Citations

Dietz, Niki M., John R. Halliwill, John M. Spielmann, Lori A. Lawler, Bettina G. Papouchado, Tamara J. Eickhoff, and Michael J. Joyner. Sympathetic withdrawal and forearm vasodilation during vasovagal syncope in humans. J. Appl. Physiol. 82(6): 1785–1793, 1997.—Our aim was to determine whether sympathetic withdrawal alone can account for the profound forearm vasodilation that occurs during syncope in humans. We also determined whether either vasodilating β2-adrenergic receptors or nitric oxide (NO) contributes to this dilation. Forearm blood flow was measured bilaterally in healthy volunteers ( n = 10) by using plethysmography during two bouts of graded lower body negative pressure (LBNP) to syncope. In one forearm, drugs were infused via a brachial artery catheter while the other forearm served as a control. In the control arm, forearm vascular resistance (FVR) increased from 77 ± 7 units at baseline to 191 ± 36 units with −40 mmHg of LBNP ( P < 0.05). Mean arterial pressure fell from 94 ± 2 to 47 ± 4 mmHg just before syncope, and all subjects demonstrated sudden bradycardia at the time of syncope. At the onset of syncope, there was sudden vasodilation and FVR fell to 26 ± 6 units ( P < 0.05 vs. baseline). When the experimental forearm was treated with bretylium, phentolamine, and propranolol, baseline FVR fell to 26 ± 2 units, the vasoconstriction during LBNP was absent, and FVR fell further to 16 ± 1 units at syncope ( P < 0.05 vs. baseline). During the second trial of LBNP, mean arterial pressure again fell to 47 ± 4 mmHg and bradycardia was again observed. Treatment of the experimental forearm with the NO synthase inhibitor NG-monomethyl-l-arginine in addition to bretylium, phentolamine, and propranolol significantly increased baseline FVR to 65 ± 5 units but did not prevent the marked forearm vasodilation during syncope (FVR = 24 ± 4 vs. 29 ± 8 units in the control forearm). These data suggest that the profound vasodilation observed in the human forearm during syncope is not mediated solely by sympathetic withdrawal and also suggest that neither β2-adrenergic-receptor-mediated vasodilation nor NO is essential to observe this response.

Engelke, Keith A., John R. Halliwill, David N. Proctor, Niki M. Dietz, and Michael J. Joyner. Contribution of nitric oxide and prostaglandins to reactive hyperemia in the human forearm. J. Appl. Physiol. 81(4): 1807–1814, 1996.—We investigated the separate and combined contributions of nitric oxide (NO) and vasodilating prostaglandins as mediators of reactive hyperemia in the human forearm. Forearm blood flow (FBF) was measured with venous occlusion plethysmography after 5 min of ischemia. In one protocol ( n = 12), measurements were made before and after intra-arterial administration of the NO synthase inhibitor NG-monomethyl-l-arginine (l-NMMA) to one forearm. In a separate protocol ( n = 7), measurements were made before and after systemic administration of the cyclooxygenase inhibitor ibuprofen and again afterl-NMMA.l-NMMA reduced baseline FBF at rest (2.7 ± 0.4 to 1.6 ± 0.2 ml ⋅ 100 ml−1⋅ min−1; P < 0.05) and had a modest effect on peak forearm vascular conductance and flow (forearm vascular conductance = 31.1 ± 3.1 vs. 25.7 ± 2.5 ml ⋅ min−1⋅ 100 ml forearm−1⋅ 100 mmHg of perfusion pressure−1⋅ min−1, P < 0.05; FBF = 26.6 ± 2.9 vs. 22.8 ± 2.6 ml ⋅ 100 ml−1⋅ min−1, P = 0.055). Total excess flow above baseline during reactive hyperemia was unaffected byl-NMMA (14.3 ± 3.0 vs. 13.1 ± 2.3 ml/100 ml; P < 0.05). Ibuprofen did not change FBF at rest, reduced peak FBF from 27.6 ± 1.9 to 20.3 ± 2.7 ml ⋅ 100 ml−1⋅ min−1( P < 0.05), but had no effect on total excess flow above baseline. Infusion ofl-NMMA after ibuprofen reduced FBF at rest by 40%, had no effect on peak flow, but reduced total excess flow above baseline from 12.0 ± 2.5 to 7.6 ± 1.3 ml/100 ml ( P < 0.05). These data demonstrate that NO synthase inhibition has a modest effect on peak vasodilation during reactive hyperemia but plays a minimal role later. Prostaglandins appear to be important determinants of peak flow. The effects of NO synthase inhibition during reactive hyperemia may also be potentiated by concurrent cyclooxygenase inhibition.

Background/aim To determine if Boys Bantam and Peewee and Girls U14 sustain fewer concussions, head hits, ‘other injuries’ and penalties in hockey tournaments governed by intensified fair play (IFP) than non-intensified fair play (NIFP). Methods A prospective comparison of IFP, a behaviour modification programme that promotes sportsmanship, versus control (non-intensified, NIFP) effects on numbers of diagnosed concussions, head hits without diagnosed concussion (HHWDC), ‘other injuries’, number of penalties and fair play points (FPPs). 1514 players, ages 11–14 years, in 6 IFP (N=950) and 5 NIFP (N=564) tournaments were studied. Results Two diagnosed concussions, four HHWDC, and six ‘other injuries’ occurred in IFP tournaments compared to one concussion, eight HHWDC and five ‘other injuries’ in NIFP. There were significantly fewer HHWDC in IFP than NIFP (p=0.018). However, diagnosed concussions, ‘other injuries’, penalties and FPPs did not differ significantly between conditions. In IFP, a minority of teams forfeited the majority of FPPs. Most diagnosed concussions, HHWDC, and other injuries occurred to Bantam B players and usually in penalised teams that forfeited their FPPs. Conclusions In response to significant differences in HHWDC between IFP and NIFP tournaments, the following considerations are encouraged: mandatory implementation of fair play in regular season and tournaments, empowering tournament directors to not accept heavily penalised teams, and introducing ‘no body checking’ in Bantam.