External Pneumatic Compression Research Articles

EXTERNAL PNEUMATIC COMPRESSION FOR PREOPERATIVE MANAGEMENT OF SWELLING FOR ANKLE FRACTURES: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Patients awaiting resolution of swelling and oedema prior to ankle surgery can represent a significant burden on hospital beds. Our study assessed whether external pneumatic intermittent compression (EPIC) can reduce delays to surgery.Our prospective randomised controlled trial (n= 20) compared outcomes of patients treated with EPIC vs control group managed with ice and elevation. Included were patients aged <18 years with isolated closed ankle fractures admitted for management of swelling prior to surgery. Excluded were open fractures, injuries to contralateral leg, diabetes, absent pulses, peripheral vascular disease, inability to consent, no requirement for admission. Eligible patients were randomised to active or control arms. All patients were managed initially with reduction and back slab application. Patients in active arm fitted with EPIC (Hydroven 3000) device over the back slab. Assessment by treating team determined the time at which patient is assessed ready for surgery.Patients in the treatment arm were assessed as ready for surgery sooner, (123 hrs vs 168hrs, T score = 1.925, P 0.035) and had a shorter time to surgery (167 hrs vs 216 hrs, T score = 1.748, P 0.047) Length of stay was reduced bud did not reach statistical significance. (259 hrs vs 269 hrs, T score 0.229, P 0.41)Our results showed a statistically and clinically significant reduction in time that patients were assessed ready for surgery and time to surgery in the treatment cohort. We conclude that although further data is needed to achieve an adequately powered study and assess the safety profile of the EPIC, incorporation of EPIC into routine clinical practice has the potential for significant cost savings.

Effects of an external pneumatic compression device vs static compression garment on peripheral circulation and markers of sports performance and recovery.

To identify the effects of a single 30min partial lower leg external pneumatic compression (EPC) treatment compared to a static compression (SC) garment or a no treatment control (CTL) on markers of recovery and performance following a muscle damaging protocol. Thirty healthy, active males(23 ± 3years; 180.2 ± 9.0cm; 81.6 ± 11.3kg) performed 100 drop jumps from a 0.6m box followed by a randomized, single 30min treatment of either a partial lower leg EPC device worn below the knee and above the ankle (110mmHg), SC garment (20-30mmHg) covering the foot and calf just below the knee, or no treatment CTL, and then returned 24 and 48h later. Participants were assessed for measures of muscle soreness, fatigue, hemodynamics, blood lactate, muscle thickness, circumferences, and performance assessments. The drop jump protocol significantly increased muscle soreness (p < 0.001), fatigue (p < 0.001), blood flow (p < 0.001), hemoglobin (p < 0.001), and muscle oxygen saturation (SMO2; p < 0.001). Countermovement jump and squat jump testing completed after treatment with either EPC, SC, or CTL revealed no differences for jump height between any condition. However, EPC treatment maintained consistent braking force and propulsive power measures across all timepoints for countermovement jump testing. EPC and SC treatment also led to better maintenance of squat jump performance for average relative propulsive force and power variables at 24 and 48h compared to CTL. A single 30min partial leg EPC treatment may lead to more consistent jump performance following a damaging bout of exercise.

A Portable Device for the Measurement of Venous Pulse Wave Velocity

Pulse wave velocity in veins (vPWV) has recently been reconsidered as a potential index of vascular filling, which may be valuable in the clinic for fluid therapy. The measurement requires that an exogenous pressure pulse is generated in the venous blood stream by external pneumatic compression. To obtain optimal measure repeatability, the compression is delivered synchronously with the heart and respiratory activity. We present a portable prototype for the assessment of vPWV based on the PC board Raspberry Pi and equipped with an A/D board. It acquires respiratory and ECG signals, and the Doppler shift from the ultrasound monitoring of blood velocity from the relevant vein, drives the pneumatic cuff inflation, and returns multiple measurements of vPWV. The device was tested on four healthy volunteers (2 males, 2 females, age 33±13 years), subjected to the passive leg raising (PLR) manoeuvre simulating a transient increase in blood volume. Measurement of vPWV in the basilic vein exhibited a low coefficient of variation (3.6±1.1%), a significant increase during PLR in all subjects, which is consistent with previous findings. This device allows for carrying out investigations in hospital wards on different patient populations as necessary to assess the actual clinical potential of vPWV.

Enhanced arthrocentesis of the effusive knee with pneumatic compression.

Complete arthrocentesis of the effusive knee ameliorates patient pain, reduces intra-articular and intraosseous pressure, removes inflammatory cytokines, and has been shown to substantially improve the therapeutic outcomes of intra-articular injections. However, conventional arthrocentesis incompletely decompresses the knee, leaving considerable residual synovial fluid in the intra-articular space. The present study determined whether external pneumatic circumferential compression of the effusive knee permitted more successful arthrocentesis and complete joint decompression. Using a paired sample design, 50 consecutive effusive knees underwent conventional arthrocentesis and then arthrocentesis with pneumatic compression. Pneumatic compression was applied to the superior knee using a conventional thigh blood pressure cuff inflated to 100mmHg which compressed the suprapatellar bursa and patellofemoral joint, forcing fluid from the superior knee to the anterolateral portal where the fluid could be accessed. Arthrocentesis success and fluid yield in mL before and after pneumatic compression were determined. Successful diagnostic arthrocentesis (≥3mL) of the effusive knee was 82% (41/50) with conventional arthrocentesis and increased to 100% (50/50) with pneumatic compression (P=.001). Synovial fluid yields increased by 144% (19.8±17.1mL) with pneumatic compression (conventional arthrocentesis; 13.7±16.4mL, pneumatic compression: 33.4±26.5mL; 95% CI: 10.9<19.7<28.9mL, P<.0001). Conventional arthrocentesis routinely does not fully decompress the effusive knee. External circumferential pneumatic compression markedly improves arthrocentesis success and fluid yield, and permits complete decompression of the effusive knee. Pneumatic compression of the effusive knee with a thigh blood pressure cuff is an inexpensive and widely available technique to improve arthrocentesis outcomes.

Synovial Fluid Cytokines, Chemokines and MMP Levels in Osteoarthritis Patients with Knee Pain Display a Profile Similar to Many Rheumatoid Arthritis Patients.

Background: There are currently no effective disease-modifying drugs to prevent cartilage loss in osteoarthritis and synovial fluid is a potentially valuable source of biomarkers to understand the pathogenesis of different types of arthritis and identify drug responsiveness. The aim of this study was to compare the differences between SF cytokines and other proteins in patients with OA (n = 21) to those with RA (n = 27) and normal knees (n = 3). Methods: SF was obtained using ultrasound (US) guidance and an external pneumatic compression device. RA patients were categorized as active (n = 20) or controlled (n = 7) based upon SF white blood cell counts (> or <300 cells/mm3). Samples were cryopreserved and analyzed by multiplex fluorescent bead assays (Luminex). Between-group differences of 16 separate biomarker proteins were identified using ANOVA on log10-transformed concentrations with p values adjusted for multiple testing. Results: Only six biomarkers were significantly higher in SF from active RA compared to OA—TNF-α, IL-1-β IL-7, MMP-1, MMP-2, and MMP-3. Only MMP-8 levels in RA patients correlated with SF WBC counts (p < 0.0001). Among OA patients, simultaneous SF IL-4, IL-6, IL-8, and IL-15 levels were higher than serum levels, whereas MMP-8, MMP-9, and IL-18 levels were higher in serum (p < 0.05). Conclusion: These results support the growing evidence that OA patients have a pro-inflammatory/catabolic SF environment. SF biomarker analysis using multiplex testing and US guidance may distinguish OA phenotypes and identify treatment options based upon targeted inflammatory pathways similar to patients with RA.

The Acute Effects Of External Pneumatic Compression On Anaerobic Performance And Blood Lactate Concentration

The use of External Pneumatic Compression (EPC) among athletes as a recovery modality is rising. However the evidence supporting efficacy of EPC on recovery and performance is limited thus it warrants for further investigation. PURPOSE: To determine the acute effects of EPC on anaerobic performance and blood lactate (BLa) concentration following a fatigue protocol. METHODS: In a randomized, counterbalanced cross-over study design, 10 healthy university male athletes, aged (25.2 ± 1.1 yrs), were recruited to complete 3 experimental sessions with two 30-seconds trails of maximum effort Wingate Anaerobic Test (WAnT)(T1 & T2) on a cycle ergometer with a constant load of .075 kg per kilogram of body mass, separated by a 20-min recovery period where either passive recovery (PR), active recovery (AR) or EPC treatment were administered. BLa levels, heart rate and ratings of perceived exertion were recorded. Power output in Watts (PO), fatigue index in %(FI) and total work in Joules(TW) were examined. RESULTS: Mean power output (MP) in Watts following AR (T1: 634.90 ± 81.18, T2: 638.06 ± 99.98)(p= .022) and EPC (T1: 642.55 ± 78.38, T2: 637.85 ± 95.62) (p= .020) were significantly higher than PR (T1: 623.21 ± 91.08, T2: 620.38 ± 103.03). However, MP between AR and EPC treatment were not significant (p= .567). Similarly, TW were significantly higher following AR (T1: 19.09 ± 2.54, T2: 19.02 ± 2.97) (p= .028) and EPC treatment (T1: 19.14 ± 2.33, T2: 19.04 ± 2.83) (p= .013) than PR (T1: 18.58 ± 2.73, T2: 18.47 ± 3.03) but mean differences were minimal between AR and EPC treatment. PO (PR T1: 954.90 ± 206.78, T2: 890 ± 178.42, AR T1: 1001.60 ± 187.16, T2: 928.50 ± 172.46, EPC T1: 970 ± 135.71, EPC T2: 943.00 ± 152.58) (p= .481) and FI (PR T1: 62.23 ± 17.05, T2: 57.40 ± 15.98, ER T1: 64.80 ± 17.41, T2: 59.42 ± 17.78, EPC T1: 63.40 ± 18.03, T2: 56.86 ± 15.15 (p= .780) were not significant. BLa concentration decreased significantly from peak BLa at 5 minute post-WAnT to 20 minutes post-WAnT in all trials (PR: p =.000, AR: p =.000, ECP: p =.000 ). However the mean difference in BLa (mmol•L-1) levels at 20 minutes post-WAnT and 5 minutes post-WAnT were 2.6 in PR, 4.0 in AR and 2.7 in ECP. CONCLUSIONS: Results indicated performance was better maintained with the use of EPC and AR. Therefore, the use of EPC may be a feasible alternative method when static recovery is desired.

Comparison of Calf Only External Pneumatic Compression and Compression Socks on Performance Characteristics in Counter Movement Jump

PURPOSETo identify the recovery effect of calf only external pneumatic compression (EPC) compared to a commercially available compression sock (CS) on markers of jump performance following a muscle damaging protocol.METHODS19 healthy active male participants (23.5 ± 3.2 yr, 181.3 ± 9.1 cm, 88.1 ± 10.1 kg) completed four testing sessions (pre, post, 24 hr, 48 hr) consisting of: visual analog scales (VAS) to assess perceived soreness and fatigue, three counter movement jumps (CMJ) and three squat jumps (SJ) via force plates (Hawkin Dynamics). After participants finished pre assessments they completed 100 drop jumps (0.6 m) followed by a randomized 30 min single treatment session of either EPC (110 mmHg) n=9 or CS (20–30 mmHg) n=10.RESULTSNo differences were found between groups for body composition (18.7 ± 2.8 % Body Fat, 61.8 ± 8.8 kg Fat Free Mass, 14.7 ± 2.8 kg Fat Mass). VAS soreness linearly increased regardless of group (p&lt;0.001). Within EPC and CS 24 hr soreness was higher than pre, post, 30 min post (p&lt;0.05); 48 hr was higher than pre and 30 min post (p&lt;0.05); and post was higher than pre (p&lt;0.05). Additionally, CS soreness at 48 hr was higher than post (p&lt;0.05). VAS fatigue changed over time regardless of group (p&lt;0.001). Within EPC post fatigue was higher than pre, 30 min post, 24 hr, and 48 hr (p&lt;0.05); 24 hr was higher than pre, post, and 48 hr (p&lt;0.05); 30 min post and 48 hr was higher than pre and post (p&lt;0.05). CS post fatigue was higher than pre and 30 min post (p&lt;0.05); 30 min post was higher than pre (p&lt;0.05); and 24 and 48 hr were higher than pre (p&lt;0.05). VAS fatigue was trending (p=0.055) towards being higher in CS compared to EPC regardless of time. For CMJ, CS peak braking force and relative peak braking force linearly declined over time (p&lt;0.001), and peak braking force was highest at pre compared to post, 24 hr and 48 hr (p&lt;0.05). For CMJ, CS relative peak braking force was highest at pre compared to post, 24 hr, 48 hr (p&lt;0.01) and post was higher than 48 hr (p=0.025). For CMJ, CS braking phase linearly increased over time (p&lt;0.001), and was higher at 24 hr and 48 hr compared to pre and post (p&lt;0.05). For CMJ, CS braking rate of force development (RFD) linearly declined over time (p&lt;0.001), and was highest at pre compared to 24 hr and 48 hr (p&lt;0.01). No differences in performance variables were found for SJ.CONCLUSIONIt appears that the drop jump protocol was successful at eliciting muscle soreness and fatigue in our participants. Additionally, these aforementioned variables seemed to effect participants in the CS group because they were unable to maintain braking force and peak braking RFD, and took longer to complete the braking phase. These results were not seen in the EPC group as they were able to maintain consistent performance in these measures. Therefore, it appears a single 30 min calf only EPC treatment may help maintain consistent breaking force and braking RFD within a CMJ when following strenuous or damaging exercise bouts.Support or Funding InformationFunding was provided to P.W.M by MAS Holdings (Colombo, Sri Lanka).

Routine surveillance for diagnosis of venous thromboembolism after pleurectomy for malignant pleural mesothelioma

ObjectiveThe purpose of this study was to determine the incidence of venous thromboembolism and utility of a routine surveillance program in patients undergoing surgery for mesothelioma. MethodsPatients undergoing pleurectomy from May 2016 to August 2018 were included. A standardized surveillance program to look for venous thromboembolism in this group included noninvasive studies every 7 days postoperatively or earlier if symptomatic. All patients received external pneumatic compression sleeves in addition to prophylactic heparin. If deep vein thrombosis or pulmonary embolus was discovered, heparin drip was initiated until conversion to therapeutic anticoagulation. ResultsA total of 100 patients underwent pleurectomy for mesothelioma. Seven patients were found to have preoperative deep vein thrombosis, and as such only 93 patients were included for analysis. The median age of patients at surgery was 71 years (30-85 years). During the study, 30 patients (32%) developed evidence of thrombosis; 20 patients (22%) developed only deep vein thrombosis without embolism, 3 patients (3%) developed only pulmonary embolism, and 7 patients (7%) developed both deep vein thrombosis and pulmonary embolus. Of the 27 patients who developed deep vein thrombosis, 9 (33%) were asymptomatic at the time of diagnosis, and none of these developed a pulmonary embolus or other bleeding complications. There were 2 (2%) events of major postoperative bleeding related to therapeutic anticoagulation. ConclusionsThe incidence of venous thromboembolism is high (32%) among patients undergoing surveillance after pleurectomy for mesothelioma. Up to 33% of patients with deep vein thrombosis are asymptomatic at the time of diagnosis, and the incidence of complications related to anticoagulation is low. Routine surveillance may be useful to diagnose and treat deep vein thrombosis before it progresses to symptomatic or fatal pulmonary embolus.

A qualitative study about the experience, knowledge and application of complementary therapies and integrative medicine in pediatrics

The purpose of this study was to determine the incidence of venous thromboembolism and utility of a routine surveillance program in patients undergoing surgery for mesothelioma.Patients undergoing pleurectomy from May 2016 to August 2018 were included. A standardized surveillance program to look for venous thromboembolism in this group included noninvasive studies every 7 days postoperatively or earlier if symptomatic. All patients received external pneumatic compression sleeves in addition to prophylactic heparin. If deep vein thrombosis or pulmonary embolus was discovered, heparin drip was initiated until conversion to therapeutic anticoagulation.A total of 100 patients underwent pleurectomy for mesothelioma. Seven patients were found to have preoperative deep vein thrombosis, and as such only 93 patients were included for analysis. The median age of patients at surgery was 71 years (30-85 years). During the study, 30 patients (32%) developed evidence of thrombosis; 20 patients (22%) developed only deep vein thrombosis without embolism, 3 patients (3%) developed only pulmonary embolism, and 7 patients (7%) developed both deep vein thrombosis and pulmonary embolus. Of the 27 patients who developed deep vein thrombosis, 9 (33%) were asymptomatic at the time of diagnosis, and none of these developed a pulmonary embolus or other bleeding complications. There were 2 (2%) events of major postoperative bleeding related to therapeutic anticoagulation.The incidence of venous thromboembolism is high (32%) among patients undergoing surveillance after pleurectomy for mesothelioma. Up to 33% of patients with deep vein thrombosis are asymptomatic at the time of diagnosis, and the incidence of complications related to anticoagulation is low. Routine surveillance may be useful to diagnose and treat deep vein thrombosis before it progresses to symptomatic or fatal pulmonary embolus.

Unilateral application of an external pneumatic compression therapy improves skin blood flow and vascular reactivity bilaterally.

BackgroundWe sought to determine the effects of unilateral lower-limb external pneumatic compression (EPC) on bilateral lower-limb vascular reactivity and skin blood flow.MethodsThirty-two participants completed this two-aim study. In AIM1 (n = 18, age: 25.5 ± 4.7 years; BMI: 25.6 ± 3.5 kg/m2), bilateral femoral artery blood flow and reactivity (flow mediated dilation [FMD]) measurements were performed via ultrasonography at baseline (PRE) and immediately following 30-min of unilateral EPC treatment (POST). AIM2 (n = 14, age: 25.9 ± 4.5; BMI: 27.2 ± 2.7 kg/m2) involved 30-min unilateral EPC (n = 7) or sham (n = 7) treatment with thermographic bilateral lower-limb mean skin temperature (MST) measurements at baseline, 15-min of treatment (T15) and 0, 30 and 60-min (R0, R30, R60) following treatment.ResultsComparative data herein are presented as mean ± 95% confidence interval. AIM1: No significant effects on total reactive hyperemia blood flow were observed for the treated (i.e., compressed) or untreated (i.e., non-compressed) leg. A significant effect of time, but no time*leg interaction, was observed for relative FMD indicating higher reactivity bilaterally with unilateral EPC treatment (FMD: +0.41 ± 0.09% across both legs; p < 0.05). AIM2: Unilateral EPC treatment was associated with significant increases in whole-leg MST from baseline during (T15: +0.63 ± 0.56 °C in the visible untreated/contralateral leg, p < 0.025) and immediately following treatment (i.e., R0) in both treated (+1.53 ± 0.59 °C) and untreated (+0.60 ± 0.45 °C) legs (p < 0.0125). Across both legs, MST remained elevated with EPC at 30-min post-treatment (+0.60 ± 0.45 °C; p < 0.0167) but not at 60-min post (+0.27 ± 0.46 °C; p = 0.165). Sham treatment was associated with a significant increase in the treated leg immediately post-treatment (+1.12 ± 0.31 °C; p < 0.0167), but not in the untreated leg (−0.27 ± 0.12 °C). MST in neither the treated or untreated leg were increased relative to baseline at R30 or R60 (p > 0.05). Finally, during treatment and at all post-treatment time points (i.e., R0, R30 and R60), independent of treatment group (EPC vs. sham), there was a significant effect of region. The maximum increase in MST was observed at the R0 time point and was significantly (p < 0.05) larger in the thigh region (+1.02 ± 0.31 °C) than the lower-leg (+0.47 ± 0.29 °C) region. However, similar rates of MST decline from R0 in the thigh and lower leg regions were observed at the R30 and R60 time points.DiscussionUnilateral EPC may be an effective intervention for increasing skin blood flow and/or peripheral conduit vascular reactivity in the contralateral limb. While EPC was effective in increasing whole-leg MST bilaterally, there appeared to be a more robust response in the thigh compared to the lower-leg. Thus, proximity along the leg may be an important consideration in prospective treatment strategies.

Concomitant external pneumatic compression treatment with consecutive days of high intensity interval training reduces markers of proteolysis.

To compare the effects of external pneumatic compression (EPC) and sham when used concurrently with high intensity interval training (HIIT) on performance-related outcomes and recovery-related molecular measures. Eighteen recreationally endurance-trained male participants (age: 21.6 ± 2.4years, BMI: 25.7 ± 0.5kg/m2, VO2peak: 51.3 ± 0.9mL/kg/min) were randomized to balanced sham and EPC treatment groups. Three consecutive days of HIIT followed by EPC/sham treatment (Days 2-4) and 3 consecutive days of recovery (Days 5-7) with EPC/sham only on Days 5-6 were employed. Venipuncture, flexibility and pressure-to-pain threshold (PPT) measurements were made throughout. Vastus lateralis muscle was biopsied at PRE (i.e., Day 1), 1-h post-EPC/sham treatment on Day 2 (POST1), and 24-h post-EPC/sham treatment on Day 7 (POST2). 6-km run time trial performance was tested at PRE and POST2. No group × time interaction was observed for flexibility, PPT, or serum measures of creatine kinase (CK), hsCRP, and 8-isoprostane. However, there was a main effect of time for serum CK (p = 0.005). Change from PRE in 6-km run times at POST2 were not significantly different between groups. Significant between-groups differences existed for change from PRE in atrogin-1 mRNA (p = 0.018) at the POST1 time point (EPC: - 19.7 ± 8.1%, sham: + 7.7 ± 5.9%) and atrogin-1 protein concentration (p = 0.013) at the POST2 time point (EPC: - 31.8 ± 7.5%, sham: +96.0 ± 34.7%). In addition, change from PRE in poly-Ub proteins was significantly different between groups at both the POST1 (EPC: - 26.0 ± 10.3%, sham: +34.8 ± 28.5%; p = 0.046) and POST2 (EPC: -33.7 ± 17.2%, sham: + 21.4 ± 14.9%; p = 0.037) time points. EPC when used concurrently with HIIT and in subsequent recovery days reduces skeletal muscle markers of proteolysis.

Does external pneumatic compression treatment between bouts of overreaching resistance training sessions exert differential effects on molecular signaling and performance-related variables compared to passive recovery? An exploratory study.

PurposeWe sought to compare the effects of external pneumatic compression (EPC) and sham when used concurrently with resistance training on performance-related outcomes and molecular measures related to recovery.MethodsTwenty (N = 20) resistance-trained male participants (aged 21.6±2.4 years) were randomized to balanced sham or EPC intervention groups. The protocol consisted of 3 consecutive days of heavy, voluminous back squat exercise followed by EPC/sham treatment (Days2-4) and 3 consecutive days of recovery (Days5-7) with EPC/sham only on Days5-6. On Day1 (PRE), and Days3-7, venipuncture, flexibility and pressure-to-pain threshold (PPT) measures were performed. Vastsus lateralis muscle tissue was biopsied at PRE, 1-h post-EPC/sham treatment on Day2 (POST1) and 24-h post-EPC/sham treatment on Day7 (POST2). Isokinetic peak torque was assessed at PRE and POST2.ResultsPeak isokinetic strength did not change from PRE to POST2 in either group. The PPT was significantly lower on Days3-6 with sham, indicating greater muscle soreness, though this was largely abolished in the EPC group. A significant decrease in flexibility with sham was observed on Day3 (+16.2±4.6% knee joint angle; P<0.01) whereas there was no change with EPC (+2.8±3.8%; P>0.01). Vastus lateralis poly-ubiquitinated proteins significantly increased at the POST2 time point relative to PRE with sham (+66.6±24.6%; P<0.025) and were significantly greater (P<0.025) than those observed with EPC at the same time point (-18.6±8.5%). 4-hydroxynonenal values were significantly lower at POST2 relative to PRE with EPC (-16.2±5.6%; P<0.025) and were significantly lower (P<0.025) than those observed with sham at the same time point (+11.8±5.9%).ConclusionEPC mitigated a reduction in flexibility and PPT that occurred with sham. Moreover, EPC reduced select skeletal muscle oxidative stress and proteolysis markers during recovery from heavy resistance exercise.

Performance-related And Molecular Effects Of External Pneumatic Compression Treatment As An Adjuvant To Heavy, Voluminous Resistance Exercise

Performance-related And Molecular Effects Of External Pneumatic Compression Treatment As An Adjuvant To Heavy, Voluminous Resistance Exercise

Impact of external pneumatic compression target inflation pressure on transcriptome-wide RNA expression in skeletal muscle.

Next‐generation RNA sequencing was employed to determine the acute and subchronic impact of peristaltic pulse external pneumatic compression (PEPC) of different target inflation pressures on global gene expression in human vastus lateralis skeletal muscle biopsy samples. Eighteen (N = 18) male participants were randomly assigned to one of the three groups: (1) sham (n = 6), 2) EPC at 30–40 mmHg (LP‐EPC; n = 6), and 3) EPC at 70–80 mmHg (MP‐EPC; n = 6). One hour treatment with sham/EPC occurred for seven consecutive days. Vastus lateralis skeletal muscle biopsies were performed at baseline (before first treatment; PRE), 1 h following the first treatment (POST1), and 24 h following the last (7th) treatment (POST2). Changes from PRE in gene expression were analyzed via paired comparisons within each group. Genes were filtered to include only those that had an RPKM ≥ 1.0, a fold‐change of ≥1.5 and a paired t‐test value of <0.01. For the sham condition, two genes at POST1 and one gene at POST2 were significantly altered. For the LP‐EPC condition, nine genes were up‐regulated and 0 genes were down‐regulated at POST1 while 39 genes were up‐regulated and one gene down‐regulated at POST2. For the MP‐EPC condition, two genes were significantly up‐regulated and 21 genes were down‐regulated at POST1 and 0 genes were altered at POST2. Both LP‐EPC and MP‐EPC acutely alter skeletal muscle gene expression, though only LP‐EPC appeared to affect gene expression with subchronic application. Moreover, the transcriptome response to EPC demonstrated marked heterogeneity (i.e., genes and directionality) with different target inflation pressures.

Analysis of Human Vastus Lateralis Skeletal Muscle Biopsy Samples Changes in Response to High and Low Inflation Pressures during Peristaltic Pulse External Pneumatic Compression Via Transcriptome‐wide RNA Sequencing

We employed next generation RNA sequencing (RNA‐seq) technology to determine the impact of peristaltic pulse external pneumatic compression (EPC) at high and low target inflation pressures on global gene expression in human vastus lateralis skeletal muscle biopsy samples.MethodsEighteen (N=18) apparently healthy male subjects participated in this study and were randomly assigned to one of three groups: 1) sham (n=6), 2) EPC with target inflation pressures of 30 mmHg (n=6) and 3) EPC with target inflation pressures of 70–80 mmHg (n=6). Daily treatment with sham or EPC was given for 7 consecutive days with each treatment lasting 1 h. Vastus lateralis skeletal muscle biopsy samples were harvested at baseline (48 hours before the first treatment; T1), 1 h following the first treatment (T2), and 24 hours following the last (7th) treatment (T3). 3,613 annotated genes with an RPKM value of ≥ 1.0 were selected for analysis. Change from baseline (T1) in gene expression was analyzed via paired comparisons within each group (i.e. T2 vs. T1 and T3 vs. T1). The 3,613 genes were then further filtered to include only those that had a fold‐change (FC) of ≥ 1.5 and a paired t‐test value of &lt;0.01.ResultsFor the sham condition, only 2 genes at T2 (SF3B5, FIS1) and 1 gene at T1 (LYPLA2) were identified as being significantly altered compared to baseline with time. For the 30 mmHg EPC condition, 9 genes were found to be significantly upregulated at T2 and 39 genes were found to be significantly upregulated at T3 compared to baseline. Two of these genes were significantly upregulated at both T2 and T3 (ARRDC2 and DYNLL2). Only one gene was found to be significantly downregulated compared to baseline in the 30 mmHg EPC group (TIMM10) and this was observed at T3. For the 70–80 mmHg EPC condition, 2 genes were found to be significantly upregulated (HBA1, HBA2) and 21 genes were found to be significantly downregulated at T2 compared to baseline. At T3, only 1 gene was found to be significantly altered (downregulation of DNAJB5) in the 70–80 mmHg EPC group. Interestingly, VEGFA was found to be differentially regulated as its expression was significantly upregulated with 30 mmHg EPC at T3 and significantly downregulated with 70–80 mmHg EPC at T3. Follow up analyses respective to gene clusters of interest are presented herein.ConclusionsIn summary, a more dynamic alteration of skeletal muscle gene expression was observed with a lower (i.e. 30 mmHg) EPC target inflation pressure, particularly after 7 consecutive days of treatment. Moreover, altered genes tended to be upregulated with 30 mmHg EPC whereas genes tended to be downregulated with 70 mmHg.Support or Funding InformationThe authors would like to thank NormaTec (Newton Center, MA) for their partial financial support (50%) of this project through a contract awarded to J.S.M.

A single 60-min bout of peristaltic pulse external pneumatic compression transiently upregulates phosphorylated ribosomal protein s6.

We investigated whether a single 60-min bout of whole leg, peristaltic pulse external pneumatic compression (EPC) altered select growth factor-related mRNAs and/or various phospho(p)-proteins related to cell growth, proliferation, inflammation and apoptosis signalling (e.g. Akt-mTOR, Jak-Stat). Ten participants (8 males, 2 females; aged 22·2±0·4years) reported to the laboratory 4h post-prandial, and vastus lateralis muscle biopsies were obtained prior to (PRE), 1h and 4h post-EPC treatment. mRNA expression was analysed using real-time RT-PCR and phosphophorylated and cleaved proteins were analysed using an antibody array. No changes in selected growth factor-related mRNAs were observed following EPC. All p-proteins significantly altered by EPC decreased, except for p-rps6 (Ser235/236) which increased 31% 1h post-EPC compared to PRE levels (P=0·016). Notable decreases also included p-BAD (Ser112; -28%, P=0·004) at 4h post-EPC compared to PRE levels. In summary, an acute bout of EPC transiently upregulates p-rps6 as well as affecting other markers in the Akt-mTOR signalling cascade. Future research should characterize whether chronic EPC application promotes alterations in lower-limb musculature and/or enhances exercise-induced training adaptations.

Interventions for varicose veins and leg oedema in pregnancy.

Interventions for varicose veins and leg oedema in pregnancy.

Preconditioning with peristaltic external pneumatic compression does not acutely improve repeated Wingate performance nor does it alter blood lactate concentrations during passive recovery compared with sham.

Application of dynamic external pneumatic compression (EPC) during recovery from athletic activities has demonstrated favorable effects on flexibility, soreness, swelling, and blood lactate (BLa) concentrations. However, the effects of "preconditioning" with a peristaltic pulse EPC device on subsequent performance and BLa concentrations have not been characterized. Herein, we demonstrate that pretreatment for 30 min with EPC has no effect on subsequent supramaximal exercise performance or BLa concentrations during passive recovery.

A single bout of whole-leg, peristaltic pulse external pneumatic compression upregulates PGC-1α mRNA and endothelial nitric oxide sythase protein in human skeletal muscle tissue.

What is the central question of this study? Does 60 min of peristaltic pulse external pneumatic compression (EPC) alter gene and protein expression patterns related to metabolism, vascular biology, redox balance and inflammation in vastus lateralis biopsy samples? What is the main finding and its importance? A single bout of EPC transiently upregulates PGC-1α mRNA, while also upregulating endothelial nitric oxide synthase protein and nitric oxide metabolite concentrations in vastus lateralis biopsy samples. We investigated whether a single 60 min bout of whole-leg, lower pressure external pneumatic compression (EPC) altered select vascular, metabolic, antioxidant and inflammation-related mRNAs. Ten participants (eight male, two female; aged 22.0 ± 0.4 years) reported to the laboratory 4 h postprandial, and vastus lateralis muscle biopsies were obtained before (PRE) and 1 and 4 h after EPC treatment. Messenger RNA expression was analysed using real-time RT-PCR, and significant mRNA findings were investigated further by Western blot analysis of respective protein concentrations. Peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) mRNA increased by 77% 1 h following EPC compared with PRE levels (P = 0.005), but no change in protein concentration 1 or 4 h post-EPC was observed. Increases in endothelial nitric oxide sythase (eNOS) mRNA (+44%) and superoxide dismutase 2 (SOD2) mRNA (+57%) 1 h post-EPC as well as an increase in interleukin-10 mRNA (+132%) 4 h post-EPC compared with PRE levels were observed, but only approached significance (P = 0.076, 0.077 and 0.074, respectively). Interestingly, eNOS protein (+40%, P = 0.025) and nitrate and nitrite (NOx) concentrations (+69%, P = 0.025) increased 1-4 h post-EPC. Moreover, SOD2 protein tended to increase from PRE to 4 h post-EPC (+43%, P = 0.074), although no changes in tissue 4-hydroxnonenal levels was observed. An acute bout of EPC transiently upregulates PGC-1α mRNA, while also upregulating eNOS protein and NOx concentrations in vastus lateralis biopsy samples. Future research should characterize the origin of these responses (e.g. vascular or muscle fibre cells) and how the acute effects of EPC application on gene and protein expression observed herein are associated with functional improvements (e.g. metabolism, vascular function) in acute and chronic models.

Peripheral conduit and resistance artery function are improved following a single, 1-h bout of peristaltic pulse external pneumatic compression.

External pneumatic compression (EPC) is being employed for a widening range of clinical and non-clinical populations. However, EPC devices vary markedly in treatment pressures, duty cycles and application sites, and the acute effects of whole limb, lower pressure EPC on peripheral vascular function have not been determined. The purpose of this study was to determine the acute effects of a single bout of peristaltic pulse EPC on peripheral conduit and resistance artery function. Twenty (n = 20; males = 12 and females = 8) young and apparently healthy subjects (aged 26.1 ± 8.2 years) participated in this study. A sequential EPC device with five inflation zones arranged linearly and inflating distal to proximal along the lower limbs was employed with target inflation pressures of 70 mmHg for 1 h. Flow-mediated dilation (FMD) of the brachial and popliteal arteries was evaluated with ultrasound before and after EPC. Venous occlusion plethysmography was employed to evaluate limb blood flow at rest and during reactive hyperemia (RH) in the forearm (FBF) and calf (CBF) before and after EPC. Peak RH CBF was increased by 9 % after EPC (P < 0.05), whereas peak RH FBF (-10 %) did not change significantly (P > 0.25). Normalized popliteal artery FMD post-EPC (2.24 ± 1.41) was significantly higher than pre-EPC (1.36 ± 0.67, P = 0.015) and post-sham (1.58 ± 0.86, P = 0.032) values. Similarly, normalized brachial artery FMD post-EPC (1.47 ± 0.32) was significantly higher than pre-EPC (1.11 ± 0.41, P = 0.004) and post-sham (0.99 ± 0.27, P = 0.026) values. Acutely, whole limb, lower pressure EPC improves conduit artery endothelial function systemically, but only improves RH blood flow locally (i.e., compressed limbs).