The Effects Of Cuff Width On Hemodynamics In The Legs During Blood Flow Restriction
Scott J. DankelJ. Grant MouserKevin T. MattocksMatthew B. JesseeSamuel L. BucknerTakashi AbeJeremy P. Loenneke
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Abstract:
Blood flow restriction allows individuals to exercise with low loads while producing similar increases in muscle size as high load resistance training. It has been suggested that the pressure should be made relative to the individual (as a percentage of their arterial occlusion pressure), but it remains unknown if a given pressure results in a similar reduction in blood flow, and further, whether this differs based on the width of the cuff being applied. PURPOSE: To examine hemodynamic responses to various relative pressures in the supine position using two commonly used cuffs (10 cm and 12 cm). METHODS: Participants (men=17, women=14) came to the laboratory for two visits. One cuff (10 cm or 12 cm) was randomly applied to the right proximal thigh for each visit and arterial occlusion pressure was measured. Ultrasound measures of blood flow, mean blood velocity, peak blood velocity, and artery diameter were taken from the posterior tibial artery at rest and during the application of 10% increments of the arterial occlusion pressure. A repeated measures ANOVA was used to examine differences across conditions. RESULTS: There was no significant interaction or overall difference between the 10 cm and 12 cm cuff relating to blood flow [-0.501 (7.9) ml•min-1, p = 0.728], mean blood velocity [-0.168 (1.7) cm•sec-1, p = 0.590], peak blood velocity [0.586 (11.7) cm•sec-1, p = 0.783], or artery diameter [0.003 (0.02) cm, p = 0.476]. There was a main effect of pressure for blood flow (p < 0.05), mean blood velocity (p < 0.05), peak blood velocity (p < 0.05), and artery diameter (p < 0.05), with each decreasing with increasing pressures. Peak blood velocity increased until 60% of arterial occlusion pressure before decreasing with increased pressure. The 80% and 90% arterial occlusion pressures reduced blood flow by 69.4% and 79.3% respectively when collapsed across the 10 cm and 12 cm cuffs. No other pressures differed significantly between the relative applied pressure and amount of blood flow restricted. CONCLUSIONS: Provided relative pressures are applied, cuff width appears to have little to no effect on the blood flow response at rest. Importantly, relative pressures may not indicate the magnitude of blood flow being reduced (e.g. 80% arterial occlusion may not reduce 80% of blood flow), particularly at higher arterial occlusion pressures.Keywords:
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The relative value of prone and supine filming in excretory urography was prospectively evaluated in 100 unselected, adult, high-dose urograms. The supine radiographs were superior or equal to prone radiographs in all cases. Significant findings were limited to the supine radiographs in six cases. Findings were seen on both supine and prone radiographs, but the supine radiograph was clearly better in nine cases. Major urinary structures were shown to better advantage on supine films, and the prone film was subject to radiographer error in a higher number of cases.
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1043 Introduction: Prolonged periods of ischemia/reperfusion (I/R) deleteriously affect skeletal muscle performance. However, in animal models, brief bouts of skeletal muscle I/R have been shown to decrease skeletal muscle injury, a phenomenon termed "preconditioning". Purpose: Because there are transient periods of I/R during isometric muscle contractions, the purpose of this study was to examine how short duration forearm occlusion/reperfusion prior to exercise, influenced isometric maximal voluntary contractions (MVC's) in humans. Methods: 11 subjects (6 men and 5 women, mean age 25 ± lyrs) participated in the study. Using a Biodex multijoint ergometer, a protocol of isometric forearm wrist flexion's was utilized to measure MVC's in 2 separate trials. In the first trial, fifteen MVC's of the wrist flexors were performed in 20 second intervals interspersed with 10 seconds of rest. In the second trial, forearm occlusion was induced (2 minutes at 200 mmHg by blood pressure cuff occlusion, with 10 seconds of hyperemia) prior to exercise. Following cuff occlusion, an identical exercise protocol was followed. Results: The total force output over fifteen MVC's was greater following intermittent cuff occlusion (no occlusion; 2619 ± 320 ft.lbs. vs. cuff occlusion; 2986 ± 195 ft.lbs.; P < 0.05). The mean force output per MVC also increased during exercise following intermittent cuff occlusion (no occlusion; 174 ± 21 ft.lbs vs. cuff occlusion; 199 ± 13 ft.lbs; P < 0.05). We found a 3 to 4 fold hyperemic blood flow following 2 minutes of cuff occlusion (with Doppler imaging). Conclusions: These data suggest that brief periods of cuff occlusion/reperfusion may increase MVC force output. Although, further study is needed to fully understand the effects of occlusion/reperfusion on skeletal muscle force output, we hypothesize that in part, this putative effect is secondary to the hyperemic blood flow which follows cuff occlusion.
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To investigate how prone and supine redistribution of a patient's adipose tissue affects the distance from skin to the renal collecting system.There were 48 patients who underwent CT intravenous urography with both supine and prone scans. The distance between skin and the posterior lower pole calix was measured in both positions. The difference was calculated using paired t tests. Subgroup analyses were conducted for patients with a body mass index (BMI) ≥ 28 and BMI ≥ 30.In all patients, the mean distance between skin and the posterior lower pole calix was 9.9 ± 0.3 cm and 8.7 ± 0.3 cm for patients supine and prone, respectively (P < 0.01). Patients with a BMI ≥ 28 had a mean distance of 10.6 ± 0.3 cm and 8.8 ± 0.3 cm in supine and prone positions, respectively (P < 0.01), while patients with BMI ≥ 30 had a mean distance of 11.3 ± 0.3 cm and 9.3 ± 0.3 cm (P < 0.01). Three patients had a BMI > 39 and exhibited differences in skin to the posterior lower pole calix ≥ 3.2 cm between supine and prone positioning. Coefficient of determination analysis for supine minus prone tract length yielded R(2) = 0.70895.The distance between skin and the renal collecting system is decreased in the prone position when compared with the supine position. This difference increases with the patient's BMI and is further accentuated in morbidly obese patients. In these obese patients, the difference when lying prone can exceed >4 cm.
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Introduction Early identification and treatment of diabetic peripheral neuropathy (DPN) are crucial. Presently, the mechanism of DPN is not very clear, and there are inconclusive conclusions about the influencing factors of vascular dynamic characteristics in DPN. This study aims to detect and compare the hemodynamic characteristics of plantar blood vessels in patients with mild DPN and healthy participants to explore a simple and reliable new idea and a potential method for early assessment of DPN and to investigate the influence of gender and age on hemodynamic characteristics. Research design and methods Sixty age-matched and gender-matched patients with mild DPN (30 men and 30 women) and 60 healthy participants were randomly recruited. Color Doppler ultrasound was used to measure and analyze the hemodynamic characteristics of plantar-related vessels. Results Ultrasonic measurements had good test–retest reliability. There may be no statistically significant differences in the blood flow velocity and blood flow in the plantar-related blood vessels of participants, irrespective of their gender and age. For patients with mild DPN, color Doppler ultrasound may indicate early hemodynamic abnormalities when there are no obvious abnormalities in the large arteries of the lower limbs, which are specifically manifested as increased blood flow velocity and blood flow in the distal small vessels. Conclusions Our study provides in vivo data support for the dynamic characteristics of the plantar blood vessel biomechanical model and provides a new idea of in vivo and non-invasive early diagnosis of DPN.
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Background: Several factors are associated with successful treatment of mild to moderate OSA with a mandibular advancement device (MAD). Data about the predictive value of supine-dependent OSA are conflicting. Very little literature is available about the predictive value of the AHI in supine position. Here, we investigate supine dependent OSA and AHI in supine position as predictors of successful treatment with MAD. Methods: From January 1, 2015 until December 31, 2017, patients with OSA with an AHI >5 and <30 receiving an MAD were included. Successful treatment was defined as a decrease of AHI with MAD of at least 50% and AHI <10/hour. Results: 118 patients were included, 78.8% had supine dependent OSA, 21.2% had non-supine dependent OSA. Successful treatment was achieved in 44% of the patients with supine dependent OSA, versus 28% of patients with non-supine dependent OSA, p=0.12. With linear regression, the only independent predictor of success was BMI. No relations were found between success and supine dependent OSA or AHI in supine position. Conclusion: In our cohort, supine dependent and AHI in supine position were not predicting factors for successful treatment of mild to moderate OSA with MAD.
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The present study was performed to evaluate the time course of hemodynamic change in axial and random pattern flaps two-dimensionally. The axial pattern flap, including the central auricular artery and vein, and the random pattern flap without these vessels were created in the auricles of the rabbit. The blood flow of these flaps was investigated and assessed using laserflowgraphy, which provides a two-dimensional analysis of microcirculation. In the axial pattern flap, a gradient of blood flow toward the short axis of the flap and decreased blood flow in the surrounding area were noticed immediately after operation. The hemodynamic changes became less marked with time. In the random pattern flap, a gradient of blood flow toward the long axis of the flap was noticed around 6 hr after operation and the blood flow in the surrounding area increased throughout the investigations.
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The relation between the nystagmus in the supine position and the affected side in patients with horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is studied because nystagmus is frequently observed in the supine position before the patient assumes the supine right-ear-down and left-ear-down positions. Thirty patients with HC-BPPV were examined using electronystagmography (ENG) in the supine, supine right-ear-down and supine left-ear-down positions, and the relation between the direction of nystagmus in the supine position and the affected side was studied. The direction of nystagmus in the supine position was consistent with the affected side in 11 of 18 (61%) patients with cupulolithiasis and in 7 of 12 (58%) patients with canalithiasis. ENG findings in HC-BPPV patients with cupulolithiasis suggested that the cupula is oriented laterally in the HC. Other ENG findings in HC-BPPV patients with canalithiasis suggested that otoconia are located in the medial position of the HC. These findings are helpful to infer the affected side in the patient with HC-BPPV by observation of the nystagmus in the supine position before placing the patient in the supine right/left-ear-positions.
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Objective: To determine the accuracy of supine and prone approaches to sonographically measured kidney dimensions. Methods: The kidney dimensions of 109 participants were sonographically determined in supine and prone patient positions. The two measurements were compared with each other using the intra-class correlation, coefficient of variation for duplicate measurements and Bland-Altman plot. The two sets of measurements were each compared with measurements from computed tomography. Results: There was a very strong agreement between kidney dimensions in supine and prone positions. There was also an agreement between kidney dimensions in supine and prone positions and computed tomography measurements. Conclusion: The kidney dimensions obtained using patient-in-supine position and patient-in-prone position approaches may be equivalent and the two approaches may be used interchangeably.
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