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The clinical evolution and management of a 22-yr-old male envenomed by a captive female inland taipan, Oxyuranus microlepidotus (McCoy, 1879), Elapidae, at a public educational reptile exhibit (Florida, USA) is reported. The patient was bitten (quick 'bite and release') in the right hand between digits #3 and 4 while performing captive maintenance. The victim did not attempt any first aid, but urgently presented to the local hospital within 25 mins post-bite. The patient had an unremarkable medical/surgical history including no previous envenoming/treatment with antivenom. Within approximately 5 mins post-bite he reported experiencing transient loss of consciousness/syncope, altered sensorium, nausea, dull headache, weakness, and "severe" bite site pain. Laboratory investigations revealed profound defibrinating coagulopathy including thrombocytopenia; there was only mildly elevated creatine kinase and renal function remained within normal limits. The patient's clinical evolution included cranial nerve palsies manifested as dysconjugate gaze, persistent, but minor, bite site bleeding, asthenia and reported myalgia as well as prolonged intense bite site pain. He was successfully and uneventfully treated with four vials of Australian polyvalent antivenom and one vial of taipan monovalent; all were expired products with expiration dates ranging from one month to 38 years. Effective antivenom therapy might have been achieved with only 2, possibly 3 vials; however, concerns about reduced efficacy of the long-expired antivenom (4/5 vials were expired 18–38 years) and persistent bite site bleeding/pain contributed to the provision of the additional vials. The patient recovered sufficiently for discharge in 48 h; there were no sequelae. There have been approximately 12 formally documented cases of O. microlepidotus envenoming and selected, detailed examples of these are briefly considered and compared with the clinical evolution of our patient; patient-centred recommendations for management of Oxyuranus spp. envenoming are discussed. The need for advanced preparedness and an action plan for any institution/collection that contains non-native, medically significant venomous species is emphasised, and a general recommended approach is outlined. • 22-yr-old male envenomed by captive Inland Taipan, Oxyuranus microlepidotus. • Transient loss of consciousness, profound defibrinating coagulopathy, cranial nerve palsies.• Effective treatment with long-expired, specific antivenoms.• Review of formally documented O. microlepidotus envenoming and management of Oxyuranus envenoming. [Display omitted] • Documentation of a life-threatening envenoming by a captive Inland Taipan, Oxyuranus microlepidotus , in Florida, USA. • Clinical evolution included loss of consciousness, defibrinating coagulopathy, cranial nerve palsies. • Patient effectively and uneventfully treated with long-expired, specific antivenoms. • Review of the handful of documented O. microlepidotus envenoming. • Recommendations for management of Oxyuranus envenoming and preparedness for collections holding non-native species. [ABSTRACT FROM AUTHOR]

Fab antivenom (FabAV) halts progression of tissue injury and improves recovery in copperhead snakebite. It is unknown if F(ab')2AV does as well. The objective of this study was to compare control of tissue injury in copperhead snakebite patients treated with F(ab')2AV versus FabAV. We performed a post hoc analysis of copperhead envenomated patients in a clinical trial comparing F(ab')2AV to FabAV. The outcomes for this analysis are the number of repeat doses required to obtain initial control, the number of patients requiring unscheduled doses during maintenance, and the time from antivenom administration to initial control. Twenty-one (13 F(ab')2AV, 8 FabAV) were copperhead patients. Median age was 46 years with a male predominance. Baseline severity was similar. One (8%) F(ab')2AV and 2(25%) FabAV patients required repeat initial dosing, difference = 17%, (95%CI −18, 57%). One (8%) F(ab')2AV and 1(13%) FabAV patients required additional doses after maintenance, difference = 5%, (95%CI −27, 45%). Median time to initial control was 2.7 range (2.0, 9.3) hours and 3.5 range (2.0, 7.4) for F(ab')2AV and FabAV respectively, difference −0.8 h (95% CI −2.6, 0.9). This exploratory analysis suggests that the available measures of the control of venom-induced tissue injury are similar between antivenom subgroups. [ABSTRACT FROM AUTHOR]

The article focuses on a case study of a potential envenomation attributed to a bite by a Western Fence Lizard. Topics include the nature of the symptoms, alternative explanations for the effects, and the need for comprehensive clinical documentation in similar cases to determine medical significance.

Abstract: A case of clinically significant local envenoming resulting from a bite inflicted by a Western hognose snake, Heterodon nasicus, is described. The patient was bitten while offering a juvenile mouse to a captive snake. The snake maintained a grip on the patient''s arm (left anticubital fossa) for several minutes. The bite resulted in marked edema, ecchymoses, lymphadenopathy, cutaneous signs suggestive of mild cellulitis and blister formation. There were no systemic effects. Recovery was complete after approximately five months. Several documented Heterodon sp. bites with significant clinical effects are reviewed. This common xenodontine colubrid must be considered capable of inflicting medically significant bites. It is currently unclear whether the pathological changes associated with these bites are due to specific Duvernoy''s secretion components, Type I hypersensitivity or a combination of these. The influence of the feeding response on the severity of clinical effects is considered as is the discrepancy between experimentally verified pharmacological activities of Duvernoy''s secretions from Heterodon sp. and medical sequelae of documented bites. Although hognose snakes may uncommonly produce medically significant bites, they should not be considered dangerous or venomous. Captive specimens should be handled carefully, particularly when offered food. [Copyright &y& Elsevier]

Abstract: This case report represents a documentation of severe envenomation by Proatheris superciliaris, a species for which no specific antivenom exists. A 27-year-old male bitten on the finger by an adult P. superciliaris developed immediate severe pain radiating up the limb and local ecchymotic features with tissue necrosis ensuing over the following 36h, requiring debridement of necrotic tissue. Approximately 72h post-envenomation jaundice and hemoglobinuria were observed, but no other clinical signs of coagulopathy or hemorrhage. Hemolysis was evidenced by fragmented red blood cells and hyperbilirubinemia. Declining renal function ensued. Hematology revealed a reduction in reticulocyte count, schistocytosis, and a marked thrombocytopenia. The coagulation profile showed partial thromboplastin time and fibrinogen values within normal range and slight prothrombin time elevation. Thrombotic microangiopathy similar to hemolytic uremic syndrome developed, and daily plasmapheresis was initiated on day 4. Erythropoietin therapy was started on the 9th day. Gradual resolution of acute systemic complications followed over a 3-month period. The debrided bite site healed and the fingernail-beds demonstrated the return of normal capillary refill. Neurotoxic effects of venom were not observed. [Copyright &y& Elsevier]

Because of the adverse effects of smoking during pregnancy, understanding the factors that influence maternal smoking may help in developing better treatments to help women quit smoking during pregnancy. Animal models could be useful for this purpose. The purpose of the present study was to begin the development of an animal model of smoking during pregnancy by initially characterizing nicotine self-administration (NSA) in pregnant rats. Another purpose was to begin to explore the effects of pregnancy on nicotine pharmacokinetics in rats. In experiment 1, female rats self-administering nicotine during 23-h sessions were examined throughout gestation and lactation. In experiment 2, locomotor activity was measured during pregnancy to assess further potential motor effects of pregnancy. Experiments 3 and 4 compared the single-dose pharmacokinetics of nicotine in male, nonpregnant female, and pregnant females in the first and third trimester of pregnancy and the first week of lactation. NSA decreased over the course of pregnancy with NSA significantly lower in the third trimester compared to nonpregnant controls. NSA remained suppressed for up to 10 days into lactation. Locomotor behavior was also significantly suppressed during the second and third trimesters and throughout lactation. Nicotine elimination was slower in pregnant females compared to nonpregnant females only in the third trimester. NSA, locomotor behavior, and nicotine elimination in rats are decreased during late pregnancy. The present study is the first to characterize NSA during pregnancy in animals, providing a potential model of maternal smoking in humans. [ABSTRACT FROM AUTHOR]

The article discusses research on the physiological and behavioral effects of a nicotine conjugate vaccine on the acquisition and maintenance of nicotine self-administration in rats. It provides information on the methods and materials used in the study. It also discusses the results of the study.

Abstract: Nicotine is a teratogen in rats and possibly in humans. Vaccination against nicotine is being studied as a possible treatment for nicotine dependence. The safety of maternal vaccination against nicotine during or prior to pregnancy is not known. In this study, female rats were vaccinated and then administered acute or chronic nicotine during pregnancy at doses simulating nicotine exposure in smokers. Maternal vaccination reduced nicotine distribution to both maternal brain (44–47%) and fetal brain (17–39%) for up to 25min after a single maternal nicotine dose administered on gestational day (GD) 20, but had a smaller effect on nicotine distribution to brain after continuous nicotine infusion. Nicotine distribution to maternal or fetal brain after repeated nicotine bolus doses was reduced immediately following an individual dose in vaccinated rats, but the chronic accumulation of nicotine in fetal brain was not altered. Nicotine distribution to whole fetus, in contrast to fetal brain, was generally not altered by vaccination. Nicotine-specific antibody concentration in fetal serum was 10% that of maternal serum, and in fetal brain was <1% of maternal serum. Although nicotine transfer to the whole fetus was not reduced by vaccination, protein binding data suggest that nicotine-specific antibody transferred from mother to fetus served to bind nicotine in fetal serum, reduce the unbound nicotine concentration, and thereby reduce nicotine distribution to fetal brain. These data comment on the safety of vaccination against nicotine during pregnancy, and suggest that vaccination may reduce the distribution of nicotine to fetal brain under some nicotine dosing conditions. [Copyright &y& Elsevier]

The tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is a lung carcinogen in the rat and believed to be a causative agent for lung cancer in smokers. To exert its carcinogenic potential NNK is metabolically activated by cytochrome P450-catalyzed α-hydroxylation. Nicotine and NNK share metabolic pathways. The purpose of this study was to determine whether nicotine alters the fraction of NNK undergoing activation to carcinogenic metabolites. Rats received acute (36 h) or chronic (2 week) s.c. infusions of nicotine at rates producing serum nicotine concentrations 2–3 times the usual venous nicotine concentrations measured in smokers. A single dose of [5-3H]-NNK was administered i.p. 24 h prior to the end of each infusion. Urine was collected for 24 h thereafter and NNK metabolites quantified by radioflow HPLC. Neither acute nor chronic nicotine infusion had any effect on the extent of NNK metabolism by α-hydroxylation. These data suggest that nicotine infusion, at rates simulating the higher doses of nicotine replacement therapy now being studied for smoking cessation, neither induces nor inhibits NNK metabolism appreciably and therefore should not alter the formation of carcinogenic NNK metabolites. [Copyright &y& Elsevier]

Rationale. The efficacy of nicotine replacement therapy (NRT) for smoking cessation is limited. One reason for this limited efficacy may be that typical serum nicotine concentrations provided by NRT do not match the peak arterial nicotine concentrations achieved from smoking. Objective. The purpose of the present study was to determine whether continuous nicotine infusion at a rate producing serum nicotine concentrations that match the estimated peak arterial nicotine concentrations associated with nicotine self-administration (NSA) in rats produces greater suppression of NSA than lower infusion rates. Methods. The effects of continuous nicotine infusion were studied by intravenously administering nicotine at various rates (1.0, 3.0, and 8.0 mg/kg per day) to rats concurrently self-administering nicotine (0.03 mg/kg per infusion) during 23-h sessions or cocaine (0.17 mg/kg per infusion) during 2-h sessions. Results. Continuous nicotine infusion suppressed NSA in a rate-related fashion. NSA was suppressed by 17, 50, and 73% at infusion rates of 1.0, 3.0 and 8.0 mg/kg per day, respectively. The 8.0-mg/kg per day infusion rate, which provided venous serum nicotine concentrations equaling the peak arterial concentrations associated with NSA, suppressed NSA to a greater extent than lower infusion rates. The 8.0-mg/kg per day nicotine infusion rate had no effect on cocaine-maintained responding, demonstrating that its effects were specific for suppression of NSA. This infusion rate provided a mean percentage replacement of nicotine from NSA of more than 700%. Reacquisition of NSA after suppression by the two highest infusion rates was delayed compared with reacquisition after saline extinction. Conclusions. Continuous nicotine infusion produced an infusion rate-related suppression of NSA that was greatest when the infusion provided nicotine doses and venous serum concentrations substantially higher than those typically associated with NRT in humans. [ABSTRACT FROM AUTHOR]

Active immunization of rats against nicotine reduces the distribution of a single intravenous dose of nicotine to brain. The current study examined the effects of immunization on the distribution of repeated doses of nicotine, and on estimates of nicotine pharmacokinetic parameters. Groups of rats received five repeated doses of nicotine over 80 min (total dose equivalent to the nicotine intake from one, three or 10 cigarettes in a human). The serum nicotine concentration in immunized rats was 160-430% higher than controls after the fifth dose, demonstrating binding of nicotine to antibody. Brain nicotine concentration in immunized rats was reduced by 30-46%. The reduction in distribution of nicotine to brain correlated with the serum hapten-specific antibody concentration, the percentage of nicotine bound in serum, and with the unbound nicotine concentration in serum. In immunized rats, nicotine had a smaller steady state volume of distribution, lower systemic clearance, and longer terminal half-life than in controls. These data demonstrate that immunization against nicotine reduces nicotine distribution to brain, even after multiple nicotine doses at rates approximating heavy cigarette smoking. Whether this reduction in nicotine distribution is large enough to alter nicotine's physiological or behavioral effects remains to be studied. [ABSTRACT FROM AUTHOR]

Addresses the potential role of calcium channel blockade in tricyclic antidepressant-induced hypotension. Inhibition of calcium influx by calcium channel blocking drugs such as verapamil or nifedipine which can contribute to the hypotension; Potential importance of calcium channel blocker as a contributor to tricyclic antidepressant (TCA) toxicity.

Abstract: Non-front-fanged colubroid snakes (NFFC; formerly and artificially taxonomically assembled as “colubrids”) comprise about 70% of extant snake species and include several taxa now known to cause lethal or life threatening envenoming in humans. Although the medical risks of bites by only a handful of species have been documented, a growing number of NFFC are implicated in medically significant bites. The majority of these snakes have oral products (Duvernoy's secretions, or venoms) with unknown biomedical properties and their potential for causing harm in humans is unknown. Increasingly, multiple NFFC species are entering the commercial snake trade posing an uncertain risk. Published case reports describing NFFC bites were assessed for evidence-based value, clinical detail and verified species identification. These data were subjected to meta-analysis and a hazard index was generated for select taxa. Cases on which we consulted or personally treated were included and subjected to the same assessment criteria. Cases involving approximately 120 species met the selection criteria, and a small subset designated Hazard Level 1 (most hazardous), contained 5 species with lethal potential. Recommended management of these cases included antivenom for 3 species, Dispholidus typus, Rhabdophis tiginis, Rhabdophis subminiatus, whereas others in this subset without commercially available antivenoms (Thelotornis spp.) were treated with plasma/erythrocyte replacement therapy and supportive care. Heparin, antifibrinolytics and/or plasmapheresis/exchange transfusion have been used in the management of some Hazard Level 1 envenomings, but evidence-based analysis positively contraindicates the use of any of these interventions. Hazard Level 2/3 species were involved in cases containing mixed quality data that implicated these taxa (e.g. Boiga irregularis, Philodryas olfersii, Malpolon monspessulanus) with bites that caused rare systemic effects. Recommended management may include use of acetylcholinesterase inhibitors (e.g. neostigmine) and wound care on a case-by-case basis. Hazard level 3 species comprised a larger group capable of producing significant local effects only, often associated with a protracted bite (eg Heterodon nasicus, Borikenophis (Alsophis) portoricensis, Platyceps (Coluber) rhodorachis). Management is restricted to wound care. Bites by Hazard level 4 species comprised the majority of surveyed taxa and these showed only minor effects of no clinical importance. This study has produced a comprehensive evidence-based listing of NFFC snakes tabulated against medical significance of bites, together with best-practice management recommendations. This analysis assumes increasing importance, as there is growing exposure to lesser-known NFFC snakes, particularly in captive collections that may uncover further species of significance in the future. Careful and accurate documentation of bites by verified species of NFFC snakes is required to increase the evidence base and establish the best medical management approach for each species. [Copyright &y& Elsevier]

Abstract: Aluminium phosphide (AlP) is a toxic agent associated with a high mortality rate following acute exposure from various routes. The aim of this study was to determine the clinical and laboratory findings useful for predicting the medical outcome of AlP‐poisoned patients using established scoring systems. This is a prospective study of AlP‐poisoned patients from 2010 to 2015 in Ardabil, Iran. All patients that presented with a confirmed diagnosis of acute AlP poisoning in the study interval were included in the study. Clinical and laboratory data, using Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scoring systems, were compared for their predictive value in determining differences between survived and non‐survived patients. Univariate analysis (Mann–Whitney or t‐test), multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the Pearson correlation test were performed using STATA/SE 13.0 and the Nomolog Software. A total of 68 AlP‐poisoned patients with confirmed acute AlP poisoning were included for evaluation. Of these, 36 were non‐survived. Multiple logistic regression analysis was performed using parameters and values derived from patient clinical and laboratory data, and revealed that four factors were significant for predicting mortality: Glasgow coma score (GCS); systolic blood pressure (SBP); urinary output (UOP); and serum HCO3. A four‐variable, risk‐prediction nomogram was developed for identifying high‐risk patients and predicting the risk of mortality. Study results showed that SBP of <92.5 mmHg (p = 0.006); HCO3‐ < 12.9 mEq/L (p = 0.01), UOP < 1725 mL/day (p = 0.04); and GCS < 14.5 (p = 0.003) were significant predictors of AlP mortality. Scoring systems analysis showed SAPS II score >24.5, APACHE II score >8.5 and SOFA score >7.5 were predictive of non‐survival patients. The results of our study showed that SBP, GCS, UOP and serum HCO3 levels are the best prognostic factors for predicting mortality in AlP‐poisoned patients. According to the area under the ROC curve of the APACHE II score, when compared with SOFA and SAPS II scores, the APACHE II score can more effectively discriminate between non‐survivors and survived patients. [ABSTRACT FROM AUTHOR]

Snakebite is a relatively common health condition in Iran with a diverse snake fauna, especially in tropical southern and mountainous western areas of the country with a plethora of snake species. The list of medically important snakes, circumstances and effects of their bite, and necessary medical care require critical appraisal and should be updated regularly. This study aims to review and map the distributions of medically important snake species of Iran, re-evaluate their taxonomy, review their venomics, describe the clinical effects of envenoming, and discuss medical management and treatment, including the use of antivenom. Nearly 350 published articles and 26 textbooks with information on venomous and mildly venomous snake species and snakebites of Iran, were reviewed, many in Persian (Farsi) language, making them relatively inaccessible to an international readership. This has resulted in a revised updated list of Iran's medically important snake species, with taxonomic revisions of some, compilation of their morphological features, remapping of their geographical distributions, and description of species-specific clinical effects of envenoming. Moreover, the antivenom manufactured in Iran is discussed, together with treatment protocols that have been developed for the hospital management of envenomed patients. [Display omitted] • A comprehensive review on medically important snakes in Iran in view of geographical distribution, taxonomy and morphology. • A focus on environmental value of medically important snakes. • A critical appraisal of venom studies and clinical effects of Iran's medically important snakes. • A detailed evaluation of clinical management of snakebite envenoming in Iran. [ABSTRACT FROM AUTHOR]

The article discusses research on the specie, "Crotalus Pyrrhus (Southwestern Speckled Rattlesnake)" and explores about its geographical distribution and collection of specimen, along with explores diet of the species.

Abstract: Degradation of heroin to 6-monoacetylmorphine (6-MAM) and then morphine happens rapidly in vivo and in vitro. The rates of heroin and 6-MAM degradation depend on the type of biological samples, and the duration and conditions of storage. In order to optimize conditions for measuring heroin and its metabolites in samples collected for pharmacokinetic studies in rats, we investigated the time course of degradation of heroin, 6-MAM, and morphine in four biological matrices: rat blood, rat brain homogenate, bovine serum, and human plasma under various conditions. Analyte concentrations were measured by LC–MS. The goal was to identify conditions that allow maximum flexibility in scheduling sample collection and analysis, as well as gain more information on the stability of heroin in blood and tissue samples. A solid-phase extraction method with ice-cold solvents, sodium fluoride (NaF) and a low pH (3.0) maintained sample stability. Quality controls were within 94.0–105% of the target value. Variability was 4.0–8.9% for all analytes within the range of 5–200ng/mL for heroin, 5–1000ng/mL for 6-MAM, and 10–200ng/mL for morphine. Heroin degradation to 6-MAM was faster in rat whole blood than in plasma, and faster in rat plasma than in rat brain homogenate. Maintaining NaF at 4mg/mL throughout processing enhanced stability; higher NaF concentrations added to whole blood caused hemolysis. Samples processed through solid phase extraction and stored as dried pellets at 80°C constituted the most stable environment for heroin, and was superior to the storing of samples in solution prior to or after extraction. Nevertheless, post-extraction heroin and 6-MAM levels declined by 6.7–8.3% over one week in rat plasma under these conditions, and by <1–4.7% in bovine serum or human plasma. [Copyright &y& Elsevier]

We previously showed different effects of tobacco and nicotine on fracture healing, but due to pump reservoir limits, maximum exposure period was 4 weeks. To allow flexibility in pre- and post-fracture exposure periods, the objective of this study was to compare a new oral administration route for nicotine to the established pump method. Four groups were studied: (1) pump saline, (2) pump saline + oral tobacco, (3) pump saline/nicotine + oral tobacco, and (4) pump saline + oral nicotine/tobacco. Sprague-Dawley rats (n = 84) received a transverse femoral fracture stabilized with an intramedullary pin 1 week after initiating dosing. After 3 weeks, no difference was found in torsional strength or stiffness between oral nicotine/tobacco or pump nicotine + tobacco, while energy absorption with oral nicotine/tobacco was greater than pump nicotine + tobacco ( p < 0.05). Compared to saline control, strength for oral nicotine/tobacco was higher than control ( p < 0.05), and stiffnesses for pump nicotine + tobacco and oral nicotine/tobacco were higher than control ( p < 0.05). No differences in energy were found for either nicotine-tobacco group compared to saline control. Mean serum cotinine (stable nicotine metabolite) was different between pump and oral nicotine at 1 and 4 weeks, but all groups were in the range of 1-2 pack/day smokers. In summary, relevant serum cotinine levels can be reached in rats with oral nicotine, and, in the presence of tobacco, nicotine can influence mechanical aspects of fracture healing, dependent on administration method. Caution should be exercised when comparing results of fracture healing studies using different methods of nicotine administration. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1235-1239, 2010 [ABSTRACT FROM AUTHOR]

Abstract: Animal models of tobacco dependence typically rely on parenteral administration of pure nicotine. Models using cigarette smoke inhalation might more accurately simulate nicotine exposure in smokers. The primary goal of this study was to validate methods for administering cigarette smoke to rats using exposure conditions that were clinically relevant and also produced brain nicotine levels similar to those produced by behaviorally active doses of pure nicotine. A secondary goal was to begin examining the behavioral effects of smoke. Nose-only exposure (NOE) to smoke for 10–45min or whole-body exposure (WBE) to smoke for 1–4h produced serum nicotine concentrations similar to those in smokers (14–55ng/ml), without excessive carbon monoxide exposure. Daily nicotine (0.1mg/kg, s.c.) induced locomotor sensitization whereas 45-min NOE producing brain nicotine levels within the same range did not. Nicotine 0.125mg/kg s.c. reversed withdrawal from a chronic nicotine infusion as measured by elevations in intracranial self-stimulation thresholds whereas 4-h WBE producing similar brain nicotine levels did not. These data demonstrate the feasibility of delivering cigarette smoke to rats at clinically relevant doses, and provide preliminary evidence that the behavioral effects of nicotine delivered in smoke may differ from those of pure nicotine. [Copyright &y& Elsevier]

Introduction:Protobothrops mangshanensis, the Mangshan pit viper, is a rare pit viper native to the area surrounding Mount Mang in China’s Hunan province. Toxicity from envenomation is not well characterized.Case details: A 33-year-old male presented to an emergency department (ED) after being bitten on the forearm by hisP. mangshanensis. He complained of mild swelling and pain at the bite site. He was admitted for observation and toxicology consultation. Following initially normal coagulation studies including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer, fibrinogen decreased to 121 mg/dL and D-dimer concurrently rose to 377 ng/mL over 24 h. On hospital day 2 fibrinogen stabilized at 109 mg/dL and he was discharged with outpatient laboratory monitoring. Three days later, he returned with bruising to the contralateral arm. Fibrinogen was undetectable (<40 mg/dL) and PT was 14.6 s. He declined admission but returned 2 d later with bruising to the nose. Bloodwork revealed immeasurably prolonged PT, aPTT, and thrombin time, but he eloped. Late that evening he returned and was treated with three vials of Green pit viper (Trimeresurus albolabris) antivenom. Within 24 h coagulopathy improved markedly; at five days, coagulation abnormalities resolved.Discussion: Mangshan pit viper envenomations may cause isolated hemotoxicity, despite molecular studies suggesting additional neurotoxicity and myotoxicity.T. albolabrisantivenom appears effective in treating the resultant coagulopathy.Conclusion: We report the natural history of envenomation by the Mangshan pit viper. A delayed coagulopathy, apparently fibrinolytic in nature, is unaccompanied by local tissue destruction and responsive to Green pit viper antivenom. [ABSTRACT FROM AUTHOR]

Abstract: Vaccination against nicotine is under investigation as a treatment for tobacco dependence. Passive immunization with nicotine-specific antibodies represents a complementary strategy to vaccination. A potential adverse effect of passive immunization in nicotine-dependent individuals is that it may lead to a rapid reduction in brain nicotine levels and trigger withdrawal. The goal of this study was to determine if passive immunization with the nicotine-specific monoclonal antibody Nic311 precipitated withdrawal in nicotine-dependent rats as measured by increases in brain reward thresholds and somatic signs. Another cohort of rats was used to measure brain nicotine levels after Nic311 administration. Nic311 30, 80 or 240 mg/kg reduced brain nicotine concentrations by 45, 83 or 92% compared to controls. None of these Nic311 doses precipitated withdrawal measured at intervals up to 72 h following antibody administration. Administration of the nicotinic antagonist mecamylamine precipitated a robust nicotine withdrawal syndrome. Therefore, a substantial, but not complete, acute reduction in brain nicotine levels following passive immunization was not sufficient to precipitate nicotine withdrawal in nicotine-dependent rats. The Nic311 doses used have been shown to attenuate the behavioral effects of nicotine, suggesting that the use of passive immunization to treat nicotine addiction is not likely to precipitate withdrawal. [Copyright &y& Elsevier]

We have previously shown that acetaldehyde, a constituent of tobacco smoke, increases nicotine self-administration in adolescent, but not adult, rats. The aim of this study was to determine whether acetaldehyde influences other behavioral, endocrine, or neuronal responses to nicotine at either age. Juvenile (postnatal day (P) 27) and adult (P90) male Sprague–Dawley rats were treated with saline, acetaldehyde (16 μg/kg/injection × 2, i.v.), nicotine (30 μg/kg/injection × 2, i.v.) or a combination of acetaldehyde and nicotine. Locomotion and center time were evaluated for 30 min in a novel open field, before measurement of plasma corticosterone levels and brain c-fos mRNA. Nicotine increased locomotor activity in juveniles but decreased it in adults; in contrast, center time was increased at both ages. Acetaldehyde potentiated nicotine's locomotor effects, but not center time. Nicotine induced c-fos expression in the bed nucleus of the stria terminalis, the central nucleus of the amygdala (CeA), nucleus accumbens, and the superior colliculus (SC) at both ages, whereas it activated the hypothalamic paraventricular nucleus (PVN) and consequent corticosterone secretion only in adults. Acetaldehyde potentiated nicotine-induced c-fos in CeA and SC, and activation of PVN c-fos expression/plasma corticosterone release; however, this drug interaction was only observed in behaviorally tested animals, not those that were minimally stressed. Thus, acetaldehyde may modulate the interaction of nicotine and stress. Although pharmacokinetic studies showed that acetaldehyde did not change nicotine levels in either brain or serum, nicotine penetration into the brain was slower in juveniles as compared to adults.Neuropsychopharmacology (2007) 32, 2025–2035; doi:10.1038/sj.npp.1301327; published online 7 February 2007 [ABSTRACT FROM AUTHOR]

Abstract: The objective of the present study was to determine the relative efficacy of nicotine priming and nicotine-paired stimuli in reinstating extinguished NSA in rats. The relative efficacy of different stimulus conditions in reinstating NSA was also determined. Rats were trained to self-administer nicotine (0.03 mg/kg/inf) under an FR 5 schedule. Onset of a light above the active lever was correlated with nicotine availability, while offset of the light was paired with each nicotine infusion. In Experiment 1, saline extinction was arranged in the presence of these light stimuli. After extinction criteria were met, the effects of priming doses of nicotine (0.01, 0.03. and 0.06 mg/kg/inf, i.v.) on active lever pressing were determined. In Experiment 2, extinction of NSA was arranged in the absence of the light stimuli. After extinction criteria were met, reinstatement sessions were arranged involving either (1) a priming infusion of nicotine (0.03 mg/kg), (2) presentation of the same light stimuli as during NSA training, (3) constant illumination of the cue light, or (4) a combination of a nicotine priming infusion with one of the stimulus-light conditions. In Experiment 1, nicotine generally failed to reinstate NSA at any priming dose. In Experiment 2, both stimulus conditions reinstated NSA, with the stimulus condition identical to training producing a greater effect. Nicotine priming alone failed to significantly reinstate NSA. Nicotine priming combined with either stimulus condition was no more effective than each stimulus condition alone in reinstating NSA. These findings suggest that nicotine-paired cues are more effective than nicotine alone in reinstating extinguished NSA and are consistent with other studies showing that nicotine-paired stimuli play an important role in the reacquisition of NSA. [Copyright &y& Elsevier]

Presents a study which investigated quality in ephedrine-containing dietary supplements. Experimental section; Results and discussion; Conclusion.