Cold Water Immersion Test Research Articles

Influence of acute beetroot juice supplementation on cold-induced vasodilation and fingertip rewarming.

Vasoactive ingredients in beetroot (BR) such as nitrate are known to induce vasodilation in temperate conditions. This study investigated the effect of BR ingestion on cold induced vasodilation (CIVD) and rewarming of finger skin temperature (Tfing) during and after hand immersion in cold water. Twenty healthy males (mean ± SD; age 22.2 ± 0.7 years, height 172.6 ± 6.0cm, body mass 61.3 ± 11.7kg) repeated a hand cold water immersion test twice with prior BR or water beverage ingestion (randomised order). They rested for 2h in thermoneutral conditions (27°C, 40% relative humidity) after consuming the beverage, then immersed their non-dominant hand in 8°C water for 30min. They then rewarmed their hand in the ambient air for 20min. Skin temperature at seven body sites, Tfing, finger skin blood flow (SkBFfing), and blood pressure were measured. During hand immersion parameters of CIVD (Tfing and SkBFfing) were not different between BR and water conditions although skin temperature gradient from proximal to distal body sites was significantly smaller with BR (P < 0.05). During rewarming, SkBFfing and cutaneous vascular conductance were significantly higher with BR than with water (P < 0.05). The rewarming speed in Tfing and SkBFfing was significantly faster with BR at 15- (BR 1.24 ± 0.22 vs water 1.11 ± 0.26°C/min) and 20-min rewarming (P < 0.05). Additionally, individuals with slower rewarming speed with water demonstrated accelerated rewarming with BR supplementation. BR accelerated rewarming in Tfing and SkBFfing after local cold stimulus, whereas, CIVD response during hand cold immersion was not affected by BR ingestion.

Ischemic Preconditioning: Modulating Pain Sensitivity and Exercise Performance.

Purpose The purpose of this study was to examine whether an individual’s IPC-mediated change in cold pain sensitivity is associated with the same individual’s IPC-mediated change in exercise performance.Methods Thirteen individuals (8 males; 5 females, 27 ± 7 years, 55 ± 5 ml.kgs–1.min–1) underwent two separate cold-water immersion tests: with preceding IPC treatment and without. In addition, each participant undertook two separate 5-km cycling time trials: with preceding IPC treatment and without. Pearson correlation coefficients were used to assess the relationship between an individual’s change in cold-water pain sensitivity following IPC with their change in 5-km time trial performance following IPC.Results During the cold-water immersion test, pain intensity increased over time (p < 0.001) but did not change with IPC (p = 0.96). However, IPC significantly reduced the total time spent under pain (−9 ± 7 s; p = 0.001) during the cold-water immersion test. No relationship was found between an individual’s change in time under pain (r = −0.2, p = 0.6) or pain intensity (r = −0.3, p = 0.3) following IPC and their change in performance following IPC.Conclusion These findings suggest that IPC can modulate sensitivity to a painful stimulus, but this altered sensitivity does not explain the ergogenic efficacy of IPC on 5-km cycling performance.

Influence of compounding conditions, treatment of wood particles with fire-retardants and artificial weathering on properties of wood-polymer composites for fa\xe7ade applications

Various fire-retardants (FR) for the pre-treatment of wood flour, for example, ammonium polyphosphate and different formulations based on phosphorus- and nitrogen-compounds, as well as for application during compounding were tested for their effectiveness in injection-molded and extruded composites based on high-density polyethylene and polypropylene. Small-scale tests for flammability of polymeric materials and for determination of the limiting oxygen index were used to characterize the composite materials. Differences pertaining to the applied compounding conditions, i.e., underwater granulation versus air granulation, were determined. The amount of phosphorus leached from FR during underwater granulation was analyzed. Artificial weathering trials were performed and reaction-to-fire performance and color changes of FR-composites were evaluated. Tensile strength properties of the composites and results for cold water immersion tests are also reported. An optimized formulation based on pre-treated wood flour was developed and extruded into façade profiles for the single burning item test according to DIN EN 13823. The test showed that classification C-s3, d0 according to DIN EN 13501-1 can be achieved if pre-treated wood flour is used. The use of untreated wood flour leads to a lower classification (D-s2, d0). Fire performance of extruded façade profiles can be improved by the use of pre-treated wood flour and enables new applications in the building sector.

Finger- and toe-temperature responses to local cooling and rewarming have limited predictive value identifying susceptibility to local cold injury-a cohort study in military cadets

The purpose was to evaluate whether a cold-water immersion test could be used to identify individuals susceptible to local cold injuries (LCI). Sixty-five healthy non-injured (N–I) subjects, and fifteen subjects, who were tested either prior to or after a LCI, sequentially immersed one hand and one foot, in 8 °C water for 30 min (CWI phase); this was followed by 15 min of spontaneous rewarming (RW phase). The LCI group showed a lower toe temperature during the CWI phase, and a lower maximum RW temperature of the fingers than the N–I group. However, digit temperatures during the CWI and RW phases exhibited low predictive values for LCI, e.g. results implied that to identify 80% of the LCI subjects, 34–78% of the N–I subjects would also be excluded. Thus, the results suggest that, in practice, hand or foot cold-water immersion tests cannot be used to identify individuals at high risk of LCI.

Ski-Everest (8848 m) Expedition: Digit Skin Temperature Responses to Cold Immersion May Reflect Susceptibility to Cold Injury

We tested the hypothesis that individual susceptibility to freezing cold injury might be reflected in an attenuated cold-induced vasodilatation (CIVD) response by comparing the CIVD responses of an elite alpinist with a history of freezing cold injury in the feet (case alpinist) with those of an age- and ability- matched noninjured alpinists control group (controls). According to this hypothesis, the vasomotor responses to a CIVD test of the case alpinist would represent a pathophysiological response when compared with the normal physiological response of a noninjured cohort. The case alpinist and the controls in the cohort group conducted a cold water immersion test comprising sequential immersion of a hand and foot for 5 min in 35°C water, followed by a 30-min immersion in 8°C water and a 10-min recovery period in room air. During this test we monitored the finger and toe skin temperatures. The case alpinist had a significantly attenuated CIVD response and a lower skin temperature in all injured and noninjured digits during immersion (∼2°C lower than in the control group) and an attenuated recovery of finger skin temperatures (∼6°C lower than in the control group). The attenuated CIVD response of the case alpinist may reflect a previously unrecognized enhanced susceptibility to frostbite. In addition to the poor vasomotor response observed in the injured toes, he also exhibited a poor vasomotor response in his noninjured fingers. The results of the present study indicate that a test of vasomotor activity during thermal stress may identify individuals predisposed to cold injury.

Cold water immersion test (10°C, 10min) for diagnosing vibration-induced white finger among a group of polishers in a subtropical environment.

This study aimed to investigate whether the finger skin temperature (FST) after cold provocation (10°C, 10min) is as a useful indicator for assisting in the diagnosis of vibration-induced white finger (VWF) in a group of polishers in a subtropical environment. Ninety male vibration-exposed metal polishers (30 patients and 60 controls) from the Guangdong Province in Southern China were recruited. The FSTs at 30, 20, 10, and 0min before cold water immersion (FSTpre-30, FSTpre-20, FSTpre-10, and FSTbaseline) and 0, 5, 10, 15, 20, 25, and 30min after immersion (FST0, FST5, FST10, FST15, FST20, FST25, and FST30) were measured on the index, middle, and ring fingers of both hands. During the first 20-min adaptation period, there was a significant increase in FST in three fingers on both hands in the two groups. In contrast, there were no significant differences between FSTpre-10 and FSTbaseline. Furthermore, FSTpre-30, FSTpre-20, FSTpre-10, and FSTbaseline of the three fingers in both hands did not differ significantly. During recovery, the indicators FST5-0, FST10-0, R5, and R10 for the index finger of the left hand in patients were lower than for the controls. Among the various indicators, the absolute recovery rate, FST5-0, at 5min after immersion was identified as the best diagnosis indicator with a sensitivity of 76.7% and specificity of 70.0% when applied to the index finger of the left hand. The cold water immersion test as applied in a subtropical environment can have a fair discriminating ability for diagnosing VWF.

Koroška 8000 Himalayan expedition: digit responses to cold stress following ascent to Broadpeak (Pakistan, 8051m).

Cold-induced vasodilatation (CIVD) is a peripheral blood flow response, observed in both the hands and feet. Exercise has been shown to enhance the response, specifically by increasing mean skin temperatures (Tsk), in part due to the increased number of CIVD waves. In contrast, hypobaric hypoxia has been suggested to impair digit skin temperature responses, particularly during subsequent hand rewarming following the cold stimulus. This study examined the combined effect of exercise and hypobaric hypoxia on the CIVD response. We compared the CIVD responses in the digits of both the hands and feet of a team of alpinists (N = 5) before and after a 35-day Himalayan expedition to Broadpeak, Pakistan (8051m). Five elite alpinists participated in hand and foot cold water immersion tests 20 days before and immediately upon return from their expedition. The alpinists summited successfully without supplemental oxygen. Post-expedition, all alpinists demonstrated higher minimum Tsk in their hands (pre: 9.9 ± 1.1, post: 10.1 ± 0.7°C, p = 0.031). Four alpinists had either greater CIVD waves, and, consequently, higher mean Tsk in their hands, or higher recovery temperatures (pre: 26.0 ± 5.5°C post: 31.0 ± 4.1°C, p = 0.052), or faster rewarming rate (pre: 2.6 ± 0.5°Cmin-1 post: 3.1 ± 0.4°Cmin-1,p = 0.052). In the feet, the responses varied: 1/5 had higher wave amplitudes and 1/5 had higher passive recovery temperatures, whereas 3/5 had lower mean toe temperatures during cold exposure. The results of the cold stress test suggest after a 35-day Himalayan expedition, alpinists experienced a slight cold adaptation of the hands, but not the feet.

Prediction of persistent post-surgery pain by preoperative cold pain sensitivity: biomarker development with machine-learning-derived analysis

BackgroundTo prevent persistent post-surgery pain, early identification of patients at high risk is a clinical need. Supervised machine-learning techniques were used to test how accurately the patients’ performance in a preoperatively performed tonic cold pain test could predict persistent post-surgery pain. MethodsWe analysed 763 patients from a cohort of 900 women who were treated for breast cancer, of whom 61 patients had developed signs of persistent pain during three yr of follow-up. Preoperatively, all patients underwent a cold pain test (immersion of the hand into a water bath at 2–4 °C). The patients rated the pain intensity using a numerical ratings scale (NRS) from 0 to 10. Supervised machine-learning techniques were used to construct a classifier that could predict patients at risk of persistent pain. ResultsWhether or not a patient rated the pain intensity at NRS=10 within less than 45 s during the cold water immersion test provided a negative predictive value of 94.4% to assign a patient to the “persistent pain” group. If NRS=10 was never reached during the cold test, the predictive value for not developing persistent pain was almost 97%. However, a low negative predictive value of 10% implied a high false positive rate. ConclusionsResults provide a robust exclusion of persistent pain in women with an accuracy of 94.4%. Moreover, results provide further support for the hypothesis that the endogenous pain inhibitory system may play an important role in the process of pain becoming persistent.

A 10-day confinement to normobaric hypoxia impairs toe, but not finger temperature response during local cold stress

The study examined the effects of a 10-day normobaric hypoxic confinement on the finger and toe temperature responses to local cooling. Eight male lowlanders underwent a normoxic (NC) and, in a separate occasion, a normobaric hypoxic confinement (HC; FO2: 0.154; simulated altitude ~3400m). Before and after each confinement, subjects immersed for 30min their right hand and, in a different session, their right foot in 8°C water, while breathing either room air (AIR) or a hypoxic gas mixture (HYPO). Throughout the cold-water immersion tests, thermal responses were monitored with thermocouples on fingers and toes. Neither confinement influenced thermal responses in the fingers during the AIR or HYPO test. In the foot, by contrast, HC, but not NC, reduced the average toe temperature by ~1.5°C (p=0.03), both during the AIR and HYPO test. We therefore conclude that a 10-day confinement to normobaric hypoxia per se augments cold-induced vasoconstriction in the toes, but not in the fingers. The mechanism underlying this dissimilarity remains to be established.

Laser acupuncture attenuates oxaliplatin-induced peripheral neuropathy in patients with gastrointestinal cancer: a pilot prospective cohort study.

Oxaliplatin is a platinum compound that is widely used in the treatment of some solid tumours. Oxaliplatin-induced peripheral neuropathy (OIPN) in the upper and lower extremities is the major adverse side effect and represents the main dose-limiting factor of this drug. The aim of this single-arm study was to evaluate the feasibility and effects of laser acupuncture (LA) in the treatment of OIPN in patients with advanced gastrointestinal cancers. 17 gastrointestinal cancer survivors (14 colorectal and 3 gastric cancers), who had been treated with oxaliplatin-based chemotherapies, were recruited. Low-level laser stimulation (50 mW) bilaterally at PC6, PC7, PC8, P9, LU11, SP6, KI3, BL60, KI1, and KI2 was administered for 20 min/point for 12 sessions over 4 weeks. The pain quality assessment scale (PQAS), chemotherapy-induced neurotoxicity questionnaire (CINQ), oxaliplatin-specific neurotoxicity scale (OSNS), quantitative touch-detection threshold (using von Frey filaments), and cold-triggered pain withdrawal latency (using the cold-water immersion test) were measured before and after completion of the 12 treatment sessions. PQAS, CINQ, and OSNS scores, as well as touch-detection threshold and cold-trigger pain withdrawal latency all improved significantly after LA in the cancer patients with OIPN (p<0.05). LA significantly relieved both oxaliplatin-induced cold and mechanical allodynia and also decreased the incidence and severity of neurotoxicity symptoms in the patients' upper and lower extremities and impact on their daily activities (all p<0.05). Following treatment with LA, neurotoxicity symptoms were significantly improved in cancer patients with OIPN. Further randomised controlled trials are needed to evaluate the role of LA as a therapeutic option in the management of OIPN.

Evaluation of Peripheral Vascular Impairment in the Fingers of Baseball Players

PURPOSE: Digital vessel trauma from repetitive impact on the fingers and hand is a concern for baseball players (BPs). Laser-Doppler blood perfusion imaging (LDPI) is a technique that employs two-dimensional horizontal scanning of the blood flow in a specific tissue, without the necessity for surface contact. The LDPI method may have the benefit of detecting vasospastic abnormalities and occlusion of the digital arteries, which generally appears as an inhomogeneous reaction to the cold. This study used LDPI to investigate whether the changes in finger skin blood flow that occurred in response to a cold water immersion test depended on the position of BPs. METHODS: The study included 57 male university BPs, aged 20 ± 1 years, who play at 3 different positions. From this study subject group, there were: 18 pitchers, 23 infielders (InF), and 16 outfielders (OtF). A cold provocation test was carried out by immersing a subject’s catching hand into cold water (10°C) for 10 min. Repeated image scanning of skin blood flow on the palm was performed every 2 min before, during, and after cold water immersion, by using LDPI. The mean blood perfusion values in the index finger area were calculated on each color-coded image. A numerical perfusion reading was also obtained for each measurement site in terms of the voltage (V). From the perfusion reading and the mean blood pressure, we calculated the cutaneous vascular conductance (CVC). The finger skin temperature was recorded by using an electrode thermistor attached to the skin on the dorsal side of the index finger. RESULTS: CVC values of the InF were significantly lower compared with those of the OtF at pre-immersion (2.4 ± 0.6 V/mmHg vs. 3.3 ± 1.0 V/mmHg, p < 0.01) and at early post-immersion (1.2 ± 0.4 V/mmHg vs. 1.5 ± 0.5 V/mmHg, p < 0.05). However, the index finger skin temperature did not significantly differ among the different player positions at any measurement point. CONCLUSIONS: These findings suggest that the changes in finger skin blood flow that occurred in response to cold water immersion, as measured by using LDPI, were dependent on the position of the BP. Repetitive trauma caused by the impact of a baseball also leads to peripheral vascular impairment in the index finger on the gloved hand of InF. Therefore, this method can be used for the assessment of peripheral circulatory function in BPs.

Acute Hypobaric Hypoxia Effects on Finger Temperature During and After Local Cold Exposure.

Mountain environments have combined stressors of lower ambient temperature and hypoxia. Cold alone can reduce finger temperature, resulting in discomfort, impaired dexterity, and increased risk of cold injury. Whether hypobaric hypoxia exacerbates these effects is unclear. To examine this, finger temperature responses to two cold water immersion tests were measured at sea level (SL, 99 kPa), 3000 m (70 kPa), and 4675 m (56 kPa) at the same air temperature (22°-23°C). Nine males sat quietly for 30 min, then completed the tests in balanced order. For the cold-induced vasodilation (CIVD) test, middle finger pad temperature was measured during immersion in 4°C water for 30 min. For the Rewarming test, finger temperature was measured for 30 min following a 5 min hand immersion in 16°C water. Average oxygen saturation was 98.6% during SL, 90.7% at 3000 m, and 75.8% at 4657 m. Mean finger temperature during the CIVD test (7.1°C) was similar among trials. There was no difference in CIVD parameters of nadir, apex, or mean finger temperatures; however both onset and apex times were earlier at 3000 m, compared to SL (0.6 min and 1.6 min, respectively). These differences did not persist at 4657 m. Rewarming after hand immersion was similar among trials, reaching 22.7°C after 30 min, compared to an initial finger temperature of 29.3°C. The results of this study provide no evidence that hypobaric hypoxia increases risk of cold injury. Previous findings of blunted finger temperatures at altitude are likely due to the lower ambient temperature that typically occurs at higher elevations.

Different Autonomic Responses to Experimental Pain in IBS Patients and Healthy Controls

Pain perception ratings in irritable bowel syndrome (IBS) patients suggest that they present either hypoalgesia or hyperalgesia. However, little is known about the physiologic responses these patients present to a somatic painful stimulus. The main goal of this project was to study autonomic nervous system responses and the cardiac response to experimental pain in IBS patients. This was addressed by exposing 27 women, 14 IBS, and 13 healthy controls (HCs), to a cold water (7 degrees C) immersion test of the forefoot for 2 minutes. Pain perception, galvanic skin responses (GSR), and heart rate (HR) were monitored during and after the immersion. For comparable pain perception, a significant group difference (P<0.02) in the cardiac response was observed during the immersion where the peak rise in HR was much higher for HCs, reaching 22%, whereas it only reached 8% for IBS patients. Moreover, HR variability analysis demonstrated that IBS and HCs had opposite autonomic cardiac reactivity to pain, where IBS had increased parasympathetic/decreased sympathetic reactivity. For comparable pain perception, IBS subject demonstrated different autonomic nervous system response to pain, which supports the view of autonomic dysregulation in IBS.

Thermal, cardiac and adrenergic responses to repeated local cooling

The aim of this study was to ascertain whether repeated local cooling induces the same or different adaptational responses as repeated whole body cooling. Repeated cooling of the legs (immersion into 12 degrees C water up to the knees for 30 min, 20 times during 4 weeks = local cold adaptation - LCA) attenuated the initial increase in heart rate and blood pressure currently observed in control subjects immersed in cold water up to the knees. After LCA the initial skin temperature decrease tended to be lower, indicating reduced vasoconstriction. Heart rate and systolic blood pressure appeared to be generally lower during rest and during the time course of cooling in LCA humans, when compared to controls. All these changes seem to indicate attenuation of the sympathetic tone. In contrast, the sustained skin temperature in different areas of the body (finger, palm, forearm, thigh, chest) appeared to be generally lower in LCA subjects than in controls (except for temperatures on the forehead). Plasma levels of catecholamines (measured 20 and 40 min after the onset of cooling) were also not influenced by local cold adaptation. Locally cold adapted subjects, when exposed to whole body cold water immersion test, showed no change in the threshold temperature for induction of cold thermogenesis. This indicates that the hypothermic type of cold adaptation, typically occurring after systemic cold adaptation, does not appear after local cold adaptation of the intensity used. It is concluded that in humans the cold adaptation due to repeated local cooling of legs induces different physiological changes than systemic cold adaptation.

Different conditions of cold water immersion test for diagnosing hand-arm vibration syndrome.

The cold water immersion test with finger skin temperature (FST) measurement is used to assess vascular disorders in hand-arm vibration syndrome (HAVS). The test method is currently being standardized within the International Organization for Standardization (ISO) in which a water temperature of 12°C for 5 min of hand immersion and an option of using a waterproof hand covering during immersion are proposed. It is necessary to evaluate the diagnostic significance of the test with FST measurement under different conditions to provide a proper management of HAVS patients. The aim of this article is to review research findings of this test with FST measurement and discuss test conditions influencing the results and diagnostic significance.Different conditions were employed, and the test results were shown to be influenced by water temperature, immersion time and other conditions such as room temperature, season, ischemia during immersion, and evaluation parameters. These factors need to be considered in the standardization of the cold water immersion test with FST measurement. It has been mentioned that a high water temperature, a short immersion time and other conditions should be chosen to expose a subject to minimal suffering during the test. A water temperature between 10°C and 15°C and a 5 min immersion might be suitable for the cold water immersion test. The reported sensitivity and specificity evaluating rewarming to the initial temperature for the test using a water temperature of 12°C and a 3 min immersion are 58% and 100%, respectively; these are low but similar to those for tlie water immersion test at 10°C. Therefore, the proposed cold water immersion test at 12°C for 5 min by the ISO (Draft International Standard) is the focus of much interest, and further studies are needed to obtain sufficient data for evaluating the diagnostic significance of the test. At present, the test needs to be used together with a test battery.

Factors influencing autonomic nervous function during cold-water immersion test in patients with hand-arm vibration syndrome.

Factors influencing autonomic nervous function in patients with hand-arm vibration syndrome (HAVS) in response to cold-water immersion test with different water temperatures and immersion times were investigated in the summer and winter seasons. Fourteen HAVS patients with vibration-induced white finger (VWF) and 14 healthy control subjects individually age-matched to the patients consented in writing and participated in this study. Patients and controls immersed their left hands in water at 10 degrees C for 10 min and at 15 degrees C for 3 min in summer and in winter in a room with temperature maintained at 21+/-1 degrees C. Electrocardiographic (ECG) data were recorded during the test period and the R-R intervals were analyzed with a fast Fourier transformation (FFT) program. Percentage of very low frequency (VLF%; indicator of both sympathetic and parasympathetic nervous function, and function of rennin-angiotensin system), low frequency (LF%; indicator of both sympathetic and parasympathetic nervous function), high frequency (HF%; indicator of parasympathetic nervous function), and LF/HF ratio (indicator of sympathetic nervous function) were calculated. The results by three-way analysis of variance (ANOVA) were reported elsewhere. In the present study, repeated measures ANOVA was used to re-analyze the factors of data measurement time (time factor) and group (group factor), and their interaction for each test method (water at 10 degrees C for 10-min immersion time; water at 15 degrees C for 3-min immersion time) in summer and winter. The HF% of HAVS patients tended to be lower than that of healthy controls throughout the cold-water immersion tests except for during tests involving water at 10 degrees C for 10-min immersion in summer. The group factor for HF% was statistically significant with an exception during the test involving water at 10 degrees C and 10-min immersion time in summer. The time factor for HF% was statistically significant with an exception during the test involving water at 15 degrees C and 3-min immersion time in winter. The findings of the present study indicated lower cardiac parasympathetic activity in HAVS patients than in healthy controls, especially in winter. The response of the autonomic nervous system to cold stimulation was to some extent more clearly observed during the immersion test with water at 10 degrees C and 10-min immersion time than during the immersion test with water at 15 degrees C and 3-min immersion time. The results revealed by three-way analysis in a previous study were similar to those in the present study with data analysis by repeated measures ANOVA.

A Study of the Hand-Arm Vibration Syndrome in Okinawa, a Subtropical Area of Japan.

The purpose of this study was to understand the peculiarity of the development of Hand-Arm Vibration Syndrome (HAVS) in a subtropical area of Japan. We analyzed the medical records of 21 subjects reported by the Okinawa Labor Bureau, and tried to determine whether the warm environment has any effect on the severity of HAVS. The mean operating time of vibration tools for all the subjects was over 10,000 hrs. Almost all the subjects from Okinawa had been working only in Okinawa. The presence of Vibration Induced White Fingers (VWF) was markedly smaller in the subjects from Okinawa as compared to those from other prefectures. The results of Cold Water Immersion Tests were similar for all subjects. Ten minutes after the Cold Water Immersion Test, the mean finger skin temperature was about 19 degrees C in all subjects. These findings suggest that not only the operating time of vibration tools but also the warm environment might have an effect on the severity of HAVS. However, the number of subjects in our study was very small. There is the need therefore for further investigations with a larger number of subjects.

A four-year follow-up study on subjective symptoms and functional capacities in workers using hand-held grinders.

Fifty-three grinders in the metal industry were re-examined 4 years after their first examination. Information about age, occupation, daily vibration exposure, drinking and smoking habits, and presence of subjective symptoms such as vibration-induced white finger (VWF), and numbness and pain in the fingers was collected during the first and second examination. Cold provocation test (10 degrees C/10 min) was also employed to evaluate disturbances in the peripheral circulatory and peripheral nerves in all subjects. The frequency-weighted vibration acceleration of various types of hand-held tools was measured. There was no subject with VWF at the first examination; however, during the course of follow-up, two cases (3.8%) of VWF with latent interval of more than 25 years were diagnosed. Prevalence of numbness in the fingers and shoulder stiffness was significantly higher at the second examination. When the prevalence of subjective symptoms was tested by the subjects' total operating time (TOT) during the 4-year follow-up period, those whose TOT was equal to or more than 2500 hours showed higher prevalence compared to the other subgroup. The paired values of recovery rate of finger skin temperature and vibration sensation threshold after the cold water immersion test were significantly different at the first and second examination. On average, the diminution of hand-grip force during the 4-year follow-up course was 7.4%; the difference being significant at 0.01 level. Significant differences in the paired data of pinching power and tapping ability could be detected. The frequency-weighted vibration acceleration of various tools was in the range of 1.1-4.6 m/s2. It was concluded that: (1) prolonged occupational exposure to the vibration of hand-held grinding tools should be considered as a risk factor causing disturbances in the hand-arm system of the operators; (2) the results of recovery rate of finger skin temperature and the vibration sensation threshold seemed to be appropriate indicators for the assessment of peripheral vascular and peripheral nerve disturbances in workers exposed to hand-arm vibration; and (3) to reduce the subjects' physical stress, attention should be paid to ergonomic factors.

Stress-induced changes in the gastrointestinal motor system.

Several autonomic, hormonal, behavioural and neuropeptidergic bodily responses to stressful stimuli have been described over the past few decades. Both animal models and human paradigms have been explored. It is acknowledged that stress modulates gastrointestinal (GI) motility through central mechanisms including corticotropin-releasing-factor. This process requires the integrity of autonomic neural pathways. It has become evident that the effects of stress on GI motility vary according to the stressful stimulus, its intensity, the animal species under study and the time course of the study. Recent evidence suggests that chronic or possibly permanent changes develop in enteric smooth muscle properties in response to stress. In animals, the most consistent findings include retardation of gastric emptying in response to various stressors; acceleration of gastric emptying upon cold stress, presumably through the secretion of brain thyroglobulin-hormone; acceleration of intestinal transit; and stimulation of colonic transit and fecal output. In humans, the cold water immersion test has been associated with an inhibition of gastric emptying, while labyrinthine stimulation induces the transition from postprandial to fasting motor patterns in the stomach and the small bowel. Psychological stress has been shown to induce a reduction in the number and amplitude of intestinal migrating motor complexes and to neither affect nor stimulate colonic motility. These various responses to stress are presumably attributed to the preferential activation of specific neuronal pathways under the influence of a given stimulus or its intensity. The significance of these findings and the directions of further studies are discussed.

A Revised Cold Water Immersion Test for Assessing Peripheral Circulatory Function.

To improve the conventional cold water immersion test for assessing peripheral circulatory function, the immersed area of the hand was changed in this study. Twenty-seven healthy medical students with a mean age of 24 years participated in the study. The cold water immersion tests were carried out using two methods (in 5 degree C water for 1 min), in which the immersed area was up to the metacarpophalangeal (MP) joints (hereafter, MP-method) which is a new method, or to the wrist (hereafter, W-method) which is a conventional method. The recovery of skin temperature, vibratory perception threshold and complaints of finger pain were determined during cold immersion tests with the two methods. The mean skin temperature for the MP-method after immersion recovered more quickly than that for the W-method. However, the time courses of recovering were parallel for the two methods. Significant differences were noted at 3 min, 5 min and 10 min after cessation of immersion. There was a significant positive correlation in the recovery rates at 5 min after immersion between the two methods (correlation coefficient = 0.65, p < 0.01). The mean vibratory thresholds for the W-method were higher than those for the MP-method, and the difference was significant (p < 0.01). All subjects preferred the MP-method to the W-method because there was less finger pain. These results indicate that the MP-method, immersion up to the MP joint of a hand, for assessing peripheral circulatory function is better than the W-method.