Symptomatic heart failure is managed with interdisciplinary approaches to reduce acute exacerbations and to improve mortality. Acupuncture is a standardized treatment of Traditional Chinese Medicine that has been shown to have beneficial effects on the cardiovascular system via a neurohumoral pathway known as the long-loop pathway. This article serves to examine recent evidence supporting the long-loop pathway as the physiologic mechanism of acupuncture and the sympatholytic, vasodilatory, and cardioprotective effects of acupuncture that could specifically improve cardiac function and quality of life measures in the management of congestive heart failure.

Dietary nitrate (NO3-) is converted to nitrite (NO2-) and can be further reduced to the vasodilator nitric oxide (NO) amid a low Oenvironment. Accordingly, dietary NO3- increases hind limb blood flow in rats during treadmill exercise; however, the evidence of such an effect in humans is unclear. We tested the hypothesis that acute dietary NO3- (via beetroot [BR] juice) increases forearm blood flow (FBF) via local vasodilation during handgrip exercise in young adults (n = 11; 25 ± 2 years). FBF (Doppler ultrasound) and blood pressure (Finapres) were measured at rest and during graded handgrip exercise at 5%, 15%, and 25% maximal voluntary contraction (MVC) lasting 4 min each. At the highest workload (25% MVC), systemic hypoxia (80% SaO) was induced and exercise continued for three additional minutes. Subjects ingested concentrated BR (12.6 mmol nitrate (n = 5) or 16.8 mmol nitrate (n = 6) and repeated the exercise bout either 2 (12.6 mmol) or 3 h (16.8 mmol) postconsumption. Compared to control, BR significantly increased FBF at 15% MVC (184 ± 15 vs. 164 ± 15 mL/min), 25% MVC (323 ± 27 vs. 286 ± 28 mL/min), and25% + hypoxia (373 ± 39 vs. 343 ± 32 mL/min) and this was due to increases in vascular conductance (i.e., vasodilation). The effect of BR on hemodynamics was not different between the two doses of BR ingested. Forearm VOwas also elevated during exercise at 15% and 25% MVC. We conclude that acute increases in circulating NO3- and NO2- via BR increases muscle blood flow during moderate- to high-intensity handgrip exercise via local vasodilation. These findings may have important implications for aging and diseased populations that demonstrate impaired muscle perfusion and exercise intolerance.

Vascular insulin resistance often precedes endothelial dysfunction in type 1 diabetes mellitus. Strategies to limit vascular dysfunction include intensive insulin therapy (4-9 mM) and aerobic training. To avoid the risk of hypoglycaemia, individuals often prescribed conventional insulin therapy (9-15 mM) and participate in resistance training. In a model of type 1 diabetes mellitus, this study examined insulin-induced vasomotor function in the aorta and femoral artery to determine (1) whether resistance training with conventional insulin therapy provides the same benefits as aerobic training with conventional insulin therapy, (2) whether aerobic training or resistance training, when paired with conventional insulin therapy, results in superior vasomotor function compared to intensive insulin therapy alone and (3) whether vessel-specific adaptations exist. Groups consisted of conventional insulin therapy, intensive insulin therapy, aerobic training with conventional insulin therapy and resistance training with conventional insulin therapy. Following multiple low doses of streptozotocin, male Sprague-Dawley rats were supplemented with insulin to maintain blood glucose concentrations (9-15 mM: conventional insulin therapy, aerobic training and resistance training; 4-9 mM: intensive insulin therapy) for 12 weeks. Aerobic training performed treadmill exercise and resistance training consisted of weighted climbing. Coinciding with increased Akt signalling, aerobic training resulted in enhanced insulin-induced vasorelaxation in the femoral artery. Intensive insulin therapy displayed increased mitogen-activated protein kinase signalling and no improvement in insulin-stimulated vasorelaxation compared to all other groups. These data suggest that aerobic training may be more beneficial for limiting the pathogenesis of vascular disease in type 1 diabetes mellitus than merely intensive insulin therapy.

OBJECTIVE:Previous studies have shown that estrogen deficiency, arising in postmenopause, promotes endothelial dysfunction. This study evaluated the effects of aerobic exercise training on endothelial dependent vasodilation of aorta in ovariectomized rats, specifically investigating the role of nitric oxide (NO) and reactive oxygen species (ROS).

METHODS:Female Wistar rats ovariectomized (OVX - n=20) or with intact ovary (SHAM - n=20) remained sedentary (OVX and SHAM) or performed aerobic exercise training on a treadmill 5 times a week for a period of 8 weeks (OVX-TRA and SHAM-TRA). In the thoracic aorta the endothelium-dependent and -independent vasodilation was assessed by acetylcholine (ACh) and sodium nitroprusside (SNP), respectively. Certain aortic rings were incubated with L-NAME to assess the NO modulation on the ACh-induced vasodilation. The fluorescence to dihydroethidium in aortic slices and plasma nitrite/nitrate concentrations were measured to evaluate ROS and NO bioavailability, respectively.

RESULTS:ACh-induced vasodilation was reduced in OVX rats as compared SHAM (Rmax: SHAM: 86±3.3 vs. OVX: 57±3.0%, p<0.01). Training prevented this response in OVX-TRA (Rmax: OVX-TRA: 88±2.0%, p<0.01), while did not change it in SHAM-TRA (Rmax: SHAM-TRA: 80±2.2%, p<0.01). The L-NAME incubation abolished the differences in ACh-induced relaxation among groups. SNP-induced vasodilation was not different among groups. OVX reduced nitrite/nitrate plasma concentrations and increased ROS in aortic slices, training as effective to restore these parameters to the SHAM levels.

CONCLUSIONS:Exercise training, even in estrogen deficiency conditions, is able to improve endothelial dependent vasodilation in rat aorta via enhanced NO bioavailability and reduced ROS levels.

Mitochondria produce reactive oxygen species that may contribute to vascular dysfunction. alpha-Lipoic acid and acetyl-L-carnitine reduce oxidative stress and improve mitochondrial function. In a double-blind crossover study, the authors examined the effects of combined alpha-lipoic acid/acetyl-L-carnitine treatment and placebo (8 weeks per treatment) on vasodilator function and blood pressure in 36 subjects with coronary artery disease. Active treatment increased brachial artery diameter by 2.3% (P=.008), consistent with reduced arterial tone. Active treatment tended to decrease systolic blood pressure for the whole group (P=.07) and had a significant effect in the subgroup with blood pressure above the median (151+/-20 to 142+/-18 mm Hg; P=.03) and in the subgroup with the metabolic syndrome (139+/-21 to 130+/-18 mm Hg; P=.03). Thus, mitochondrial dysfunction may contribute to the regulation of blood pressure and vascular tone. Further studies are needed to confirm these findings and determine the clinical utility of alpha-lipoic acid/acetyl-L-carnitine as antihypertensive therapy.

BACKGROUND AND OBJECTIVE: Several epidemiological and experimental studies have associated the intake of antioxidants, which are abundant in the Mediterranean diet, with a low incidence of cardiovascular disease. One possible mechanism of this action is the oxidative protection in low density lipoproteins (LDL). The aim of our study was to compare the antioxidative activity of diverse phenolic compounds present in virgin olive oil on these lipoproteins.

SUBJECTS AND METHOD: LDL was isolated from blood plasma of healthy volunteers by sequential ultracentrifugation. This was followed by oxidation with CuC12 in the presence of different concentrations of phenolic compounds and virgin olive oil extract. Production of conjugated dienes was determined by the continuous monitoring of increased absorbency at 234 nm as an indicator of LDL oxidation.

RESULTS: Virgin olive oil extract prolonged the latency phase and significantly lowered the progression rate (p<0.05) at low concentrations (2 g/ml). This antioxidative effect was also observed with low concentrations (2 M) of caffeic acid and oleuropein (p<0.05). However, it was necessary to increase the concentration of flavone up to 50 times to observe a similar effect (p<0.05).

CONCLUSION: Both virgin olive oil extract enriched in phenolic compounds and phenolic compounds present in olive oil (caffeic acid and oleuropein) are potent antioxidants at very low concentrations. Thus, the beneficial effects of a Mediterranean diet may be partly due to the protective action of these compounds.

The effects of pomegranate extract (PE) supplementation were evaluated on high-intensity exercise performance, blood flow, vessel diameter, oxygen saturation (SPO2), heart rate (HR), and blood pressure (BP). In a randomized, crossover design, nineteen recreationally resistance-trained participants were randomly assigned to PE (1000 mg) or placebo (PL), which were consumed 30 min prior to a repeated sprint ability (RSA) test and repetitions to fatigue (RTF) on bench and leg press. The RSA consisted of ten six-second sprints on a friction-loaded cycle ergometer with 30 s recovery. Brachial artery blood flow and vessel diameter were assessed by ultrasound. Blood flow, vessel diameter, SPO2, HR, and BP were assessed at baseline, 30 min post ingestion, immediately post exercise (IPost), and 30 min post exercise (30minPost). With PE, blood flow significantly increased IPost RSA (mean difference = 18.49 mL min(-1); P < .05), and IPost and 30minPost RTF (P < .05) according to confidence intervals (CI). Vessel diameter increased significantly 30minPost RSA according to CI and resulted in a significant interaction IPost and 30minPost RTF (P < .05). With PE, according to CI, average and peak power output increased significantly in sprint 5 of the RSA (P < .05). There was no significant difference between PE and PL for bench (P = .25) or leg press (P = .15) repetitions. Acute PE supplementation enhanced vessel diameter and blood flow, suggesting possible exercise performance enhancement from increased delivery of substrates and oxygen. Theacute timing and capsule form of PE may be advantageous to athletic populations due to ergogenic effects, taste, and convenience.

OBJECTIVE: To compare the efficacy and safety of a homeopathic remedy (Vertigoheel, Heel Inc, Albuquerque, NM) vs betahistine hydrochloride (active control) in the treatment of patients with vertigo of various origins in a confirmative equivalence trial. DESIGN: Randomized (1:1) double-blind controlled clinical trial. SETTING: Fifteen study centers (general practice) in Germany between November 1995 and November 1996. SUBJECTS: A total of 119 patients with vertigo of various origins (from whom 105 patients could be analyzed as intended per protocol). MAIN OUTCOME MEASURES: Frequency, duration, and intensity of vertigo attacks. RESULTS: Both homeopathic and conventional treatments showed a clinically relevant reduction in the mean frequency, duration, and intensity of the vertigo attacks. The therapeutic equivalence of the homeopathic remedy and betahistine was established statistically. CONCLUSIONS: Concerning the main efficacy variable, therapeutic equivalence between the homeopathic remedy and betahistine could be shown with statistical significance (confirmative analysis). Both remedies reduced the frequency, duration, and intensity of vertigo attacks during a 6-week treatment period. Also, vertigo-specific complaints were significantly reduced in both treatment groups.

The main basic effect of hyperbaric oxygenation (HBO2) on the human body, in our study, was an increased partial pressure of oxygen resulting from an increased amount of oxygen dissolved in plasma. Thus the plasma can become capable of carrying enough oxygen to meet the needs of the body's tissues. From 1 January 2004 to 31 December 2007, a total of 61 patients (62 ears) received medical treatment at the ENT clinic of the 3rd Faculty of Medicine, Charles University, and at the Central Military Hospital in Prague. Treatment consisted of a combination of vasodilatation infusion treatment and HBO2 therapy. The results were evaluated in a retrospective study. The overall percentage of patients showing improvement was 59.7%. However, for those patients who started HBO2 treatment within 10 days of onset, complete recovery, or significant improvement was noted in 65.9%. In contrast, patients who started treatment after 10 days of onset, improvement was noted in only 38.9%. NMR examination revealed that two patients had vestibular schwannoma (also known as acoustic neuroma).

:Rationale/ Objectives: The model traffic-related air pollutant exposure, diesel exhaust inhalation, is associated with vascular dysfunction. We studied whether healthy subjects exposed to diesel exhaust exhibit acute vasoconstriction and whether this effect could be modified by the use of antioxidants or by common variants in the angiotensin II type 1 receptor (AGTR1) and other candidate genes.

METHODS:In a genotype- stratified double-blind, four-way crossover study, 22 healthy adult participants were exposed in randomized, balanced order to exposure with diesel exhaust (200μg/m3 PM2.5) and filtered air and to pretreatment with antioxidants (N- acetyl cysteine and ascorbate) and placebo. Before and after each exposure, brachial artery diameter was assessed using ultrasound. Changes in brachial artery diameter were compared across pretreatment and exposure sessions. Gene-exposure interactions were evaluated in the AGTR1 A1166C polymorphism, on which recruitment was stratified, and other candidate genes including TRPV1 and GSTM1.

MAIN RESULTS:Compared with filtered air, exposure to diesel exhaust resulted in a significant reduction in brachial artery diameter (mean -0.09mm, 95% CI -0.01, -0.17; p = 0.03). Pretreatment with antioxidants augmented diesel exhaust related vasoconstriction; participants pretreated with antioxidants had a diesel exhaust effect of -0.18mm (95%CI -0.28 to -0.07 mm; p = 0.01). Diesel exhaust related vasoconstriction was primarily observed in the variant alleles of AGTR1 and TRPV1.

CONCLUSION:We confirmed that short-term exposure to diesel exhaust in healthy participants is associated with acute vasoconstriction in a conductance artery, and found suggestive evidence of involvement of nociception and renin-angiotensin systems in this effect. Pretreatment with an antioxidant regimen increased vasoconstriction. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00434005.

OBJECTIVE: Alternative medical practices are common in the treatment of vertigo. This study compared the effects of Ginkgo biloba treatment with the homeopathic remedy Vertigoheel (Biologische Heilmittel Heel GmbH, Baden-Baden, Germany). DESIGN: Randomized, double-blinded, parallel group study. SUBJECTS: One hundred and seventy (170) patients, ages 60-80 years, with atherosclerosis-related vertigo. INTERVENTIONS: Patients were randomly allocated to receive treatment with either Vertigoheel (n = 87) or G. biloba (n = 83). OUTCOME MEASURES: The results were analyzed for the non-inferiority of Vertigoheel to G. biloba on the combined endpoint of changes from baseline to week 6 in dizziness score (assessed by questionnaire), frequency, duration, and intensity of vertigo episodes (recorded in patient diaries). RESULTS: Both treatments improved vertigo status. From a baseline mean value of 26.1 +/- 5.2 (on a 50-point scale) in the Vertigoheel group, the dizziness questionnaire score improved by -10.6 +/- 10.0, and by -10.7 +/- 9.0 from 25.8 - 4.7 in the G. biloba group. Statistical analysis of this endpoint showed that Vertigoheel was not inferior to G. biloba. The 95% confidence interval for the difference between treatment did not reach the inferiority threshold of 0.36 at any of the time points tested. The results were supported by the results of a line walking test, Unterberger's stepping test, and patient and physician global assessments of therapeutic effect. Both treatments were well tolerated. CONCLUSIONS: Vertigoheel is an appealing alternative to established G. biloba therapy for atherosclerosis-related vertigo.