Compliance changes in femoral veins of rabbits after 21 days of simulated weightlessness

Increased venous compliance in lower limbs may be contributed to postflight orthostatic intolerance; however, direct animal studies to address the changes of venous compliance to microgravity have been rare. The purpose of this study was to determine compliance changes in femoral veins of rabbits after 21 days of head-down rest. Head-down rest -20 dgrees rabbit model was used to simulate weightlessness. 24 healthy male New Zealand Rabbits were randomly divided into 21 days of head-down rest group (HDR), horizontal immobilization group (HIG) and Ctrl group (Ctrl), with 8 in each. We constructed pressure-volume relationships from femoral veins in vivo for all groups after simulation by changing the venous internal volume and measuring the corresponding pressure. Microstructure of femoral vein wall in 3 groups was observed. Compared among the groups, the corresponding intravenous pressure of Ctrl was the highest when intravenous volume was expanded and HDR was the lowest. The parameter 3 , and P 2 in quadratic equations of femoral venous P-V relationship of HDR group were significantly higher than these values of HIG group and Ctrl group. The structure of femoral vein wall of HDR rabbits changed significantly, outlines of some endothelium cells (EC) became short and columnar or cubic, some of EC fell off and smooth muscle layer became thinner. These results indicate that, the femoral venous compliance increased after weightlessness simulation. This may partially underlie the mechanism of orthostatic hypotension seen in astronauts during an orthostatic stress after exposure to microgravity.

Local changes in the insulin-like growth factor system in human skeletal muscle assessed by microdialysis and arterio-venous differences technique

IGF-I plays a direct role in whole body glucose homeostasis primarily by stimulating skeletal muscle glucose uptake. IGF-I is also involved in exercise induced muscle hypertrophy. Knowledge regarding local changes in muscle IGF-I bioavailability and its regulation by IGFBPs at rest and during exercise is limited. We have therefore explored changes in total IGF-I levels as well as circulating IGFBP levels and their post-translational modifications over an exercising leg. For the first time we have determined IGF-I levels in exercising skeletal muscle microdialysate in an attempt to assess local IGF-I bioavailability. Eighteen healthy young men performed one legged knee-extension exercise during 45min. Blood samples were taken from the femoral artery and vein of the exercising leg. No significant differences between arterial and venous concentrations of total IGF-I or IGFBP-1 were detected over the leg at any time. IGF-I concentrations increased significantly during exercise in the artery but not in the vein. Total IGFBP-1 increased after exercise in both artery and vein. The increase in non-plus less phosphorylated forms of IGFBP-1 was less pronounced and did not reach statistical significance. The proportion of fragmented IGFBP-3 (IGFBP-3 proteolysis) assessed by Western immunoblotting did not change significantly during or after exercise. Although optimization and validation of IGF-I determinations in muscle microdialysate (md) will be required, our first results using this technique demonstrate a significant 2-fold increase in mdIGF-I collected during and after exercise. We conclude that determination of A-V-differences appears to be of limited value in the assessments of local muscle change in the IGF-system. A substantial release of IGF-I during short time is required to detect significant change in the large circulating store of IGF-I. We suggest that an optimized and validated microdialysis technique for determination of local IGF-I may be advantageous in future studies.

Area-pressure relationship of lower limb main veins in man

Background: The mechanical properties of human veins remain incompletely known. However they play an important part in number of physiological and pathological situations, as hemodynamic adjustment to orthostasis, deep venous thrombosis (DVP) and chronic venous insufficiency (CVI). The aim of the study was to describe the pressure/volume (area) relationship of some important conduit veins of the human’s lower limb. Probands and methods: We investigated the area/pressure relationship of the femoral vein (FV) at mid thigh, the great saphenous vein (GSV) at lower third of the leg, and a deep leg vein (DLV), either the peroneal or posterior tibial vein, in fifteen healthy young men. The cross section areas were measured with B-mode ultrasound while various positive and negative venous pressures were generated by body’s tilting. Results: Over the range of pressures investigated, the area/pressure relationship was roughly linear, the classical sigmoid relation did not emerge from our data. The relative compliance of FV, GSV and DLV was 0.0312, 0.0118, and 0.0147 mmHg-1, respectively. Conclusions: The relative compliance of FV is more than two times higher than the relative compliance of both the DLV and the GSV.

Carbohydrate metabolism during prolonged exercise and recovery: interactions between pyruvate dehydrogenase, fatty acids, and amino acids

During prolonged exercise, carbohydrate oxidation may result from decreased pyruvate production and increased fatty acid supply and ultimately lead to reduced pyruvate dehydrogenase (PDH) activity. Pyruvate also interacts with the amino acids alanine, glutamine, and glutamate, whereby the decline in pyruvate production could affect tricarboxycylic acid cycle flux as well as gluconeogenesis. To enhance our understanding of these interactions, we studied the time course of changes in substrate utilization in six men who cycled at 44+/-1% peak oxygen consumption (mean+/-SE) until exhaustion (exhaustion at 3 h 23 min+/-11 min). Femoral arterial and venous blood, blood flow measurements, and muscle samples were obtained hourly during exercise and recovery (3 h). Carbohydrate oxidation peaked at 30 min of exercise and subsequently decreased for the remainder of the exercise bout (P<0.05). PDH activity peaked at 2 h of exercise, whereas pyruvate production peaked at 1 h of exercise and was reduced (approximately 30%) thereafter, suggesting that pyruvate availability primarily accounted for reduced carbohydrate oxidation. Increased free fatty acid uptake (P<0.05) was also associated with decreasing PDH activity (P<0.05) and increased PDH kinase 4 mRNA (P<0.05) during exercise and recovery. At 1 h of exercise, pyruvate production was greatest and was closely linked to glutamate, which was the predominant amino acid taken up during exercise and recovery. Alanine and glutamine were also associated with pyruvate metabolism, and they comprised approximately 68% of total amino-acid release during exercise and recovery. Thus reduced pyruvate production was primarily associated with reduced carbohydrate oxidation, whereas the greatest production of pyruvate was related to glutamate, glutamine, and alanine metabolism in early exercise.

Comparison of two intermittent pneumatic compression systems. A hemodynamic study

AIM

Sequential leg compression has been previously shown to be superior to uniform compression. The aim of our study was to compare the hemodynamic effectiveness of the portable sequential compression device (SCD Express Compression System, Tyco Healthcare Group LP, Mansfield, MA, USA) with a rapid inflation device (VenaFlow, Aircast, Inc, Summit, NJ, USA). The former, by sensing venous refill time, commences compression when the calf veins are refilled.

METHODS

The two devices were tested in 12 normal volunteers in the semirecumbent position using duplex ultrasound. Baseline and augmented flow velocity and volume flow were measured at the level of the common femoral vein, above the saphenofemoral junction. Refilling time was determined from velocity recordings of the common femoral vein. Total and peak volume of blood expelled per hour during compression were calculated using flow data and the individual cycling rate.

RESULTS

Both devices increased venous flow velocity, up to 3.8 times the baseline (all P<0.001). Refill time of the rapid inflation device was shorter in comparison with the sequential compression device (15+/-2.2 vs 25+/-4 s; P<0.001), suggesting incomplete vein evacuation. The sequential compression device, by augmenting flow throughout a significantly longer compression period per cycle (10.9 s vs 6.3 s), expelled significantly more venous blood (121+/-68 vs 81+/-63 mL; P<0.001). Similarly, the total volume of blood expelled per hour with the sequential compression device was 100% higher than the rapid inflation device (9685+/-5426 vs 4853+/-3658 mL; P<0.001). Although peak velocity enhancement was higher with the rapid inflation device, flow augmentation (a product of average blood flow velocity) was comparable (669+/-367 vs 771+/-574 cm/s; P=0.223) with the sequential compression device, mainly because the rapid inflation device failed to maintain flow enhancement beyond the initial flow surge.

CONCLUSIONS

Sequential compression showed hemodynamic superiority compared to a rapid inflation device. This was enhanced further by the sensing of refill time, which resulted in more compression cycles over time. The relative efficacy of the two devices in deep vein thrombosis prevention should be tested in future studies.

Non-invasive assessment of human large vein diameter, capacity, distensibility and ellipticity in situ: dependence on anatomical location, age, body position and pressure

The objective was to compare in-situ diameter, capacity and distensibility changes as well as ellipticity of large human veins of different locations, reveal alterations with age, body position and increased intraluminal pressure. Ultrasonographic assessment of mediolateral and anteroposterior diameters was performed of femoral, axillary and inner jugular veins, in erect and reclined positions as well as before and during controlled Valsalva test. Groups of young (24.0+/-0.4 years, n=11) and elderly (72.6+/-1.5 years, n=11) subjects were studied. Capacity of the femoral vein (reclined patients) gradually increased when a graded Valsalva test was applied. Its in situ distensibility was found to be 0.048+/-0.011 mm Hg(-1) between 0-15 mm Hg (1 mm Hg=0.133 kPa) pressure loads in reclined young subjects, which decreased to 0.009+/-0.005 mm Hg(-1) at 45-60 mm Hg. The femoral vein was considerably more rigid in the erect than in the reclined body position while an opposite correlation was found for the inner jugular vein. Axillary vein distensibility was very low and independent of body position. Ellipticity of femoral and axillary veins was minimal (the ratio of the two perpendicular diameters <1.25). Inner jugular veins were more elliptic in the erect position and without Valsalva (2.94+/-0.99 in young patients). Old femoral veins had higher capacity in the reclined position without Valsalva, while distensibility at low pressures was much more prominent in young vessels. The in situ femoral vein is more distensible in supine than in erect position, opposite to the inner jugular vein. The axillary vein is rather rigid in both positions. Only the inner jugular vein shows significant elipticity in situ. Aging decreases the distensibility of the femoral vein in reclined position.

Association between regional quadriceps oxygenation and blood oxygen saturation during normoxic one-legged dynamic knee extension

It is not clear whether muscle oxygenation (O(2-NIRS)) measured by near-infrared spectroscopy (NIRS) correlates with femoral venous SO2 (S(fv)o2) during normoxic exercise. Therefore, the purpose of this study was to compare physiologically calibrated O(2-NIRS) with S(fv)o2 in subjects performing one-legged dynamic knee extension exercise (1L-KEE). Five healthy male subjects (age 25+/-2 year, height 177.8+/-4.8 cm, body weight 67.1 +/- 5.0 kg; mean +/- SD) performed 1L-KEE at 20, 40, and 60% of peak work rate (WR-peak) each for 4 min. S(fv)o2 was measured at rest and during the 3rd minute of each work rate. O(2-NIRS) was continuously monitored in a proximal region of the vastus lateralis (VL-p), a distal region of VL (VL-d), and a proximal region of the rectus femoris (RF-p). S(fv)o2 was 56.0% at rest and decreased to 36.6 at 20% WR-peak, 35.8 at 40% WR-peak, and 31.1 at 60% WR-peak. There was a significant correlation between O(2-NIRS) and S(fv)o2(VL-p: r (2) = 0.62, VL-d: r2 = 0.35, RF-p: r2 = 0.62, with a moderate variation among individuals at each site; residual values = 4.83 - 11.75). These data indicate that NIRS measurement provides a reflection of S(fv)o2 during 20-60% WR-peak of normoxic 1L-KEE.

Countercurrent compartmental models describe hind limb skeletal muscle helium kinetics at resting and low blood flows in sheep

AIMS

This study evaluated the relative importance of perfusion and diffusion mechanisms in compartmental models of blood : tissue helium exchange in a predominantly skeletal muscle tissue bed in the sheep hind limb. Helium has different physiochemical properties from previously studied gases and is a common diluent gas in underwater diving where decompression schedules are based on theoretical models of inert gas kinetics.

METHODS

Helium kinetics across skeletal muscle were determined during and after 20 min of helium inhalation, at separate resting and low steady-states of femoral vein blood flow in six sheep under isoflurane anaesthesia. Helium concentrations in arterial and femoral vein blood were determined using gas chromatographic analysis and femoral vein blood flow was monitored continuously. Parameters and model selection criteria of various perfusion-limited or perfusion-diffusion compartmental models of skeletal muscle were estimated by simultaneous fitting of the models to the femoral vein helium concentrations for both blood flow states.

RESULTS

A model comprising two parallel perfusion-limited compartment models fitted the data well but required a 51-fold difference in relative compartment perfusion that did not seem physiologically plausible. Models that allowed a countercurrent diffusion exchange of helium between arterial and venous vessels outside of the tissue compartments provided better overall fit of the data and credible parameter estimates.

CONCLUSIONS

These results suggest a role of arterial-venous diffusion in blood : tissue helium equilibration in skeletal muscle.

[Shifts in human venous hemodynamics in long-term space flight]

Veins and venous hemodynamics before, during and after long-term space flights (SF) were evaluated with the ultrasonic (B-scan, Doppler) techniques and occlusion plethysmography. Fifteen cosmonauts were investigated in eight SFs of about 6 months in duration. In three SFs, 30 investigations of the main veins in different parts of the body were fulfilled with participation of 7 cosmonauts. In five SFs, 48 investigations of venous distensibility in legs were fulfilled with occlusion plethysmography with participation of 8 cosmonauts. Femoral veins tended to increase distension throughout SF. Exaggerated leg veins distensibility and compliance was persistently observed during application of occlusion from the early period of SF (wks 1-2) which, in our opinion, extenuates the reduction in LBNP tolerance and post-flight degradation of orthostatic stability. These shifts were growing markedly till months 2-3 of exposure to microgravity and tended to stabilize at the worst (as compared with prelaunch values) level at the end of six-month SFs.

Decreases in pulmonary artery oxygen saturation during total hip arthroplasty variations using 2 leg positioning techniques

When the femoral component is being inserted during total hip arthroplasty, venous obstruction occurs because of twisting and kinking of the femoral vein. Relocation of the hip joint is associated with an acute reduction in pulmonary artery oxygen saturation (s(v)O(2)). To determine whether changes in leg positioning could influence femoral venous occlusion, 19 patients undergoing 1-stage bilateral total hip arthroplasty were studied using a randomized crossover study design of 2 leg positioning maneuvers. Keeping the thigh flexed and internally rotated throughout implantation of the femoral component (technique 1) was compared to bringing the leg into extension while maintaining internal rotation (technique 2) after insertion of the femoral component. After relocation of the hip joint, the reduction in s(v)O(2) was significantly less with technique 2 than technique 1 (P < .0001).

Why do arms extract less oxygen than legs during exercise?

To determine whether conditions for O2 utilization and O2 off-loading from the hemoglobin are different in exercising arms and legs, six cross-country skiers participated in this study. Femoral and subclavian vein blood flow and gases were determined during skiing on a treadmill at approximately 76% maximal O2 uptake (V(O2)max) and at V(O2)max with different techniques: diagonal stride (combined arm and leg exercise), double poling (predominantly arm exercise), and leg skiing (predominantly leg exercise). The percentage of O2 extraction was always higher for the legs than for the arms. At maximal exercise (diagonal stride), the corresponding mean values were 93 and 85% (n = 3; P < 0.05). During exercise, mean arm O2 extraction correlated with the P(O2) value that causes hemoglobin to be 50% saturated (P50: r = 0.93, P < 0.05), but for a given value of P50, O2 extraction was always higher in the legs than in the arms. Mean capillary muscle O2 conductance of the arm during double poling was 14.5 (SD 2.6) ml.min(-1).mmHg(-1), and mean capillary P(O2) was 47.7 (SD 2.6) mmHg. Corresponding values for the legs during maximal exercise were 48.3 (SD 13.0) ml.min(-1).mmHg(-1) and 33.8 (SD 2.6) mmHg, respectively. Because conditions for O2 off-loading from the hemoglobin are similar in leg and arm muscles, the observed differences in maximal arm and leg O2 extraction should be attributed to other factors, such as a higher heterogeneity in blood flow distribution, shorter mean transit time, smaller diffusing area, and larger diffusing distance, in arms than in legs.

Blood flow velocity of the femoral vein with foot exercise compared to pneumatic foot compression

STUDY OBJECTIVE

To compare the effects of foot exercise with an intermittent pneumatic foot compression (IPC) device on blood flow velocity of the femoral veins.

DESIGN

Prospective, controlled study.

SETTING

General intensive care unit of a university hospital.

PATIENTS

20 patients on bed rest in the intensive care unit.

INTERVENTIONS

Patients were divided into 2 groups: group A, foot exercise (n = 10); and group B, IPC device (n = 10). The foot exercise was done once by a nurse for 5 minutes with the dorsiflexion of the ankle (15 times per minute) in group A patients. The IPC device (A-V Impulse System, compression setting: 130 mm Hg for 3 seconds followed by a resting period of 60 seconds) was used for 2 hours in group B.

MEASUREMENTS

Peak blood flow velocity of the femoral vein was measured using the ultrasound unit with a 7.5-MHz linear array probe (ALOKA SSD-5500) at 0, 5, 15, 30, 60, and 120 minutes.

MAIN RESULTS

Peak blood flow velocities in both groups increased significantly vs the control values during the study. At 5 minutes, group A showed a significant increase in the peak blood flow velocity compared with group B.

CONCLUSIONS

Foot exercise by a nurse for 5 minutes was equally or more effective compared with the IPC device in increasing peak blood flow velocity of the femoral vein. The effect of the 5-minute foot exercise lasted for 2 hours.

[Phlebohemodynamics in the femoral vein and postcava during a voluntary quick single contraction of shin muscles in supine and standing humans]

Effects of a voluntary single quick shin contraction on quantitative parameters of the venous outflow in the femoral vein and postcava were investigated in 65 normal males and females with the Doppler ultrasonic and duplex blood pool scanning techniques. Measured were linear spontaneous blood flow, mean linear and peak velocites of the transport of blood after the muscle contraction, baseline linear cross sections of the femoral vein and postcava cross section, and their extension in the course of mobilized blood evacuation. Based on these measurements calculated were weight power space velocities of the spontaneous blood flow and volumes of mobilized venous blood The investigations were made in supine and standing subjects. According to our data, hemodynamic productivity of the muscle contraction in vertical subjects was much higher than in horizontal with the peak and mean linear blood evacuation outrunning the mean spontaneous outflow from the femoral vein in 25.7 and 10.3 times, respectively. Besides, the weight power space velocity of the contraction-induced outflow exceeded that of the spontaneous blood flow 12.5 times. Simultaneous contraction of the muscles on both legs increased four times the weight power space velocity in the subdiaphragmatic part of the postcava.

Simple screening method for deep vein thrombosis by duplex ultrasonography using patients' active maximum ankle dorsiflexion

We hypothesized that venous obstruction by deep vein thrombosis (DVT) only slightly augments venous outflow from lower limbs by active ankle movements. If our hypothesis is true, we thought that we could develop a new screening method for DVT using duplex ultrasonography. Subjects were 22 lower limbs of 11 patients who gave informed consent for venography after total hip or knee arthroplasty. Around postoperative 19.0 days (range 15-32 days), we measured the ratios, called flow ratios, of the peak flow signal with active maximum ankle dorsiflexion and that at rest using duplex ultrasonography in the bilateral femoral veins. On the same day, we then performed bilateral venography. Thrombosis was detected in 5 of the 22 lower limbs. The mean flow ratios with and without DVT were 1.18 (range 1.0-1.3) and 3.31 (range 1.8-4.8), respectively. The flow ratios with DVT were significantly lower than those without DVT. Pain or difficulty performing active maximum ankle dorsiflexion was not observed in any of the operated or unoperated lower limbs during the ultrasound examination. In conclusion, ultrasonographic measurement of flow ratios may become a simple screening method for DVT in lower limbs without the pain or difficulty of performing active maximum ankle dorsiflexion.

Skeletal muscle pump versus respiratory muscle pump: modulation of venous return from the locomotor limb in humans

The vast majority of quantitative data examining the effects of breathing on venous return have been derived from anaesthetized or reduced animal preparations, making an extrapolation to an upright exercising human problematic due to the lack of a hydrostatic column and an absence of muscular contraction. Thus, this study is the first to quantitatively examine the effects of different breathing mechanics on venous return from the locomotor limbs both at rest and during calf contraction exercise in the semirecumbent human. When subjects inspired using predominantly their ribcage/accessory inspiratory muscles at rest (change in gastric pressure (DeltaP(GA)) = <2 cmH(2)O, change in oesophageal pressure (DeltaP(ES)) = approximately -6 cmH(2)O; inspiratory time/total breath time (T(I)/T(TOT)) = 0.5), a slight facilitation of femoral venous return was observed during inspiration (65% of all flow occurred during inspiration), with a slight reduction in femoral venous return during the ensuing expiratory phase of the breath. However, when subjects inspired using a predominantly diaphragmatic breath at rest (DeltaP(GA) = > 5 cmH(2)O, DeltaP(ES) = approximately -6 cmH(2)O; T(I)/T(TOT) = 0.5), femoral venous return was markedly impeded (net retrograde flow of 11%) and significantly lower than that observed during ribcage breathing conditions (P < 0.01). During the ensuing expiratory phase of a diaphragmatic breath, there was a large resurgence of femoral venous blood flow. The pattern of modulation during ribcage and diaphragmatic breathing persisted during both mild (peak calf force = 7 kg) and moderate (peak calf force = 11 kg) levels of calf contraction. Despite the significant within-breath modulation of femoral venous return by breathing, net blood flow in the steady state was not altered by the breathing pattern followed by the subjects. Though popliteal blood flow appeared to be modulated by respiration at rest, this pattern was absent during mild calf contraction where popliteal outflow was phasic with the concentric phase of calf contraction. We conclude that respiratory muscle pressure production is the predominant factor modulating venous return from the locomotor limb both at rest and during calf contraction even when the veins of the lower limb are distended due to the presence of a physiologic hydrostatic column.

Comparison of the effect of venovenous versus venoarterial extracorporeal membrane oxygenation on renal blood flow in newborn lambs

Venovenous extracorporeal membrane oxygenation (VV ECMO) using double lumen catheters is an alternative to venoarterial (VA) ECMO and allows for total blood flow using the patient's cardiac output in comparison to partial blood flow provided during VA ECMO.

OBJECTIVE

To compare the effects of VV versus VA ECMO on renal blood flow.

DESIGN

Prospective study.

SETTING

Research laboratory in a hospital.

SUBJECT

Newborn lambs 1-7 days of age (n = 15).

INTERVENTIONS

In anesthetized, ventilated lambs, femoral artery and vein were cannulated for monitoring and renal venous blood sampling. An ultrasonic flow probe was placed on the left renal artery for continuous renal blood flow measurements. Animals were randomly assigned to control (non-ECMO), VV ECMO and VA ECMO groups. After systemic heparinization, the animals were cannulated and studied at bypass flows of 120 mL/kg/min (partial bypass) for two hours in both ECMO groups and 200 mL/kg/min (full bypass) for an additional 30 min in the VA group. Changes in blood pressure and renal flow on ECMO and during ECMO bridge unclamping were recorded continuously. Plasma renin activity (PRA) levels were sequentially sampled.

RESULTS

Systemic blood pressure was not different in VV or VA ECMO at partial bypass flow. However, systemic blood pressure increased significantly at maximal bypass flow in the VA ECMO group. There was no change in renal flow in either VV or VA ECMO groups. PRA levels did not correlate with bypass flow change. During unclamping of the ECMO bridge, blood pressure and renal flow drop significantly in the VA group, but not in the VV group.

CONCLUSION

VV and VA ECMO at partial bypass flows had comparable effect on blood pressure, renal blood flow and PRA level in this short-term study. However, unclamping of the ECMO bridges did differentially affect blood pressure and renal blood flow between VV and VA groups. We speculate that this repeated acute change in long-run VA ECMO support may play a role in the persistent hypertension seen in some patients.

Effect of PPADS on P2X receptor-mediated responses of human blood vessels

In vitro experiments showed that pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid almost completely suppressed contractile responses of the gallbladder artery to alpha,beta-methylene-ATP, while alpha,beta-methylene-ATP-induced contractions of the major subcutaneous vein of patients with varicose disease did not change under the effect of the antagonist. Pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid significantly reduced contractions of the major subcutaneous veins induced by alpha,beta-methylene-ATP (in two highest concentrations) in patients without varicosity. These results indicate different sensitivity of human blood vessels to the studied P2 receptor agonist and antagonist.

Changes in femoral vein blood flow velocity by intermittent pneumatic compression: calf compression device versus plantar-calf sequential compression device

Intermittent pneumatic compression has become widely used to prevent deep venous thrombosis potentially causing fatal pulmonary embolism. Although uniform compression has been commonly applied, a new method of sequential compression from plantar to calf has recently been developed. In this report, changes in maximum blood flow velocity in the femoral vein were compared with compression of only the calf uniformly and compression from plantar to calf sequentially in 10 healthy adult volunteers. A compression pressure of 60 mm Hg was applied for 5 min, and the velocity was measured before and after this treatment by ultrasound echography. There was no statistically significant difference in the change in maximum velocity between calf compression and plantar-calf sequential compression. The maximum velocity increased significantly with both compressions. However, plantar-calf sequential compression tended to have a greater effect. Although the results did not demonstrate an advantage of plantar-calf sequential compression compared with calf compression only, if the former compression is applied for a long time, it may have a greater effect.

Changes in hemodynamic and post-flights orthostatic tolerance of cosmonauts under application of the preventive device--thigh cuffs bracelets in short-term flights

SPECIFIC AIMS

to evaluate the influence of the use thigh cuffs "Bracelet" on the hemodynamic adaptation to microgravity during short-term (up to a month) space flights, in-flight tolerance to LBNP-tests and post-flight orthostatic tolerance. 6 cosmonauts applied and 7 others did not apply the occlusive cuffs when on flight. The "Bracelet" device notably relieved the cosmonauts from the subjective discomfort following by the blood redistribution at initial period of exposure to microgravity. It was established that "Bracelet" lessened shifts in central and peripheral hemodynamics typical for exposure to microgravity, venous stasis in the cervical-cephalic region in particular. There were no differences between the hemodynamic reaction on LBNP-test in cosmonauts who applied and not applied "Bracelet" during short-term flights. The objective data are received, that the application of the device during short-term space flight does not make negative effects on post-flight orthostatic tolerance.

Counteracting effect of head-up tilt on increased femoral venous compliance after simulated weightlessness in rabbits

BACKGROUND

The increased femoral venous compliance is one of the factors of orthostatic intolerance after space flight. The purpose of this study was to observe the effect of daily head-up tilt (HUT) on stress-strain relationship of femoral vein during simulated weightlessness in rabbits.

METHODS

Head-down tilt (HDT) 20 degrees rabbit model was used to simulate weightlessness. Twenty-four healthy male New-Zealand rabbits were randomly divided into three groups: simultaneous control, 21 d HDT, and 21 d HDT plus daily 2 h HUT 45 degrees, with 8 in each. Twenty-one days later, stress-strain relationship of femoral vein was examined.

RESULTS

Under the same stress, the circumferential strain both in the 21 d HDT group and the 21 d HDT plus daily 2 h HUT group increased significantly than those in the control group. There were no significant differences between these two groups. There were no significant changes in the longitudinal strain among three groups under the same stress.

CONCLUSIONS

The femoral venous compliance of rabbits increase significantly after 21 days simulated weightlessness. Daily 2 h HUT 45 degrees could not prevent increase of femoral venous compliance in rabbits induced by 21 days simulated weightlessness.

Effects of ankle exercise combined with deep breathing on blood flow velocity in the femoral vein

Ankle exercises are commonly used to facilitate venous return in the lower extremity and to prevent deep vein thrombosis. Moreover, the respiratory cycle affects venous return. This study examined the effects of ankle exercise combined with deep breathing on the blood flow velocity in the femoral vein. Twenty healthy males (mean age 21.3 years), who had no medical history of lower extremity disease, were recruited for this study. The blood flow velocity in the femoral vein was measured while performing four exercise protocols: quiet breathing while resting (QR), deep breathing (DB), ankle exercise with quiet breathing (AQB), and ankle exercising combined with deep breathing (ADB). Using a Doppler ultrasound with an 8 MHz probe, peak blood flow velocities were collected for a 20 second period at the start of the inspiration phase in each protocol, three times. There were statistically significant differences in the peak blood flow velocity in the femoral vein with the four protocols (p lt 0.001). The mean (SD) peak blood flow velocity in the femoral vein was as follows: QR 10.1 (4.2) cm/sec, DB 15.5 (3.9) cm/sec, AQB 20.7 (6.6) cm/sec, and ADB 26.5 (9.4) cm/sec. Post hoc analyses revealed significant differences between each of the four protocols (p(adj) lt 0.01). The mean peak blood flow velocity in the femoral vein was greatest with the ADB protocol, which implies that the ADB protocol may be useful to prevent the blood stasis in patients at risk of deep vein thrombosis.

Increased spillover of norepinephrine to the portal vein during CO-pneumoperitoneum in pigs

BACKGROUND

Elevated intra abdominal pressure (IAP) during CO2-insufflation has been associated with increased catecholamine concentrations in plasma. We have previously indicated that this may be due to a regional increased spillover from the abdominal region. In this experimental study we investigated catecholamine spillover from the drainage area of the portal vein during CO2-pneumoperitoneum.

METHODS

Eight pigs under general anesthesia were investigated before and after CO2-pneumoperitoneum with an IAP of 15 mmHg. Regional spillover of catecholamines was determined by measuring plasma catecholamine concentrations and flow simultaneously. Plasma concentrations of catecholamines were measured from the portal and femoral veins, the pulmonary and carotid arteries. Flow data were collected with laser-Doppler transit time flow probes around the portal and femoral veins. Cardiac output was measured by the thermo-dilution technique. Estimated spillover was calculated by the veno-arterial difference multiplied by flow.

RESULTS

We found a significant increase in estimated spillover of norepinephrine from the drainage area of the portal vein from 10 (-1.2, 78) ng x min(-1) to 27 (1.8, 475) ng x min(-1)[median (range)] (P = 0.05), but no change in estimated spillover of norepinephrine from the drainage area of the femoral vein. Plasma concentrations of norepinephrine increased in central venous and arterial blood. There was no significant change in epinephrine concentrations in arterial blood.

CONCLUSION

Estimated norepinephrine spillover from the drainage area of the portal vein increased during CO2-pneumoperitoneum in pigs. This may indicate that the increased norepinephrine concentrations found in arterial plasma reflects a local activation of sympathetic nerves in the region of the portal drainage area.

Effects of monoamines formed in the cecum of horses on equine digital blood vessels and platelets

OBJECTIVE

To determine in vitro vasoactive potency of monoamines formed in the cecum and found in the systemic circulation of horses.

SAMPLE POPULATION

Segments of digital blood vessels obtained from 6 healthy mixed-breed horses and ponies euthanatized at an abattoir and platelets isolated from 4 healthy ponies.

PROCEDURE

Paired rings of digital artery and vein from the same horse were examined, and isometric tension was recorded. Concentration-response curves for tryptamine (TRP), tyramine (TYR), phenylethylamine (PEA), isoamylamine (IAA), and isobutylamine (IBA) were obtained. Vasoconstrictor mechanisms were investigated for TRP and TYR by the use of antagonists. Washed platelets loaded with [3H]-5-hydroxytryptamine (5-HT) were incubated with monoamines; the amount of radioactivity displaced after 30 minutes was estimated.

RESULTS

TRP, TYR, and PEA were potent constrictors of arteries and veins, with TRP and TYR being more potent in veins than arteries. Constrictions induced by TYR were inhibited by benextramine (alpha-antagonist) and nisoxetine (neuronal-uptake blocker), whereas TRP responses were inhibited by ketanserin (5-HT receptor antagonist). All 5 amines displaced 5-HT from platelets with the order of potency being TYR > TRP > PEA > IAA > IBA.

CONCLUSIONS AND CLINICAL RELEVANCE

Amines from the equine cecum cause digital vasoconstriction. The most potent (TRP and TYR) cause selective venoconstriction. Tyrosine activates predominantly alpha-adrenoceptors through the release of neuronal norepinephrine, whereas TRP activates 5-HT receptors. All amines tested released 5-HT from platelets. Amines formed in the cecum and released into the systemic circulation warrant additional investigation as trigger factors for digital ischemia and subsequent laminitis.

Improved venous return by elliptical, sequential and seamless air-cell compression

AIM

The risk of deep vein thrombosis (DVT) in the peri-operative period is significant, but can be reduced with the use of mechanical intermittent pneumatic compression (IPC). These devices have reached widespread use in hospitals and have been found to be effective prophylactic measures against DVT. This study evaluates the latest design features of one particular IPC device in comparison to current models.

METHODS

Duplex ultrasound scanning was performed on 40 lower extremities of 20 healthy volunteers before and during the application of the IPC device (VenaFlow System, Aircas, NJ, USA. Two hemodynamic parameters were measured, acceleration time from spontaneous baseline venous flow and peak vein velocity. All measurements were obtained by scanning proximal to the saphenofemoral junction in the common femoral vein in both extremities for each subject. Data were obtained from 3 compression cycles and averaged for each extremity. Results were compared with a recent prospective study form our center using a slow-filling and a rapid-filling sequential IPC devices.

RESULTS

The medians for spontaneous average peak velocities at rest of the right and left lower extremities were 26 cm/s and 24.1 cm/s. The median augmented peak velocities during the compression cycle of the device in the right and left side were 79.6 cm/s and 79.0 cm/s. This represented a 306.2% increase in average peak velocity on the right side and a 327.8% increase on the left side. The median acceleration time was 305 ms +/- 40 in the left and 310 ms +/- 50 in the right limb. There was no statistically significant difference in the spontaneous and augmented velocities between the right and left lower extremities in each subject. In comparison to existing slow- and rapid-filling IPC devices the VenaFlow System had superior peak velocities and shorter acceleration times.

CONCLUSION

The use of elliptical, sequential and rapid-filling compression of the leg with overlapping air-cells produces significant hemodynamic changes in the common femoral vein, which are superior to other sequential slow- or rapid-filling IPC devices. Randomized studies should be performed to determine the efficacy of this new device in DVT prevention.