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Mao Y, Xu L, Xu J, Tang Y, Liu T. Application Value of Limb Ischemic Preconditioning in Preventing Intradialytic Hypotension during Maintenance Hemodialysis. Kidney Blood Press Res 2023; 48:535-544. [PMID: 37497943 PMCID: PMC10614484 DOI: 10.1159/000531855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate the efficacy and safety of limb ischemia preconditioning (LIPC) in the treatment of intradialytic hypotension (IDH) in patients with maintenance hemodialysis (MHD). METHODS This was a single-center, prospective, and randomized controlled case study. A total of 38 patients with MHD who met the inclusion criteria from September 2021 to August 2022 were selected from the Blood Purification Center of our hospital. They were randomly divided into the LIPC group (n = 19) and the control group (n = 19). For patients in the LIPC group, the femoral artery blood flow was blocked with an LIPC instrument for 5 min (pressurized to 200 mm Hg) before each dialysis, and they were reperfused for 5 min. The cycle was repeated five times, with a total of 50 min for 12 weeks. The control group was pressurized to 20 mm Hg with an LIPC instrument, and the rest was the same as the LIPC group. The blood pressure of 0 h, 1 h, 2 h, 3 h, 4 h, and body weight before and after hemodialysis were measured in the two groups during hemodialysis, the incidence of IDH and the changes of serum troponin I (TNI) and creatine kinase isoenzyme MB (CK-MB) levels before and after the intervention were observed, and the ultrafiltration volume and ultrafiltration rate were recorded. RESULTS At the 8th and 12th week after intervention, the MAP in the LIPC group was higher than that in the control group (103.28 ± 12.19 mm Hg vs. 93.18 ± 11.11 mm Hg, p = 0.04; 101.81 ± 11.36 mm Hg vs. 91.81 ± 11.92 mm Hg, p = 0.047). The incidence of IDH in the LIPC group was lower than that in the control group (36.5% vs. 43.1%, p = 0.01). The incidence of clinical treatment in IDH patients in the LIPC group was lower than that in the control group (6.3% vs. 12.4%, p = 0.00). The incidence of early termination of hemodialysis in the LIPC group was lower than that in the control group (1.6% vs. 3.8%, p = 0.01). The levels of TNI and CK-MB in the LIPC group after the intervention were lower than those in the control group (322.30 ± 13.72 ng/dL vs. 438.50 ± 24.72 ng/dL, p = 0.00; 159.78 ± 8.48 U/dL vs. 207.00 ± 8.70 U/dL, p = 0.00). The changes of MAP before and after the intervention were negatively correlated with the changes of TNI and CK-MB before and after the intervention (r = -0.473, p = 0.04; r = -0.469, p = 0.04). There were no differences in dry body mass and ultrafiltration rate between the two groups before and after the LIPC intervention (p > 0.05). Multiple linear regression analysis shows that TNI is the main influencing factor of ΔMAP. No LIPC-related adverse events were found during the study period. CONCLUSION LIPC can effectively reduce the incidence of IDH in patients with MHD and may be associated with the alleviation of myocardial damage.
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Affiliation(s)
- Yaqin Mao
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China,
- Graduate School, Dalian Medical University, Dalian, China,
| | - Linfang Xu
- Blood Purification Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Juntian Xu
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Graduate School, Dalian Medical University, Dalian, China
| | - Yushang Tang
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Blood Purification Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Tongqiang Liu
- Division of Nephrology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
- Blood Purification Center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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The response of peripheral microcirculation to gravity-induced changes. Clin Biomech (Bristol, Avon) 2018; 57:19-25. [PMID: 29894856 DOI: 10.1016/j.clinbiomech.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The peripheral microcirculation supplies fresh blood to the small blood vessels, providing oxygen and nutrients to the tissues, removing waste, and maintaining normal homeostatic conditions. The goal of this study was to characterize the response of the peripheral microcirculation, in terms of blood flow and tissue oxygenation variables, to gravity-induced changes. METHODS The study included 20 healthy volunteers and the experiment involved monitoring central and peripheral variables with the right hand positioned at different heights. These positions correspond to various gravitational levels. Peripheral perfusion and oxygenation were monitored using a laser Doppler flowmeter, photoplethysmograph, and transcutaneous oxygen tension monitor. Local blood pressure and respiration rate were also measured. FINDINGS At the heart level, tissue oxygenation displayed a nadir, while capillary flow displayed a peak. Similar but weaker changes were observed at the control hand. In contrast, the photoplethysmograph's amplitude strongly decreased upon reducing the arm position below heart level. Both systolic and diastolic pressures decreased linearly between the highest to lowest arm position. INTERPRETATION The results may reflect peripheral compensation mechanisms, as well as an interaction between the central and peripheral cardiovascular systems, in response to local changes in blood pressure. The observed dependence of the oxygenation pattern on height could lead to important new insights for the diagnosis and treatment of problems in the regulation of tissue perfusion.
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Intermittent mild negative pressure applied to the lower limb in patients with spinal cord injury and chronic lower limb ulcers: a crossover pilot study. Spinal Cord 2018; 56:372-381. [PMID: 29497177 DOI: 10.1038/s41393-018-0080-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Randomized, assessor-blinded crossover pilot study. OBJECTIVES To explore the use of an intermittent negative pressure (INP) device for home use in addition to standard wound care (SWC) for patients with spinal cord injury (SCI) and chronic leg and foot ulcers before conducting a superiority trial. SETTING Patient homes and outpatient clinic. METHODS A 16-week crossover trial on 9 SCI patients (median age: 57 years, interquartile range [IQR] 52-66), with leg ulcers for 52 of weeks (IQR: 12-82) duration. At baseline, patients were allocated to treatment with INP + SWC or SWC alone. After 8 weeks, the ulcers were evaluated. To assess protocol adherence, the patients were then crossed over to the other group and were evaluated again after another 8 weeks. Lower limb INP treatment consisted of an airtight pressure chamber connected to an INP generator (alternating 10 s -40mmHg/7 s atmospheric pressure) used 2 h/day at home. Ulcer healing was assessed using a photographic wound assessment tool (PWAT) and by measuring changes in wound surface area (WSA). RESULTS Seven of nine recruited patients adhered to a median of 90% (IQR: 80-96) of the prescribed 8-week INP-protocol, and completed the study without side effects. PWAT improvement was observed in 4/4 patients for INP + SWC vs. 2/5 patients for SWC alone (P = 0.13). WSA improved in 3/4 patients allocated to INP + SWC vs. 3/5 patients in SWC alone (P = 0.72). CONCLUSIONS INP can be used as a home-based treatment for patients with SCI, and its efficacy should be tested in an adequately sized, preferably multicenter randomized trial.
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Ichinose M, Ichinose-Kuwahara T, Kondo N, Nishiyasu T. Increasing blood flow to exercising muscle attenuates systemic cardiovascular responses during dynamic exercise in humans. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1234-42. [PMID: 26377556 DOI: 10.1152/ajpregu.00063.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022]
Abstract
Reducing blood flow to working muscles during dynamic exercise causes metabolites to accumulate within the active muscles and evokes systemic pressor responses. Whether a similar cardiovascular response is elicited with normal blood flow to exercising muscles during dynamic exercise remains unknown, however. To address that issue, we tested whether cardiovascular responses are affected by increases in blood flow to active muscles. Thirteen healthy subjects performed dynamic plantarflexion exercise for 12 min at 20%, 40%, and 60% of peak workload (EX20, EX40, and EX60) with their lower thigh enclosed in a negative pressure box. Under control conditions, the box pressure was the same as the ambient air pressure. Under negative pressure conditions, beginning 3 min after the start of the exercise, the box pressure was decreased by 20, 45, and then 70 mmHg in stepwise fashion with 3-min step durations. During EX20, the negative pressure had no effect on blood flow or the cardiovascular responses measured. However, application of negative pressure increased blood flow to the exercising leg during EX40 and EX60. This increase in blood flow had no significant effect on systemic cardiovascular responses during EX40, but it markedly attenuated the pressor responses otherwise seen during EX60. These results demonstrate that during mild exercise, normal blood flow to exercising muscle is not a factor eliciting cardiovascular responses, whereas it elicits an important pressor effect during moderate exercise. This suggests blood flow to exercising muscle is a major determinant of cardiovascular responses during dynamic exercise at higher than moderate intensity.
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Affiliation(s)
- Masashi Ichinose
- Human Integrative Physiology Laboratory, School of Business Administration, Meiji University, Tokyo, Japan;
| | - Tomoko Ichinose-Kuwahara
- Human Integrative Physiology Laboratory, School of Business Administration, Meiji University, Tokyo, Japan; Laboratory for Human Performance Research, Osaka International University, Osaka, Japan
| | - Narihiko Kondo
- Laboratory for Applied Human Physiology, Faculty of Human Development, Kobe University, Kobe, Japan; and
| | - Takeshi Nishiyasu
- Institute of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
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Li W, Ji L, Tao W. Effect of vacuum sealing drainage in osteofascial compartment syndrome. Int J Clin Exp Med 2015; 8:16112-16116. [PMID: 26629121 PMCID: PMC4659010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate the effect of vacuum sealing drainage in the patients with osteofascial compartment syndrome in comparison to conventional treatment. METHODS Fifty-two patients diagnosed with osteofascial compartment syndrome were enrolled in this study. They were randomly divided into two groups based on treatments: vacuum sealing drainage and conventional treatment. After operation, the length of hospital stay and antibiotics administration were recorded in the two groups, as well as swelling elimination and wound closure. RESULTS No significant difference was observed in terms of the baseline characteristics between the two groups. There are no obvious local or systemic complications in all cases. In contrast to conventional treatment group, the time of swelling elimination, wound closure, hospital stay and antibiotics application were reduced significantly in vacuum sealing drainage group. No allergic reactions or other side effects were observed after the application of vacuum sealing drainage material, indicating its safety. CONCLUSION Vacuum sealing drainage is effective in treating osteofascial compartment syndrome with better clinical outcomes than conventional therapy.
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Affiliation(s)
- Weihua Li
- The Second Peoples Hospital of Nantong 43 Xinglong St., Tangzha Town, Natong 226002, Jiangsu, China
| | - Lei Ji
- The Second Peoples Hospital of Nantong 43 Xinglong St., Tangzha Town, Natong 226002, Jiangsu, China
| | - Weidong Tao
- The Second Peoples Hospital of Nantong 43 Xinglong St., Tangzha Town, Natong 226002, Jiangsu, China
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Cui J, Blaha C, Herr MD, Drew RC, Muller MD, Sinoway LI. Limb suction evoked during arterial occlusion causes systemic sympathetic activity in humans. Am J Physiol Regul Integr Comp Physiol 2015; 309:R482-8. [PMID: 26136530 DOI: 10.1152/ajpregu.00117.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/29/2015] [Indexed: 12/30/2022]
Abstract
Venous saline infusions in an arterially occluded forearm evokes reflex increases in muscle sympathetic nerve activity (MSNA) and blood pressure (BP). We hypothesized that the application of suction to the human limbs would activate this venous distension reflex and raise sympathetic outflow. We placed airtight pressure tanks and applied 100 mmHg negative pressure to an arterially occluded limb (occlusion and suction, O&S) to induce tissue deformation without fluid translocation. BP, heart rate (HR), and MSNA were assessed in 19 healthy subjects during 2 min of arm or leg O&S. Occlusion without suction served as a control. During a separate visit, saline (5% forearm volume) was infused into veins of the arterially occluded arm (n = 13). The O&S increased limb circumference, MSNA burst rate (arm: Δ6.7 ± 0.7; leg: Δ6.8 ± 0.7 bursts/min), and total activity (arm: Δ199 ± 14; leg: Δ172 ± 22 units/min) and BP (arm: Δ4.3 ± 0.3; leg: Δ9.4 ± 1.4 mmHg) from the baseline. The MSNA and BP responses during arm O&S correlated with those during leg O&S. Occlusion alone had no effect on MSNA and BP. MSNA (r = 0.607) responses during arm O&S correlated with those evoked by the saline infusion into the arm. These correlations suggest that sympathetic activation during limb O&S is likely, at least partially, to be evoked via the venous distension reflex. These data suggest that suction of an occluded limb evokes sympathetic activation and that the limb venous distension reflex exists in arms and legs of normal humans.
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Affiliation(s)
- Jian Cui
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Cheryl Blaha
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael D Herr
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rachel C Drew
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew D Muller
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Pennsylvania State University College of Medicine, Penn State Hershey Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Hickey M, Phillips JP, Kyriacou PA. The effect of vascular changes on the photoplethysmographic signal at different hand elevations. Physiol Meas 2015; 36:425-40. [PMID: 25652182 DOI: 10.1088/0967-3334/36/3/425] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In order to further understand the contribution of venous and arterial effects to the photoplethysmographic (PPG) signal, recordings were made from 20 healthy volunteer subjects during an exercise in which the right hand was raised and lowered with reference to heart level. Red (R) and infrared (IR) PPG signals were obtained from the right index finger using a custom-made PPG processing system. Laser Doppler flowmetry (LDF) signals were also recorded from an adjacent fingertip. The signals were compared with simultaneous PPG signals obtained from the left index finger. On lowering the hand to 50 cm below heart level, both ac and dc PPG amplitudes from the finger decreased (e.g. 18.70 and 63.15% decrease in infrared dc and ac signals respectively). The decrease in dc amplitude most likely corresponded to increased venous volume, while the decrease in ac PPG amplitude was due to regulatory adjustments on the arterial side in response to venous distension. Conversely, ac and dc PPG amplitudes increased on raising the arm above heart level. Morphological changes in the ac PPG signal are thought to be due to vascular resistance changes, predominately venous, as the hand position is changed.
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Affiliation(s)
- M Hickey
- School of Mathematics, Computer Science and Engineering, City University London, London, EC1V 0HB, UK
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Fairfax ST, Holwerda SW, Credeur DP, Zuidema MY, Medley JH, Dyke PC, Wray DW, Davis MJ, Fadel PJ. The role of α-adrenergic receptors in mediating beat-by-beat sympathetic vascular transduction in the forearm of resting man. J Physiol 2013; 591:3637-49. [PMID: 23652594 DOI: 10.1113/jphysiol.2013.250894] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sympathetic vascular transduction is commonly understood to act as a basic relay mechanism, but under basal conditions, competing dilatory signals may interact with and alter the ability of sympathetic activity to decrease vascular conductance. Thus, we determined the extent to which spontaneous bursts of muscle sympathetic nerve activity (MSNA) mediate decreases in forearm vascular conductance (FVC) and the contribution of local α-adrenergic receptor-mediated pathways to the observed FVC responses. In 19 young men, MSNA (microneurography), arterial blood pressure and brachial artery blood flow (duplex Doppler ultrasound) were continuously measured during supine rest. These measures were also recorded in seven men during intra-arterial infusions of normal saline, phentolamine (PHEN) and PHEN with angiotensin II (PHEN+ANG). The latter was used to control for increases in resting blood flow with α-adrenergic blockade. Spike-triggered averaging was used to characterize beat-by-beat changes in FVC for 15 cardiac cycles following each MSNA burst and a peak response was calculated. Following MSNA bursts, FVC initially increased by +3.3 ± 0.3% (P = 0.016) and then robustly decreased to a nadir of -5.8 ± 1.6% (P < 0.001). The magnitude of vasoconstriction appeared graded with the number of consecutive MSNA bursts; while individual burst size only had a mild influence. Neither PHEN nor PHEN+ANG infusions affected the initial rise in FVC, but both infusions significantly attenuated the subsequent decrease in FVC (-2.1 ± 0.7% and -0.7 ± 0.8%, respectively; P < 0.001 vs. normal saline). These findings indicate that spontaneous MSNA bursts evoke robust beat-by-beat decreases in FVC that are exclusively mediated via α-adrenergic receptors.
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Affiliation(s)
- Seth T Fairfax
- Biomedical Sciences, University of Missouri, Columbia, MO 65212, USA
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Mateus J, Hargens AR. Bone hemodynamic responses to changes in external pressure. Bone 2013; 52:604-10. [PMID: 23168293 DOI: 10.1016/j.bone.2012.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 10/15/2012] [Accepted: 11/13/2012] [Indexed: 11/19/2022]
Abstract
Adequate blood supply and circulation to the bones is required to maintain a healthy skeleton. Inadequate blood perfusion is associated with numerous bone pathologies and a decrease in bone mineral density, yet bone hemodynamics remains poorly understood. This study aims to 1) quantify bone hemodynamic responses to changes in external pressure, and 2) identify the predominant mechanisms regulating bone hemodynamic responses to pressure changes. Photoplethysmography was used to measure bone and skin perfusion in response to changes in external pressure. Single-limb pressure chamber experiments were performed over a pressure range of -50 to +50mmHg. Bone perfusion is decreased at all negative pressures, and larger decrements in perfusion are observed at the more extreme pressure differences. At positive pressures we observed an initial increase in perfusion followed by activation of intramuscular pressure receptors at +30mmHg, which overrides the initial response and results in decreased perfusion at the highest positive pressure levels. The myogenic effect is observed and is shown to be the predominant control mechanism in bone over a wide range of pressure exposures. Greater understanding of these hemodynamic mechanisms may be important in developing new drugs and therapies to treat various bone disorders.
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Affiliation(s)
- Jaime Mateus
- Massachusetts Institute of Technology, Man-Vehicle Laboratory, Department of Aeronautics and Astronautics, 77 Massachusetts Avenue, Room 37-219, Cambridge, MA 02139, USA.
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Yamazaki F, Yuge N. Limb-specific differences in the skin vascular responsiveness to adrenergic agonists. J Appl Physiol (1985) 2011; 111:170-6. [DOI: 10.1152/japplphysiol.00068.2011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, to test the hypothesis that adrenergic vasoconstrictor responses of the legs are greater compared with the arms in human skin, cutaneous vascular conductance (CVC) in the forearm and calf were compared during the infusion of adrenergic agonists in healthy young volunteers. Under normothermic conditions, norepinephrine (NE, α- and β-agonist, 1 × 10−8 to 1 × 10−2 M), phenylephrine (PHE, α1-agonist, 1 × 10−8 to 1 × 10−2 M), dexmedetomidine (DEX, α2-agonist, 1 × 10−9 to 1 × 10−4 M), and isoproterenol (ISO, β-agonist, 1 × 10−8 to 1 × 10−3 M) were administered by intradermal microdialysis. Skin blood flow (SkBF) was measured by laser-Doppler flowmetry, and the local temperature at SkBF-measuring sites was maintained at 34°C throughout the experiments. CVC was calculated as the ratio of SkBF to blood pressure and expressed relative to the baseline value before drug infusion. The dose of NE at the onset of vasoconstriction and the effective dose (ED50) resulting in 50% of the maximal vasoconstrictor response for NE were lower ( P < 0.001) in the calf than forearm. The ED50 for PHE and DEX was also lower ( P < 0.05) in the calf than forearm. Increases in CVC in response to ISO were potentially smaller in the calf, but the statistical differences in the responses were dependent on the expressions of CVC. These findings suggest that the cutaneous vasoconstrictor responsiveness to exogenous NE is greater in the legs than in the arms due to a higher α1- and α2-adrenoceptor reactivity, while the β-adrenoceptor function plays a minor role in regional differences in adrenergic vasoconstriction in normothermic humans.
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Affiliation(s)
- Fumio Yamazaki
- School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Nagisa Yuge
- School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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Frequency of slow oscillations in arterial pressure and R–R intervals during muscle metaboreflex activation. Auton Neurosci 2010; 152:88-95. [DOI: 10.1016/j.autneu.2009.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 08/17/2009] [Accepted: 08/31/2009] [Indexed: 01/27/2023]
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