The effect of straining maneuvers on G-protection during assisted pressure breathing

INTRODUCTION: Pilots flying high-performance aircraft increase their acceleration tolerance by using straining maneuvers and anti-G suits. Recently, assisted positive pressure breathing has been added in some aircraft systems. This study assessed the effect of anti-G straining maneuvers on the G-protective properties of one such system, the AGE-39 anti-G ensemble used in the Swedish JAS 39 Gripen aircraft. METHODS: Ten subjects were studied in a centrifuge using each of the following: 1) the AGE-39 in combination with anti-G straining maneuvers (AGSM) throughout each high-G exposure (full maneuver; FM); 2) the AGE-39 in combination with AGSM only during the initial part of each high-G exposure (reduced maneuver; RM). G-tolerance was established during exposures to rapid onset rate (ROR) G profiles with plateau levels ranging from 6.5 to 9.0 G. RESULTS: Mean G-tolerance was > or = 8.8 G (range: 8.5 to > or = 9.0 G) in the RM condition and > or = 9.0 G in all subjects in the FM condition. Mean arterial pressure was 30-50 mm Hg higher (p < 0.001) in the FM than in the RM condition at any given ROR G-load. CONCLUSIONS: AGE-39 in combination with a brief period of straining provide efficient G-protection as illustrated by the finding that all subjects could tolerate 8.5 G while performing AGSM during the initial part of the high-G exposures. However, at 9.0 G, 40% of the subjects had to perform AGSM throughout the duration of the G-exposure. That arterial pressure was only 30-50 mm Hg higher in the FM than RM condition suggests that in the presence of straining maneuvers, pressure breathing makes only a minute contribution to the arterial-pressure response.     

Maximum intra-thoracic pressure with anti-G straining maneuvers and positive pressure breathing during +Gz.

Positive pressure breathing during +Gz (PBG) and anti-G straining maneuvers (AGSM) each improve +Gz tolerance by increasing blood pressure through increases in intra-thoracic pressure, but the maximal intra-thoracic pressure from their combined effect is not known. Six subjects performed the following: 1) maximal AGSM at +1 Gz; 2) assisted PBG (constant 60 mm Hg) at +Gz; 3) submaximal AGSM at +Gz (enough to maintain peripheral vision); 4) maximal AGSM at +Gz; and 5) combined PBG and maximal AGSM at +Gz. They wore TLSS mask/helmet ensemble, CSU-15/P G-suit, and TLSS-style jerkin. Intra-thoracic pressure was measured with a catheter-tip pressure transducer in the esophagus (Pes). The change in gastric pressure was also measured (delta Pga). For both Pes and delta Pga, there were no significant differences among experimental conditions (1), (4) and (5), as above. Group mean Pes and delta Pga in these three conditions were 139 and 197 mm Hg, respectively. The similar results between maximal AGSM, and maximal AGSM and PBG are explained by limited support from the thoracic counter-pressure garment, and the characteristics of the respiratory system.     

推拉动作后近红外光谱对脑血氧饱和度的监测

目的 :用近红外光谱仪对推拉动作后的大鼠进行脑血氧饱和度 (%SaO2 )的无损监测。方法 :用近红外光谱仪和血气分析仪同时测定缺血缺氧大鼠头部血流的吸光强度和血氧饱和度 ,绘制出吸光强度差值与血氧饱和度差值之间的关系曲线。根据关系曲线 ,推测出高 +Gz和推拉动作后脑血氧饱和度。结论 :高 +Gz和推拉动作组分别与 0Gz组比较 ,脑血氧饱和度降低 ;推拉动作后脑血氧饱和度降低更明显。结论 :用近红外光谱仪可以无损监测推拉动作后脑血氧饱和度的变化。     

Blood pressure changes during barium enema

AIMS: To document blood pressure changes during barium enema examination and to determine at what point in the examination changes are likely to occur. METHODS AND RESULTS: Blood pressure measurements were taken at seven points during the course of barium enema examination in 107 consecutive patients. We found that patients over the age of 60 years had statistically significant decreases in blood pressure when they were stood up during the course of the examination. Many of these patients were asymptomatic. Patients who had symptoms (15/107, 14%) when standing up had a degree of hypotension. The duration of barium enema examination is longer in those patients who experience symptoms. CONCLUSION: During a barium enema examination hypotension occurs at the point of standing up more frequently in patients over 60 years and in those who suffer symptoms at this time. Patients who fall into one of these groups should be considered at risk of fainting at this point in the examination. A modified technique to avoid standing should be considered in at-risk patients. Roach, S. C.et al. (2001). Clinical Radiology56, 393-396.     

下体负压联合旋转床模拟推拉效应的心率变化特征

目的 建立下体负压联合旋转床模拟推拉效应的方法,观察不同预先-Gz作用后Gz时心率反应的变化特征.方法 8名健康男性志愿者,利用旋转床或联合下体负压随机暴露于预先0°(0 Gz)、-30°(-0.5 Gz)和-90°(-1 Gz),分析在模拟推拉动作时-Gz或0 Gz、"拉"时相及与单纯+1 Gz时相同时间段的平均心率,比较在不同倾斜角度即不同预先-Gz作用或联合下体负压模拟推拉动作时"拉"时相的心率反应.结果 利用旋转床模拟推拉动作时,在"推"时相即头低位时心率显著降低,随倾斜角度的增大降低更加显著,"拉"时相的心率随预先倾斜角度增大回升更明显.下体负压联合旋转床模拟推拉动作时,心率变化与单纯旋转床模拟推拉动作时基本一致.后者在"拉"时相与单纯+1 Gz作用时相比心率变化更大,提示心率回升更加缓慢.结论 旋转床或联合下体负压可以模拟推拉效应,其心率反应随预先-Gz值的增大在"拉"时相回升明显,并且受随后模拟+Gz负荷大小的影响.     

抗荷正压呼吸对下体正压模拟推拉效应的防护作用

目的利用下体正压在单轴向离心机上模拟推拉动作,观察抗荷正压呼吸对推拉效应的防护效果。方法受试者5名,均参加过载人离心机试验并掌握了正确的抗荷正压呼吸方法。第1天测定受试者的基础 Gz耐力、穿KH-x抗荷服时的 Gz耐力和实施抗荷正压呼吸时的 Gz耐力;第2天依次测定受试者的基础耐力、下体正压作用后穿KH-x抗荷服 Gz耐力和抗荷正压呼吸时的 Gz耐力。结果与第1天的试验结果相比,下体正压作用后受试者穿着KH-x抗荷服的 Gz耐力显著降低(P<0.05);但是进行抗荷正压呼吸时的 Gz耐力没有变化。结论抗荷正压呼吸可以减轻推拉效应对 Gz耐力的影响。关于抗荷正压呼吸的压力制度及其训练方法还有待进一步优化。     

Head position of helicopter pilots during slalom maneuvers

INTRODUCTION: Pilots typically tilt their heads when executing coordinated banking turns, a phenomenon commonly attributed to the putative opto-kinetic cervical reflex (OKCR). The OKCR is usually described as a reflex, primarily driven by stimuli in the visual periphery, and is important to a pilot's spatial orientation by providing a relatively stabilized horizontal frame of reference. The present paper presents an alternative hypothesis for the observed head tilting seen in pilots. METHODS: An archived data set, originally collected for other purposes, contained the head turn, pitch, and tilt of 4 helicopter pilots recorded at 10 Hz as the pilots executed 42 slalom maneuvers in an AH Mk 7 Lynx helicopter under visual flight conditions. The analytic method was a correlational analysis of head turn, pitch, and tilt. RESULTS: As expected, pilots routinely tilted their heads during the slaloms in a fashion typically attributed to the OKCR. Correlations among head turn, tilt, and pitch showed that when the helicopter turned left, the head, presumably to look into the turn, turned left and also pitched up and tilted right. Similarly, when the helicopter turned right, the head, presumably to look into the turn, turned right, pitched up, and tilted left. CONCLUSIONS: The head tilting usually attributed to a neuromuscular reflex driven by visual stimuli may be a biomechanical consequence of the head posture pilots assume when they simply look where they are going, eliminating the need to postulate the existence of a novel neuromuscular reflex.     

G protection: interaction of straining maneuvers and positive pressure breathing

INTRODUCTION: G protection in the 39 Gripen aircraft is provided by a full coverage anti-G suit, a pressure-breathing system, and anti-G straining maneuvers (AGSM). The purpose was to study (1) the interaction of pressure breathing and AGSM while wearing an anti-G suit; and (2) the G-protective properties of the anti-G suit alone and in combination with the pressure-breathing system. METHODS: During rapid onset rate G-time profiles (< or =9 G), 10 subjects were investigated in 5 conditions: (I) sitting relaxed, without any G-protective garment; (II) sitting relaxed and wearing an anti-G suit; (III) sitting relaxed, wearing an anti-G suit, and pressure breathing; IV) wearing an anti-G suit and performing AGSM; and V) wearing an anti-G suit, pressure breathing, and performing AGSM. In supplementary experiments (n=9), the share of the anti-G suit protection afforded by the abdominal bladder was investigated. RESULTS: G tolerance was 3.4 Gz (range: 2.8-4.3) in condition I, > or = 6.5 Gz (4.5-9.0) in II, > or = 8.0 Gz (6.5-9.0) in III, > or = 8.9 Gz (8.5-9.0) in IV and > or = 9.0 Gz (8.5-9.0) in V. In the supplementary experiments, the anti-G suit afforded a 2.8-G protection, a third of which was contributed by the abdominal bladder. In the relaxed state, pressure applied to the airways was transmitted undistorted to the intrathoracic space. During AGSM, intrathoracic pressure rose to 10-14 kPa, regardless of whether AGSM was performed with or without pressure breathing. DISCUSSION: AND CONCLUSIONS: The anti-G suit and the pressure breathing system provide G protection of > or = 4.6 G, of which the anti-G suit contributes about 3.0 G. The C-protective properties of the anti-G suit and those of pressure breathing appears to be additive, whereas the G protection afforded by pressure breathing does not add to that provided by AGSM.     

Intracarotid blood pressure changes during contrast medium injection.

PURPOSETo investigate changes in blood pressure during intracarotid injection of contrast material.METHODSTwo catheters were inserted into the ipsilateral common carotid artery of dogs. The proximal catheter was used for injection of contrast material and the other was positioned distally to monitor blood pressure.RESULTSDistal intracarotid pressure rose significantly during injection of contrast material at all rates (5, 7, and 10 mL/s) and at all doses (0.2, 0.5, 0.7, and 1.0 mL/kg). In addition, these blood pressure elevations were shown to be correlated with injection rates and doses. Even when the pressure-monitoring coaxial catheter was advanced into smaller arteries, no decline in the impact of injection was observed.CONCLUSIONIntracarotid injection of contrast material causes a temporal elevation of cerebral blood pressure in dogs.     

Frostbite injuries during winter maneuvers: a long-term disability

Frostbite injuries are a common problem associated with military operations in cold environments. Long-term disability can result. A follow-up study of 40 patients with documented frostbite injuries reveals that 65% are still having symptoms attributable to their initial injuries. This appears to be a higher percentage than most studies would suggest.     

Passive properties of human skeletal muscle during stretch maneuvers

Despite limited scientific knowledge, stretching of human skeletal muscle to improve flexibility is a widespread practice among althletes. This article reviews recent findings regarding passive properties of the hamstring muscle group during stretch based on a model that was developed which could synchronously and continuously measure passive hamstring resistance and electromyographic activity, while the velocity and angle of stretch was controlled. Resistance to stretch was defined as passive torque (Nm) offered by the hamstring muscle group during passive knee extension using an isokinetic dynamometer with a modified thigh pad. To simulate a clinical static stretch, the knee was passively extended to a pre-determined final position (0.0875 rad/s, dynamic phase) where it remained stationary for 90s (static phase). Alternatively, the knee was extended to the point of discomfort (stretch tolerance). From the torque-angle curve of the dynamic phase of the static stretch, and in the stretch tolerance protocol, passive energy and stiffness were calculated. Torque decline in the static phase was considered to represent viscoelastis stress relaxation. Using the model, studies were conducted which demonstrated that a single static stretch resulted in a 30% viscoelastic stress relaxation. With repeated stretches muscle stiffness declined, but returned to baseline values within 1 h. Long-term stretching (3 weeks) increased joint range of motion as a result of a change in stretch tolerance rather than in the passive properties. Strength training resulted in increased muscle stiffness, which was unaffected by daily stretching. The effectiveness of different stretching tecniques was attributed to a change in strech tolerance rather than passive properties. Inflexible and older subjects have increased muscle stiffness, but a lower stretch tolerance compared to subjects with normal flexiblity and younger subjects, respectively. Although far from all questions regarding the passive properties of humans skeletal muscle have been answered in these studies, the measurement technique permited skeletal muscle.     

Carotid baroreceptor influence on forearm vascular resistance during low level lower body negative pressure.

The degree of forearm vasoconstriction induced by low levels of lower body negative pressure (LBNP) provides a measure of the responsiveness of the cardiopulmonary baroreflex. The validity of this measurement is based on the assumption that this vasoconstriction response is not influenced by unloading of carotid baroreceptors. To test the hypothesis that arterial baroreceptor unloading does not alter the degree of forearm vascular resistance during low levels of LBNP, we exposed 12 subjects to -15 and -20 mm Hg LBNP with and without additional artificial (+10 mm Hg neck pressure) unloading of the carotid baroreceptors. There was no measurable influence of carotid unloading on forearm vascular resistance at either level of LBNP. We conclude that forearm vascular resistance measured during cardiopulmonary baroreceptor unloading is unaffected by carotid baroreceptor unloading within the magnitude encountered during low levels of LBNP.     

Age-related plantar centre of pressure trajectory changes during barefoot walking

Plantar centre of pressure (COP) variables during gait have been used to predict risk of injury, or consequences thereof. The aim of this study was to determine the effect of age on the COP trajectory during barefoot gait at a self-selected speed. 287 participants (aged 18–80 year, 163 women) walked barefoot at self-selected speed across a Footscan^® force platform, completing five trials for each side. COP trajectories were extracted and trajectory-level canonical correlation analysis was used to test their correlation with age. Post hoc linear regressions were performed on the medio-lateral (COPx) and anterior-posterior (COPy) components. The test statistic trajectory exceeded the critical threshold for the left (p = 0.001) and right foot (p = 0.003). Post hoc analyses showed positive correlation between age and COPx in late stance, placed more laterally with increasing age, while no significant correlation was found for COPy. While no significant correlations were observed for the test statistic trajectory during heel strike and mid-stance, post hoc analysis indicated that the COPx component was placed more laterally at heel strike for the left foot with increasing age (p = 0.016). The findings suggest that older individuals tend to push-off with less metatarso-phalangeal dorsiflexion. These results do not necessarily imply that ageing itself causes the observed correlation. Further evidence is needed to determine whether the laterally placed COP during roll-off may be a useful factor for determining risk for falling in the older population, or as a risk for future injuries or overuse disorders.     

Neck exercises compared to muscle activation during aerial combat maneuvers

INTRODUCTION: Performing specific neck strengthening exercises has been proposed to decrease the incidence of neck injury and pain in high performance combat pilots. However, there is little known about these exercises in comparison to the demands on the neck musculature in flight. METHODS: Eight male non-pilots performed specific neck exercises using two different modalities (elastic band and resistance machine) at six different intensities in flexion, extension, and lateral bending. Six Royal Australian Air Force Hawk pilots flew a sortie that included combinations of three +Gz levels and four head positions. Surface electromyography (EMG) from selected neck and shoulder muscles was recorded in both activities. RESULTS: Muscle activation levels recorded during the three elastic band exercises were similar to in-flight EMG collected at +1 Gz (15% MVIC). EMG levels elicited during the 50% resistance machine exercises were between the +3 Gz (9-40% MVIC) and +5 Gz (16-53% MVIC) ranges of muscle activations in most muscles. EMG recorded during 70% and 90% resistance machine exercises were generally higher than in-flight EMG at +5 Gz. DISCUSSION: Elastic band exercises could possibly be useful to pilots who fly low +Gz missions while 50% resistance machine mimicked neck loads experienced by combat pilots flying high +Gz ACM. The 70% and 90% resistance machine intensities are known to optimize maximal strength but should be administered with care because of the unknown spinal loads and diminished muscle force generating capacity after exercise.     

Carotid rupture during stent-assisted aneurysm treatment

We report the case of a supraclinoid carotid rupture during the delivery of a balloon-expandable stent in a 59-year-old patient with incidental paraclinoid berry aneurysms for whom stent-assisted coiling was planned. The deployment of the stent resulted in immediate rupture of the artery. We describe the emergent management of this complication with prolonged balloon inflation to occlude the site of rupture, a treatment that led to the discharge of the patient 2 weeks later without any sequelae.     

Muscle activation strategies at the knee during running and cutting maneuvers

PURPOSE: The purpose of this article was to investigate the activation patterns of muscles surrounding the knee during preplanned (PP) and unanticipated (UN) running and cutting tasks, with respect to the external moments applied to the joint. It was hypothesized that activation strategies during PP tasks would correspond to the magnitude and direction of the external loads applied to the knee joint, and the muscle activation patterns would differ between PP and UN tasks. METHODS: Eleven healthy male subjects performed a series of running and cutting tasks under PP and UN conditions. Activation from 10 knee muscles were determined using full-wave rectified, filtered, and normalized EMG calculated during a precontact phase and two epochs across the stance phase. Knee joint flexor and extensor muscle group ratios indicated the level of co-contraction. Individual muscles were also grouped into medial/lateral and internal/external rotation muscle groups, based upon their ability to counter externally applied varus/valgus and internal/external rotation joint loads, respectively. RESULTS: Selective activation of medial/lateral and internal/external rotation muscles and co-contraction of flexors and extensors were used to stabilize the joint under PP conditions, whereas generalized co-contraction strategies were employed during the UN condition. Net muscle activation during the UN sidestepping tasks increased by 10-20%, compared with an approximately 100% increase in applied varus/valgus and internal/external rotation joint moments. CONCLUSION: In PP conditions, activation patterns appear to be selected to support the external loads experienced at the knee, e.g., medial muscles activated to resist applied valgus moments. Under UN conditions, there was no selective activation of muscles to counter the external knee load, with generalized co-contraction being the activation pattern adopted. These findings have implications for the etiology of noncontact knee ligament injuries.