transection. To elucidate a novel ipsilateral cutaneous pathway, we measured facial perfusion following painfully-cold water foot immersion in 10 complete spinal cord-injured patients, 10 healthy humans before and after lower thigh capsaicin C-fiber cutaneous conduction blockade, and 10 warm-immersed healthy participants. As in healthy volunteers, ipsilateral facial perfusion in spinal cord injured patients increased significantly. Capsaicin resulted in contralateral increase in perfusion, but only following cold immersion and not in 2 spinal cord-injured patients who underwent capsaicin administration. Supported by skin biopsy results from a healthy participant, we speculate that the pathway involves peripheral C-fiber cross-talk, partially bypassing the cord. This might also explain referred itch and jogger's migraine and it is possible that it may be amenable to training spinal-injured patients to recognize lower limb sensory stimuli.

Perfusion of the skin's microcirculation after cold-water immersion (10°C) and partial-body cryotherapy (-135°C)

Background

Investigations of the perfusion of the skin's microcirculation with laser speckle contrast imaging (LSCI) after cold treatments are rare. Therefore, the aim of this study was to compare the effects between cold‐water immersion (CWI) conduction and partial‐body cryotherapy (PBC) convection on perfusion of the microcirculation and skin temperature on the thigh.

Materials and Methods

Twenty healthy males were randomly allocated to CWI (10°C for 10 minutes) or PBC (−60°C for 30 seconds, −135°C for 2 minutes). Perfusion and skin temperature measurements were conducted on the anterior thigh region up to 60 minutes post‐treatment.

Results

Cold‐water immersion decreased perfusion of the microcirculation significantly compared to baseline values between 10 minutes (P = 0.003) and 30 minutes (P = 0.01) post‐treatment. PBC increased perfusion of the microcirculation and decreased skin temperature only at the first measurement interval (0 minute, both P = 0.01) post‐treatment. Additionally, local skin temperature was significantly decreased compared to baseline values only after CWI up to 30 minutes (P = 0.04) post‐treatment.

Conclusion

Cold‐water immersion reduced local skin microcirculation and skin temperature while PBC only slightly increased the perfusion of the microcirculation immediately after the treatment. For cooling purposes, the conduction method seems superior compared to the convection method, assessed with a LSCI device.

Possible Influence of Oxidative Stress on Development of Raynaud Phenomenon in Patients With CREST Scleroderma Syndrome

CREST syndrome represents a form of scleroderma where the progressive autoimmune reaction is mainly manifested by the main symptoms, which make this acronym: calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly and teleangiectasia. Among the first affected organs is the skin followed by the excessive fibrosis manifested by the deposition of collagen in dermis. Reactive oxygen species (ROS) theory has been underlined as one of the main pathogenetic mechanisms and triggering factor in development of scleroderma. The present study was aimed at estimating the marker of lipid peroxidation products (MDA) in plasma of patients with CREST syndrome having manifested symptoms of both Raynaud syndrome and positive ANA antibodies. The lipid peroxidation (MDA) level was significantly higher in the patients who had CREST syndrome and Raynaud syndrome for less than 10 years compared to the patients suffering from Raynoud syndrome for more than 10 years (p<0.05). Both groups were found to have a significant MDA level increase (p<0.001) compared to the control healthy subjects. In conclusion, the relationship between lipid peroxidation (MDA level) and Raynaud syndrome appearance may emphasize the role of ROS produced by the ischemia-reperfusion injury as an early pathogenetic mechanism in CREST scleroderma syndrome.

Acral coldness - severely reduced blood flow to fingers and toes

The term acral coldness is used to describe physiologic or pathologic situations in humans where the fingers and toes are exceptionally cold in spite of normal central body temperature. In the thermoneutral zone, the blood flow to acral skin normally shows large fluctuations between high and low values, with a frequency of about 3 cycles per minute. At an acral skin temperature of about 21°C, finger blood flow is constantly low. At lower temperatures the fingers and toes become painful. This is a normal physiologic reaction, probably because of ischemia. The characteristics of the most frequent acral vascular syndromes, Raynaud phenomenon, acrocyanosis, and chilblains, are discussed. Common to all three is pathologically low blood flow and disappearance of physiologic fluctuations even in the thermoneutral zone. Ischemic vascular diseases in acral skin are usually diagnosed from clinical observations. Measurements of fluctuating blood flow by laser or ultrasound Doppler could be useful, but should be carried out at a room temperature of 24-25°C.

Level of Cutaneous Blood Flow Depression During Cryotherapy Depends on Applied Temperature: Criteria for Protocol Design

Cryotherapy is commonly used for the management of soft tissue injury. The dose effect of the applied cooling temperature has not been quantified previously. Six subjects were exposed during five different experiments to local skin temperatures of 16.6 °C, 19.8 °C, 24.7 °C, 27.3 °C, and 37.2 °C for 1 h of active heat transfer followed by 2 h of passive environmental interaction. Skin blood perfusion and temperature were measured continuously at treatment and control sites. All treatments resulted in significant changes in cutaneous vascular conductance (CVC, skin perfusion/mean arterial pressure) compared to baseline values. The drop in CVC for cooling to both 19.8 °C and 16.6 °C was significantly larger than for 27.3 °C (P < 0.05 and P < 0.0005, respectively). The depression of CVC for cooling to 16.6 °C was significantly larger than at 24.7 °C (P < 0.05). Active warming at 37.2 °C produced more than a twofold increase in CVC (P < 0.05). A simulation model was developed to describe the coupled effects of exposure time and temperature on skin perfusion. The model was applied to define an equivalent cooling dose defined by exposure time and temperature that produced equivalent changes in skin perfusion. The model was verified with data from 22 independent cryotherapy experiments. The equivalent doses were applied to develop a nomogram to identify therapeutic time and temperature combinations that would produce a targeted vascular response. The nomogram may be applied to design cryotherapy protocols that will yield a desired vascular response history that may combine the benefits of tissue temperature reduction while diminishing the risk of collateral ischemic injury.

Glabrous and non-glabrous vascular responses to mild hypothermia

This study examined cutaneous vasoconstriction to whole-body hypothermia, specifically contributions of neural and endothelial vasomotor responses in glabrous and non-glabrous skin. Eleven participants were semi-recumbent at an ambient temperature of 22 °C for 30 min, after which ambient temperature was decreased to 0 °C until rectal temperature (T_re) had decreased by 0.5 °C. Laser-Doppler fluxmetry was measured at the forehead and thigh for measures of glabrous and non-glabrous skin, respectively; wavelet analysis was performed on the laser-Doppler signal to determine endothelial and neural activities. Hypothermia took on average 97 ± 7 min and caused marked decreases at glabrous (42 ± 5%baseline, p < 0.001) and non-glabrous (69 ± 4%baseline, p < 0.001) skin. In glabrous skin, neural activity increased from 11 ± 1% at thermoneutral to 18 ± 1% (p < 0.001). In non-glabrous skin there was an initial decrease (p = 0.001) in neural activity from 13 ± 2% to 9 ± 1% (-0.2 °C decrease in T_re) and then increased (p = 0.002) to 21 ± 2% baseline at -0.5 °C T_re. Endothelial activity decreased in both glabrous (16 ± 3% to 6 ± 1%, p < 0.001) and non-glabrous (15 ± 1% to 7 ± 1%, p = 0.003) skin. Hypothermia elicits large decreases in skin blood flow in both glabrous and non-glabrous skin that are related to increases in neural activity and a reduction of endothelial activity.

Skin vasoconstriction as a heat conservation thermoeffector

Cold exposure stimulates heat production and conservation to protect internal temperature. Heat conservation is brought about via reductions in skin blood flow. The focus, here, is an exploration of the mechanisms, particularly in humans, leading to that cutaneous vasoconstriction. Local skin cooling has several effects: (1) reduction of tonic nitric oxide formation by inhibiting nitric oxide synthase and element(s) downstream of the enzyme, which removes tonic vasodilator effects, yielding a relative vasoconstriction; (2) translocation of intracellular alpha-2c adrenoceptors to the vascular smooth-muscle cell membrane, enhancing adrenergic vasoconstriction; (3) increased norepinephrine release from vasoconstrictor nerves; and (4) cold-induced vasodilation, seen more clearly in anastomoses-rich glabrous skin. Cold-induced vasodilation occurs in nonglabrous skin when nitric oxide synthase or sympathetic function is blocked. Reflex responses to general body cooling complement these local effects. Sympathetic excitation leads to the increased release of norepinephrine and its cotransmitter neuropeptide Y, each of which contributes significantly to the vasoconstriction. The contributions of these two transmitters vary with aging, disease and, in women, reproductive hormone status. Interaction between local and reflex mechanisms is in part through effects on baseline and in part through removal of the inhibitory effects of nitric oxide on adrenergic vasoconstriction.

Pronounced and sustained cutaneous vasoconstriction during and following cyrotherapy treatment: Role of neurotransmitters released from sympathetic nerves

Cryotherapy is a therapeutic technique using ice or cold water applied to the skin to manage soft tissue trauma and injury. While beneficial, there are some potentially detrimental side effects, such as pronounced vasoconstriction and tissue ischemia that are sustained for hours post-treatment. This study tested the hypothesis that this vasoconstriction is mediated by 1) activation of post-synaptic α-adrenergic receptors and/or 2) activation of post-synaptic neuropeptide Y1 (NPY Y1) receptors. 8 subjects were fitted with a commercially available cryotherapy unit with a water perfused bladder on the lateral portion of the right calf. Participants were instrumented with four intradermal microdialysis probes beneath the bladder. The following conditions were applied at the four treatment sites: 1) control (Ringer solution), 2) combined post-synaptic β-adrenergic receptors and neuropeptide (NPY) Y₁ receptors blockade (P+B site), 3) combined post-synaptic α-adrenergic receptor, β-adrenergic receptor, and NPY Y₁ receptor blockade (Y+P+B site), and 4) blockade of pre-synaptic release of all neurotransmitters from the sympathetic nerves (BT site). Following thermoneutral baseline data collection, 1°C water was perfused through the bladder for 30min, followed by passive rewarming for 60min. Skin temperature (T_skin) fell from ~34°C to ~18.5°C during active cooling across all sites and there was no difference between sites (P>0.05 vs. control for each site). During passive rewarming T_skin rose to a similar degree in all sites (P>0.05 relative to the end of cooling). In the first 20min of cooling %CVC was reduced at all sites however, this response was blunted in the BT and the Y+P+B sites (P>0.05 for all comparisons). By the end of cooling the degree of vasoconstriction was similar between sites with the exception that the reduction in %CVC in the Y+B+P site was less relative to the reduction in the control site. %CVC was unchanged in any of the sites during passive rewarming such that each remained similar to values obtained at the end of active cooling. These findings indicate that the initial vasoconstriction (i.e. within the 1st 20min) that occurs during cryotherapy induced local cooling is achieved via activation of post-synaptic α-adrenergic receptors; whereas nonadrenergic mechanisms predominate as the duration of cooling continues. The sustained vasoconstriction that occurs following cessation of the cooling stimulus does not appear to be related to activation of post-synaptic α-adrenergic receptors or NPY Y1 receptor.

Role of cyclooxygenase in the vascular responses to extremity cooling in Caucasian and African males

NEW FINDINGS

What is the central question of this study? Compared with Caucasians, African individuals are more susceptible to non-freezing cold injury and experience greater cutaneous vasoconstriction and cooler finger skin temperatures upon hand cooling. We investigated whether the enzyme cyclooxygenase is, in part, responsible for the exaggerated response to local cooling. What is the main finding and its importance? During local hand cooling, individuals of African descent experienced significantly lower finger skin blood flow and skin temperature compared with Caucasians irrespective of cyclooxygenase inhibition. These data suggest that in young African males the cyclooxygenase pathway appears not to be the primary reason for the increased susceptibility to non-freezing cold injury. Individuals of African descent (AFD) are more susceptible to non-freezing cold injury (NFCI) and experience an exaggerated cutaneous vasoconstrictor response to hand cooling compared with Caucasians (CAU). Using a placebo-controlled, cross-over design, this study tested the hypothesis that cyclooxygenase (COX) may, in part, be responsible for the exaggerated vasoconstrictor response to local cooling in AFD. Twelve AFD and 12 CAU young healthy men completed foot cooling and hand cooling (separately, in 8°C water for 30 min) with spontaneous rewarming in 30°C air after placebo or aspirin (COX inhibition) treatment. Skin blood flow, expressed as cutaneous vascular conductance (as flux per millimetre of mercury), and skin temperature were measured throughout. Irrespective of COX inhibition, the responses to foot cooling, but not hand cooling, were similar between ethnicities. Specifically, during hand cooling after placebo, AFD experienced a lower minimal skin blood flow [mean (SD): 0.5 (0.1) versus 0.8 (0.2) flux mmHg^-1 , P < 0.001] and a lower minimal finger skin temperature [9.5 (1.4) versus 10.7 (1.3)°C, P = 0.039] compared with CAU. During spontaneous rewarming, average skin blood flow was also lower in AFD than in CAU [2.8 (1.6) versus 4.3 (1.0) flux mmHg^-1 , P < 0.001]. These data provide further support that AFD experience an exaggerated response to hand cooling on reflection this appears to overstate findings; however, the results demonstrate that the COX pathway is not the primary reason for the exaggerated responses in AFD and increased susceptibility to NFCI.

Neuropeptide Y not involved in cutaneous vascular control in young human females taking oral contraceptive hormones

We previously reported that the cutaneous vasodilator response to local warming in males required noradrenaline (NA) and neuropeptide-Y (NPY). Animal work has shown no role for NPY in female vascular control. We investigated the contribution of NA and NPY in human female cutaneous vascular control. Nine female and nine male participants volunteered. To elucidate whether synthetic oestrogen and progesterone altered cutaneous vascular responses, females were tested in high-hormone (HH) and low-hormone (LH) phases of oral contraceptive pill (OCP). Skin blood flow was assessed by laser-Doppler flowmetry and expressed as cutaneous vascular conductance (CVC). Treatments were: control, combined yohimbine and propranolol (YP), BIBP-3226, and bretylium tosylate (BT). YP and BT increased basal CVC (p<0.05) relative to control sites in both HH and LH phases; though, BIBP-3226 had no effect in either phase (both p>0.05). Males basal CVC was increased at all treated sites compared to control sites (all p<0.05). YP and BT treated sites were higher in HH compared to LH (p<0.05). YP and BT treatment reduced the local warming-induced vasodilatation compared to control sites (p>0.05) in both HH and LH phases; whereas, BIBP-3226 treatment had no effect (p>0.05). In males, the vasodilatation achieved at all treated sites was reduced compared to the untreated control site (p<0.05). Data indicate that NA, not NPY, regulates basal skin blood flow and contributes to the vasodilator response to local warming in young females; however, both NA and NPY play a role in both basal and heat-induced cutaneous responses in males.

Desensitization of menthol-activated cold receptors in lower extremities during local cooling in young women with a cold constitution

To test the hypothesis that topical menthol-induced reactivity of cold sensation and cutaneous vasoconstriction to local cooling is augmented in individuals with a cold constitution, we examined thermal sensation and cutaneous vasoconstrictor responses at menthol-treated and untreated sites in the legs during local skin cooling in young women complaining of chilliness (C group) and young women with no complaint as a normal control group (N group). During local skin cooling, the sensitivity to cold sensation was greater in the C group than in the N group. The application of menthol enhanced the cold sensation at a low temperature in the N group, but not in the C group. Cutaneous vasoconstrictor responses to local skin cooling were not altered by menthol treatment in either of the two groups. These findings suggest the desensitization of menthol-activated cold receptors in the legs of C group subjects, and a minor role of cold receptor activity in cutaneous vasoconstrictor response to local cooling.

Evidence for physiological and pathological roles for sensory nerves in the microvasculature and skin

This review highlights the progress from the initial finding of neurogenic inflammation up to the most recent development in the field of sensory nerves research, focusing on their roles in the microvasculature and the skin. Recent discovery of Transient Receptor Potential (TRP) channels highlight their important roles in detecting a range of environmental stimuli, including chemical and temperature. This provides us novel mechanisms for driving neurogenic inflammation upstream of neuropeptide release in addition to promising potential therapeutic targets in various diseases, including pain, itching and skin inflammation.

Cryotherapy-Induced Persistent Vasoconstriction After Cutaneous Cooling: Hysteresis Between Skin Temperature and Blood Perfusion

The goal of this study was to investigate the persistence of cold-induced vasoconstriction following cessation of active skin-surface cooling. This study demonstrates a hysteresis effect that develops between skin temperature and blood perfusion during the cooling and subsequent rewarming period. An Arctic Ice cryotherapy unit (CTU) was applied to the knee region of six healthy subjects for 60 min of active cooling followed by 120 min of passive rewarming. Multiple laser Doppler flowmetry perfusion probes were used to measure skin blood flow (expressed as cutaneous vascular conductance (CVC)). Skin surface cooling produced a significant reduction in CVC (P < 0.001) that persisted throughout the duration of the rewarming period. In addition, there was a hysteresis effect between CVC and skin temperature during the cooling and subsequent rewarming cycle (P < 0.01). Mixed model regression (MMR) showed a significant difference in the slopes of the CVC-skin temperature curves during cooling and rewarming (P < 0.001). Piecewise regression was used to investigate the temperature thresholds for acceleration of CVC during the cooling and rewarming periods. The two thresholds were shown to be significantly different (P = 0.003). The results show that localized cooling causes significant vasoconstriction that continues beyond the active cooling period despite skin temperatures returning toward baseline values. The significant and persistent reduction in skin perfusion may contribute to nonfreezing cold injury (NFCI) associated with cryotherapy.

Synergistic Effect of Ferulic Acid and Z-Ligustilide, Major Components of A. sinensis, on Regulating Cold-Sensing Protein TRPM8 and TPRA1 In Vitro

Angelica sinensis has been used to attenuate cold-induced cutaneous vasospasm syndrome, such as Raynaud's disease and frostbite, in China for many years. Ferulic acid (PubChem CID: 445858) and Z-ligustilide (PubChem CID: 529865), two major components extracted from Angelica sinensis, had been reported to inhibit vasoconstriction induced by vasoconstrictors. In this study, the pharmacological interaction in regulating cold-induced vascular smooth muscle cell contraction via cold-sensing protein TRPM8 and TRPA1 was analyzed between ferulic acid and Z-ligustilide. Pharmacological interaction on inhibiting [Ca²⁺]_i influx evoked by TRPM8 agonist WS-12 or TRPA1 agonist ASP 7663 as well as cold-induced upregulation of TRPM8 was determined using isobolographic analysis. The isobolograms demonstrated that the combinations investigated in this study produced a synergistic interaction. Combination effect of two components in inhibiting RhoA activation and phosphorylation of MLC₂₀ induced by WS-12 or ASP 7663 was also being quantified. These findings suggest that the therapeutic effect of Angelica sinensis on cold-induced vasospasm may be partially attributed to combinational effect, via TRPM8 and TPRA1 way, between ferulic acid and Z-ligustilide.

Effects of cryotherapy methods on circulatory, metabolic, inflammatory and neural properties: a systematic review

Abstract Introduction: The cooling therapy (cryotherapy) is commonly used in clinical environmental for the injuries treatment according to its beneficial effects on pain, local inflammation and the recovery time of patients. However, there is no consensus in the literature about the effects of cryotherapy in the physiological reactions of affected tissues after an injury. Objective: To realize a systematic review to analyze the cryotherapy effects on circulatory, metabolic, inflammatory and neural parameters. Materials and methods: A search was performed in PubMed, SciELO, PEDro and Scopus databases following the eligibility criteria. Included studies were methodologically assessed by PEDro scale. Results: 13 original studies were selected and presented high methodological quality. Discussion: The cryotherapy promotes a significant decrease in blood flow, in venous capillary pressure, oxygen saturation and hemoglobin (only for superficial tissues) and nerve conduction velocity. However, the effect of cryotherapy on the concentration of inflammatory substances induced by exercise, as the creatine kinase enzyme and myoglobin, remains unclear. Conclusion: The physiological reactions to the cryotherapy application are favorable to the use of this therapeutic tool in inflammatory treatment and pain decrease, and demonstrate its importance in the neuromuscular system injuries rehabilitation.

Sustained cutaneous vasoconstriction during and following cyrotherapy treatment: Role of oxidative stress and Rho kinase

Cryotherapy is a therapeutic technique using ice or cold water applied to the skin to reduce bleeding, inflammation, pain, and swelling following soft tissue trauma and injury. While beneficial, there are some side effects such as pronounced vasoconstriction and tissue ischemia that are sustained for hours post-treatment. This study tested the hypothesis that this vasoconstriction is mediated by 1) the Rho-kinase pathway and/or 2) elevated oxidative stress. 9 subjects were fitted with a commercially available cryotherapy unit with a water perfused bladder on the lateral portion of the right calf. Participants were instrumented with three microdialysis probes underneath the bladder. One site received lactated ringers (control site), one received the Rho-Kinase inhibitor Fasudil, and one received Ascorbic Acid. Skin temperature (Tskin) and cutaneous vascular conductance (CVC) was measured at each site. Subjects had 1°C water perfused through the bladder for 30min, followed by passive rewarming for 90min. Tskin fell from ~34°C to ~18.0°C during active cooling across all sites and this response was similar for all sites (P>0.05 for all comparisons). During passive rewarming Tskin rose to a similar degree in all sites (P>0.05 relative to the end of cooling). %CVC was reduced during active cooling in all sites; however, the magnitude of this response was blunted in the Fasudil site relative to control (P<0.001 for all comparisons) and min 25 and 30 of cooling in the Ascorbic Acid site (P<0.05). During passive rewarming %CVC at the control and Ascorbic Acid sites did not change such that values were similar to the end of cooling (P>0.05 for each comparison). %CVC at the Fasudil site remained elevated during passive rewarming such that values were higher compared to the control and Ascorbic Acid sites throughout the 90min of passive rewarming (P<0.001 main effect of Fasudil). These findings indicate that the Rho-kinase pathway contributes to pronounced vasoconstriction during cryotherapy as well as the sustained vasoconstriction during the subsequent rewarming period post treatment.

Camphor induces cold and warm sensations with increases in skin and muscle blood flow in human

Application of camphor to the skin has been empirically thought to improve blood circulation. However, camphor's effects on blood circulation to the skin and on thermal sensation have not been well elucidated. In this study, we examined its effects on the quality of sensation as well as on skin and muscle blood flow in human. Nine adults (average age 37±9.4 years) participated in the study. Petroleum jelly containing 5%, 10%, 20% camphor, or 2% menthol was separately applied to the skin on the medial side of one forearm of each subject. Just after the application, camphor at each concentration induced a cold sensation in a dose-dependent manner. Within 10 min, each subject reported that the cold sensation had faded, after which it was replaced by a warm sensation. As reported previously, a cold sensation was induced by application of 2% menthol, but the subjects did not adapt to that sensation. In addition, menthol did not induce a warm sensation at all. Application of menthol has been shown to increase blood flow in the skin. Finally, we measured blood flow in skin and muscle after the application of camphor or menthol. Application of camphor or menthol separately induced increases in local blood flow in the skin and muscle. The present results indicate that camphor induces both cold and warm sensations and improves blood circulation.

Regulation of the microvascular circulation in the leg muscles, pancreas and small intestine in rats

To study the microvascular circulation, we examined the proportion of open and functioning capillaries in the leg muscles, pancreas and small intestine of anesthetized rats. Fluorescein isothiocyanate (FITC)-labeled Lycopersicon esculentum lectin was injected into the heart and allowed to circulate for 3 min to label open and functioning capillaries. Specimens were removed, frozen, sectioned and double-immunostained. Using one section, open and functioning capillaries were detected by immunostaining for this lectin bound to endothelial cells, while all capillaries were visualized by immunostaining for platelet endothelial cell adhesion molecule-1 (PECAM-1 or CD31). These capillaries were semi-automatically detected and counted by fluorescence microscopy. The percentages of open and functioning capillaries were as follows: the soleus muscle, 93.0 ± 5.5%; superficial zone of the gastrocnemius muscle, 90.8 ± 6.2%; deep zone of the gastrocnemius muscle, 95.6 ± 4.0%; the plantaris muscle, 94.1 ± 2.7%; the pancreas, 86.3 ± 11.7%; and the small intestine, 91.1 ± 4.9% (n = 8, each). There was no significant difference among these data by the Kruskal–Wallis test. This study clearly demonstrated that the proportions of open and functioning capillaries are high and similar among the leg muscles, pancreas and small intestine in spite of their structural and functional differences. This finding agrees with previous studies and supports the notion that the microvascular circulation is mainly controlled by changing of the blood flow in each capillary rather than changing the proportion of open and functioning capillaries.

The contribution of sensory nerves to cutaneous vasodilatation of the forearm and leg to local skin heating

PURPOSE

The initial cutaneous vasodilatory response to local skin heating is larger in the forearm than the leg. While the initial vasodilatation of the forearm to local heating is primarily dependent on sensory nerves, their role in the leg is unknown. We compared the contribution of sensory nerves in driving the cutaneous vasodilatory response of the forearm and leg to local heating using local anaesthetic (EMLA) cream.

METHOD

In seven participants, two skin sites were selected on both the dorsal forearm and anterolateral calf; one site on each region received EMLA, with the other an untreated control. All sites were controlled at 33 °C and then locally heated to 42 °C with integrated laser-Doppler local heating probes.

RESULTS

Cutaneous vascular conductance (CVC) during the initial vasodilatation to local heating was smaller in the leg (47 ± 9% max) compared to the forearm (62 ± 7 % max) (P = 0.012). EMLA reduced the initial vasodilatation at both the leg (27 ± 13 % max) (P = 0.02) and forearm (33 ± 14% max) (P < 0.001). The times to onset of vasodilatation, initial vasodilatory peak, and plateau phase were longer in the leg compared to the forearm (all P < 0.05), and EMLA increased these times in both regions (both P < 0.05). CVC during the plateau phase to sustained local skin heating was higher in the leg compared to the forearm at both the untreated (93 ± 6 vs. 85 ± 4% max) (P = 0.33) and EMLA-treated (94 ± 5 vs. 86 ± 6% max) (P = 0.001) sites; EMLA did not affect CVC (P > 0.05).

CONCLUSION

The differences in the initial vasodilatory peak to local skin heating between the forearm and the leg are due to the contribution of sensory nerves.

Effect of skin temperature on cutaneous vasodilator response to the β-adrenergic agonist isoproterenol

The vascular response to local skin cooling is dependent in part on a cold-induced translocation of α2C-receptors and an increased α-adrenoreceptor function. To discover whether β-adrenergic function might contribute, we examined whether β-receptor sensitivity to the β-agonist isoproterenol was affected by local skin temperature. In seven healthy volunteers, skin blood flow was measured from the forearm by laser-Doppler flowmetry and blood pressure was measured by finger photoplethysmography. Data were expressed as cutaneous vascular conductance (CVC; laser-Doppler flux/mean arterial blood pressure). Pharmacological agents were administered via intradermal microdialysis. We prepared four skin sites: one site was maintained at a thermoneutral temperature of 34°C (32 ± 10%CVCmax) one site was heated to 39°C (38 ± 11%CVCmax); and two sites were cooled, one to 29°C (22 ± 7%CVCmax) and the other 24°C (16 ± 4%CVCmax). After 20 min at these temperatures to allow stabilization of skin blood flow, isoproterenol was perfused in concentrations of 10, 30, 100, and 300 μM. Each concentration was perfused for 15 min. Relative to the CVC responses to isoproterenol at the thermoneutral skin temperature (34°C) (+21 ± 10%max), low skin temperatures reduced (at 29°C) (+17 ± 6%max) or abolished (at 24°C) (+1 ± 5%max) the vasodilator response, and warm (39°C) skin temperatures enhanced the vasodilator response (+40 ± 9%max) to isoproterenol. These data indicate that β-adrenergic function was influenced by local skin temperature. This finding raises the possibility that a part of the vasoconstrictor response to direct skin cooling could include reduced background β-receptor mediated vasodilation.

Thermoregulatory modeling for cold stress

Modeling for cold stress has generated a rich history of innovation, has exerted a catalytic influence on cold physiology research, and continues to impact human activity in cold environments. This overview begins with a brief summation of cold thermoregulatory model development followed by key principles that will continue to guide current and future model development. Different representations of the human body are discussed relative to the level of detail and prediction accuracy required. In addition to predictions of shivering and vasomotor responses to cold exposure, algorithms are presented for thermoregulatory mechanisms. Various avenues of heat exchange between the human body and a cold environment are reviewed. Applications of cold thermoregulatory modeling range from investigative interpretation of physiological observations to forecasting skin freezing times and hypothermia survival times. While these advances have been remarkable, the future of cold stress modeling is still faced with significant challenges that are summarized at the end of this overview.

Responses of the hands and feet to cold exposure

An initial response to whole-body or local exposure of the extremities to cold is a strong vasoconstriction, leading to a rapid decrease in hand and foot temperature. This impairs tactile sensitivity, manual dexterity, and muscle contractile characteristics while increasing pain and sympathetic drive, decreasing gross motor function, occupational performance, and survival. A paradoxical and cyclical vasodilatation often occurs in the fingers, toes, and face, and this has been termed the hunting response or cold-induced vasodilatation (CIVD). Despite being described almost a century ago, the mechanisms of CIVD are still disputed; research in this area has remained largely descriptive in nature. Recent research into CIVD has brought increased standardization of methodology along with new knowledge about the impact of mediating factors such as hypoxia and physical fitness. Increasing mechanistic analysis of CIVD has also emerged along with improved modeling and prediction of CIVD responses. The present review will survey work conducted during this century on CIVD, its potential mechanisms and modeling, and also the broader context of manual function in cold conditions.

TRPA1 is essential for the vascular response to environmental cold exposure

The cold-induced vascular response, consisting of vasoconstriction followed by vasodilatation, is critical for protecting the cutaneous tissues against cold injury. Whilst this physiological reflex response is historic knowledge, the mechanisms involved are unclear. Here by using a murine model of local environmental cold exposure, we show that TRPA1 acts as a primary vascular cold sensor, as determined through TRPA1 pharmacological antagonism or gene deletion. The initial cold-induced vasoconstriction is mediated via TRPA1-dependent superoxide production that stimulates α_2C-adrenoceptors and Rho-kinase-mediated MLC phosphorylation, downstream of TRPA1 activation. The subsequent restorative blood flow component is also dependent on TRPA1 activation being mediated by sensory nerve-derived dilator neuropeptides CGRP and substance P, and also nNOS-derived NO. The results allow a new understanding of the importance of TRPA1 in cold exposure and provide impetus for further research into developing therapeutic agents aimed at the local protection of the skin in disease and adverse climates.

Blood flow in the skin of mammals changes in response to cold, but the mechanisms driving this response are unclear. Aubdool et al. show that the non-selective cation channel, TRPA1, is a vascular cold sensor and required for the vascular protective response to local cold exposure.

Cutaneous vasodilator and vasoconstrictor mechanisms in temperature regulation

In this review, we focus on significant developments in our understanding of the mechanisms that control the cutaneous vasculature in humans, with emphasis on the literature of the last half-century. To provide a background for subsequent sections, we review methods of measurement and techniques of importance in elucidating control mechanisms for studying skin blood flow. In addition, the anatomy of the skin relevant to its thermoregulatory function is outlined. The mechanisms by which sympathetic nerves mediate cutaneous active vasodilation during whole body heating and cutaneous vasoconstriction during whole body cooling are reviewed, including discussions of mechanisms involving cotransmission, NO, and other effectors. Current concepts for the mechanisms that effect local cutaneous vascular responses to local skin warming and cooling are examined, including the roles of temperature sensitive afferent neurons as well as NO and other mediators. Factors that can modulate control mechanisms of the cutaneous vasculature, such as gender, aging, and clinical conditions, are discussed, as are nonthermoregulatory reflex modifiers of thermoregulatory cutaneous vascular responses.

Effects of L-citrulline diet on stress-induced cold hypersensitivity in mice

BACKGROUND

L-citrulline is an amino acid discovered in watermelon (Citrullus lanatus, Cucurbitaceae) and is a known component of the nitric oxide (NO) cycle that plays an important role in adjusting blood circulation and supplying NO and a key component of the endothelium-derived relaxing factor.

OBJECTIVE

The objective of this study is to evaluate the effect of L-citrulline on a newly established stress-induced cold hypersensitivity mouse model.

MATERIALS AND METHODS

When normal mice were forced to swim in water at 25°C for 15 min, their core body temperature dropped to 28.9°C, and then quickly recovered to normal temperature after the mice were transferred to a dry cage at room temperature (25°C). A 1-h immobilization before swimming caused the core body temperature to drop to ca. 24.1°C (4.8°C lower than normal mice), and the speed of core body temperature recovery dropped to 57% of the normal control. We considered this delay in recovery from hypothermia to be a sign of stress-induced cold hypersensitivity. Similar cold hypersensitivity was induced by administration of 50 mM L-NG-nitroarginine methyl ester, a NO synthesis inhibitor.

RESULTS

In this study, we showed that recovery speed from the stress-induced hypothermia remarkably improved in mice fed a 1% L-citrulline-containing diet for 20 days. Furthermore, the nonfasting blood level of L-arginine and L-citrulline increased significantly in the L-citrulline diet group, and higher serum nitrogen oxide levels were observed during recovery from the cold.

CONCLUSIONS

These results suggested that oral L-citrulline supplementation strengthens vascular endothelium function and attenuates stress-induced cold hypersensitivity by improving blood circulation.

Oxidative damage and antioxidative therapy in systemic sclerosis

Systemic sclerosis (SSc) is an autoimmune connective tissue disorder of unknown etiology. This disease is characterized by a large variety of clinical patterns, which include the fibrosis of skin and visceral organs causing a variety of clinical manifestations. Genetic and environmental factors participate in the etiology of this disease; however, recently many studies underline the oxidative background influencing the course and complications of this disease. Reactive oxygen species (ROS) synthesized in SSc can mediate extra- and intracellular oxidative processes affecting endothelial cells and fibroblasts. The estimation of prooxidative markers in the pathogenesis of SSc can enable the identification of useful markers for disease activity and, thus, may help in planning appropriate therapy focusing on the fibrotic or vascular pattern. Recently, many attempts have been made to find antioxidative molecules (nutritional and pharmacological) reducing the prooxidant state in a variety of cells—mainly in endothelium and proliferating fibroblasts. This paper presents both the background of oxidative stress processes in systemic sclerosis mediated by different mechanisms and the evidence suggesting which of the dietary and pharmacological antioxidants can be used as therapeutic targets for this disease.

Short-term sensory and cutaneous vascular responses to therapeutic ultrasound in the forearms of healthy volunteers

Background

Therapeutic ultrasound (US) is used for a variety of clinical pathologies and is thought to accelerate tissue repair and help with pain reduction via its thermal and nonthermal effects. The evidence on physiological effects of US on both sensory and vascular functions in humans is incomplete. Hence, the purpose of this study was to determine the short-term impact of two doses of US (3 MHz, 1:4, 0.25 W/cm², 5 min; 1 MHz, continuous, 0.8 W/cm², 3 min), on sensory and vascular responses in the healthy forearms.

Methods

Twenty healthy subjects were recruited (mean age, 29.6 ± 8.8 years) for the study. Superficial blood flow (SBF) in the distal forearms was determined using the tissue viability imaging system. Sensory perception thresholds (SPT) were determined from ring finger (C7, C8) to assess A-beta (at 2,000 Hz) and C fiber function (at 5 Hz), using a Neurometer CPT/C device. Subject’s two hands were randomly allocated to group order (AB/BA). Scores were obtained before and immediately after the application of US and control. Differences in these were analyzed using repeated measures.

Results

Both 3 MHz pulsed US and 1 MHz continuous US showed small to moderate (effect size = 0.12 to 0.68), statistically significant reductions in SBF (3 MHz, mean change = 2.8 AU and 1 MHz, mean change = 3.9 AU, p < 0.05 respectively), skin temperature (2.5°C and 1.1°C, p < 0.05), and SPT at 5 Hz (1.3 and 1 mA, p < 0.05) across time. SPT at 2,000 Hz remained unaltered by all three conditions (p > 0.05). Age and gender also had no effect on all outcome measures (p > 0.05).

Conclusion

This study demonstrated minor reductions in skin blood flow, skin temperatures, and C fiber perception thresholds immediately after 3 MHz, and 1 MHz US. The responses observed may have been due to a thermo-cooling effect of the gel or due to the direct effect of US on C fibers of median and ulnar nerves. US had a negligible effect on A-beta fibres. This would suggest that future studies looking at physiological effects of US should move towards investigating larger dosages and study the effects in patient populations.