Ice vests extend physiological work time while wearing explosive ordnance disposal protective clothing in hot and humid conditions.

BACKGROUND: Explosive ordnance disposal (EOD) technicians may be required to work in hot, humid environments while wearing heavy protective clothing. We investigated the ability of an ice vest to attenuate physiological strain and subsequently extend work tolerance. METHODS: Eight male participants (24.3 ± 4.1 yr, 51.9 ± 4.6 mL kg-1 min-1) walked (4.5 km h-1) in simulated hot and humid conditions (35 °C; 50% relative humidity). Participants wore either an EOD suit (CON) or EOD and ice vest (IV). Heart rate, core and skin temperature were recorded continuously. RESULTS: Participants walked longer in IV compared to CON (8.1 ± 7.4 min, p < .05). Over 90% of trials were terminated based on participants reaching 90% of their maximum heart rate. IV resulted in cooled skin (p < .001) and a physiologically negligible change in core temperature (p < .001). A condition by time interaction was identified for heart rate (p < .001), with a lower rate of rise in the IV condition. CONCLUSIONS: The cardiovascular inefficiency that limited performance was attenuated in the IV condition. The ice vest facilitated heat loss from the periphery; thus, the observed reduction in heart rate may reflect the preservation of central blood volume. The results identify the efficiency of a simple, inexpensive ice vest to assist EOD technicians working in the heat.

Hot water immersion acutely reduces peripheral glucose uptake in young healthy males: An exploratory crossover randomized controlled trial.

Whether glucose concentration increases during heat exposure because of reduced peripheral tissue uptake or enhanced appearance is currently unknown. This study aimed to report glucose concentrations in both capillary and venous blood in response to a glucose challenge during passive heating (PH) to assess whether heat exposure affects glucose uptake in healthy males. Twelve healthy male participants completed two experimental sessions, where they were asked to undertake an oral glucose tolerance test (OGTT) whilst immersed in thermoneutral (CON, 35.9 (0.6) °C) and hot water (HWI, 40.3 (0.5) °C) for 120 min. Venous and capillary blood [glucose], rectal temperature, and heart rate were recorded. [Glucose] area under the curve for HWI venous (907 (104) AU) differed from CON venous (719 (88) AU, all P < 0.001). No other differences were noted (P > 0.05). Compared with CON, HWI resulted in greater rectal temperature (37.1 (0.3) °C versus 38.6 (0.4) °C, respectively) and heart rate (69 (12) bpm versus 108 (11) bpm, respectively) on cessation (P < 0.001). An OGTT results in similar capillary [glucose] during hot and thermoneutral water immersion, whereas venous [glucose] was greater during HWI when compared with CON. This indicates that peripheral tissue glucose uptake is acutely reduced in response to HWI. Abbreviations: AUC: Area under the curve; CON: Thermoneutral immersion trial; HWI: Hot water immersion trial; OGTT: Oral glucose tolerance test; PH: Passive heating; T-msk: Mean skin temperature; Trec: Rectal temperature.

The peripheral vascular responses in non-freezing cold injury and matched controls.

NEW FINDINGS: What is the central question of this study? Does non-freezing cold injury (NFCI) alter normal peripheral vascular function? What is the main finding and its importance? Individuals with NFCI were more cold sensitive (rewarmed more slowly and felt more discomfort) than controls. Vascular tests indicated that extremity endothelial function was preserved with NFCI and that sympathetic vasoconstrictor response might be reduced. The pathophysiology underpinning the cold sensitivity associated with NFCI thus remains to be identified. ABSTRACT: The impact of non-freezing cold injury (NFCI) on peripheral vascular function was investigated. Individuals with NFCI (NFCI group) and closely matched controls with either similar (COLD group) or limited (CON group) previous cold exposure were compared (n = 16). Peripheral cutaneous vascular responses to deep inspiration (DI), occlusion (PORH), local cutaneous heating (LH) and iontophoresis of acetylcholine and sodium nitroprusside were investigated. The responses to a cold sensitivity test (CST) involving immersion of a foot in 15°C water for 2 min followed by spontaneous rewarming, and a foot cooling protocol (footplate cooled from 34°C to 15°C), were also examined. The vasoconstrictor response to DI was lower in NFCI compared to CON (toe: 73 (28)% vs. 91 (17)%; P = 0.003). The responses to PORH, LH and iontophoresis were not reduced compared to either COLD or CON. During the CST, toe skin temperature rewarmed more slowly in NFCI than COLD or CON (10 min: 27.4 (2.3)°C vs. 30.7 (3.7)°C and 31.7 (3.9)°C, P < 0.05, respectively); however, no differences were observed during the footplate cooling. NFCI were more cold-intolerant (P < 0.0001) and reported colder and more uncomfortable feet during the CST and footplate cooling than COLD and CON (P < 0.05). NFCI showed a decreased sensitivity to sympathetic vasoconstrictor activation than CON and greater cold sensitivity (CST) compared to COLD and CON. None of the other vascular function tests indicated endothelial dysfunction. However, NFCI perceived their extremities to be colder and more uncomfortable/painful than the controls.

Plasma biomarkers of endothelial function, inflammation and oxidative stress in individuals with non-freezing cold injury.

NEW FINDINGS: What is the central question of this study? Are biomarkers of endothelial function, oxidative stress and inflammation altered by non-freezing cold injury (NFCI)? What is the main finding and its importance? Baseline plasma [interleukin-10] and [syndecan-1] were elevated in individuals with NFCI and cold-exposed control participants. Increased [endothelin-1] following thermal challenges might explain, in part, the increased pain/discomfort experienced with NFCI. Mild to moderate chronic NFCI does not appear to be associated with either oxidative stress or a pro-inflammatory state. Baseline [interleukin-10] and [syndecan-1] and post-heating [endothelin-1] are the most promising candidates for diagnosis of NFCI. ABSTRACT: Plasma biomarkers of inflammation, oxidative stress, endothelial function and damage were examined in 16 individuals with chronic NFCI (NFCI) and matched control participants with (COLD, n = 17) or without (CON, n = 14) previous cold exposure. Venous blood samples were collected at baseline to assess plasma biomarkers of endothelial function (nitrate, nitrite and endothelin-1), inflammation [interleukin-6 (IL-6), interleukin-10 (IL-10), tumour necrosis factor alpha and E-selectin], oxidative stress [protein carbonyl, 4-hydroxy-2-nonenal (4-HNE), superoxide dismutase and nitrotyrosine) and endothelial damage [von Willebrand factor, syndecan-1 and tissue type plasminogen activator (TTPA)]. Immediately after whole-body heating and separately, foot cooling, blood samples were taken for measurement of plasma [nitrate], [nitrite], [endothelin-1], [IL-6], [4-HNE] and [TTPA]. At baseline, [IL-10] and [syndecan-1] were increased in NFCI (P < 0.001 and P = 0.015, respectively) and COLD (P = 0.033 and P = 0.030, respectively) compared with CON participants. The [4-HNE] was elevated in CON compared with both NFCI (P = 0.002) and COLD (P < 0.001). [Endothelin-1] was elevated in NFCI compared with COLD (P < 0.001) post-heating. The [4-HNE] was lower in NFCI compared with CON post-heating (P = 0.032) and lower than both COLD (P = 0.02) and CON (P = 0.015) post-cooling. No between-group differences were seen for the other biomarkers. Mild to moderate chronic NFCI does not appear to be associated with a pro-inflammatory state or oxidative stress. Baseline [IL-10] and [syndecan-1] and post-heating [endothelin-1] are the most promising candidates for diagnosing NFCI, but it is likely that a combination of tests will be required.

Infrared cameras overestimate skin temperature during rewarming from cold exposure.

OBJECTIVE: The primary aim of this study was to assess the accuracy of an infrared camera and that of a skin thermistor, both commercially available. The study aimed to assess the agreement over a wide range of skin temperatures following cold exposure. METHODS: Fifty-two males placed their right hand in a thin plastic bag and immersed it in 8 °C water for 30 min whilst seated in an air temperature of 30 °C. Following hand immersion, participants removed the bag and rested their hand at heart level for 10 min. Index finger skin temperature (Tsk) was measured with a thermistor, affixed to the finger pad, and an infrared camera measured 1 cm distally to the thermistor. Agreement between the infrared camera and thermistor was assessed by mean difference (infrared camera minus thermistor) and 95% limits of agreement analysis, accounting for the repeated measures over time. The clinically significant threshold for Tsk differences was set at ±0.5 °C and limits of agreement ±1 °C. RESULTS: As an average across all time points, the infrared camera recorded Tsk 1.80 (SD 1.16) °C warmer than the thermistor, with 95% limits of agreement ranging from -0.46 °C to 4.07 °C. CONCLUSION: Collectively, the results show the infrared camera overestimated Tsk at every time point following local cooling. Further, measurement of finger Tsk from the infrared camera consistently fell outside the acceptable level of agreement (i.e. mean difference exceeding ±0.5 °C). Considering these results, infrared cameras may overestimate peripheral Tsk following cold exposure and clinicians and practitioners should, therefore, adjust their risk/withdrawal criteria accordingly.

Extending work tolerance time in the heat in protective ensembles with pre- and per-cooling methods.

OBJECTIVES: Investigate whether a range of cooling methods can extend tolerance time and/or reduce physiological strain in those working in the heat dressed in a Class 2 chemical, biological, radiological, nuclear (CBRN) protective ensemble. METHODS: Eight males wore a Class 2 CBRN ensemble and walked for a maximum of 120 min at 35 °C, 50% relative humidity. In a randomised order, participants completed the trial with no cooling and four cooling protocols: 1) ice-based cooling vest (IV), 2) a non-ice-based cooling vest (PCM), 3) ice slushy consumed before work, combined with IV (SLIV) and 4) a portable battery-operated water-perfused suit (WPS). Mean with 95% confidence intervals are presented. RESULTS: Tolerance time was extended in PCM (46 [36, 56] min, P = 0.018), SLIV (56 [46, 67] min, P < 0.001) and WPS (62 [53, 70] min, P < 0.001), compared with control (39 [30, 48] min). Tolerance time was longer in SLIV and WPS compared with both IV (48 [39, 58 min]) and PCM (P ≤ 0.011). After 20 min of work, HR was lower in SLIV (121 [105, 136] beats·min-1), WPS (117 [101, 133] beats·min-1) and IV (130 [116, 143] beats·min-1) compared with control (137 [120, 155] beats·min-1) (all P < 0.001). PCM (133 [116, 151] beats·min-1) did not differ from control. CONCLUSION: All cooling methods, except PCM, utilised in the present study reduced cardiovascular strain, while SLIV and WPS are most likely to extend tolerance time for those working in the heat dressed in a Class 2 CBRN ensemble.

Validity of a noninvasive estimation of deep body temperature when wearing personal protective equipment during exercise and recovery.

BACKGROUND: Deep body temperature is a critical indicator of heat strain. However, direct measures are often invasive, costly, and difficult to implement in the field. This study assessed the agreement between deep body temperature estimated from heart rate and that measured directly during repeated work bouts while wearing explosive ordnance disposal (EOD) protective clothing and during recovery. METHODS: Eight males completed three work and recovery periods across two separate days. Work consisted of treadmill walking on a 1% incline at 2.5, 4.0, or 5.5 km/h, in a random order, wearing EOD protective clothing. Ambient temperature and relative humidity were maintained at 24 °C and 50% [Wet bulb globe temperature (WBGT) (20.9 ± 1.2) °C] or 32 °C and 60% [WBGT (29.0 ± 0.2) °C] on the separate days, respectively. Heart rate and gastrointestinal temperature (TGI) were monitored continuously, and deep body temperature was also estimated from heart rate (ECTemp). RESULTS: The overall systematic bias between TGI and ECTemp was 0.01 °C with 95% limits of agreement (LoA) of ±0.64 °C and a root mean square error of 0.32 °C. The average error statistics among participants showed no significant differences in error between the exercise and recovery periods or the environmental conditions. At TGI levels of (37.0-37.5) °C, (37.5-38.0) °C, (38.0-38.5) °C, and > 38.5 °C, the systematic bias and ± 95% LoA were (0.08 ± 0.58) °C, (- 0.02 ± 0.69) °C, (- 0.07 ± 0.63) °C, and (- 0.32 ± 0.56) °C, respectively. CONCLUSIONS: The findings demonstrate acceptable validity of the ECTemp up to 38.5 °C. Conducting work within an ECTemp limit of 38.4 °C, in conditions similar to the present study, would protect the majority of personnel from an excessive elevation in deep body temperature (> 39.0 °C).

An Evaluation of Personal Cooling Systems for Reducing Thermal Strain Whilst Working in Chemical/Biological Protective Clothing.

OBJECTIVE: The use of personal cooling systems to mitigate heat strain on first-responders achieves two potential performance benefits relative to the absence of such cooling: (1) the completion of a workload with less effort; and/or (2) the completion of a greater workload for the same effort. Currently, claims made by manufacturers regarding the capability of their products for use in conjunction with chemical/biological protective clothing remain largely unsubstantiated. The purpose of this investigation was to evaluate the means by which heat strain can be alleviated during uncompensable heat stress in chemical/biological clothing, using the ASTM F2300-10 methodology. METHODS: Eight healthy males completed five trials of continuous walking (4.5 km h-1; 35°C; 49% RH) for up to 120 min while wearing one of four cooling systems and/or a National Fire and Protection Association 1994 Class-3 chemical/biological ensemble. The four cooling methods (ice vest [IV], phase-change vest [PCM], water-perfused suit [WS], and combination ice slurry/ice vest [SLIV]) and no cooling (CON). RESULTS: We observed significant improvements in trial times for IV (18 ± 10 min), PCM (20 ± 10 min) and SLIV (22 ± 10 min), but no differences for WS (4 ± 7 min). Heart rate, rectal, mean skin, and body temperatures were significantly lower in all cooling conditions relative to control at various matched time points in the first 60 min of exercise. Thermal sensation, comfort and perceived exertion all had significant main effects for condition, and time, there were no differences in their respective interactions. CONCLUSION: The IV, PCM, and SLIV produced lower heart rate, mean skin, rectal and mean body temperatures in addition to improved work times compared to control. The WS did not improve work times possibly as a result of the cooling capacity of the suit abating, and magnifying thermal insulation. Considering the added time and resources required to implement combination cooling in the form of ice slurry and ice vest (SLIV), there was no significant additive effect for perception, cardiovascular strain, rectal temperature and total trial time relative to the phase change vest or ice vest alone. This may be a product of a "ceiling" effect for work limit set to 120 min as part of ASTM F2300-10.

Passive heating and glycaemic control in non-diabetic and diabetic individuals: A systematic review and meta-analysis.

OBJECTIVE: Passive heating (PH) has begun to gain research attention as an alternative therapy for cardio-metabolic diseases. Whether PH improves glycaemic control in diabetic and non-diabetic individuals is unknown. This study aims to review and conduct a meta-analysis of published literature relating to PH and glycaemic control. METHODS: Electronic data sources, PubMed, Embase and Web of Science from inception to July 2018 were searched for randomised controlled trials (RCT) studying the effect of PH on glycaemic control in diabetic or non-diabetic individuals. To measure the treatment effect, standardised mean differences (SMD) with 95% confidence intervals (CI) were calculated. RESULTS: Fourteen articles were included in the meta-analysis. Following a glucose load, glucose concentration was greater during PH in non-diabetic (SMD 0.75, 95% CI 1.02 to 0.48, P < 0.001) and diabetic individuals (SMD 0.27, 95% CI 0.52 to 0.02, P = 0.030). In non-diabetic individuals, glycaemic control did not differ between PH and control only (SMD 0.11, 95% CI 0.44 to -0.22, P > 0.050) and a glucose challenge given within 24 hours post-heating (SMD 0.30, 95% CI 0.62 to -0.02, P > 0.050). CONCLUSION: PH preceded by a glucose load results in acute glucose intolerance in non-diabetic and diabetic individuals. However, heating a non-diabetic individual without a glucose load appears not to affect glycaemic control. Likewise, a glucose challenge given within 24 hours of a single-bout of heating does not affect glucose tolerance in non-diabetic individuals. Despite the promise PH may hold, no short-term benefit to glucose tolerance is observed in non-diabetic individuals. More research is needed to elucidate whether this alternative therapy benefits diabetic individuals.

Occupational cooling practices of emergency first responders in the United States: A survey.

Despite extensive documentation directed specifically toward mitigating thermal strain of first responders, we wished to ascertain the degree to which first responders applied cooling strategies, and what opinions are held by the various agencies/departments within the United States. An internet-based survey of first responders was distributed to the International Association of Fire Chiefs, International Association of Fire Firefighters, National Bomb Squad Advisory Board and the USA Interagency Board and their subsequent departments and branches. Individual first responder departments were questioned regarding the use of pre-, concurrent, post-cooling, types of methods employed, and/or reasons why they had not incorporated various methods in first responder deployment. Completed surveys were collected from 119 unique de-identified departments, including those working in law enforcement (29%), as firefighters (29%), EOD (28%) and HAZMAT technicians (15%). One-hundred and eighteen departments (99%) reported heat strain/illness to be a risk to employee safety during occupational duties. The percentage of departments with at least one case of heat illness in the previous year were as follows: fire (39%) HAZMAT (23%), EOD (20%) and law enforcement (18%). Post-cooling was the scheduled cooling method implemented the most (63%). Fire departments were significantly more likely to use post-cooling, as well as combine two types of scheduled cooling compared to other departments. Importantly, 25% of all departments surveyed provided no cooling whatsoever. The greatest barriers to personnel cooling were as follows - availability, cost, logistics, and knowledge. Our findings could aid in a better understanding of current practices and perceptions of heat illness and injury prevention in United States first responders. Abbreviations: EOD: explosive ordnance disposal; HAZMAT: hazardous materials.

Internal and external cooling methods and their effect on body temperature, thermal perception and dexterity.

OBJECTIVE: The present study aimed to compare a range of cooling methods possibly utilised by occupational workers, focusing on their effect on body temperature, perception and manual dexterity. METHODS: Ten male participants completed eight trials involving 30 min of seated rest followed by 30 min of cooling or control of no cooling (CON) (34°C, 58% relative humidity). The cooling methods utilised were: ice cooling vest (CV0), phase change cooling vest melting at 14°C (CV14), evaporative cooling vest (CVEV), arm immersion in 10°C water (AI), portable water-perfused suit (WPS), heliox inhalation (HE) and ice slushy ingestion (SL). Immediately before and after cooling, participants were assessed for fine (Purdue pegboard task) and gross (grip and pinch strength) manual dexterity. Rectal and skin temperature, as well as thermal sensation and comfort, were monitored throughout. RESULTS: Compared with CON, SL was the only method to reduce rectal temperature (P = 0.012). All externally applied cooling methods reduced skin temperature (P<0.05), though CV0 resulted in the lowest skin temperature versus other cooling methods. Participants felt cooler with CV0, CV14, WPS, AI and SL (P<0.05). AI significantly impaired Purdue pegboard performance (P = 0.001), but did not affect grip or pinch strength (P>0.05). CONCLUSION: The present study observed that ice ingestion or ice applied to the skin produced the greatest effect on rectal and skin temperature, respectively. AI should not be utilised if workers require subsequent fine manual dexterity. These results will help inform future studies investigating appropriate pre-cooling methods for the occupational worker.

An Overt Chemical Protective Garment Reduces Thermal Strain Compared with a Covert Garment in Warm-Wet but Not Hot-Dry Environments.

Objectives: A commercial chemical, biological, radiological and nuclear (CBRN) protective covert garment has recently been developed with the aim of reducing thermal strain. A covert CBRN protective layer can be worn under other clothing, with equipment added for full chemical protection when needed. However, it is unknown whether the covert garment offers any alleviation to thermal strain during work compared with a traditional overt ensemble. Therefore, the aim of this study was to compare thermal strain and work tolerance times during work in an overt and covert ensemble offering the same level of CBRN protection. Methods: Eleven male participants wore an overt (OVERT) or covert (COVERT) CBRN ensemble and walked (4 km·h-1, 1% grade) for a maximum of 120 min in either a wet bulb globe temperature [WBGT] of 21, 30, or 37°C (Neutral, WarmWet and HotDry, respectively). The trials were ceased if the participants' gastrointestinal temperature reached 39°C, heart rate reached 90% of maximum, walking time reached 120 min or due to self-termination. Results: All participants completed 120 min of walking in Neutral. Work tolerance time was greater in OVERT compared with COVERT in WarmWet (P < 0.001, 116.5[9.9] vs. 88.9[12.2] min, respectively), though this order was reversed in HotDry (P = 0.003, 37.3[5.3] vs. 48.4[4.6] min, respectively). The rate of change in mean body temperature and mean skin temperature was greater in COVERT (0.025[0.004] and 0.045[0.010]°C·min-1, respectively) compared with OVERT (0.014[0.004] and 0.027[0.007]°C·min-1, respectively) in WarmWet (P < 0.001 and P = 0.028, respectively). However, the rate of change in mean body temperature and mean skin temperature was greater in OVERT (0.068[0.010] and 0.170[0.026]°C·min-1, respectively) compared with COVERT (0.059[0.004] and 0.120[0.017]°C·min-1, respectively) in HotDry (P = 0.002 and P < 0.001, respectively). Thermal sensation, thermal comfort, and ratings of perceived exertion did not differ between garments at trial cessation (P > 0.05). Conclusion: Those dressed in OVERT experienced lower thermal strain and longer work tolerance times compared with COVERT in a warm-wet environment. However, COVERT may be an optimal choice in a hot-dry environment. These findings have practical implications for those making decisions on the choice of CBRN ensemble to be used during work.

Thermographic imaging in sports and exercise medicine: A Delphi study and consensus statement on the measurement of human skin temperature.

The importance of using infrared thermography (IRT) to assess skin temperature (tsk) is increasing in clinical settings. Recently, its use has been increasing in sports and exercise medicine; however, no consensus guideline exists to address the methods for collecting data in such situations. The aim of this study was to develop a checklist for the collection of tsk using IRT in sports and exercise medicine. We carried out a Delphi study to set a checklist based on consensus agreement from leading experts in the field. Panelists (n = 24) representing the areas of sport science (n = 8; 33%), physiology (n = 7; 29%), physiotherapy (n = 3; 13%) and medicine (n = 6; 25%), from 13 different countries completed the Delphi process. An initial list of 16 points was proposed which was rated and commented on by panelists in three rounds of anonymous surveys following a standard Delphi procedure. The panel reached consensus on 15 items which encompassed the participants' demographic information, camera/room or environment setup and recording/analysis of tsk using IRT. The results of the Delphi produced the checklist entitled "Thermographic Imaging in Sports and Exercise Medicine (TISEM)" which is a proposal to standardize the collection and analysis of tsk data using IRT. It is intended that the TISEM can also be applied to evaluate bias in thermographic studies and to guide practitioners in the use of this technique.

Role of cyclooxygenase in the vascular responses to extremity cooling in Caucasian and African males.

NEW FINDINGS: What is the central question of this study? Compared with Caucasians, African individuals are more susceptible to non-freezing cold injury and experience greater cutaneous vasoconstriction and cooler finger skin temperatures upon hand cooling. We investigated whether the enzyme cyclooxygenase is, in part, responsible for the exaggerated response to local cooling. What is the main finding and its importance? During local hand cooling, individuals of African descent experienced significantly lower finger skin blood flow and skin temperature compared with Caucasians irrespective of cyclooxygenase inhibition. These data suggest that in young African males the cyclooxygenase pathway appears not to be the primary reason for the increased susceptibility to non-freezing cold injury. Individuals of African descent (AFD) are more susceptible to non-freezing cold injury (NFCI) and experience an exaggerated cutaneous vasoconstrictor response to hand cooling compared with Caucasians (CAU). Using a placebo-controlled, cross-over design, this study tested the hypothesis that cyclooxygenase (COX) may, in part, be responsible for the exaggerated vasoconstrictor response to local cooling in AFD. Twelve AFD and 12 CAU young healthy men completed foot cooling and hand cooling (separately, in 8°C water for 30 min) with spontaneous rewarming in 30°C air after placebo or aspirin (COX inhibition) treatment. Skin blood flow, expressed as cutaneous vascular conductance (as flux per millimetre of mercury), and skin temperature were measured throughout. Irrespective of COX inhibition, the responses to foot cooling, but not hand cooling, were similar between ethnicities. Specifically, during hand cooling after placebo, AFD experienced a lower minimal skin blood flow [mean (SD): 0.5 (0.1) versus 0.8 (0.2) flux mmHg-1 , P < 0.001] and a lower minimal finger skin temperature [9.5 (1.4) versus 10.7 (1.3)°C, P = 0.039] compared with CAU. During spontaneous rewarming, average skin blood flow was also lower in AFD than in CAU [2.8 (1.6) versus 4.3 (1.0) flux mmHg-1 , P < 0.001]. These data provide further support that AFD experience an exaggerated response to hand cooling on reflection this appears to overstate findings; however, the results demonstrate that the COX pathway is not the primary reason for the exaggerated responses in AFD and increased susceptibility to NFCI.

Role of cyclooxygenase in the vascular response to locally delivered acetylcholine in Caucasian and African descent individuals.

INTRODUCTION: Individuals of African descent (AFD) are more susceptible to non-freezing cold injury (NFCI) compared with Caucasian individuals (CAU). Vasodilatation to acetylcholine (ACh) is lower in AFD compared with CAU in the non-glabrous foot and finger skin sites; the reason for this is unknown. Prostanoids are responsible, in part, for the vasodilator response to ACh, however it is not known whether the contribution differs between ethnicities. METHODS: 12 CAU and 12 AFD males received iontophoresis of ACh (1 w/v%) on non-glabrous foot and finger skin sites following placebo and then aspirin (600mg, single blinded). Aspirin was utilised to inhibit prostanoid production by inhibiting the cyclooxygenase (COX) enzyme. Laser Doppler flowmetry was utilised to measure changes in skin blood flow. RESULTS: Not all participants could receive iontophoresis charge due to high skin resistance; these participants were therefore excluded from the analyses. Foot: ACh elicited greater maximal vasodilatation in CAU than AFD following placebo (P=0.003) and COX inhibition (COXib) (P<0.001). COXib did not affect blood flow responses in AFD, but caused a reduction in the area under the curve for CAU (P=0.031). Finger: ACh elicited a greater maximal vasodilatation in CAU than AFD following placebo (P=0.013) and COXib (P=0.001). COXib tended to reduce the area under the curve in AFD (P=0.053), but did not affect CAU. CONCLUSIONS: CAU have a greater endothelial reactivity than AFD in both foot and finger skin sites irrespective of COXib. It is concluded that the lower ACh-induced vasodilatation in AFD is not due to a compromised COX pathway.

Vascular responses of the extremities to transdermal application of vasoactive agents in Caucasian and African descent individuals.

PURPOSE: Individuals of African descent (AFD) are more susceptible to non-freezing cold injury than Caucasians (CAU) which may be due, in part, to differences in the control of skin blood flow. We investigated the skin blood flow responses to transdermal application of vasoactive agents. METHODS: Twenty-four young males (12 CAU and 12 AFD) undertook three tests in which iontophoresis was used to apply acetylcholine (ACh 1 w/v %), sodium nitroprusside (SNP 0.01 w/v %) and noradrenaline (NA 0.5 mM) to the skin. The skin sites tested were: volar forearm, non-glabrous finger and toe, and glabrous finger (pad) and toe (pad). RESULTS: In response to SNP on the forearm, AFD had less vasodilatation for a given current application than CAU (P = 0.027-0.004). ACh evoked less vasodilatation in AFD for a given application current in the non-glabrous finger and toe compared with CAU (P = 0.043-0.014) with a lower maximum vasodilatation in the non-glabrous finger (median [interquartile], AFD n = 11, 41[234] %, CAU n = 12, 351[451] %, P = 0.011) and non-glabrous toe (median [interquartile], AFD n = 9, 116[318] %, CAU n = 12, 484[720] %, P = 0.018). ACh and SNP did not elicit vasodilatation in the glabrous skin sites of either group. There were no ethnic differences in response to NA. CONCLUSION: AFD have an attenuated endothelium-dependent vasodilatation in non-glabrous sites of the fingers and toes compared with CAU. This may contribute to lower skin temperature following cold exposure and the increased risk of cold injuries experienced by AFD.

The effect of ethnicity on the vascular responses to cold exposure of the extremities.

PURPOSE: Cold injuries are more prevalent in individuals of African descent (AFD). Therefore, we investigated the effect of extremity cooling on skin blood flow (SkBF) and temperature (T sk) between ethnic groups. METHODS: Thirty males [10 Caucasian (CAU), 10 Asian (ASN), 10 AFD] undertook three tests in 30 °C air whilst digit T sk and SkBF were measured: (i) vasomotor threshold (VT) test--arm immersed in 35 °C water progressively cooled to 10 °C and rewarmed to 35 °C to identify vasoconstriction and vasodilatation; (ii) cold-induced vasodilatation (CIVD) test--hand immersed in 8 °C water for 30 min followed by spontaneous warming; (iii) cold sensitivity (CS) test--foot immersed in 15 °C water for 2 min followed by spontaneous warming. Cold sensory thresholds of the forearm and finger were also assessed. RESULTS: In the VT test, vasoconstriction and vasodilatation occurred at a warmer finger T sk in AFD during cooling [21.2 (4.4) vs. 17.0 (3.1) °C, P = 0.034] and warming [22.0 (7.9) vs. 12.1 (4.1) °C, P = 0.002] compared with CAU. In the CIVD test, average SkBF during immersion was greater in CAU [42 (24) %] than ASN [25 (8) %, P = 0.036] and AFD [24 (13) %, P = 0.023]. Following immersion, SkBF was higher and rewarming faster in CAU [3.2 (0.4) °C min(-1)] compared with AFD [2.5 (0.7) °C min(-1), P = 0.037], but neither group differed from ASN [3.0 (0.6) °C min(-1)]. Responses to the CS test and cold sensory thresholds were similar between groups. CONCLUSION: AFD experienced a more intense protracted finger vasoconstriction than CAU during hand immersion, whilst ASN experienced an intermediate response. This greater sensitivity to cold may explain why AFD are more susceptible to cold injuries.