Accelerating multidimensional NMR and MRI experiments using iterated maps

Techniques that accelerate data acquisition without sacrificing the advantages of fast Fourier transform (FFT) reconstruction could benefit a wide variety of magnetic resonance experiments. Here we discuss an approach for reconstructing multidimensional nuclear magnetic resonance (NMR) spectra and MR images from sparsely-sampled time domain data, by way of iterated maps. This method exploits the computational speed of the FFT algorithm and is done in a deterministic way, by reformulating any a priori knowledge or constraints into projections, and then iterating. In this paper we explain the motivation behind this approach, the formulation of the specific projections, the benefits of using a 'QUasi-Even Sampling, plus jiTter' (QUEST) sampling schedule, and various methods for handling noise. Applying the iterated maps method to real 2D NMR and 3D MRI of solids data, we show that it is flexible and robust enough to handle large data sets with significant noise and artifacts.

Phosphorus-31 MRI of hard and soft solids using quadratic echo line-narrowing

Magnetic resonance imaging (MRI) of solids is rarely attempted. One of the main reasons is that the broader MR linewidths, compared to the narrow resonance of the hydrogen ((1)H) in free water, limit both the attainable spatial resolution and the signal-to-noise ratio. Basic physics research, stimulated by the quest to build a quantum computer, gave rise to a unique MR pulse sequence that offers a solution to this long-standing problem. The "quadratic echo" significantly narrows the broad MR spectrum of solids. Applying field gradients in sync with this line-narrowing sequence offers a fresh approach to carry out MRI of hard and soft solids with high spatial resolution and with a wide range of potential uses. Here we demonstrate that this method can be used to carry out three-dimensional MRI of the phosphorus ((31)P) in ex vivo bone and soft tissue samples.

[Immunity and immunosuppression in childhood idiopathic nephrotic syndrome]

Steroid sensitive idiopathic nephrotic syndrome is a T-cell disorder characterized by a functional renal impairment. Concluding a still relevant demonstration involving cellular immunity in the pathogenesis of the disease, R. Shalhoub in 1974 suggested a "special role for the thymus" based on the efficiency of steroids and alkylating agents, dramatic recoveries following measles, sensibility to bacterial infection due to a lack of cooperation between T and B cell and association to Hodgkin disease. As a matter of fact, the selected drugs based on medical empirism somehow enhance thymocytes apoptosis and negative selection of T cell, except cyclosporin. Steroids have been the first historical treatment of idiopathic nephrotic syndrome and have steadily been the first-line treatment for 50 years. Their unavoidable ability to induce rapid recovery of proteinuria and long-lasting or definite remission are dependent to a strict compliance to treatment. Indications of steroids-sparing treatments are not that clearcut in patients with steroids intoxication. Objectively, efficiency of levamisole and cyclophosphamide are much more limited than previously reported and cyclosporin nephrotoxicity might severely impair renal function following long-lasting treatment as well as it may paradoxically increase the activity of the disease. An alternate strategy to those currently adopted would use cyclosporin as the first-line steroids-sparing treatment during a very limited period, awaiting favourable ageing of patients and natural dampening activity of the disease to a full efficiency of alkylating agents. Compared to cyclophosphamide and cyclosporin, the relative safety of levamisole is encouraging to a more frequent uses. Its association to a full dose of prednisone in the treatment of the inaugural episode should be investigated. According to the limitations of those therapies, emerging drugs as mycophenolate might be worthwhile in the treatment of nephrotic patients.

Effects of HZE particle on the nigrostriatal dopaminergic system in a future Mars mission

Because of long duration travel outside the Earth's magnetic field, the effect of iron-rich high charge and energy (HZE) particles in Galactic Cosmic Rays on human body is the major concern in radiation protection. Recently attention has been directed to effects on the central nervous system in addition to mutagenic effects. In particular, a reduction in striatal dopamine content on nigrostriatal dopaminergic system has been reported by investigators using accelerated iron ions in ground-based mammalian studies. In addition, studies of the pathophysiology of Parkinson's disease demonstrated that excess iron cause a reduction in the dopamine content in the substantia nigra. This suggests an intriguing possibility to explain the selective detrimental effects of HZE particles on the dopaminergic system. Should these particles have biochemical effects, possible options for countermeasures are: (1) nutritional prevention, (2) medication, and (3) surgical placement of a stimulator electrode at a specific anatomic site in the basal ganglia.

Risky behavior and risk in adolescents with IDDM

PURPOSE

To determine: (1) the frequency of risky behaviors (alcohol and other drug use, smoking cigarettes, smokeless tobacco use, and unprotected intercourse); (2) the perception of general risks and diabetes-related risks from risky behaviors; (3) if perception of risk is related to engaging in risky behaviors; and (4) if perception of general risks and diabetes-related risks are influenced by age, gender, or race in adolescents with insulin dependent diabetes mellitus (IDDM). Decreasing risky behaviors in youth with IDDM is important because of their increased vulnerability to specific disease related physiologic and pathologic changes.

METHODS

A descriptive, cross-sectional design was used. Data on risky behavior and perception of risk were obtained by self-report during a regularly scheduled clinic visit. One hundred and fifty-five adolescents between ages of 10-20 years participated. Correlational and student's t-test analyses were used to test relationships and group differences (age, race, gender).

RESULTS

Thirty-nine percent of the sample reported alcohol use, 34% reported smoking cigarettes, 8% reported smokeless tobacco use, 10% reported drug use, and 29% reported unprotected intercourse. Perception of risk to peers from these behaviors was significantly higher (t = 8.1, df 153; p < .001) than risk to self. Females reported significantly lower (t = 3.08, df 52; p < .002) risk to self than males. There was no difference in perception of risk between youth who reported participating in risky behaviors (N = 38%) and those who did not (62%). Not surprisingly, the frequency of risky behavior increased with age (F = 15.46; p < .001).

CONCLUSIONS

Compared to community samples of middle school children, our sample had lower rates for most risky behaviors. As with community samples, the physical risks were known and perceived to be higher for peers than self. Perception of risk was not related to self-reports of risky behaviors. The lower rate of risky behaviors might reflect the success of educational efforts directed toward diabetes management or may be due to later initiation of behaviors, especially if personal social development is delayed. Additional research is indicated in order to understand the timing and trajectory of risky behavior and whether or not perception of risk deters youth with IDDM from engaging in risky behavior.

Space research activities during missions of the past

For over 30 yr, men and women have lived for various periods of time in a weightless (or free-fall) environment while orbiting the Earth. During these years, we have learned that humans function quite well for short periods of weightlessness, that is, for up to a little more than a year. Some space flight missions have provided physiologic data, including cardiovascular data, from the spacefarers. In fact, some missions have provided laboratories for systematic study of cardiovascular responses and adaptation to space flight. However, the opportunity to obtain physiologic data from people in space is a rarity. It is important to remember that the population sample sizes are small, other stresses may confound the effects of weightlessness, and in some situations the crewmembers are subjects for several experiments at the same time. Furthermore, comparison of cardiovascular data from space flight to data obtained on the ground is sometimes difficult because the subject's posture on the ground is not always reported; in a gravity environment, posture influences the hydrostatic gradient. This over view describes what we have learned about cardiovascular function during flight and after return to Earth.

King's framework and theory in Japan, Sweden, and the United States

In this article, we present our work in extending and testing Imogene King's conceptual framework and theory in Japan, Sweden, and the United States. Comparing and contrasting cultural relevance, methodology, and issues of validity provide examples of international scholarship and knowledge development that result from networking and collaboration.

Use of lower body negative pressure to assess changes in heart rate response to orthostatic-like stress during 17 weeks of bed rest

This study examined the heart rate response to lower body negative pressure (LBNP) during 17 weeks of horizontal bed rest to estimate the development and duration of orthostatic instability elicited by this model for space flight. Based on data from Skylab, the authors hypothesized that orthostatic (LBNP) instability would appear during the first 3 to 4 weeks, and would then remain constant for the duration of bed rest. Heart rates of four healthy adult male subjects were monitored at rest and during LBNP for 1 week of ambulatory control, 17 weeks of horizontal bed rest, and 5 weeks of recovery. The LBNP protocol consisted of 10 minutes of control (atmospheric pressure) and 5 minutes each at 5, 10, 20, 30, 40, and 50 mm Hg decompression, followed by a 10-minute recovery period; this protocol was repeated weekly to document the progressive changes in heart rate response to LBNP. Lower body negative pressure was terminated early if symptoms compatible with the onset of syncope occurred. Throughout the study, heart rate was unchanged at 5, 10, and 20 mm Hg, but it increased at 30, 40, and 50 mm Hg LBNP. During the pre-bed rest period, peak heart rate was 97 +/- 10 beats/min (mean +/- SE), occurring at 50 mm Hg for all four subjects. After 3 days of bed rest, all monitored heart rate responses, including values after release of LBNP, were only slightly elevated (NS) above pre-bed rest level. Peak heart rate was 118 +/- 21 beats/min at 50 mm Hg decompression (NS; N = 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular responses to standing: effect of hydration

Many astronauts experience intolerance to orthostatic stress after space flight, despite the ingestion of salt tablets and water equivalent to 0.9% saline just before their return to Earth. Previous research indicates that the ingestion of 1.07% saline solution increased plasma volume more than did 0.9% saline. Therefore, the authors hypothesized that the 1.07% saline would be more effective in reducing orthostatic stress during standing. In this study, six men (22-47 years) performed a 5-minute "stand test" (5 minutes supine followed by 5 minutes standing) under four hydration conditions: 1) hypohydrated (HYPO, 20 mg intravenous [IV] Lasix), 2) euhydrated (EU), 3) rehydrated with 1 L 0.9% saline 2 hours after Lasix, or 4) rehydrated with 1 L 1.07% saline. Stand tests were done 4 5 hours after rehydration. Plasma volume was reduced 10% after Lasix, and was restored by both rehydration solutions. When subjects stood, their diastolic pressure, mean pressure, heart rate (HR), and peripheral resistance increased (P < .05), and their stroke volume (SV), cardiac output (CO), and thoracic fluid (TF, by impedance cardiography) decreased (P < .05). Systolic arterial pressure (SBP) increased when subjects stood after saline, but decreased if subjects were HYPO or EU (P < .05 for 1.07% versus HYPO and EU). Heart rate (HR), another indicator of orthostatic stress, did not differ among hydration states. During the last minute of the stand test, TF was greater if subjects had fluid countermeasures. Stroke volume, CO, and TF were significantly less during minute 5 of standing than during minute 3. Whether they would continue to fall in a longer stand test is not known. The results for SBP indicate that 1.07% saline may have advantages over 0.9% saline as a countermeasure to postspace-flight or postbedrest orthostatic intolerance.

Cardiovascular responses to postural changes: differences with age for women and men

The cardiovascular responses to postural change, and how they are affected by aging, are inadequately described in women. Therefore, the authors examined the influence of age and sex on the responses of blood pressure, cardiac output, heart rate, and other variables to change in posture. Measurements were made after 10 minutes each in the supine, seated, and standing positions in 22 men and 25 women who ranged in age from 21 to 59 years. Several variables differed, both by sex and by age, when subjects were supine. On rising, subjects' diastolic and mean arterial pressures, heart rate, total peripheral resistance (TPR), and thoracic impedance increased; cardiac output, stroke volume, and mean stroke ejection rate decreased; and changes in all variables, except heart rate, were greater from supine to sitting than sitting to standing. The increase in heart rate was greater in the younger subjects, and increases in TPR and thoracic impedance were greater in the older subjects. Stroke volume decreased less, and TPR and thoracic impedance increased more, in the women than in the men. The increase in TPR was particularly pronounced in the older women. These studies show that the cardiovascular responses to standing differ, in some respects, between the sexes and with age. The authors suggest that the sex differences are, in part, related to greater decrease of thoracic blood volume with standing in women than in men, and that the age differences result, in part, from decreased responsiveness of the high-pressure baroreceptor system.

Hemodynamic and hormonal responses to lower body negative pressure in men with varying profiles of strength and aerobic power

Hemodynamic, cardiac, and hormonal responses to lower-body negative pressure (LBNP) were examined in 24 healthy men to test the hypothesis that responsiveness of reflex control of blood pressure during orthostatic challenge is associated with interactions between strength and aerobic power. Subjects underwent treadmill tests to determine peak oxygen uptake (VO2max) and isokinetic dynamometer tests to determine knee extensor strength. Based on predetermined criteria, subjects were classified into one of four fitness profiles of six subjects each, matched for age, height, and body mass: (a) low strength/average aerobic fitness, (b) low strength/high aerobic fitness, (c) high strength/average aerobic fitness, and (d) high strength/high aerobic fitness. Following 90 min of 0.11 rad (6 degrees) head-down tilt (HDT), each subject underwent graded LBNP to -6.7 kPa or presyncope, with maximal duration 15 min, while hemodynamic, cardiac, and hormonal responses were measured. All groups exhibited typical hemodynamic, hormonal, and fluid shift responses during LBNP, with no intergroup differences between high and low strength characteristics. Subjects with high aerobic power exhibited greater (P < 0.05) stroke volume and lower (P < 0.05) heart rate, vascular peripheral resistance, and mean arterial pressure during rest, HDT, and LBNP. Seven subjects, distributed among the four fitness profiles, became presyncopal. These subjects showed greatest reduction in mean arterial pressure during LBNP, had greater elevations in vasopressin, and lesser increases in heart rate and peripheral resistance. Neither VO2max nor leg strength were associated with fall in arterial pressure or with syncopal episodes. We conclude that interactions between aerobic and strength fitness characteristics do not influence responses to LBNP challenge.

Effects of spaceflight on the musculoskeletal system: NIH and NASA future directions

Prolonged bed rest, undertaken by volunteers or resulting from injury and disease, can impair bone and muscle function and structure; extended travel in space also induces these effects. Fluid shifts and disrupted fluid balance may also contribute to observed musculoskeletal aberrations in the weightless environment. Some molecular and cellular events involved in the loading and unloading of the musculoskeletal system are under neural and endocrine influence or control, whereas other events are influenced by local growth factors. Studies are in progress to develop interventions that preserve or improve musculoskeletal integrity in 1g. The NIAMS and NASA are interested in basic and clinical studies of the influence of microgravity on the musculoskeletal system. The interagency workshop results form the basis for new collaborative and cooperative research emphases for the biomedical community under a broad agreement between the National Institutes of Health and NASA.

Cerebral blood velocity and other cardiovascular responses to 2 days of head-down tilt

Spaceflight induces a cephalad redistribution of fluid volume and blood flow within the human body, and space motion sickness, which is a problem during the first few days of spaceflight, could be related to these changes in fluid status and in blood flow of the cerebrum and vestibular system. To evaluate possible changes in cerebral blood flow during simulated weightlessness, we measured blood velocity in the middle cerebral artery (MCA) along with retinal vascular diameters, intraocular pressure, impedance cardiography, and sphygmomanometry on nine men (26.2 +/- 6.6 yr) morning and evening for 2 days during continuous 10 degrees head-down tilt (HDT). When subjects went from seated to head-down bed rest, their heart rate and retinal diameters decreased, and intraocular pressures increased. After 48 h of HDT, blood flow velocity in the MCA was decreased and thoracic impedance was increased, indicating less fluid in the thorax. Percent changes in blood flow velocities in the MCA after 48 h of HDT were inversely correlated with percent changes in retinal vascular diameters. Blood flow velocities in the MCA were inversely correlated (intersubject) with arterial pressures and retinal vascular diameters. Heart rate, stroke volume, cardiac output, systolic arterial pressure, and at times pulse pressure and blood flow velocities in the MCA were greater in the evening. Total peripheral resistance was higher in the morning. Although cerebral blood velocity is reduced after subjects are head down for 2 days, the inverse relationship with retinal vessel diameters, which have control analogous to that of cerebral vessels, indicates cerebral blood flow is not reduced.

Effect of breakfast on selected serum and cardiovascular variables

We compared high-density lipoprotein cholesterol (HDL-C) and other blood and cardiovascular variables of subjects when they had been fasting overnight to those values when they had eaten breakfast. The subjects were 47 men (24 to 70 years) and 34 women (23 to 63 years) who visited our laboratory on two occasions, once fasting and once after breakfast, at the same time of the morning, exactly 1 week apart. Systolic (SBP) and diastolic (DBP) pressures and heart rates (HR) were recorded, and 24-ml blood samples were obtained from an antecubital vein and analyzed for hemoglobin (Hgb), hematocrit (Hct), HDL-C, total cholesterol (T Chol), triglycerides (Trig), total calcium (T Ca), ionized calcium (Ca++), and phosphorus (P). When subjects were fasting, their SBP, HR, Trig, T Ca, and Ca++ were lower than when they had eaten breakfast. SBP, DBP, Hgb, and Trig of the women were lower than those of the men; and HDL-C and phosphorus of the women were higher. Several correlations between variables were significant only when subjects were fasting. These were SBP with age, Hct with T Ca, and T Chol with Trig. Several correlations were significant only for one sex. For the women only, SBP, DBP, and HR were correlated with T Chol, and Trig and HDL-C were correlated with T Ca. For the men only, Hgb was correlated with HDL-C, Trig, T Ca, and P; and HDL-C was correlated with Trig.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood and urine responses to ingesting fluids of various salt and glucose concentrations

Several hours before returning to Earth, Space Shuttle astronauts consume fluid and salt tablets equivalent to a liter of 0.9% saline as a countermeasure to postflight orthostatic intolerance. This countermeasure is not completely successful. Therefore, in search of a countermeasure that would protect against orthostatic intolerance better and for a longer duration, the authors compared the blood and urine responses of five men (21-41 yr) after they drank 1 L of 0.9% saline to their responses after drinking five other solutions: distilled water, 1% glucose, 0.74% saline with 1% glucose, 0.9% saline with 1% glucose, and 1.07% saline. Each subject ingested a different solution on 6 different days and remained seated for the ensuing 4 hours. Heart rate, blood pressures, and urine variables were measured before ingestion of the fluids and every 30 minutes thereafter; blood samples were drawn before, immediately after, and every 60 minutes after ingestion. Change in plasma volume, which was estimated from hemoglobin and hematocrit, was considered the most critical variable. Data for all solutions were compared by analysis of variance. Since plasma volume was increased most after ingestion of 1.07% saline, all variables (at 2 hours, at 3 hours and at 4 hours) were compared between 1.07% saline and 0.9% saline, the current countermeasure. Plasma volume was increased more after 1.07% saline than after 0.9% saline, and this difference was most significant at 4 hours after ingestion (P = .056). Diuresis occurred promptly after ingestion of the two saline-free solutions, water and 1% glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Gender-based differences in the cardiovascular response to standing

Reduced tolerance to orthostatic stress is a recognized consequence of spaceflight. Both men and women serve as astronauts and are staying longer in space. While there are recognized cardiovascular differences in baseline function based on gender, little is known about any gender-based differences in cardiovascular responses to orthostatic stress. The purpose of this study was to compare the cardiovascular responses of men and women to the stand test. The subjects were 10 men and 10 women, 20-30 years of age. Heart rate, blood pressure, stroke volume, cardiac output, and total peripheral resistance were monitored during 5 min supine and 5 min standing. Men responded similarly in heart rate (39 vs. 35%); but had significantly greater decreases in stroke volume (-53 vs. -40%), cardiac output (-36 vs. -21%), and pulse pressure (-19 vs. -12%); and greater increases in blood pressure (11 vs. 6%) and total peripheral resistance (77 vs. 34%) than did the women. Men and women demonstrated fundamental differences in cardiovascular responses during standing. Differences in the height of the subjects did not account for these differing cardiovascular responses. The mechanisms for these differences are not yet clear. Men and women should be studied as separate groups until these differences are understood.

Assessing and teaching self-care to youths with diabetes mellitus

PURPOSE

To investigate the nature of diabetes (health deviation) self-care in youths with IDDM and to relate diabetes self-care to metabolic control, perceived health status, and general (universal) self-care.

METHOD

Thirty seven youths with IDDM between the ages of 11-19 completed the Diabetes Self-Care Practices Instrument, Denyes Self-Care Practice Instrument, and Denyes Health Status Instrument. Metabolic control was measured by glycosylated hemoglobin. Data were analyzed by correlational analysis.

RESULTS

Diabetes self-care was positively related to general (universal) self-care, health status, and metabolic control.

CONCLUSIONS

Results of the study provide clear direction for ongoing assessment and teaching of diabetes self-care in youths with IDDM.

Effect of a central redistribution of fluid volume on response to lower-body negative pressure

We studied cardiovascular responses to lower-body negative pressure (LBNP) following 1 hour (h) of 6 degrees head-down tilt to determine whether a redistribution of blood volume toward the central circulation modifies the subsequent response to orthostatic stress. Responses of 12 men, ages 30-39 years, were evaluated by electrocardiography, impedance cardiography, sphygmomanometry, and measurement of calf circumference. During the LBNP that followed head-down tilt--as compared with control LBNP (no preceding head-down tilt)--subjects had smaller stroke volume and cardiac output, greater total peripheral resistance, and less calf enlargement. These differences reflect differences in the variables immediately preceding LBNP. Magnitudes of the responses from pre-LBNP to each pressure stage of the LBNP procedure did not differ between protocols. Mean and diastolic arterial pressures were slightly elevated after LBNP-control, but they fell slightly during LBNP post-tilt. These cardiovascular responses to simulated gravitational stress following head-down tilt may reflect the manner in which adaptation to microgravity affects subsequent responses to orthostatic stress on return to Earth.

Health and illness self-care in adolescents with IDDM: a test of Orem's theory

Orem's theory suggests that different self-care actions are necessary to meet requisites related to health (universal self-care) and illness (health-deviation self-care). The authors differentiate these types of self-care, propose hypotheses relating these concepts to other concepts in Orem's theory, and test them in a sample of adolescents with diabetes mellitus. As predicted, universal self-care is significantly related to a measure of the global health state, and health-deviation self-care is related to control of pathology. The findings provide direction for additional research and theory development.

Social support and health: a theoretical formulation derived from King's conceptual framework

This article describes the development and initial empirical testing of a theoretical formulation of social support, family, health, and child health derived from Imogene King's conceptual framework for nursing. A correlational design was used to test the formulation with 103 families who have children with diabetes mellitus. Three hypotheses were supported: parents' social support had a direct and positive effect on family health, parents' social support and child's social support were positively related, and illness factors had a direct and negative effect on child health. Both the supported and unsupported hypotheses are discussed in terms of the present substantive knowledge base and evidence of validity for King's framework. Direction for further theory development and research are identified.

Association of sex and age with responses to lower-body negative pressure

Responses of 21 women and 29 men (29-56 yr of age) to -50 Torr lower body negative pressure (LBNP) were examined for differences due to sex or age. Responses to LBNP were normal, including fluid shift from thorax to lower body, increased heart rate and peripheral resistance, and decreased stroke volume, cardiac output, and Heather index of ventricular function. Mean arterial blood pressure did not change. Comparison of responses of the women to responses of an age-matched subset of the men (n = 26) indicated the men had larger relative increases in calf circumference and greater increases in peripheral resistance during LBNP than the women, whereas the women experienced greater increases in thoracic impedance and heart rate. Analyses of responses of the 29 men for age-related differences indicated older subjects had greater increases in peripheral resistance and less heart rate elevation in response to LBNP (P less than 0.05 for all differences, except sex-related heart rate difference, where P less than 0.10). Based on these data and the data of other investigators, we hypothesize the age-related circulatory differences in response to LBNP are due to a reduction in vagal response and a switch to predominant sympathetic nervous system influence in older men. We cannot exclude the possibility that diminished responsiveness in the afferent arm of the baroreceptor reflex also plays a role in the attenuated heart rate response of older men to LBNP.

Aerobic fitness in women and responses to lower body negative pressure

High aerobic fitness may be associated with impaired responsiveness to orthostatic challenge. This could be detrimental to astronauts returning from spaceflight. Thus, we examined the cardiovascular responses of a group of 45 healthy women to graded lower body negative pressure (LBNP) through 5 min at -50 mm Hg or until they become presyncopal. The ages (range = 23-43 years, mean = 30.4) and peak aerobic capacities (range = 23.0-55.3 ml.kg-1.min-1, mean = 37.8) of these subjects paralleled those of the women astronauts. We monitored heart rate, stroke volume, cardiac output, Heather index of contractility, arterial pressure, peripheral resistance, change in calf circumference, and thoracic impedance (ZO)--a measure of fluid in the chest. The women in this study exhibited the same response pattern to LBNP as previously reported for male subjects. VO2peak of the six subjects who became presyncopal was not different from VO2peak of the tolerant subjects. At rest, only systolic and mean arterial pressures were significantly correlated with VO2peak. Percent changes in calf circumference (i.e. fluid accumulation in the legs) at -30 and -40 mm Hg were the only responses to LBNP significantly related to VO2peak. The greater pooling of blood in the legs during LBNP by women with higher aerobic fitness, and lower percent body fat may be related to more muscle tissue and vasculature in the legs of the more fit subjects. These data indicated that orthostatic tolerance is not related to aerobic capacity in women, and orthostatic tolerance need not be a concern to aerobically fit women astronauts.

Considerations in prescribing preflight aerobic exercise for astronauts

Many human responses to the weightless environment have been documented from actual spaceflights. These include physiological effects on the nervous system, cardiovascular system and fluid balance, and the musculoskeletal system, as well as psychological effects. Simulations on Earth have added to our knowledge about the physiology of weightlessness. Early data on orthostatic intolerance after real and simulated spaceflight led some scientists to discourage a high level of aerobic fitness for astronauts. They believed it was detrimental to orthostatic tolerance on return to Earth. However, most of the data available today do not support this contention. Furthermore, aerobic fitness is beneficial to cardiovascular function and mental performance. Therefore, it may be important in performing extra-vehicular activities during flight. Some astronauts claim exercise enhances their feeling of well-being and self image. And, although the cardiovascular system and exercise performance may recover more slowly after flight to preflight levels when fitness level prior to flight is high, the musculoskeletal system may recover more rapidly. Research is needed to determine optimal levels of aerobic training for performing tasks in flight, maintaining health and well-being during flight, and assuring satisfactory recovery on return to Earth.

Hysteresis in response to descending and ascending lower-body negative pressure

We have investigated the pattern of fluid redistribution and cardiovascular responses during graduated orthostatic stress. Twelve men, age 30-39 yr, underwent a 25-min lower-body negative pressure (LBNP) test protocol that involved sequential stages of LBNP at -8 mmHg (1 min), -16 mmHg (1 min), -30 mmHg (3 min), -40 mmHg (5 min), -50 mmHg (5 min), -40 mmHg (5 min), -30 mmHg (3 min), -16 mmHg (1 min), and -8 mmHg (1 min). Data were recorded at the end of each stage. For many measured variables values during the descending phase of LBNP (-8 to -40 mmHg) were significantly different from values during the ascending phase of (-40 to -8 mmHg). These differences appear to be due to a component of fluid translocation that occurs during LBNP and cannot be reversed within the duration of the procedure. We hypothesize that this slowly reversed component is sequestration of fluid in the interstitial and lymphatic compartments. In contrast, venous pooling is a rapidly reversible component of fluid movement during LBNP. A scheme describing fluid and cardiovascular responses to LBNP based on these data and the data of other investigators is presented.

Cardiovascular dynamics during the initial period of head-down tilt

The cardiovascular response to 1 h of 6 degrees head-down tilt was studied in 12 male subjects, ages 30-39 years, to simulate the early effects of weightlessness. Fluid shifts, hemodynamic variables, and indices of myocardial contractility were evaluated by utilizing electrocardiography, systolic time intervals, impedance cardiography, sphygmomanometry, and measurement of calf circumference. Most cardiovascular variables remained stable throughout the initial 30 min of the protocol, even though translocation of fluid from the legs to the thorax commenced immediately with the onset of head-down tilt. In contrast, minutes 30-60 were characterized by reduced stroke volume, cardiac output, mean stroke ejection rate, and Heather Index concomitant with an elevation in mean arterial pressure. Intrathoracic fluid volume continued to increase while leg volume continued to decrease. This latter physiological response suggests intrathoracic sequestration of fluid volume; blood was apparently redistributed to the pulmonary circulation rather than being retained in the great veins.

Cardiovascular responses of women to lower body negative pressure

Lower body negative pressure (LBNP) has provided a method for studying cardiovascular responses in men while simulating a return to the stresses of 1-G following space flight. In this study, we have monitored responses of women to the stresses provided by LBNP. There were 20 women, 23-43 years, each tested in the follicular and luteal phases of the menstrual cycle. Variables were recorded during supine control; at -30, -40, -50 mm Hg LBNP; immediately after pressure release; and after 5 min recovery. There were no significant differences in response to LBNP between the two menstrual phases. During LBNP calf circumference was enlarged; transthoracic impedance was increased; stroke volume, left ventricular ejection time, the Heather Index of contractility and systolic pressure were reduced; total peripheral resistance was elevated; and cardiac output fell despite a rise in heart rate. Differences in cardiovascular variables between 0 mm Hg LBNP and -50 mm Hg LBNP were generally similar to reported differences between supine and standing. The responses of these women to LBNP were qualitatively similar to those reported for the Apollo astronauts and other male subjects. These women appeared to compensate with a greater heart rate response; however, the net cardiovascular compensation as determined from arterial pressure appears to be similar in men and women.

Metabolic, hemodynamic, and respiratory responses to performing cardiopulmonary resuscitation

The purpose of this study was to evaluate the cardiorespiratory demands inherent to the maintenance of continuous one- and two-man cardiopulmonary resuscitation (CPR) for 10 min. Ten male paramedics (X age = 26 yrs) certified to perform CPR participated. Each subject assumed the three possible roles for administering CPR: ventilator, compressor, and one-man technique. Cardiorespiratory responses were determined by impedance cardiography and open-circuit spirometry at 2 min intervals while performing CPR with a resuscitation manikin. Left ventricular performance was evaluated by impedance ventricular function indices (VFI) and systolic time intervals (STI). All three roles elicited an increase in oxygen uptake compared to kneeling rest, with the roles of one-man and compressor being the most demanding. There were moderate increases in cardiac output and heart rate during the exercise roles, but stroke volume remained similar to resting values. Pulmonary ventilation increased during exercise, with the greatest increase occurring for the one-man role. STI and impedance VFI reflected an enhanced ventricular performance while performing the roles of one-man and compressor. These findings suggest that the energetic demands placed on the rescuer depend upon the specific role assumed. Properly trained and experienced individuals can perform CPR efficiently for at least 10 min while eliciting only moderate physiological stress.

Central hemodynamics during progressive upper- and lower-body exercise and recovery

The purpose of this study was to compare stroke volume (SV) and myocardial contractility responses during and immediately after upper- and lower-body exercise. Nine men (mean 28 yr, 78 kg) completed progressive intensity discontinuous tests on both an arm crank and cycle ergometer. Exercise for each power output (PO) was 7 min with 20-min rest periods interspersed. Impedance cardiography was used to measure cardiac output (Q), SV, and contractility on a beat-by-beat basis during exercise and a 15-s recovery period. Q increased linearly, and total peripheral resistance decreased exponentially with increasing PO levels. During recovery from exercise, the Q and heart rate (HR) values decreased immediately at all PO levels. When the exercise VO2 exceeded 1.0 1 X min-1, SV fell significantly during recovery for both exercise modes. In general, the recovery myocardial contractility indices remained similar to exercise values. It was concluded that immediately after low intensities of exercise, Q decreases because of a fall in HR. After moderate- and high-intensity exercise, Q decreases because of a fall in both HR and SV.

Correlations between ejection times measured from the carotid pulse contour and the impedance cardiogram

Systolic time interval (STI) analysis is a commonly employed noninvasive technique for evaluating myocardial function. It requires simultaneous recording of an electrocardiogram, phonocardiogram, and the carotid pulse contour, from which left ventricular ejection time is measured. The carotid pulse contour may be difficult to record when there is subject movement, such as with exercise or other stresses utilized in aerospace medical research. Impedance cardiography is a relatively new noninvasive technique for measuring stroke volume. It also provides a measure of systolic ejection time without the necessity of recording a carotid pulse contour. The purpose of this study was to determine the correlation between left ventricular ejection time (LVET) determined from conventional STI analysis and systolic ejection time (T) obtained with impedance cardiography. The electrocardiogram, phonocardiogram, carotid pulse contour, and impedance cardiogram were monitored simultaneously in 17 male subjects 39-63 years of age (6 normotensive, 7 with established hypertension, and 4 with labile hypertension). Subjects were monitored at seated rest and during submaximal and maximal cycle ergometer exercise. Beat-by-beat analysis revealed high intrasubject correlations between LVET and T for each subject during all three activity levels. Correlations between LVET and T for the combined group of 17 subjects were: rest r = 0.990, submaximal exercise r = 0.976, maximal exercise r = 0.986; p less than 0.01. These results indicate impedance cardiography can be used in the determination of STIs for the evaluation of ventricular function, as well as for the noninvasive determination of stroke volume and cardiac output.

Cardiovascular response to a mentally stressful stimulus

The purpose of this study was to investigate multivariable cardiovascular responses to a non-mathematical mental task. Fifty-two subjects, 8 to 69 years of age, were monitored at rest and while attempting to solve a Raven's matrix test without prodding or pressure from the experimentors. Adults (greater than or equal to 18 years) had higher blood pressures (BP) and longer pre-ejection periods (PEP) at rest than did the children. Women had higher resting heart rates (HR) than men. The task induced significant increases in systolic and diastolic BP and HR in adults and children, with the adults exhibiting larger BP responses. During the stressful stimulus significant decreases in left ventricular ejection time occurred in men and women, and significant increases in forearm blood flow occurred in men. The stability in PEP during the stressful period when both BP and HR were increased is evidence of enhanced contractility brought on by the stress. In general, men and women responded similarly. Thus, even a mild, non-mathematical stress of short duration elicits the multiple cardiovascular responses, including increases in BP, HR, muscle blood flow, and contractility, which are observed with more threatening tasks.

Cardiac function monitored by impedance cardiography during changing seatback angles and anti-G suit inflation

Impedance cardiography (IC) appears to be a promising noninvasive technique for monitoring small changes in pilot cardiovascular status during conditions simulating flight. Heart rate (HR), stroke volume (SV), cardiac output (CO), ventricular ejection time (VET), and thoracic impedance (Zo) were monitored in ten volunteers for 5 min at each of four seatback angles from vertical: 12 degrees, 30 degrees, 45 degrees, and 60 degrees. Data were also obtained at three seatback angles (12 degrees, 30 degrees, 60 degrees) for 6 min each before, during, and after inflation of the standard USAF anti-G suit to 1.5 psi. Significant differences (p less than 0.05) in HR, SV, CO, VET and Zo were observed among the four positions. Inflation of the standard anti-G suit to 1.5 psi at 1.0 +Gz did not significantly alter HR, SV, or CO; whereas, 1 min of deflation of the anti-G suit significantly altered HR, SV, CO compared to inflation values. The results suggest IC can detect small differences in HR, SV, CO, VET, and Zo within subjects as a function of minor changes in body position.

Transthoracic impedance: differences between men and women with implications for impedance cardiography

Impedance cardiography (IC) is a reliable noninvasive technique for monitoring stroke volume (SV) and cardiac output. Transthoracic impedance (Zo) is one variable in the equation used for the calculation of SV. Thoracic impedance reflects the resistivity offered by tissues and air and the length and cross-sectional area of the thoracic volume. The purpose of this study was to evaluate possible differences in Zo between men and women. Measurements (Mean +/- S.D.) of Zo in 29 men (age 25.6 +/- 4.6 yr) and 35 women (24.2 +/- 6.0 yr) in the seated posture revealed Zo values were significantly (p less than 0.05) greater for the women (31.5 +/- 3.3 ohm) than the men (23.5 +/- 1.84 ohm). The observed differences in Zo cannot be attributed to thoracic length; distances between the monitoring electrodes were similar for the men (25.1 cm) and the women (25.7 cm). We hypothesize that the greater Zo observed for women is due to a smaller thoracic cross-sectional area and greater resistivity resulting primarily from relatively more fat tissue, smaller heart size, and lesser central blood volume as compared with men.

Exercise does not change high-density lipoprotein cholesterol in women after ten weeks of training

Effects of a 10 wk, three times per wk individualized bicycle ergometer training program were investigated in 16 healthy sedentary women 19-29 yr-old who were not taking oral contraceptives or other medications. Twelve women were in an interval type program, 6 in a continuous program, all performing 30 min exercise per session at 70% maximum heart rate reserve. Conditioning responses did not differ between the training regimens. Training produced increases in maximum oxygen uptake and physical work capacity. Percent body fat determined by underwater weighing was significantly reduced as was resting heart rate, after the training program. Maximum heart rate was unchanged. Despite changes in "fitness" variables, post-training values of high density lipoprotein cholesterol and triglycerides did not differ from pretraining. High-density lipoprotein cholesterol was significantly reduced at 2 and 5 wk of training and returned to control levels at 10 wk. Exercise conditioning leading to improved physical fitness in healthy women may not be associated with increments in high density lipoprotein cholesterol levels.

Computer-assisted method for performing impedance cardiography calculations

Impedance cardiography provides a noninvasive technique to monitor stroke volume on a beat-by-beat basis. It correlates well with other techniques at rest, with both cycle and arm-ergometer exercise, and during head-up tilt. It has the advantage that it does not require active subject participation, as does the CO2-rebreathing technique; yet it is still noninvasive. The method described herein facilitates the measurement and calculation of stroke volume, cardiac output, and indices of ventricular function when this technique is used - whether a few or many beats are recorded. This method utilizes a recording of the impedance cardiogram, which may include a simultaneously recorded electrocardiogram and phonocardiogram; a digitizer for reading the coordinates from the recording; a CRT terminal with keyboard for additional data input and for monitoring output; a printer; and a minicomputer for calculation of variables and data analysis. Data related to approximately 100 cardiac beats can be read, calculated, printed, and statistically analyzed in about an hour.

Influence of respiration on stroke volume determined by impedance cardiography

The conventional method of calculating stroke volume (SV) with impedance has been to measure changes in thoracic impedance for only those beats of the impedance cardiogram (IC) which cross on a specific baseline. This severely limits the number of usable beats since respiration produces oscillation of the IC around this baseline. This study investigated the influence of respiration on SV calculated independent of the baseline in seven women, 20-44 years old, in each of three postures: seated, supine, and standing. SV was determined in three continuous respiratory cycles from the following beats: 1. all; 2. all inspiratory (I); 3. I on baseline; 4. all expiratory (E); 5. E on baseline; 6. all end-E; 7. end-E on baseline (conventional). The absolute values for SV, heart rate (HR), and cardiac output (Q) were posture dependent. SVs did not differ among the respiratory phases in the standing and seated postures; in the supine posture, the smallest SV occurred at end-E on baseline. HR varied with respiration in both the standing and seated postures but not in the supine posture. Despite significant changes in HR in the seated and standing postures, Qs did not differ among the respiratory phases. Supine Qs were significantly smaller during end-E due primarily to a small SV. Consequently, when reporting Q values for supine subjects, it is important to designate the respiratory phase and baseline criteria. Our results indicate that SVs calculated independent of the baseline in general agree with the more conventional method of calculation. Therefore, we recommend the calculation of SV independent of the baseline. The reliability of the data will be increased by increasing the number of observations and SVs can be determined under circumstances where it is difficult to obtain end-E beats on the baseline.

A new ventricular-performance variable using electrocardiogram and carotid pulse contour derivative

The pre-ejection period (PEP) of systole is a widely used, non-invasive index of ventricular performance. For precise measurements, simultaneous recordings are required from which the Q-wave on the electrocardiogram, second heart sound on the phonocardiogram, and upstroke and incisura of the carotid pulse contour are discretely identifiable and temporally accurate. This is frequently difficult to accomplish. We, therefore, have compared 2 other noninvasive indices of ventricular performance for correlation with PEP in 17 female and 18 male subjects while supine and during head-up tilt. We also examined similarity of these indices to PEP in correlations with heart rate and blood pressure and compared them for ease in monitoring and precision in measurement. The ratio of the peak amplitude of the carotid pulse contour derivative to its total amplitude (DAR) is easier to monitor and more reliably measured than PEP; however, it is poorly correlated with PEP. Time from electrocardiographic Q-wave to peak dD/dt (Q-MAX) is also easier to monitor and somewhat more reliably measured than PEP. Although correlations of PEP and Q-MAZ with subject age are dissimilar, Q-MAX is correlated with PEP in supine and tilted subjects; the 2 variables are similarly correlated with heart rate and arterial pressure; and in 6 subjects both variables were prolonged after intravenous administration of propranolol-hydrochloride. We, therefore, propose Q-MAX as an alternative measure of ventricular performance.

Effect of a controlled exercise program on serum lipoprotein levels in women on oral contraceptives

The effects of a 10-wk individualized bicycle ergometer interval training program were investigated in a group of 13 sedentary women on a specific oral contraceptive (50 micrograms mestranol, 1 mg norethisterone) to determine if, like men on physical training, their high-density lipoprotein cholesterol levels would increase. Six additional women on the oral contraceptive served as a nonexercising control group. All subjects were between 18 and 30 yr and were nonsmokers. Diet and alcohol intake were stable throughout the study period, and were monitored throughout. The interval training program was three times per week, 30-min exercise per session, at 70% maximum heart rate reserve (resting heart rate + 0.7 x [maximum heart rate-resting heart rate]). Training produced increases (p < 0.05) in maximum oxygen uptake. Body weight was unchanged. However, unlike similar training programs with males, there were no significant changes in plasma high-density lipoprotein cholesterol or triglycerides. In women receiving estrogen progestin oral contraceptives, consistent exercise programs may fail to elevate high density lipoprotein cholesterol levels, consistent with an interaction of sex hormone-exercise effects and/or with the less marked effect of exercise on high-density lipoprotein cholesterol in women.

Reflex cardiovascular responses to cold exposure of the face or foot

Six subjects performed a breathholding maneuver during facial cooling and immersed their foot in cold water, without drugs and after the intravenous administration of propranolol plus atropine (P + A). Cardiac interval (INT), mean interval for longest consecutive 5 cycles (L5INT/5); systolic time intervals including electromechanical systole (EMS), left ventricular ejection time (LVET), pre-ejection period (PEP), and PEP/LVET; and systolic (SP) and diastolic pressures (DP) were monitored during supine rest, during apnea with a plastic bag of ice water on the face, and from 16-30th and 46-60th sec of 1-min periods of foot immersion in 4 degrees C water. P+A administration induced reduction in INT, L5INT/5, and LVET and increase in PEP, PEP/LVET, and DP. INT, L5INT/5, PEP, SP, and DP increased during facial cooling without drugs. Only the increases in INT and L5INT/5 were abolished by P+A and thus considered to result from reflexes mediated by vagal or sympathetic outflow to the heart. Reductions in INT, L5INT/5, EMS, PEP, and PEP/LVET at 16-30 sec of foot immersion without drugs were not observed after P+A; 46-60 sec responses neared resting values, however, with and without P+A. These results indicate an initial cardiac reflex response to foot immersion may be overpowered by the ventricular afterload and the foot immersion may be overpowered by the ventricular afterload and the baroreceptor response due to the increased arterial pressure.

Blood pressure, electrolytes, and body size: their relationships in young relatives of men with essential hypertension

In 154 white chldren aged 8 to 18 years from four large kindreds, relationships among blood pressure (BP), age, sex, body size, and electrolyte excretion were studied. Each kindred was ascertained through one male aged 35-58 years with essential hypertension, namely, a diastolic blood pressure (DBP) over 95 mm Hg. Weight, relative weight (relative to NCHS median for age, sex, and stature), subcutaneous fatfolds, various indices of obesity, and other measures of body size were significantly correlated with systolic blood pressure (SBP) and DBP in each sex (r = 0.3 to 0.7). Sodium and potassium excretion in 24-hour urine was also positively correlated with some measures of body size, and tended to increase with body size at a slightly more rapid rate in boys than in girls. In addition, there was a strong correlation between electrolyte excretion and BP in boys (r = 0.2 to 0.6); however, when the effects of age, body size and fatness were statistically removed, the correlations between BP and electrolyte excretion were not significant, except for 4th phase diastolic pressure (DBP4). These data, therefore, while not strongly supporting a relationship between sodium excretion and BP in children, do not rule out such a relationship, especially in families with a history of hypertension. In addition, these data provide further evidence of a very strong association between BP and body size and fatness in boys and girls.

Blood pressure, electrolytes, and body size: their relationships in young relatives of men with essential hypertension

In 154 white chldren aged 8 to 18 years from four large kindreds, relationships among blood pressure (BP), age, sex, body size, and electrolyte excretion were studied. Each kindred was ascertained through one male aged 35-58 years with essential hypertension, namely, a diastolic blood pressure (DBP) over 95 mm Hg. Weight, relative weight (relative to NCHS median for age, sex, and stature), subcutaneous fatfolds, various indices of obesity, and other measures of body size were significantly correlated with systolic blood pressure (SBP) and DBP in each sex (r = 0.3 to 0.7). Sodium and potassium excretion in 24-hour urine was also positively correlated with some measures of body size, and tended to increase with body size at a slightly more rapid rate in boys than in girls. In addition, there was a strong correlation between electrolyte excretion and BP in boys (r = 0.2 to 0.6); however, when the effects of age, body size and fatness were statistically removed, the correlations between BP and electrolyte excretion were not significant, except for 4th phase diastolic pressure (DBP4). These data, therefore, while not strongly supporting a relationship between sodium excretion and BP in children, do not rule out such a relationship, especially in families with a history of hypertension. In addition, these data provide further evidence of a very strong association between BP and body size and fatness in boys and girls.

Cardiovascular response to cooling of limbs determined by noninvasive methods

Cold, even local exposure to a limited portion of the body, is a stress to man which elevates arterial pressure, thereby intensifying cardiac workload. The sequence of cardiac events following local cooling was noninvasively studied by observation of changes in cardiac interval, left ventricular ejection time, time from A wave of electrocardiogram to the peak of the dD/dt of the carotid pulse wave (which includes pre-ejection period), and amplitude of the pulse wave from a photoelectric cell on the earlobe, along with arterial pressures. Twelve subjects, aged 22--41 years, exposed a hand or foot to cold water for 1 min while seated and while supine (four experiements each). Results indicate that arterial pressure is monotonically elevated throughout the minute of exposure. Cardiac intervals are initially abbreviated, then return towards control. This may include an initial response to the cold, followed by a baroreflex at the heart. Subject posture and limb exposed also affect cardiac responses.