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PubMed1991

Arm blood flow at rest and during arm exercise.

To test the applicability of a dye-dilution method to quantitate total arm blood flow at rest and during arm exercise, indocyanine green was infused at a constant rate into the brachial artery. Eight subjects performed continuous 30-min arm exercises with an increase in intensity every 10 min (30, 60, and 90 W). The loads corresponded to 29 +/- 1, 48 +/- 2, and 78 +/- 4% (means +/- SE) of the maximal O2 uptake (VO2max 2.13 +/- 0.08 l/min) during arm exercise. VO2max during arm exercise was 61 +/- 1.7% of that during leg exercise. The dye concentration was analyzed in blood samples from three arm veins, two ipsi- and one contralateral, at shoulder level. Corresponding dye concentrations in both ipsilateral veins and a stable concentration difference between ipsi- and contralateral veins were achieved. Total arm blood flow was calculated to be 0.21 +/- 0.04 l/min at rest and 2.43 +/- 0.14 l/min at 90 W. Arm O2 uptake rose from 9 +/- 2 to 323 +/- 21 ml/min. Arm blood flow and O2 uptake each correlated linearly with both work load (r = 0.98) and pulmonary O2 uptake (r greater than or equal to 0.98). Mechanical efficiency for the arm and body was 34-44 and 16-19%, respectively. We conclude that arm blood flow can be determined by continuous infusion of indocyanine green.

Adult↗
PubMed1996

Should we embrace new drugs with open arms? Experience from a community-based, open-arm, randomized clinical trial of combination antiretroviral therapy in advanced HIV disease.

The effect of an open arm in the enrollment to a randomized clinical trial comparing zidovudine (ZDV) plus didanosine (ddI) versus ZDV plus zalcitabine (ddC) was assessed. HIV-infected individuals were eligible to participate in this protocol if they were ddI and ddC naive, had CD4 counts of 50-350/mm3, and were residents of the province of British Columbia. Participating individuals could choose between open-label ZDV/ddI, ZDV/ddC, or randomization to open-label ZDV/ddI or ZDV/ ddC. Study drugs were made available free of charge for all participants through a centralized drug distribution system. There is no other source of these drugs in the province. Primary care physicians were required to renew the patient's prescription every 2 months. Enrollment was initiated in November 1992 and was closed in March 1994 when the randomized arm of the protocol met the predetermined target sample size of 120 evaluable participants. A total of 582 patients received combination therapy in the province through this protocol: 138 (28%) enrolled in the randomized arm and 444 (76%) in the open arm. In the latter group, 320 (72%) were initially prescribed ZDV/ddI and 124 (28%) were prescribed ZDV/ddC. The enrollment rate was strikingly higher in the open arm, with 168 patients enrolled in the first 2 months compared with 138 patients enrolled in the randomized arm over 17 months. Of the 78 study physicians, 69 enrolled patients in the open arm and 23 enrolled patients in the randomized arm of the study. Experienced physicians were more likely to refer patients for randomization (p = 0.025). No statistically significant differences were observed between patients enrolled in either study arm. Our results illustrate the challenge posed to recruitment into clinical trials by the coexistence of an open arm. This is despite the noncoercive, open-label and community-based nature of our randomized protocol and the high priority given to it by a variety of local and national organizations. It is clear that an increased commitment by all interested parties will be required if randomized clinical trials are to be carried out with coexistent open arms.

Adult↗
PubMed2004

Modulation of cutaneous reflexes in human upper limb muscles during arm cycling is independent of activity in the contralateral arm.

The amplitudes and signs of cutaneous reflexes are modulated during rhythmic movements of the arms and legs (during walking and arm or leg cycling for instance). This reflex modulation is frequently independent of the background muscle activity and may involve central pattern generator (CPG) circuits. The purpose of the present study was to investigate the nature and degree of coupling between the upper limbs during arm cycling, with regard to the regulation of cutaneous reflexes. Responses to electrical stimulations of the right, superficial radial nerve (five 1 ms pulses, 300 Hz) were recorded bilaterally in six arm muscles of eight participants during arm cycling involving only the limb ipsilateral to the stimulation, only the limb contralateral to the stimulation, and bilateral movement when the limbs were both in-phase and 180 degrees out of phase. The pattern of cutaneous reflex modulation throughout the arm cycle was independent of the functional state of the limb contralateral to the recording site, irrespective of whether recordings were made ipsilateral or contralateral to the stimulation. Furthermore, cutaneous reflexes were significantly (p<0.05) modulated with arm position in only 8% of cases in which the limb containing the responding muscle was either stationary or being moved passively by the experimenter. The results show that there is relatively weak coupling between the arms with regard to the regulation of cutaneous reflexes during rhythmic, cyclical arm movements. This suggests a loose connection between the CPGs for each arm that regulate muscle activity and reflex amplitude during rhythmic movement.

Adult↗
PubMed2004

Effects of vision and arm position on amplitude of arm postural tremor in patients with multiple sclerosis.

OBJECTIVES: To quantify the effects of vision and arm position on arm postural tremor, comparisons were made between flexed and extended arm positions performed with the eyes open and closed. DESIGN: Case-control study. SETTING: National multiple sclerosis (MS) center in Belgium. PARTICIPANTS: Sixteen patients (32 arms) with MS who had intention tremor and 16 healthy controls (32 arms). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The amplitude of postural tremor was assessed by a magnetic position sensor attached to the index finger. RESULTS: The amplitude of postural tremor was not influenced by changes in visual condition or different arm positions. Both healthy controls and MS patients made more directional changes in the flexed, compared with the extended arm position. CONCLUSIONS: The amplitude of the arm postural tremor in MS is independent of vision and arm position. Selecting 1 arm position is sufficient to assess postural tremor amplitude.

Arm↗
PubMed1997

Effects of arm support on shoulder and arm muscle activity during sedentary work.

The aim of this study was to evaluate different arm supports by comparing the activity of shoulder and arm muscles during various work tasks, with and without the lower arm supported. Twelve female subjects, aged between 23 and 37 years, were asked to perform three types of tasks: typing, simulated assembly work (in two different positions), and pipetting. The supports used were: fixed arm support (FIX), horizontal movable arm support (HOR), and spring-loaded arm support (SLA). During the experiments, the electromyograms (EMG) of four muscles were simultaneously recorded: m. deltoideus anterior and lateralis, m. trapezius pars descendens and m. extensor carpi radialis brevis. Normalization was made against maximum isometric contraction. The mean values of the normalized EMG levels showed a reduced EMG level of the shoulder muscles when using arm supports in all the tasks, and for all muscles but the wrist extensor, compared to the EMG levels without arm supports. The horizontal movable support was more effective in reducing the EMG levels of the shoulder muscles than other arm supports, in tasks at table height. Thus, it is possible to reduce muscle activity of the shoulder region by using arm supports. Further research is needed to make biomechanical calculations to compare the EMG level of these muscles using suspension and the effects of inclination of work task.

Adult↗
PubMed1993

Pulmonary rehabilitation that includes arm exercise reduces metabolic and ventilatory requirements for simple arm elevation.

Simple arm elevation results in increased metabolic and ventilatory requirements in patients with chronic airflow obstruction (CAO). These demands contribute to the dyspnea that is frequently reported when these patients perform activities of daily living involving the arms. We hypothesized that a comprehensive pulmonary rehabilitation (PR) program that includes upper extremity training would lower the ventilatory requirement for arm elevation. Metabolic and ventilatory responses to 2 min of simple arm elevation were studied in 14 patients with CAO before and after PR. Respiratory muscle strength was determined in 11 patients by measurement of maximal transdiaphragmatic pressure (Pdimax). Oxygen uptake (VO2), carbon dioxide production (VCO2), heart rate (HR), minute ventilation (VE), tidal volume (VT), and respiratory rate were measured at rest with the arms down and during 2 min of arm elevation. Before PR, arm elevation led to significant increases in VO2, VCO2, HR, and VE. After PR, pulmonary function, Pdimax, and resting metabolic and ventilatory parameters with the arms down were unchanged; however, during arm elevation, VO2, VCO2, and VE were significantly less than they were before PR. We conclude that a comprehensive PR program that includes upper extremity exercises leads to a reduction in the ventilatory requirement for simple arm elevation. This type of program may allow patients with CAO to perform sustained upper extremity activities with less dyspnea.

Aged↗
PubMed2006

Comparing an experimental agent to a standard agent: relative merits of a one-arm or randomized two-arm Phase II design.

BACKGROUND: Phase II clinical trials in cancer are used to assess whether a new agent has sufficiently promising efficacy to proceed on to a larger definitive study comparing the new agent to a standard agent. PURPOSE: A crucial issue in determining the usefulness of a one-arm design is the uncertainty of the historical response rate of the standard therapy. Therefore, we contrast the usual one-arm design of a Phase II trial with a randomized two-arm design that uses the same number of patients. METHODS: We use simulations and analytical approximations to compare the two designs under a range of realistic values for the historical rate uncertainty and a range of treatment effects. We also extend the simulation model to compare the efficiency of the two designs in settings where multiple Phase II studies are used to make decisions about moving on to a Phase III study. RESULTS: For a one-arm design the probability of correctly identifying an effective experimental agent tends to be at least 0.7 in the cases considered, with the corresponding value for a randomized two-arm design within 0.05-0.10 above or below the one-arm design. An increase in total sample size from 30 patients to 80 patients tends to increase the probability of correctly identifying an effective experiment agent more in the two-arm design than the the one-arm design, particularly when the uncertainty in the historical response rate is large. LIMITATIONS: These results for binary response measures are derived from the specific scenarios and assumptions considered in the simulation study and may not apply to situations outside the range considered. CONCLUSIONS: We find that a one-arm design is preferred for small sample sizes, but a two-arm design may be preferred with larger sample sizes or if the uncertainty in the historical response rates is large.

Antineoplastic Agents↗
PubMed2002

Do psychological variables modify motor recovery among patients with mild arm paresis after stroke or traumatic brain injury who receive the Arm Ability Training?

PURPOSE: The Arm Ability Training improves motor function among stroke and traumatic brain injury patients with mild arm paresis. There is, however, a considerable variability in motor recovery among patients receiving the Arm Ability Training. The study investigated whether psychological variables can explain the variability in motor recovery. METHODS: In a sample of 33 patients receiving the Arm Ability Training both motor performance (by use of the standardised arm function test TEMPA) and cognitive functions (attention, perceptual abilities, and learning) as well as depression were assessed before training was commenced. Both univariate correlational analyses and stepwise multiple regression were used to investigate these variables' ability to predict motor improvement (TEMPA difference scores from pre to post test after 3 weeks). RESULTS: The degree of motor dysfunction of the affected arm explained most (70%) of the variance of motor improvement scores of the standardised arm function test (TEMPA). Psychometric scores showed no or at the most weak associations with motor improvement (explaining at the most 10% of the variance). CONCLUSIONS: Psychological variables had not been critical modifiers of motor recovery among stroke and traumatic brain injury patients with mild arm paresis receiving the Arm Ability Training.

Adolescent↗
PubMed1991

Inactive renin release from the human arm vascular wall during upper arm occlusion: relation to beta-adrenoceptors.

To investigate the extrarenal release of renin, plasma active renin (PAR) and plasma trypsin activatable or inactive renin (PIR) in blood taken simultaneously from bilateral median cubital veins were measured in seven normal men before and after occlusion of the right upper arm with a standard cuff inflated halfway between systolic and diastolic blood pressures for 15 min. After 15 min, both PAR (P less than 0.05) with PIR (P less than 0.01) increased significantly in occluded arms compared with 0 min. PIR rose significantly (P less than 0.01) in occluded arms compared with controls at 15 min, but PAR was unchanged. The same studies were repeated after pretreatment with oral doses of either 1 mg prazosin or 10 mg propranolol at 1600 h and 2400 h on the previous day and 1 hour before the experiment. After prazosin, both PAR (P less than 0.05) and PIR (P less than 0.01) in occluded arms increased significantly at 15 min compared with those at 0 min and PIR rose significantly (P less than 0.01) in occluded arms compared with controls at 15 min, as observed in the control studies. On the other hand, after propranolol, the significant increment of PAR in the occluded arms was abolished. Moreover, the significant difference of PIR between the occluded and the control arms at 15 min was also abolished. These results indicate that inactive renin may be present in the vascular wall of the arm and released into circulation by a stimulus such as arm occlusion by mechanisms related to beta-adrenoceptors.

Administration, Oral↗
PubMed1998

Cellular and molecular mechanisms of arm regeneration in crinoid echinoderms: the potential of arm explants.

Crinoid echinoderms can provide a valuable experimental model for studying all aspects of regenerative processes from molecular to macroscopic level. Recently we carried out a detailed study into the overall process of arm regeneration in the crinoid Antedon mediterranea and provided an interpretation of its basic mechanisms. However, the problem of the subsequent fate of the amputated arm segment (explant) once isolated from the animal body and of its possible regenerative potential have never been investigated before. The arm explant in fact represents a simplified and controlled regenerating system which may be very useful in regeneration experiments by providing a valuable test of our hypotheses in terms of mechanisms and processes. In the present study we carried out a comprehensive analysis of double-amputated arm explants (i.e. explants reamputated at their distal end immediately after the first proximal amputation) subjected to the same experimental conditions as the regenerating donor animals. Our results showed that the explants undergo similar regenerative processes but with some significant differences to those mechanisms described for normal regenerating arms. For example, whilst the proximal-distal axis of arm growth is maintained, there are differences in terms of the recruitment of cells which contribute to the regenerating tissue. As with normal regenerating arms, the present work focuses on (1) timing and modality of regeneration in the explant; (2) proliferation, migration and contribution of undifferentiated and/or dedifferentiated/transdifferentiated cells; (3) putative role of neural growth factors. These problems were addressed by employing a combination of conventional microscopy and immunocytochemistry. Comparison between arm explants and regenerating arms of normal donor adults indicates an extraordinary potential and regenerative autonomy of crinoid tissues and the cellular plasticity of the phenomenon.

Animals↗
PubMed1996

Inner dynein arms but not outer dynein arms require the activity of kinesin homologue protein KHP1(FLA10) to reach the distal part of flagella in Chlamydomonas.

Inner dynein arms, but not outer dynein arms, require the activity of KHP1(FLA10) to reach the distal part of axonemes before binding to outer doublet microtubules. We have analyzed the rescue of inner or outer dynein arms in quadriflagellate dikaryons by immunofluorescence microscopy of p28(IDA4), an inner dynein arm light chain, or IC69(ODA6), an outer dynein arm intermediate chain. In dikaryons two strains with different genetic backgrounds share the cytoplasm. As a consequence, wild-type axonemal precursors are transported to and assembled in mutant axonemes to complement the defects. The rescue of inner dynein arms containing p28 in ida4-wild-type dikaryons progressively occurred from the distal part of the axonemes and with time was extended towards the proximal part. In contrast, the rescue of outer dynein arms in oda2-wild-type dikaryons progressively occurred along the entire length of the axoneme. Rescue of inner dynein arms containing p28 in ida4fla10-fla10 dikaryons was similar to the rescue observed in ida4-wild-type dikaryons at 21 degrees C, whereas it was inhibited at 32 degrees C, a nonpermissive temperature for KHP1(FLA10). In contrast, rescue of outer dynein arms in oda2fla10-fla10 dikaryons was similar to the rescue observed in oda2-wild-type dikaryons at both 21 degrees and 32 degrees C and was not inhibited at 32 degrees C. Positioning of substructures in the internal part of the axonemal shaft requires the activity of kinesin homologue protein 1.

Algal Proteins↗
PubMed1993

Supported arm exercise vs unsupported arm exercise in the rehabilitation of patients with severe chronic airflow obstruction.

OBJECTIVE: Compare unsupported (UAEx) vs supported (SAEx) arm exercise in training of patients with severe chronic airflow obstruction (CAO). DESIGN: Randomized trial of UAEx vs SAEx training added to a 10-week outpatient program of lower extremity (LE) exercise training, respiratory muscle training, breathing retraining, psychological support, and teaching. SETTING: The Lahey Clinic Medical Center, a tertiary referral center. PATIENTS: Forty patients with CAO entered the rehabilitation program with 32 completing training and testing. INTERVENTIONS: All underwent progressive bicycle ergometer and treadmill training and respiratory muscle training using a threshold inspiratory pressure trainer. Patients were randomized to progressive SAEx training (arm cycle ergometer, n = 17) or UAEx training (raising weighted dowel, n = 18). MAIN OUTCOME MEASURES AND RESULTS: There was no significant difference in disease severity or exercise capacity between the two groups. Twelve-min walk test, bicycle ergometer power output, and respiratory muscle function improved with no significant difference in improvement between the two groups. Both groups showed similar improvements in arm ergometer testing while those trained with UAEx showed greater improvement in dowel testing (UAEx > SAEx, p = 0.002). In 17 patients VO2isotime (time at which patient performed pre-training and post-training tests) was measured during dowel testing. Only those trained with UAEx showed decreases in VO2isotime (UAEx trained, p = 0.02; SAEx, p = 0.18). VO2 during the last minute of a 2-min period of simple arm elevation was also measured in 17 patients. Only those trained with UAEx showed decreases in VO2 (UAEx, p = 0.02; SAEx, p = 0.20). CONCLUSION: We confirm that a pulmonary rehabilitation program incorporating exercise training improves LE and respiratory muscle function. Arm exercise training improved arm activity with greater increases in unsupported arm activity seen in those trained with unsupported arm training. Metabolic cost of UAEx decreased only in those trained with UAEx. As UAEx is typical of activities of daily living in patients with CAO, the changes seen with UAEx training may be of greater clinical significance. Arm training should be incorporated in exercise training and a simple program of UAEx appears the optimal format.

Adult↗
PubMed2002

Arm mechanical efficiency and arm exercise capacity are relatively preserved in chronic obstructive pulmonary disease.

PURPOSE: Previous studies indicate that energy expenditure related to physical activity is enhanced and that mechanical efficiency of leg exercise is reduced in patients with chronic obstructive pulmonary disease (COPD). However, it is yet unclear whether an inefficient energy expenditure is also present during other activities in COPD. This study was carried out to examine arm efficiency and peak arm exercise performance relative to leg exercise in 33 (23 male) patients with COPD ((mean +/- SEM) age: 61 +/- 2 yr; FEV : 40 +/- 2% of predicted) and 20 sex- and age-matched healthy controls. METHODS: Body composition, pulmonary function, resting energy expenditure (REE), and peak leg and arm exercise performance were determined. To calculate mechanical efficiency, subjects performed submaximal leg and arm ergometry at 50% of achieved peak loads. During exercise testing, metabolic and ventilatory parameters were measured. RESULTS: In contrast to a reduced leg mechanical efficiency in patients compared with controls (15.6 +/- 0.6% and 22.5 +/- 0.6%, respectively; < 0.001), arm mechanical efficiency was comparable in both groups (COPD: 18.3 +/- 0.9%, controls: 21.0 +/- 1.2%; NS). Arm efficiency was not related to leg efficiency, pulmonary function, work of breathing, or REE. Also, arm exercise capacity was relatively preserved in patients with COPD (ratio arm peak work rate/leg peak work rate in patients: 89% vs 53% in controls; < 0.001). CONCLUSION: Mechanical efficiency and exercise capacity of the upper and lower limbs are not homogeneously affected in COPD, with a relative preservation of the upper limbs. This may have implications for screening of exercise tolerance and prescription of training interventions in patients with COPD. Future studies need to elucidate the mechanism behind this observation.

Arm↗
PubMedDate not supplied

Arm training reduces the VO2 and VE cost of unsupported arm exercise and elevation in chronic obstructive pulmonary disease.

BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) may develop dyspnea with minimal arm activity, thoracoabdominal dyssynchrony with unsupported arm exercise (UAEX) and increased oxygen uptake (VO2), and minute ventilation (VE) with simple unsupported arm elevation (UAE) and UAEX. We investigated whether unsupported arm training, as the only form of exercise, could decrease the VO2 and VE cost (percentage increase from resting baseline) associated with unsupported arm elevation and exercise, respectively. METHODS: Twenty-six patients with severe COPD were randomized to 21-24 sessions of unsupported arm (ARMT) or low-intensity resistive breathing (RBT) training as the only form of exercise. Patients were studied before and after training using a metabolic cart and esophageal and gastric pressures to evaluate metabolic and respiratory muscle function. RESULTS: After ARMT, the VO2 (58% vs 38% increase, P < 0.05) and VE (41% v. 21% increase, P < 0.05) cost for UAEX at exercise isotime decreased and endurance time increased. Similarly the VO2 (25% vs 18% increase, P < 0.05) cost decreased and VE no longer increased in response to 2 minutes of UAE after ARMT. The RBT group showed no such change. No improvement in ventilatory load or respiratory muscle function could be identified to explain the physiologic changes observed. After ARMT, mean inspiratory flow (VT/TL), a measure of central respiratory drive, was reduced during UAEX and the expected increase during UAE did not occur. CONCLUSION: We conclude that arm training reduces the VO2 and VE cost of UAE and UAEX, possibly through improved synchronization and coordination of accessory muscle action during unsupported arm activity.

Aged↗
PubMed2003

Effect of standard cuff on blood pressure readings in patients with obese arms. How frequent are arms of a 'large circumference'?

OBJECTIVE: To measure the effect on blood pressure readings when a standard cuff is used on patients with arms of a large circumference, and to determine the frequency of arms of a large circumference. SUBJECTS: Blood pressures were taken in 120 subjects with an arm circumference greater than 33 cm. Also, the arm circumference was determined in 244 patients from a family health unit, and in 216 patients from a hypertension clinic. METHOD: A mercury sphygmomanometer and two different cuff sizes were used in a random sequence; therefore, 60 patients' blood pressure were first measured with a large cuff, followed by a standard cuff; the opposite sequence was then applied for another 60 patients. With the obtained values and using a regression analysis, the difference in blood pressure overestimation was calculated. Arm circumference measurement percentages were used to determine the frequency of arms of a large circumference. RESULTS: Both systolic and diastolic blood pressures were significantly greater when the standard cuff was used. For every 5 cm increase in arm circumference, starting at 35 cm, a 2-5 mmHg increase in systolic blood pressure, and a 1-3 mmHg increase in diastolic blood pressure was observed. The prevalence of arms with a large circumference in the family medicine unit and hypertension clinic was 42% and 41.8%, respectively. CONCLUSIONS: There is an overestimation of blood pressure when a standard cuff is used in obese subjects. The high prevalence of these individuals in our environment, both in the hypertensive and normotensive population, makes it necessary to have on hand different sizes of cuffs for taking blood pressure in order to avoid incorrect decisions.

Adult↗
PubMed1975

Limitations to maximum oxygen uptake in arms, leg, and combined arm-leg ergometry.

Our purpose was to study the effect of arm, leg, and combined arm-leg ergometry on the oxygen uptake (Vo2), cardiac output (Q), ventilation, and anaerobic threshold (AT) of three healthy men. At submaximum work intensities, Vo2 was not significantly different in the three tasks, but differences were observed for heart rate, ventilation, and Q. The AT was reached at progressively higher work rates in arm, leg and combined arm-leg ergometry, respectively. The Vo2 max in arm ergometry averaged 68 percent of the Vo2max in leg ergometry and 60 percent of Vo2 max in combined arm-leg ergometry. Two subjects with Vo2max's less than 45 ml/kg-min had a mean Vo2max in combined arm-leg ergometry 19 per cent higher than in leg ergometry. A third subject, with a Vo2max greater than 50 ml/kg-min, showed no change. Differences in Vo2max were primarily due to the differences in Q. Skeletal muscle blood flow appears to be a critical factor in the limitation of Vo2max in arm or leg ergometry.

Adult↗
PubMed1976

Spontaneous alternation of the working arm in one-arm cranking.

One-arm cranking was done by ten healthy male adults at an oxygen intake level of about 1.0 liter/min. Each subject performed two kinds of cranking at a speed of 60 rpm: forced cranking using only one arm continuously for 15 min and free cranking for 30 min with the instructions to alternate from one arm to the other whenever fatigue set in. The results, excluding those of a subject who changed arms very frequently, were analyzed. In forced cranking, oxygen intake and heart rate steadily increased, the average time of appearance of local fatigue being 161 sec for the stronger arm and 122 sec for the weaker one. In free cranking, the working arm was changed 6 to 23 times during the 30-minute period, while oxygen intake and heart rate increased with fluctuations. The mean duration interval was 175 sec with the stronger arm and 123 sec with the weaker one. The mean interval of arm alternation was positively correlated with the individual time of onset of the sensation of local rigidness during forced cranking, but not with the individual time of initiation of respiratory distress. It is suggested that alternation of active muscles in moderately dynamic work may be linked with an early stage of local fatigue which is different from that of static work.

Adult↗