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Nitric oxide signaling mechanisms in the forearm vasculature of pregnant women.

During pregnancy, forearm blood flow and constrictor responses to nitric oxide synthase inhibition are enhanced. Responses to brachial artery infusion of N(G)-monomethyl-L -arginine in pregnant women who have normal resting forearm blood flow and in pregnant women who have norepinephrine-induced reduced forearm blood flow were no different. Mechanisms independent of acute flow effects may account for the enhanced vascular nitric oxide activity during pregnancy.

Blood Flow Velocity↗

Wrist and forearm postures and motions during typing.

Awkward upper extremity postures and repetitive wrist motions have been identified by some studies as risk factors for upper extremity musculoskeletal disorders during keyboard work. However, accurate body postures and joint motions of typists typing on standardized workstations are not known. A laboratory study was conducted to continuously measure wrist and forearm postures and motions of 25 subjects while they typed for 10-15 min at a standard computer workstation adjusted to the subjects' anthropometry. Electrogoniometers continuously recorded wrist and forearm angles. Joint angular velocities and accelerations were calculated from the postural data. The results indicate that wrist and forearm postures during typing were sustained at non-neutral angles; mean wrist extension angle was 23.4 +/- 10.9 degrees on the left and 19.9 +/- 8.6 degrees on the right. Mean ulnar deviation was 14.7 +/- 10.1 degrees on the left and 18.6 +/- 5.8 degrees on the right. More than 73% of subjects typed with the left or right wrist in greater than 15 degrees extension and more than 20% typed with the left or right wrist in greater than 20 degrees ulnar deviation. Joint angles and motions while typing on an adjusted computer workstation were not predictable based on anthropometry or typing speed and varied widely between subjects. Wrist motions are rapid and are similar in magnitude to wrist motions of industrial workers performing jobs having a high risk for developing cumulative trauma disorders. The magnitude of the dynamic components suggests that wrist joint motions may need to be evaluated as a risk factor for musculoskeletal disorders during typing.

Adult↗

The effect of amitriptyline on forearm blood flow.

The local effect of intra-arterial infusion of amitriptyline (AT) on forearm blood flow was studied in seven healthy subjects. AT was infused at rates of 0.05, 0.10, 0.15, and 0.20 mg-min--1 for periods of 5 min. Forearm blood flow showed a dose-dependent increase when the dose exeeded 0.10 mg-min--1. On the highest dose level the blood flow increased on an average by 73%. No systemic effects, as reflected by changes in heart rate, blood pressure, and blood flow in the contralateral forearm, were observed during the infusion. The present data indicate a dilatating effect of AT on resistance vessels possibly mediated by an alpha-adrenergic blockade.

Adult↗

Bone mass measured by photon absorptiometry: comparison of forearm, heel, and spine.

We assessed bone mass quantification at different skeletal sites by single and dual photon absorptiometric (SPA and DPA) methods. Improved DPA measurement of spinal bone mineral density in young healthy subjects showed a short- and long-term precision of 1.2% and 1.6%. Compared to the conventional DPA method the imprecision was reduced by more than 50%. The appendicular measurements were more precise (0.5-1.2%). We present the intercorrelations and predictive errors between peripheral measurements and improved spinal and total body bone measurements in early postmenopausal women (n = 144) recruited in 1988. To compare the improved system with the conventional methods, we retrieved data on age-matched early postmenopausal women (n = 151) recruited in 1983. In the 1988 population all peripheral methods had similar predictive errors in estimation of spinal bone mineral density (SEE = 11-13%) and total body bone mineral density (SEE = 4-5%). Measurement of trabecular bone in the heel and distal forearm did not improve the validity of predicting spinal bone mass. In a cadaver study (n = 11) the predictive error in estimation of the spinal ash weight from forearm measurements was of the same magnitude (15%) as that in estimation of the spinal BMC from the forearm (16%). We conclude that the predictive error in estimation of spinal bone mass from peripheral bone measurements is more likely to be caused by intra-skeletal variation in bone mass than by precision errors. However, this does not reflect the inability of peripheral bone mass measurements to predict fracture risk.

Absorptiometry, Photon↗

The independent effect of ketone bodies on forearm glucose metabolism in normal man.

Ketone bodies and non-esterified fatty acids (NEFA) inhibit insulin stimulated glucose uptake in muscle in-vitro. In man the infusion of ketone bodies lowers plasma NEFA levels thus confounding the interpretation of individual effects. The aim of this study was to examine the effect of ketone bodies on insulin mediated forearm glucose metabolism independent of the changes in the plasma NEFA levels. Seven healthy men received sodium 3-hydroxybutyrate (15 mumol kg-1 min-1) or sodium bicarbonate (control) for 240 min. Heparin (0.2 U kg-1 min-1) and insulin (0.01 U kg-1 h-1) were infused for 90 min (pre-clamp), followed by insulin alone (0.025 U kg-1 h-1) and euglycaemia was maintained (clamp). Plasma NEFA levels and rates of forearm NEFA uptake (+23 +/- 14 and +49 +/- 21 [mean +/- SEM] nmol 100 ml forearm [FA]-1 min-1) were comparable during the pre-clamp periods, and were suppressed equally during hyperinsulinaemia. Sodium 3-hydroxybutyrate infusion raised the blood ketone body levels from 70 +/- 4 mumol/l to a plateau of 450 +/- 30 mumol/l, while control levels declined from baseline (ketone body vs control; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

String vibration dampers do not reduce racket frame vibration transfer to the forearm.

In this study, we examined the effect of string vibration damping devices on reducing racket frame vibration transfer to the forearm. Twenty participants volunteered to hold a tennis racket stationary in a forehand and backhand stroking position while tennis balls were fired at 20 m x s(-1) towards two impact locations, the node of vibration and the dead spot. A three-way analysis of variance with repeated measures on damping condition, impact location and stroke condition was performed on the data. The resonant frequency of the hand-held racket was found to be approximately 120 Hz. No significant differences in amplitude of vibration at the resonant frequency were found for the wrist or the elbow when damped and non-damped impacts were compared. Impacts at the dead spot produced greater amplitudes of vibration (P < 0.01) but no interaction between impact location and string dampers was evident. The string dampers had no effect on the grip force used or the muscle electrical activity in the forearm after impact. In conclusion, we found that string dampers do not reduce the amount of racket frame vibration received at the forearm. We suggest that string dampers remain a popular accessory among tennis players because of their acoustic effects and psychological support rather than any mechanical advantage.

Adult↗

Shooting performance is related to forearm temperature and hand tremor size.

The changes in postural tremor of the hand and the subsequent effect on shooting performance produced by moderate cooling and heating of the forearm were studied in six subjects. Cooling produced a large decrease in tremor size of the ipsilateral hand, whereas warming the limb produced an increase in tremor size. Cooling or warming the forearm did not change the peak frequency of tremor significantly, which was quite stable for each subject. The improvement in shooting performance after cooling the forearm, as measured by grouping pattern of the shots, reached statistical significance and warming caused a significant worsening. This measure of performance was shown to correlate (r = 0.776) inversely with tremor size. The causes and implications of these changes are discussed. It is suggested that local cooling may be useful for people who wish temporarily to reduce tremor in order to improve dexterity for shooting and for other purposes.

Adult↗

Reconstruction of soft tissue defects of the hand using the shape-modified radial forearm flap.

We have reconstructed soft tissue defects in 121 hands with radial forearm flaps. So that the flap perfectly fitted the defect, and to minimise the size of the donor site, we divided the flap into two or three components in each case. We call this the shape-modified radial forearm flap. Of the 118 patients, 113 had complete survival of the flap. The follow-up time was 1 to 15 years. The donor sites were closed primarily in all patients, giving good aesthetic results. The shape-modified radial forearm flap seems to be reliable, and makes it possible to adjust the flap according to the defect. The donor area can be closed primarily in all cases.

Adolescent↗

Laser Doppler perfusion imaging of the radial forearm flap: a clinical study.

Laser Doppler perfusion imaging (LDPI) allows non-invasive assessment of blood flow in a predefined area of skin rather than at one single point. We have used LDPI to study the pattern of skin blood flow in the radial forearm flap before and after the flap has been raised. The data were collected from a consecutive series of 11 patients with cancer of the oral cavity or oropharynx in whom the radial forearm flap had been used during the reconstructive procedure. Reperfusion leads to an immediate hyperaemic response both in the flap and the surrounding skin. This hyperaemia remains for at least the first 30 minutes after reperfusion. The perfusion of the radial side of the forearm skin distal to the flap is significantly lower than that on the ulnar side after the skin island has been raised and the distal artery divided. We suggest that LDPI is useful for monitoring the perfusion of free skin flaps.

Aged↗

Comparison of three computer office workstations offering forearm support: impact on upper limb posture and muscle activation.

The aims of the study were: 1) to determine whether resting the forearms on the work surface, as compared to chair armrests, reduces muscular activation; 2) to compare the sensitivity of different electromyographic (EMG) summary parameters. Eighteen healthy subjects performed computer work (with keyboard and mouse alternately) for 20 min while resting their forearms on a work surface adjustable in height (Workstation A), on the chair's armrests with an adjustable workstation (Workstation B) or on their chair's armrests with a non-adjustable workstation (Workstation C). The EMG amplitude of the trapezius and deltoid muscles was little influenced by the workstations, whereas their EMG variability increased with Workstation A, which was interpreted as a positive effect. However, the EMG amplitude of the mouse-side extensor digitorum muscle was higher with Workstation A. Alternating between resting the forearms on the work surface and on the chairs' armrests could solicit different muscles during computer work, and could be considered as a strategy for preventing musculoskeletal disorders. The new exposure variation analysis summary parameters used were sensitive to small workstation changes, thus supporting their use in future studies.

Adult↗

Prolonged local forearm hyperinsulinemia induces sustained enhancement of nitric oxide-dependent vasodilation in healthy subjects.

Systemic hyperinsulinemia induces enhancement of endothelium-dependent vasodilation of healthy subjects. During systemic infusion of insulin, endothelium-dependent vasodilation may be improved through a decrease in the concentration of free fatty acids. To explore the direct effect of continued insulin on the vascular endothelium, the authors infused insulin in the brachial artery for 4 h and measured the effect on endothelium-dependent vasodilation in the human forearm. Thirty-six experiments were performed in healthy subjects, mean age 47.7 +/- 1.1 years. Endothelium-dependent and -independent vasodilatation was studied during intra-arterial infusion of serotonin and sodium nitroprusside (SNP), respectively. Forearm blood flow was measured by plethysmography. Intra-arterial insulin was infused for 240 min at a constant rate and blood flow was measured hourly during stimulation of endothelium-dependent and -independent vasodilation.N(G)-monomethyl-L-arginine (L-NMMA) was coinfused to test the degree of nitric oxide (NO)-mediated vasodilation. Insulin infusion for 60 min enhanced serotonin-induced vasodilation by 37% compared to vehicle, p = .016. This increase was maintained for 4 h and was blocked by L-NMMA. The SNP response was increased by insulin but the increment was inhibited by L-NMMA. Four hours of local forearm hyperinsulinemia causes a sustained increase in endothelium dependent vasodilation in resistance vessels, which is mediated by NO.

Aged↗

The effect of smoking on endothelial vasodilatory function evaluated by local infusion of metacholine in the forearm is dependent on the duration of smoking.

The objective of the study was to evaluate if endothelial vasodilatory function in the human forearm is impaired by regular cigarette smoking. The setting was a tertiary university hospital. Subjects were 56 apparently healthy subjects from a population screening (mean age 50) and 52 young healthy volunteers (mean age 25) who were investigated regarding endothelial-dependent (EDV) and endothelial-independent vasodilation (EIDV) by means of local infusion of metacholine (MCh; 2 and 4 mg/min) and sodium nitroprusside (SNP; 5 and 10 mg/min) in the forearm. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. The MCh to SNP FBF ratio was denoted the endothelial function index. In the young subjects, no differences between smokers (n = 12) and non-smokers regarding EDV or EIDV were seen. In the population sample, however, the smokers (n = 8) showed an attenuated endothelial function index when compared with non-smokers (1.0 +/- 0.1 vs. 1.3 +/- 0.3, p = .02). The EDV showed a significant inverse relationship to the duration of smoking (r = -0.52, p < .05), independent of age, when the smokers in both groups were analyzed together. A similar, although not significant, relation was found between the endothelial function index and the duration of smoking (p = -.44). The present study showed that endothelial vasodilatory function was impaired in middle-aged, but not young, smokers, suggesting that the duration of smoking is of major importance for the deleterious effects of smoking on endothelial vasodilatory function.

Endothelium↗

Forearm arterial pressure-volume relationships in man.

Pressure-volume (p-V) relationships of a segment of the forearm circulation have been measured in nine male healthy subjects. Forearm volume was measured using electrical impedance plethysmography, arterial transmural pressure by subtracting mean arterial pressure measured contralaterally in a finger from the pressure in a cuff placed over the sensing electrodes of the plethysmograph. A special two-phase measurement waveform was designed with which cuff pressure was first increased step wise to a suprasystolic level and held at that level for 120 s, then ramped down to zero pressure in another 300 s. The step phase inflation allowed us to estimate the parameters of the interstitial liquids and total blood compartments. The total blood compartment amounted to 6.2 ml per 100 ml of tissue. The ramp phase deflation allowed us to discriminate between a first phase in which only the arteries refilled and a second phase in which the veins also distended. An arctangent function was fitted to the first phase arterial p-V relationship, describing it in model form. Total arterial volume per 100 ml of tissue amounted to 3.8 ml at physiological pressures, total arterial compliance of the forearm per centimetre length to 19.5 microliter kPa-1 cm-1 (2.6 microliter mmHg-1 cm-1) at physiological pressures, and to 340 microliter kPa-1 cm-1 (45 microliter mmHg-1 cm-1) maximum compliance at the lower, inflection point pressures. These values are in general agreement with the literature. Pulse wave velocity cannot be computed reliably from these data.

Adult↗

Impairment of lymph drainage in subfascial compartment of forearm in breast cancer-related lymphedema.

BACKGROUND: In arm lymphedema secondary to axillary surgery and radiotherapy (breast cancer-related lymphedema), the swelling is largely epifascial and lymph flow per unit epifascial volume is impaired. The subfascial muscle compartment is not measurably swollen despite the iatrogenic damage to its axillary drainage pathway, but this could be due to its low compliance. Our aim was to test the hypothesis that subfascial lymph drainage too is impaired. METHODS AND RESULTS: Quantitative lymphoscintigraphy was used to measure the removal rate constant (local lymph flow per unit distribution volume) for technetium-99m-human immunoglobulin G injected intramuscularly in the forearms of nine women with unilateral lymphedema. The removal rate constant was on average 31% lower in the ipsilateral swollen forearm than in the contralateral forearm (swollen arm: -0.096+/-0.041% min(-1), contralateral arm: -0.138+/-0.037% min(-1); mean+/-SD, p = 0.037). The decrease in subfascial rate constant correlated strongly with increase in arm volume (r = -0.88, p = 0.002), even though the swelling is mainly epifascial. There was no convincing evidence of dermal backflow. CONCLUSIONS: Lymph flow in the subfascial muscle compartment is decreased in breast cancer-related lymphedema. The correlation between impairment of subfascial drainage and epifascial arm swelling could be because both depend on the severity of axillary damage, or because loss of function in subfascial lymphatics impairs drainage from the epifascial to the subfascial system.

Aged↗

Amino acid levels across normal forearm muscle and splanchnic bed after a protein meal.

To characterize further the role of blood cells in amino acid transport, four normal volunteers were asked to ingest 200 g of broiled ground sirloin within a 10-min period. Blood samples from a radial artery, a deep vein draining forearm muscle bed, and a tributary of the hepatic vein were obtained prior to and for 4 hr after the meal and analyzed for various hormones and substrates. At rest, analysis of arterio-deep venous differences across the forearm revealed the blood cell and plasma amino acid compartmentmental contents to be relatively constant except for alanine and glutamine. Whole blood arterio-hepatic venous (A-HV) amino acid differences were not significantly different from zero; however, blood cell A-HV difference analysis revealed a significant release of threonine from the splanchnic bed while plasma A-HV difference analysis revealed modest but significant releases of glutamate and ornithine and uptakes of phenylalanine and histidine. After the ingestion of the meat meal, plasma and blood cell levels of almost all of the measured amino acids increased significantly. Notable exceptions included glycine and alanine, levels of which did not change significantly and glutamine. The arterial blood cell content of the latter amino acid paradoxically decreased while arterial plasma levels increased significantly. Most importantly, large quantities of branched chain amino acids were released from the splanchnic bed and removed by forearm muscle. These data suggest that the blood cells of normal man do actively participate in amino acid transport, and that the magnitude and direction of change induced by the ingestion of a proteins meal varies with the individual amino acid.

Abdomen↗

Forearm bone mineral density by age in 7,620 men and women: the Tromsø study, a population-based study.

Population-based studies of adult forearm bone mineral density (BMD) by age are scarce, and standardized reference values are lacking. In this cross-sectional study, men aged 55-74 years, women aged 50-74 years, and representative 5-10% samples of remaining age groups between 25 and 84 years living in Tromsø, Norway, were invited for forearm BMD measurement in 1994-1995. The authors measured 3,062 men and 4,558 women (response rate, 78%) by single x-ray absoptiometry at distal and ultradistal forearm sites. Up to age 50, the mean BMD difference was -0.1% per 1-year age group in both sexes. After age 50, the mean BMD difference per 1-year age group was -0.6% in men and -1.3% (distal) and -1.5% (ultradistal) in women. The BMD by age curve was linear for men throughout senescence, but women had a slope change to -0.7% (distal) and -0.8% (ultradistal) per 1-year age group from the 65- to 69-year age group. BMD levels and BMD by age association in the general population (n = 7,620) and in the population without bone-threatening diseases or medication (n = 5,179) were similar. Only longitudinal studies can clarify whether cohort effects or longitudinal BMD development patterns explain these cross-sectional results.

Absorptiometry, Photon↗

Correlates of forearm bone mineral density in young Norwegian women: the Nord-Trøndelag Health Study.

Maximizing attainment of optimal peak bone mineral density (BMD) is a potential osteoporosis prevention strategy. The main objective of this study was to identify correlates of forearm BMD in young adult women. Population-based data derived from standardized questionnaires administered to healthy women aged 19-35 years in Nord-Trøndelag, Norway (n = 963), were collected in 1995-1997. Forearm BMD was assessed by single x-ray absorptiometry. Multiple linear and logistic regression analyses were used to determine correlates of BMD (g/cm(2)) and lowest quintile of BMD, respectively, at the ultradistal and distal sites. The mean age and weight of the cohort were 29.7 years (standard deviation 4.7) and 68.6 kg (standard deviation 12.5), respectively. Age and weight were positively associated with BMD at both forearm sites. When data were controlled for age and weight, later age at menarche and lack of milk consumption were associated with lower BMD values. In both linear models and logistic models, none of the factors vitamin D intake, physical activity, smoking, alcohol consumption, amenorrhea, oral contraceptive use, number of pregnancies, history of breastfeeding, and family history of osteoporosis were found to be significantly associated with BMD. Prior studies have suggested that calcium supplementation in children is useful for optimizing peak BMD. Further studies exploring the relation between lifestyle factors and BMD are warranted to search for ways to maximize attainment of peak BMD.

Adult↗

Forearm hemodynamics at rest and stress in borderline hypertensive adolescents.

Cardiovascular adaptations to mild elevations of blood pressure (BP) may occur early in the development of essential hypertension (EH). We used strain gauge plethysmography to study forearm hemodynamics in adolescents. Ten normotensive males (N) were compared to ten males with borderline hypertension (H). Measurements of forearm blood flow (FBF) were obtained after supine rest, during ten minutes of mental stress (mental arithmetic) and five minutes post stress. Mean arterial pressure (MAP) and forearm vascular resistance (FVR) were calculated. The H maintained higher MAP and FVR (P less than or equal to .05) throughout the study. The vascular response patterns were assessed by comparing the slopes of the linear regression equation FBF = a ln FVR + b (where a = slope and b = intercept). From baseline to stress, the N exhibit a significant change in slope (P less than .05), shifting to a decrease in FVR per unit FBF change. However, the H maintain a constant slope and FVR per unit FBF change remains constant. The study suggests that a primary peripheral vascular abnormality may be present even in the young with marginally elevated BP.

Adolescent↗