Supine Conditions Research Articles

Computational Imaging to Compensate for Soft-Tissue Deformations in Image-Guided Breast Conserving Surgery.

During breast conserving surgery (BCS), magnetic resonance (MR) images aligned to accurately display intraoperative lesion locations can offer improved understanding of tumor extent and position relative to breast anatomy. Unfortunately, even under consistent supine conditions, soft tissue deformation compromises image-to-physical alignment and results in positional errors. A finite element inverse modeling technique has been developed to nonrigidly register preoperative supine MR imaging data to the surgical scene for improved localization accuracy during surgery. Registration is driven using sparse data compatible with acquisition during BCS, including corresponding surface fiducials, sparse chest wall contours, and the intra-fiducial skin surface. Deformation predictions were evaluated at surface fiducial locations and subsurface tissue features that were expertly identified and tracked. Among n = 7 different human subjects, an average of 22 ± 3 distributed subsurface targets were analyzed in each breast volume. The average target registration error (TRE) decreased significantly when comparing rigid registration to this nonrigid approach (10.4 ± 2.3 mm vs 6.3 ± 1.4 mm TRE, respectively). When including a single subsurface feature as additional input data, the TRE significantly improved further (4.2 ± 1.0 mm TRE), and in a region of interest within 15 mm of a mock biopsy clip TRE was 3.9 ± 0.9 mm. These results demonstrate accurate breast deformation estimates based on sparse-data-driven model predictions. The data suggest that a computational imaging approach can account for image-to-surgery shape changes to enhance surgical guidance during BCS.

Differences in Inter-Rectus Distance and Abdominopelvic Function between Nulliparous, Primiparous and Multiparous Women.

Widening of the inter-rectus distance (IRD) is highly prevalent among postpartum women and can lead to dysfunction of abdominopelvic muscles. The aim of this study was to evaluate the differences in IRD and abdominopelvic function between nulliparous, primiparous and multiparous women. A cross-sectional study was conducted on 75 women (25 nulliparous, 25 primiparous and 25 multiparous at 6 months postpartum). The participants underwent ultrasound assessment under three conditions (at rest, abdominal draw-in maneuver (ADIM) and curl-up) at two locations (2 cm above and 2 cm below the umbilicus). Furthermore, abdominopelvic muscle function was determined by prone, supine and side bridge tests. In all conditions and locations, the IRD were significantly higher (p < 0.05) in the primiparous and multiparous women than in the nulliparous. The multiparous women presented greater (p > 0.05) IRD at rest and during ADIM compared to the primiparous women. Regarding abdominopelvic muscle function, differences were only significant (p < 0.05) between the nulliparous with primiparous women in prone and supine conditions. These findings suggest that parity influences IRD: women at 6 months postpartum present greater IRD compared to nulliparous women; multiparous women present greater IRD at rest and during the activation of deep abdominal muscles than primiparous women; and primiparous women exhibit worse abdominopelvic muscle function than nulliparous women.

Influence of simulated hypogravity on oxygen uptake during treadmill running.

Prolonged exposure to microgravity during spaceflights leads to severe deterioration in the physical performance of astronauts. To understand the effectiveness of existing in‐flight daily countermeasures and to plan exercise onboard the International Space Station, we compared supine treadmill running to traditional upright treadmill running on earth. Specifically, we assessed the cardiorespiratory responses to conventional upright running to the responses to supine treadmill running under 0.3 g, 0.6 g, and 1 g of body weight in younger (20–30 years, n = 14, 8 females) and older healthy adults (50–60 years, n = 12, 6 females). Maximal cardiorespiratory capacity was additionally evaluated by performing an incremental running protocol on each treadmill. Maximum speed was greater for 0.3 g and 0.6 g in supine than for upright running (18.5 km/h (1.1) and 15.9 (3.1) vs 13.2 (2.4) p < 0.001). In contrast, maximum oxygen uptake (V˙O2max) and maximum heart rate (HRmax) were greater in upright running than in all supine conditions (Upright treadmill running vs S1.0G vs S0.6G vs S0.3G, 41.7 ml kg−1 min−1 (7.2) vs 30.5 (6.6) vs 32.9 (7.0) vs 30.9 (5.2), p < 0.001 and 171 beats min−1 (14) vs 152 (24) vs 155 (20) vs 152 (18), p < 0.001, respectively). The reduction in V˙O2max was remarkably similar across all three supine conditions, could not be increased by higher running speeds and can be well explained by reduced ground reaction forces (GRF). Thus, although a gravity‐related restriction of pulmonary gas exchange or perfusion of the legs when exercising in the supine position can be suspected, findings are also explicable on grounds of the vertical treadmill mechanics. Reduced loading will constitute a substantial limitation to V˙O2 in space with implications for crew health and the physical deterioration of astronauts.

The diagnostic potential of low-field MRI in problematic total knee arthroplasties - a feasibility study

PurposeLow-field MRI, allowing imaging in supine and weight-bearing position, may be utilized as a non-invasive and affordable tool to differentiate between causes of dissatisfaction after TKA (‘problematic TKA’). However, it remains unclear whether low-field MRI results in sufficient image quality with limited metal artefacts. Therefore, this feasibility study explored the diagnostic value of low-field MRI concerning pathologies associated with problematic TKA’s’ by comparing low-field MRI findings with CT and surgical findings. Secondly, differences in patellofemoral parameters between supine and weight-bearing low-field MRI were evaluated.MethodsEight patients with a problematic TKA were scanned using low-field MRI in weight-bearing and supine conditions. Six of these patients underwent revision surgery. Scans were analysed by a radiologist for pathologies associated with a problematic TKA. Additional patellofemoral and alignment parameters were measured by an imaging expert. MRI observations were compared to those obtained with CT, the diagnosis based on the clinical work-up, and findings during revision surgery.ResultsMRI observations of rotational malalignment, component loosening and patellofemoral arthrosis were comparable with the clinical diagnosis (six out of eight) and were confirmed during surgery (four out of six). All MRI observations were in line with CT findings (seven out of seven). Clinical diagnosis and surgical findings of collateral excessive laxity could not be confirmed with MRI (two out of eight).ConclusionLow-field MRI shows comparable diagnostic value as CT and might be a future low cost and ionizing radiation free alternative. Differences between supine and weight-bearing MRI did not yield clinically relevant information.The study was approved by the Medical Research Ethics Committees of Twente (Netherlands Trial Register: Trial NL7009 (NTR7207). Registered 5 March 2018, https://www.trialregister.nl/trial/7009).

Cross-Wavelet Time-Frequency Analysis Reveals Sympathetic Contribution to Baroreflex Sensitivity as Cause of Variable Phase Delay Between Blood Pressure and Heart Rate.

IntroductionBaroreflex sensitivity (BRS) is often presented as a single number, but it is actually a frequency-dependent phenomenon whose value changes constantly due to internal and external stimuli. The standing posture, for instance, necessitates a changeover from vagal to sympathetic predominance for cardiovascular control. We present a wavelet cross-spectral analysis of blood pressure (BP) and interbeat interval (IBI) recordings in the search for variations in gain and phase between these signals. Additionally, we show how the lag in sympathetic response dictates BP-to-IBI phase relations.MethodsRecordings in supine and head-up tilted (HUT) position, obtained earlier in 10 healthy subjects (4f/6m, aged 27–47 years) were used. BP and IBI were measured from the continuous finger pressure (by Finometer). The cross-wavelet analysis produced time- and frequency dependent gain (wBRS, wavelet derived BRS) and phase, using the MATLAB® wavelet toolbox. We also applied the wBRS method to model-generated BP- and IBI-data with known interrelations to test the results of this analysis technique. Finally, wBRS values were compared with the xBRS-approach, which is a time domain method for continuous BRS estimation in a sliding 10-s window.ResultsIn resting supine conditions, wBRS fluctuates; more at respiratory frequencies than in the 0.1 Hz band. After HUT, wBRS at the respiratory frequency decreases from average 22.7 to 8.5 ms/mmHg, phase between BP and IBI increases from −30° to −54°; in the sympathetic 0.1 Hz range these numbers are 13.3→6.3 ms/mmHg and −54°→−59°. The values found by xBRS are intermediate between wBRS-resp and wBRS-0.1 Hz. The Appendix shows that for the simulated data the BRS and phase values as found by the wavelet technique can be explained from vector additions of vagal and sympathetic BRS contributions.DiscussionDuring supine rest parasympathetic control of heart rate dominates BRS; after HUT this is diminished and less effective. Due to the reaction times of the autonomic effectors, the phase relations between the signals depend on the relative contribution of the sympathetics, which explains the larger phase shift.ConclusionCross wavelet analysis allows to follow fast BRS changes in time and frequency, while the computed phase relations help understand sympathetic participation.

Assumed Lighting Direction in the Interpretation of Cast Shadows.

Assumed lighting direction in cast-shadow interpretation was investigated. Experiment 1 used an ambiguous object–shadow-matching task to measure bias in shadow-matching direction. The shadow-matching bias was largest when the lighting direction was on average 38.3° left from above (a median of 25.1°). Experiment 2 tested the effect of body posture (head orientation) on cast-shadow interpretation using stimuli aligned in a head-centrically vertical or horizontal orientation. The below-shadow (light-from-above) bias in the head-centric frame was robust across the sitting upright, reclining-on-the-left-side, reclining-on-the-right-side, and supine conditions. A right-shadow (light-from-left) bias in the head-centric frame was found for the sitting upright and reclining-on-the-right-side conditions. In the reclining-on-the-left-side condition, shadow biases to the gravitational below direction and head-centric right direction may have cancelled each other out. These results are consistent with findings from previous shape-from-shading studies, suggesting that the same light-source assumption is applied to shading and shadow interpretations.

OP.5C.07] THE LINK BETWEEN CARDIORESPIRATORY FITNESS AND CARDIAC AUTONOMIC NERVOUS SYSTEM IN OBESE YOUTH

Objective: Over the last decades the prevalence of obesity in children and adolescents has increased worldwide. This fact affects health expectancy and quality of life and then, assessment of cardiovascular risk factors has been emphasized. Among cardiovascular risk factors in adults, the relevance of cardiorespiratory fitness has been highlighted by the American Heart Association (AHA, Circulation 2016). To assess the cardiorespiratory fitness and its relationship with the cardiac autonomic neural activity, a marker of early cardiometabolic risk, in youths with abnormally increased body weight. Design and method: Sixty-four overweight and obese subjects, 9 to 17 years, of both sexes, stratified according to the international body mass index cut-off, were enrolled. Continuous electrocardiogram was recorded during 15 minutes in resting and supine conditions, and afterwards heart rate variability was analysed in the time and frequency domain as well as non-linear dynamics. In addition, cardiorespiratory fitness in effort conditions was assessed (VO2peak). Results: Among the obese youths, cardiorespiratory fitness was the lowest in severe obese despite that no significant differences were observed regarding heart rate nor heart rate variability in time and frequency domain. A positive and significant relationship, independent of the degree of obesity, pubertal stage and breathing rate under resting conditions, were observed between cardiorespiratory fitness (assessed by VO2peak) and sympatho-vagal balance, estimated by standard deviation of the NN interval (SDNN: r = 0.268, p < 0.05) and the long term variation using the Poincaré plot (PS1: r = 0.275, p < 0.05; PS2 r = 0.273, p < 0.05). Conclusions: The key finding of the present study was the presence of a link between cardiorespiratory fitness and cardiac autonomic nervous system activity, independent of the degree of obesity. This emphasises that cardiorespiratory fitness can be a relevant tool in the assessment of early cardiovascular risk in obese youths.

Supine posture inhibits cortical activity: Evidence from Delta and Alpha EEG bands

Past studies have shown consistent evidence that body position significantly affects brain activity, revealing that both head-down and horizontal bed-rest are associated with cortical inhibition and altered perceptual and cognitive processing. The present study investigates the effects of body position on spontaneous, open-eyes, resting-state EEG cortical activity in 32 young women randomly assigned to one of two conditions, seated position (SP) or horizontal bed rest (BR). A between-group repeated-measure experimental design was used, EEG recordings were made from 38 scalp locations, and low-frequency (delta and alpha) amplitudes of the two groups were compared in four different conditions: when both groups (a) were seated (T0), (b) assumed two different body positions (seated vs. supine conditions, immediate [T1] and 120min later [T2]), and (c) were seated again (T3). Overall, the results showed no a priori between-group differences (T0) before experimental manipulation. As expected, delta amplitude, an index of cortical inhibition in awake resting participants, was significantly increased in group BR, revealing both rapid (T1) and mid-term (T2) inhibitory effects of supine or horizontal positions. Instead, the alpha band was highly sensitive to postural transitions, perhaps due to baroreceptor intervention and, unlike the delta band, underwent habituation and decreased after a 2-h bed rest. These results indicate clear-cut differences at rest between the seated and supine positions, thus supporting the view that the role of body position in the differences found between brain metabolic methods (fMRI and PET) in which participants lie horizontally, and EEG-MEG-TMS techniques with participants in a seated position, has been largely underestimated so far.

The effect of exercise training on left ventricular relaxation and diastolic suction at rest and during orthostatic stress after bed rest

A marked reduction in upright stroke volume (SV) contributes substantially to orthostatic intolerance after exposure to spaceflight or bed rest. It is unclear whether slowed left ventricular (LV) relaxation and diastolic suction contribute to the reduction in SV or whether these changes are influenced by exercise training while in bed. Twenty-seven healthy adults completed 5 weeks of -6 deg head-down bed rest (HDBR). During HDBR, nine subjects were sedentary (NOEX), while 18 performed near-daily rowing ergometry (EX). Left ventricular mass, SV, LV end-diastolic volume (LVEDV), pulmonary capillary wedge pressure and Doppler ultrasound indices of LV function were collected pre- and post-HDBR during supine rest (twice) and during reduced LV loading (lower body negative pressure; LBNP) and increased LV loading (saline infusion). Post-HDBR, LV mass increased in the EX group, but decreased in the NOEX group. The reduction in SV and LVEDV during supine rest and LBNP were greater with NOEX in comparison to EX after HDBR. Peak early mitral annular velocity, isovolumic relaxation time, early propagation velocity, a non-invasive index of early diastolic filling and ventricular diastolic suction, and peak global longitudinal early strain rate were slowed during supine rest after HDBR with NOEX; however, these variables were either unaltered or the reduction was less prominent with EX. Doppler ultrasound measures of early diastolic filling, ventricular relaxation and diastolic suction were not significantly affected during LV unloading by LBNP after HDBR in either group. All Doppler indices were restored to pre-HDBR levels in both groups during saline infusion to normalize LV filling pressure after HDBR. It is concluded that Doppler indices of dynamic LV filling were reduced in both groups after HDBR; however, these effects were more pronounced in the NOEX group. Irrespective of group, post-HDBR Doppler parameters were restored when LV filling pressure was increased to pre-HDBR levels during saline infusion. Therefore, the reduction in upright SV after HDBR is more influenced by changes in LV loading conditions, namely left atrial pressure in the setting of LV remodelling, rather than ventricular relaxation and diastolic suction.

Increased phase synchronization and decreased cerebral autoregulation during fainting in the young

Vasovagal syncope may be due to a transient cerebral hypoperfusion that accompanies frequency entrainment between arterial pressure (AP) and cerebral blood flow velocity (CBFV). We hypothesized that cerebral autoregulation fails during fainting; a phase synchronization index (PhSI) between AP and CBFV was used as a nonlinear, nonstationary, time-dependent measurement of cerebral autoregulation. Twelve healthy control subjects and twelve subjects with a history of vasovagal syncope underwent 10-min tilt table testing with the continuous measurement of AP, CBFV, heart rate (HR), end-tidal CO2 (ETCO2), and respiratory frequency. Time intervals were defined to compare physiologically equivalent periods in fainters and control subjects. A PhSI value of 0 corresponds to an absence of phase synchronization and efficient cerebral autoregulation, whereas a PhSI value of 1 corresponds to complete phase synchronization and inefficient cerebral autoregulation. During supine baseline conditions, both control and syncope groups demonstrated similar oscillatory changes in phase, with mean PhSI values of 0.58+/-0.04 and 0.54+/-0.02, respectively. Throughout tilt, control subjects demonstrated similar PhSI values compared with supine conditions. Approximately 2 min before fainting, syncopal subjects demonstrated a sharp decrease in PhSI (0.23+/-0.06), representing efficient cerebral autoregulation. Immediately after this period, PhSI increased sharply, suggesting inefficient cerebral autoregulation, and remained elevated at the time of faint (0.92+/-0.02) and during the early recovery period (0.79+/-0.04) immediately after the return to the supine position. Our data demonstrate rapid, biphasic changes in cerebral autoregulation, which are temporally related to vasovagal syncope. Thus, a sudden period of highly efficient cerebral autoregulation precedes the virtual loss of autoregulation, which continued during and after the faint.

Influence of Blood Pressure Manometer Feedback on the Parameters of the Vestibular Evoked Myogenic Potential Test

The objective of this study was to evaluate the merits of a blood pressure (BP) manometry feedback method for measurement of vestibular evoked myogenic potentials. Sixty ears of 30 normal volunteers were prospectively investigated. The vestibular evoked myogenic potentials were recorded under 3 different conditions: in the feedback-negative (FB-) condition, ie, in a sitting position without feedback; in the feedback-positive (FB+) condition, ie, in a sitting position with self-monitored BP feedback (using a BP cuff); and in a supine condition, ie, in a supine position without feedback. The interaural amplitude difference (IAD) ratios and interaural latency differences were analyzed. The mean IAD ratio was smaller in the FB+ condition than in the FB- and supine conditions, but the difference was without statistical significance. The upper limits of the normal range of the IAD ratios were 39.5%, 18.3%, and 25.9% for the FB-, FB+, and supine conditions, respectively. The interaural latency difference of p13 was significantly smaller in the supine condition than in the FB- and FB+ conditions. Although the reduction of the mean IAD ratio did not reach statistical significance by feedback monitoring in our study, feedback using a BP manometer may have some clinical significance, in that a more stable IAD ratio may be obtained with a narrower normal range and a smaller variation.

AN EFFECT OF POSTURE ON ANTICIPATORY ANXIETY

This study investigated the effects of body posture on state anxiety and psychological stress. Twenty normal adults performed a demanding mental arithmetic task in both standing and supine conditions, with subjective measures of anxiety and stress obtained before, immediately, and 10 min after the task. Participants were found to experience anticipatory anxiety when standing, although not when supine. The mechanism underlying this effect remains to be determined, although it could involve a postural difference in baroreceptor load.

Baroreflex sensitivity assessment and heart rate variability: relation to maneuver and technique

In the present study, we examined two baroreflex sensitivity (BRS) issues that remain uncertain: the differences among diverse BRS assessment techniques and the association between BRS and vagal outflow. Accordingly, the electrocardiogram and non-invasive arterial pressure were recorded in 27 healthy subjects, during supine with and without controlled breathing, standing, exercise, and recovery conditions. Vagal outflow was estimated by heart rate variability indexes, whereas BRS was computed by alpha-coefficient, transfer function, complex demodulation in low- and high-frequency bands, and by sequence technique. Our results indicated that only supine maneuvers showed significantly greater BRS values over the high frequency than in the low-frequency band. For maneuvers at the same frequency region, supine conditions presented a larger number of significant differences among techniques. The plots between BRS and vagal measures depicted a funnel-shaped relationship with significant log-log correlations (r=0.880-0.958). Very short latencies between systolic pressure and RR interval series in high-frequency band and strong log-log correlations between frequency bands were found. Higher variability among different baroreflex measurements was associated with higher level of vagal outflow. Methodological assumptions for each technique seem affected by non-baroreflex variation sources, and a modified responsiveness of vagal motoneurons due to distinct stimulation levels for each maneuver was suggested. Thus, highest vagal outflows corresponded to greatest BRS values, with maximum respiratory effect for the high-frequency band values. In conclusion, BRS values and differences across the tested techniques were strongly related to the vagal outflow induced by the maneuvers.

Influence of the CYP11B2 -344C/T polymorphism on plasma aldosterone, sodium excretion and blood pressure responses to aerobic exercise training in middle-aged to older prehypertensives

Aldosterone influences renal Na+ handling and normal blood pressure (BP) regulation but if consistently elevated, aldosterone may contribute to the development of hypertension. A few studies have found that as with BP, plasma aldosterone (PA) levels can change with aerobic exercise training (AEX) in hypertensives, but the response of these phenotypes to AEX vary by individual. The CYP11B2 (-344C/T) gene polymorphism has been associated with variability in both blood pressure and urinary and PA levels among hypertensives and may help explain the response of these phenotypes to AEX. The purpose of this study was to determine if the -344C/T polymorphism was associated with changes in PA levels, 24-hour Na+ excretion and BP after 6 months of AEX in middle-aged to older White prehypertensives. 23 Caucasian disease free, sedentary prehypertensives completed a standardized AEX program. All participants followed the AHA Step 1 diet. Blood samples were collected under fasting and supine conditions and PA was measured by RIA. The T and C allele frequencies were 0.61 and 0.39, respectively. There were 9 participants in the TT genotype group and 13 in the TC+CC genotype group. The TC+CC genotype group tended to decrease PA levels (−39±21 pg/ml, p=0.09) and had a greater reduction in PA levels with AEX than the TT genotype group after accounting for baseline plasma aldosterone levels (TC+CC −47±8 pg/ml; TT: −23±10 pg/ml, p<0.001). The TC+CC genotype group significantly decreased systolic BP (−4±2 pg/ml, p=0.03) and had a greater reduction in systolic BP with AEX than the TT genotype group after accounting for baseline systolic BP (TC+CC −4±1pg/ml; TT: −2±2 mm Hg, p<0.02). Neither genotype group changed diastolic BP or 24 hour Na+ excretion and there was no difference in the change in diastolic BP and 24-hour Na+ excretion between the two genotype groups. Based on this preliminary evidence, the presence of the C allele among prehypertensives is associated with a greater reduction in plasma aldosterone and systolic BP with AEX.

From head orientation to hand control: evidence of both neck and vestibular involvement in hand drawing.

This research investigated the effect of head to trunk relation in a sensorimotor drawing task. In the first experiment, seated participants were asked to reproduce with eyes closed geometric shapes (square or diamond) with the tip of their right index finger in the frontoparallel plane. Their head was either aligned with the trunk or tilted 25 degrees towards the left or right shoulder. Results showed that drawings were subjected to an overall rotation of a few degrees in the opposite direction to the tilt. In two subsequent experiments, the respective contribution of both otoliths and neck receptors to this head tilt effect was investigated. In Experiment 2, seated participants kept their head straight but were subjected to 2.5 mA vestibular galvanic stimulation (GVS). Results indicated that GVS induced a small but significant deviation of the drawings towards the anode. Finally, in Experiment 3, subjects performed the drawing task either seated upright (seated condition) or lying on their back (supine condition). Unlike in the seated condition, tilting the head towards the shoulders in a supine posture does not modulate afferents from the otolith stimulation and therefore mainly stimulates neck receptors. Head tilt induced rotations of hand-drawn reproductions in both seated and supine conditions, suggesting a significant contribution of neck afferents in the control of hand motion in space in the absence of vision. Overall the data provided evidence for a strong head-hand linkage during kinaesthetically guided drawing movements.

Do vestibular otolith organs participate in human orthostatic blood pressure control?

We hypothesized that vestibular otolith organ stimulation contributes to human orthostatic responses. Twelve subjects underwent three 60° upright tilts: (1) with the neck flexed from 0° to 30° relative to the body during 60° tilt, such that the head moved from horizontal to 90° above horizontal (0 to 1 Gz otolith stimulation); (2) with the head and body aligned, such that they tilted together to 60° (0 to 0.87 Gz otolith stimulation); and (3) with the neck flexed 30° relative to the body during supine conditions, and the neck then extended to −30° during 60° body tilting, such that the head remained at 30° above horizontal throughout body tilting (constant 0.5 Gz otolith stimulation). All three tilt procedures increased thoracic impedance, sympathetic nerve activity ( N=8 of 12), arterial pressure, and heart rate relative to supine conditions (all P<0.04). Within the first 20 s of tilt, arterial pressure increased most obviously in the 0 to 1 Gz otolith condition. Thoracic impedance tended to increase more in otolith-constant conditions, but no dependent variable differed significantly between tilt conditions, and no significant time×tilt interactions emerged. Otolith inputs may contribute to early transient adjustments to orthostasis. However, lack of significant main effects of tilt condition and time×tilt interactions suggests that potential otolith effects on the variables we studied are relatively subtle and ephemeral, or that other mechanisms compensate for a lack of change in otolith input with orthostasis.

Twenty-four-hour non-invasive monitoring of systemic haemodynamics and cerebral blood flow velocity in healthy humans.

Acute short-term changes in blood pressure (BP) and cardiac output (CO) affect cerebral blood flow (CBF) in healthy subjects. As yet, however, we do not know how spontaneous fluctuations in BP and CO influence cerebral circulation throughout 24 h. We performed simultaneous monitoring of BP, systemic haemodynamic parameters and blood flow velocity in the middle cerebral artery (MCAV) in seven healthy subjects during a 24-h period. Finger BP was recorded continuously during 24 h by Portapres and bilateral MCAV was measured by transcranial Doppler (TCD) during the first 15 min of every hour. The subjects remained supine during TCD recordings and during the night, otherwise they were seated upright in bed. Stroke volume (SV), CO and total peripheral resistance (TPR) were determined by Modelflow analysis. The 15 min mean value of each parameter was assumed to represent the mean of the corresponding hour. There were no significant differences between right vs. left, nor between mean daytime vs. night time MCAV. Intrasubject comparison of the twenty-four 15-min MCAV recordings showed marked variations (P < 0.001). Within each single 15-min recording period, however, MCAV was stable whereas BP showed significant short-term variations (P < 0.01). A day-night difference in BP was only observed when daytime BP was evaluated from recordings in the seated position (P < 0.02), not in supine recordings. Throughout 24 h, MCAV was associated with SV and CO (P < 0.001), to a lesser extent with mean arterial pressure (MAP; P < 0.005), not with heart rate (HR) or TPR. These results indicate that in healthy subjects MCAV remains stable when measured under constant supine conditions but shows significant variations throughout 24 h because of activity. Moreover, changes in SV and CO, and to a lesser extent BP variations, affect MCAV throughout 24 h.

Fluid volume control during short-term space flight and implications for human performance.

Space flight exerts substantial effects on fluid volume control in humans. Cardiac distension occurs during the first 1-2 days of space flight relative to supine and especially upright 1g conditions. Plasma volume contraction occurs quickly in microgravity, probably as a result of transcapillary fluid filtration into upper-body interstitial spaces. No natriuresis or diuresis has been observed in microgravity, such that diuresis cannot explain microgravity-induced hypovolemia. Reduction of fluid intake occurs irrespective of space motion sickness and leads to hypovolemia. The fourfold elevation of urinary antidiuretic hormone (ADH) levels on flight day 1 probably results from acceleration exposures and other stresses of launch. Nevertheless, it is fascinating that elevated ADH levels and reduced fluid intake occur simultaneously early in flight. Extracellular fluid volume decreases by 10-15% in microgravity, and intracellular fluid volume appears to increase. Total red blood cell mass decreases by approximately 10% within 1 week in space. Inflight Na(+) and volume excretory responses to saline infusion are approximately half those seen in pre-flight supine conditions. Fluid volume acclimation to microgravity sets the central circulation to homeostatic conditions similar to those found in an upright sitting posture on Earth. Fluid loss in space contributes to reduced exercise performance upon return to 1g, although not necessarily in flight. In-flight exercise training may help prevent microgravity-induced losses of fluid and, therefore, preserve the capacity for upright exercise post-flight. Protection of orthostatic tolerance during space flight probably requires stimulation of orthostatic blood pressure control systems in addition to fluid maintenance or replacement.

Effects of spaceflight on human calf hemodynamics.

Chronic microgravity may modify adaptations of the leg circulation to gravitational pressures. We measured resting calf compliance and blood flow with venous occlusion plethysmography, and arterial blood pressure with sphygmomanometry, in seven subjects before, during, and after spaceflight. Calf vascular resistance equaled mean arterial pressure divided by calf flow. Compliance equaled the slope of the calf volume change and venous occlusion pressure relationship for thigh cuff pressures of 20, 40, 60, and 80 mmHg held for 1, 2, 3, and 4 min, respectively, with 1-min breaks between occlusions. Calf blood flow decreased 41% in microgravity (to 1.15 +/- 0.16 ml x 100 ml(-1) x min(-1)) relative to 1-G supine conditions (1.94 +/- 0.19 ml x 100 ml(-1) x min(-1), P = 0.01), and arterial pressure tended to increase (P = 0.05), such that calf vascular resistance doubled in microgravity (preflight: 43 +/- 4 units; in-flight: 83 +/- 13 units; P < 0.001) yet returned to preflight levels after flight. Calf compliance remained unchanged in microgravity but tended to increase during the first week postflight (P > 0.2). Calf vasoconstriction in microgravity qualitatively agrees with the "upright set-point" hypothesis: the circulation seeks conditions approximating upright posture on Earth. No calf hemodynamic result exhibited obvious mechanistic implications for postflight orthostatic intolerance.

Contribution of the otoliths to the human torsional vestibulo-ocular reflex

The dynamic contribution of the otolith organs to the human ocular torsion response was examined during passive sinusoidal body roll about an earth-horizontal axis (varying otolith inputs) and about an earth-vertical axis (invariant otolith inputs). Torsional eye movements were registered in 5 subjects by means of video-oculography. At a fixed amplitude of 25 degrees, the stimulus frequency was varied from 0.05 to 0.4 Hz. Additionally, at a fixed frequency of 0.2 Hz, the response was also measured at the amplitudes to 12.5 degrees and 50 degrees. The results showed that the gain and phase of the torsional slow component velocity (SCV) did not depend on stimulus amplitude, indicating a linear response. Contribution of the otoliths affected the ocular torsion response in three different ways. First, the gain of the SCV was slightly, but consistently, higher during rotation about an earth-horizontal axis than during rotation about an earth-vertical axis. With invariant otolith inputs the average gain increased from 0.10 at 0.05 Hz to 0.26 at 0.25 Hz. With varying otolith inputs, the average gain increased from 0.14 to 0.37. Second and more substantially, contribution of the otoliths improved the response dynamics by reducing the phase lead at frequencies up to 0.02 Hz. Third, the nystagmus showed considerably less anticompensatory saccades in upright conditions than in supine conditions, even though the SCV gain was lower in the latter. As a consequence, the average excursion of torsional eye position was highest during earth-horizontal rotation. This effect was observed in the entire frequency range. Thus, the otoliths controlled the human torsional VOR not only at low stimulus frequencies by keeping the slow component in phase with head motion, but also in a wider frequency range by modulating the saccadic behavior as to increase the amplitude of ocular torsion. We conclude that the primary concern of the otolith-oculomotor system during head tilt is to stabilize eye position in space, rather than to prevent retinal blur.