军事飞行员前庭神经炎的医学鉴定

目的 对军事飞行员前庭神经炎的医学鉴定以及未来的发展趋势进行综述.资料来源与选择 该领域的相关研究论文和综述.资料引用 国内外公开发表的论文和综述40篇.资料综合 主要对前庭神经炎的研究进展、前庭神经炎对军事飞行的影响、军事飞行员前庭神经炎的医学鉴定以及未来的发展趋势4个相关问题进行了介绍和讨论.结论 对于军事飞行员的医学鉴定,需要进行全面的前庭功能评估.未来还需要进一步研制新的前庭功能检测设备,为在模拟真实飞行环境下对患者进行评估提供支持,从而为患前庭神经炎的飞行员重返飞行岗位,提供最直接和最可靠的依据.     

高性能战斗机飞行员前庭习服训练效果观察

目的 通过前庭习服训练,提高高性能战斗机飞行员前庭稳定性,以降低空晕病的发生.方法 应用VTS-0型电动转椅对45例前庭稳定性评定等级为D、E级的高性能战斗机飞行员进行每天1次,持续2周的前庭习服训练,记录训练前后前庭稳定性评定中的Coriolis加速度耐受值及训练耐受时间.结果 训练后,45例高性能战斗机飞行员的前庭稳定性较训练前有不同程度提高,均达到C级以上,Coriolis加速度耐受值和训练耐受时间明显提高,且有统计学意义(t=14.55、12.66,P＜0.01).结论 前庭习服训练对提高高性能战斗机飞行员的前庭稳定性效果明显. Abstract： Objective To explore the effects of vestibular accliratization training of highperformance fighter pilots for improving their vestibular stability and reducing airsickness. Methods Forty-five high-performance fighter pilots, who were graded as D and E in vestibular stability evaluation, performed vestibular acclimatization training by VTS-0 rotational chair once a day for 2weeks. In vestibular stability evaluation, tolerated Coriolis acceleration value and endurable duration of rotation were compared between the states before and after training.Results All 45 pilots'vestibular stability was variously improved and reached or exceeded grade C by training. Tolerated Coriolis acceleration value and endurable duration were significantly increased (t=14.55, 12.66, P＜0.01).Conclusions Vestibular acclimatization training shows significant effects on improving the vestibular stability of high-performance fighter pilots.     

军事飞行员前庭诱发肌性电位临床正常值的建立

目的记录中国空军战斗机飞行员前庭诱发肌性电位（VEMP）参数,以便建立战斗机飞行员的正常值数据。方法 40名现役健康战斗机飞行员作为受试者,采用短纯音双侧给声双侧进行了记录。记录40名健康飞行员VEMP的p13和n23波潜伏期、p13/n23波间幅度以及双侧幅度不对称比,以获得正常值数据。结果 40名健康飞行员均记录到VEMP。p13波的潜伏期为（13.50±1.20）ms;n23波的潜伏期为（21.35±1.60）ms;p13/n23波间幅度为（169.70±38.50）μV;双侧幅度的不对称比（AR）为0.12±0.11。结论本研究建立了军事飞行员VEMP参数标准的常模,为促进VEMP在军事飞行员医学选拔鉴定中的应用,提供了实验依据。     

Neuroendocrine responses to psychological workload of instrument flying in student pilots.

BACKGROUND: Information processing and stress tolerance are necessary features for instrument flying (IFR), especially among student pilots. Psychological workload of IFR flight may lead to stress reactions such as neuroendocrine activity. METHODS: Neuroendocrine responses to an IFR flight with Vinka piston-engined primary trainer were studied in 35 male volunteers who participated in the basic military flying course of the Finnish Air Force (FAF). The student pilots performed a 40-min IFR flight mission and a control session on land in randomized order between 11.00 h and 15.00 h. The IFR flight included 3 NDB approaches and was evaluated by flight instructors. Blood samples were collected 15 min before, 5 min and 60 min after the flight as well as control session, and. Plasma ACTH, beta3-endorphin (BE), cortisol, prolactin, adrenaline (A) and noradrenaline (NA) were measured. Psychological evaluations included psychomotor test (Wiener), Multi Coordination and Attention Test, ability tests and personality tests (CMPS and 16 PF). The overall psychological evaluation was made by an aviation psychologist. RESULTS: Plasma ACTH was significantly higher before and 5 min after the flight compared with control levels, but plasma BE increased significantly only before the flight. Plasma cortisol was significantly elevated before and 5 min after the flight. Plasma prolactin, NA and A increases were significant 5 min after the flight. High A levels after the flight correlated significantly with poor IFR flight performance as well as with poor psychomotor test results. CONCLUSIONS: The plasma prolactin and NA increases after the flight represented a direct type of stress reaction to the flight situation. The plasma BE response to IFR flight was an anticipatory stress reaction, but plasma ACTH, cortisol and A responses included both anticipatory and direct types of stress reactions. Psychological factors, flight performance and neuroendocrine responses to IFR flight appear to be associated with each other. Therefore, neuroendocrine reactions as a response to the psychological workload of military flying could be used for identifying stress tolerance in military pilots.     

Physiologic responses of pilots flying high-performance aircraft

This study deals with the physiologic responses to stress in F-4 fighter pilots and aircrew engaged in surface attack training (SAT) missions. Blood levels of HDL-cholesterol, LDH and LDH isoenzymes, CPK, and myoglobin were determined before and after each mission. Continuous EKG and transcutaneous PO2 recordings were made during briefing, preflight, and inflight. The personal history and habits of each participant were recorded. Each mission consisted of six successive bomb deliveries at 80-s intervals and at increasingly steep dive angles, each terminating in 5.5-6 +Gz during pull-up. Results revealed no apparent effect on HDL, COP isoenzymes, and LDH isoenzymes. Many myoglobin levels dropped as much as 50%. EKG recordings revealed ST elevations, ST depressions, T wave inversions, and marked sinus arrhythmias in some, while others showed increases in cardiac rate. Pilots flying these SAT missions in F-4C aircraft were found not to be significantly physiologically stressed.     

超声检查飞行员反复正加速度暴露后心脏功能的变化

目的观察中等强度反复正加速度( Gz)暴露是否会对飞行员心脏功能产生不利影响。方法38名歼击机飞行员接受离心机检查, Gz暴露峰值从 2.5Gz/10s开始。通过后,每次再递增 0.5Gz~ 1.0Gz,达到最高加速度暴露强度 4.5Gz/10s后结束检查。观察飞行员 Gz暴露前后心脏超声多项心功能指标的变化。结果飞行员 Gz暴露后2~4h,左室射血分数(EF)、短轴缩短率(ΔD)、主动脉血流速度、肺动脉血流速度和二尖瓣E峰速度,以及左心房收缩末前后径、左心室收缩末前后径、左右径和左心室舒张末左右径与暴露前比较变化不明显(P>0.05)。二尖瓣A峰速度轻度增加(P<0.01),左心室舒张末前后径和E/A峰速比值有所减小(P<0.05)。其中12名飞行员 Gz暴露后24h,EF、ΔD和二尖瓣A峰速度较暴露前轻度增加(P<0.05),E/A峰速比值仍有所减小(P<0.05)。结论中等强度反复 Gz暴露对飞行员心脏收缩功能无明显影响,但对心脏舒张晚期功能可造成暂时轻度不利影响,24h后趋向恢复,提示应重视 Gz暴露后飞行员心脏功能的保护。     

Immunoglobulin responses to a repeated bout of downhill running

Objective

To examine the effect of downhill running on immunoglobulin responses.

Method

Eleven untrained men performed 2 × 60 minute bouts of downhill running (−13.5% gradient), at a speed eliciting 75% of their V̇o₂peak on a level grade. Two runs were spaced 14 days apart. Serum samples were collected before, after, and every hour for 12 hours and every 24 hours for six days. Serum total creatine kinase and immunoglobulin isotypes and subclasses were measured, and results were analysed using a repeated measures analysis of variance (12 hour period, 2 × 14; 24 hour intervals, 2 × 6, p⩽0.05).

Results

There was a significant interaction effect for creatine kinase (activity lower after run 2 than after run 1, 6–24 h) and exercise effect, with the serum concentrations of IgG1, IgG2, IgG4, and IgE lower, and IgM higher, after run 2.

Conclusion

Lower concentrations of IgG1, IgG2, and IgE after run 2 may reflect a dampened autoimmune inflammatory response to autoantigens and enhanced autoantigen clearance mediated by the upregulation of IgM.     

Work capacity, exercise responses and body composition of professional pilots in relation to age

Body composition and submaximal and maximal cardiorespiratory responses during a progressive upright bicycle ergometer test were measured in 410 professional male pilots, aged 20 to 68 years, and divided into four groups (30, 39, 49, and 59 years). Fat-free weight by hydrostatic weighing was not significantly different between groups and fat increased linearly with age, while height was lower and weight levelled off in the oldest group. Aerobic work capacity (VO2max) fell at a rate of 0.25 ml.min-1.kg-1 per year in this unique population of healthy, but generally sedentary men. A subgroup of 10 pilots, tested annually from age 31 to 47, demonstrated a reversal of the age-related decline in VO2max. This was attributable to regular physical activity, short of athletic training, and changes in personal health habits stimulated by self-assessment available from the repeated tests incorporated into the medical prevention program. These data considered in relation to more recent reports of stroke volume during similar maximal exercise protocols suggest that VO2max is limited during aging by a reduction in tissue diffusing capacity or increased maldistribution of perfusion in relation to O2 uptake in muscle and this can be partially prevented by training. Reference standards for heart rate, blood pressure and ventilation during submaximal and maximal exercise levels are presented in relation to energy requirements and work intensity at various ages.     

Physiological responses to repeated apneas in underwater hockey players and controls.

The aim of this study was to investigate the effects of short repeated apneas on breathing pattern and circulatory response in trained (underwater hockey players: UHP) and untrained (controls: CTL) subjects. The subjects performed five apneas (A1-A5) while cycling with the face immersed in thermoneutral water. Respiratory parameters were recorded 1 minute before and after each apnea and venous blood samples were collected before each apnea and at 0, 2, 5 and 10 minutes after the last apnea. Arterial saturation (SaO2) and heart rate were continuously recorded during the experiment. Before the repeated apneas, UHP had lower ventilation, higher P(ET)CO2 (p < 0.05) and lower P(ET)O2 than CTL (p < 0.001). After the apneas, the P(ET)O2 values were always lower in UHP (p < 0.001) than CTL but with no difference for averaged P(ET)CO2 (p = 0.32). The apnea response, i.e., bradycardia and increased mean arterial blood pressure, was observed and it remained unchanged throughout the series in the two groups. The SaO, decreased in both groups during each apnea but the post-exercise SaO2 values were higher in UHP after A2 to A5 than in CTL (p < 0.01). The post-apnea lactate concentrations were lower in UHP than in CTL. These results indicate that more pronounced bradycardia could lead to less oxygen desaturation during repeated apneas in UHP. The UHP show a specific hypoventilatory pattern after repeated apneas, as well as a more pronounced cardiovascular response than CTL. They indeed showed no detraining of the diving response.     

Promethazine affects optokinetic but not vestibular responses in monkeys

BACKGROUND: Promethazine is used to treat motion sickness including Space Adaptation Syndrome, but there is incomplete information about how it affects vestibular and optokinetic responses. METHODS: Vestibular and optokinetic nystagmus, recorded with eye coils, were characterized in monkeys after administration of promethazine at dosages approximately equivalent to those used by humans in space. RESULTS: The initial increase of horizontal eye velocity during optokinetic nystagmus (OKN) was reduced after receiving the drug. Consequently, it took a longer time for eye velocity to rise to 60% of steady state value, the normal initial jump in eye velocity. Steady state OKN, maximum gains of optokinetic after-nystagmus (OKAN) and OKAN falling time constants were unaffected. The gains and time constants of the horizontal, vertical and roll angular vestibulo-ocular reflex (aVOR), the amplitude and velocity of saccades, and ocular counter-rolling (OCR), induced by off-vertical axis rotation (OVAR) were unaffected by promethazine. A two-component optokinetic model simulated the data simply by reducing the gain of the initial (rapid) component of OKN. A reduction in coupling between a non-linear element and the velocity storage integrator was required to simulate some vertical OKN data. CONCLUSIONS: Promethazine reduces the gain of the direct visual-oculomotor pathway in monkeys. It has little effect on saccades, the gain and time constant of the aVOR and the low frequency linear vestibulo-ocular reflex (IVOR), which orients the eyes during ocular counterrolling. The optokinetic deficit is consistent with reported reduction in ocular pursuit and VOR suppression after promethazine in humans.     

新型高性能战斗机飞行员前庭功能选拔鉴定训练方法研究中存在的问题及展望

目的 综述新型高性能战斗机飞行员前庭功能选拔鉴定训练方法研究中存在的问题并展望未来的发展方向.资料来源与选择国内该领域相关研究论文与综述.资料引用引用公开发表的论文共62篇.资料综合综合分析高性能战斗机对飞行员前庭功能的影响,明确飞行员前庭功能选拔、鉴定、训练等方面存在的问题,提出高性能战斗机飞行员前庭功能选拔鉴定训练未来的发展方向.结论 必须要建立快速、简便、易耐受的前庭功能筛选与全面的前庭功能评估方法、研究具有良好预测率的晕机病易感性预测方法、研制有效的前庭定向能力训练设备,以便更好地开展高性能战斗机飞行员前庭功能选拔鉴定训练工作.     

Thermal and circulatory responses to repeated bouts of prolonged running.

The purpose of this study was to determine the thermal and circulatory responses of seven runners (X VO2max = 66 ml kg min) to two bouts of high intensity prolonged treadmill running (PTR) [each 80-min at 70% VO2max] spaced by a 90-min rest. After the transition to exercise, oxygen uptake (VO2) and percent change in plasma volume remained constant throughout each PTR. Rectal temperature (Tr) and heart rate (HR) increased while stroke volume (SV) and cardiac output (Q) decreased during the course of each PTR. The pattern of response for each variable was similar for both PTRs. However, Tr and HR were higher and SV and Q were lower during the second PTR when compared to the first of each respective time period.     

Hormonal responses of pilots to training flights: the effects of experience on apparent stress

INTRODUCTION: The levels of urinary noradrenaline (NAd), adrenaline (Ad) and salivary cortisol (Cor) were determined in student and instructor pilots during Phase 1 (training with propeller engine; PH1), and Phase 2 (training with jet engine; PH2) flight training. METHODS: The subjects in PH1 were 30 students and 33 instructors, and in PH2 were 17 students and 15 instructors. Urine and saliva were collected approximately 30 min before and 20 min after the flights. The ratio (post/preflight) of the hormonal levels was calculated to compare the students with the instructors and/or PH1 with PH2. RESULTS: In PH1, the levels of all three hormones for postflight were significantly higher than for preflight in students, and the ratios of all three hormones in students were significantly higher than in instructors. In PH2, the ratios of all three hormones for students and instructors did not differ significantly, and the ratios of Ad and Cor levels in students for PH2 were significantly lower than for PH1 (Ad: 1.64 +/- 0.10 vs. 2.23 +/- 0.14; Cor: 0.86 +/- 0.16 vs. 1.68 +/- 0.11, respectively). CONCLUSIONS: The results from PH1 clearly demonstrated that flight stress for students was significantly higher than for instructors. The ratios might be regarded as result of adaptation to flight stress in students. We conclude that the ratios of Ad and Cor levels are a good indicator of stress coping in student pilots.     

Some effects of sleep loss on vestibular responses

This study assessed ocular nystagmus and motion experiences of men exposed to both simple (angular acceleration) and complex (Coriolis) vestibular stimulation during approximately 55 h of sleep loss. Control and sleep-deprived groups each comprised 10 young men. Angular accelerations and Coriolis stimulation (30 degrees head movements during CW rotation) were accomplished in darkness in an enclosed Still-Werner rotating device. Nystagmus and motion experiences (turning, "diving," and "climbing") were recorded throughout each session. Tests were given at 0900 and 1300 on each of 3 successive days. Subjects ingested 10-mg of d-amphetamine at 1200 on Day 3. During simple stimulation, the sleep-deprived group showed regular declines across sessions in slow phase and duration measures of nystagmus but fast phase ocular frequency and measures of experienced turning resisted declines until the final predrug session; subjective response latencies increased with sleep loss. Declines during rotation for ocular output and measures of perceived displacement during rightward head tilts ("climbing" sensation) were obtained for the sleep deprived, but both nystagmus and sensations were unaffected by return (leftward) movements of the head ("diving" sensation). d-Amphetamine had no consistent effect on responses of control subjects, but significantly increased nystagmus and elevated (but not significantly) measures of turning experiences for the sleep deprived.     

Postural responses to vibration of neck muscles in patients with uni- and bilateral vestibular loss

Postural responses to vibration applied unilaterally to the dorsal neck muscles were recorded with a sway platform in 11 patients with bilateral vestibular loss (BLD), 13 patients with unilateral vestibular lesions (ULD) and 19 normal subjects. In the normals, the vibration induced a forward postural deviation. Vibration failed to induce postural sway in the BLD patients but induced a backwards head movement in 7 patients. In the ULD patients, vibration contralateral to the lesion induced normal forward sway, whereas ipsilateral vibration resulted in sway directed to the side of the lesion and backwards. The findings demonstrate the importance of concurrent vestibular signals in determining the behavioural response to neck afferent input. We propose that in normal subjects the intact vestibular signal gives no confirmation that a head movement has occurred so it is assumed that the lower body has tilted forwards which provokes a compensatory sway. In the total absence of vestibular function the neck signal may represent a real head movement so the preferential response is a head tilt to restore upright posture. The vestibular imbalance in the ULD patients is roughly equivalent to the asymmetrical signals obtained in a normal subject during head rotation to the intact side. The stretch signal induced by ipsi-lesional vibration confirms possible head rotation, thus provoking a compensatory postural sway.     

A preliminary cross-sectional assessment of postural control responses to continuous platform rotations following a sport-related concussion

BackgroundIndividuals suffering a sport-related concussion typically recover within 1 month; however, persistent post-concussive symptoms are known to occur beyond this period. Clinical guidelines may not be sufficient to determine if dynamic postural control is still impaired at the point of the return to play decision.Research questionDo individuals with a previous sport-related concussion who have returned to play show differences in postural control compared to individuals without a previous concussion, in response to continuous platform perturbations?MethodsEight previously concussed and eight age- and position-matched participants completed six one-minute trials (three with eyes open/closed) whilst stood on a moving platform that rotated about the pitch axis with a peak-to-peak amplitude of 4° at a frequency of 0.8 Hz. Six trials were also captured during static quiet stance for comparison. Reactive and anticipatory stages of postural control were analysed by determining anteroposterior margins of stability (MoS) as a measure of whole-body postural control and head-to-trunk anchoring index as an indication of the head-trunk segmental coupling strategy.ResultsPosterior MoS during platform rotations reduced for both groups during eyes closed trials, but previously concussed participants exhibited a significantly greater reduction (1.97 cm) in comparison to matched-controls (0.34 cm). Participants, regardless of group, showed a preference towards a head-stabilised-to-trunk strategy during platform rotations. There were no differences during static trials.SignificanceThis preliminary study suggests previously concussed athletes demonstrate a greater reduction in postural control whilst undergoing continuous platform rotations with eyes closed, which could indicate possible lingering deficits to other sensory systems such as the vestibular system, though participants were not likely to lose their balance.     

Cytokine responses to repeated,prolonged walking in lean versus overweight/obese individuals

Objectives

Obesity is characterized by a pro-inflammatory state, which plays a role in the pathogenesis of metabolic and cardiovascular disease. An exercise bout causes a transient increase in pro-inflammatory cytokines, whilst training has anti-inflammatory effects. No previous study examined whether the exercise-induced increase in pro-inflammatory cytokines is altered with repeated prolonged exercise bouts and whether this response differs between lean and overweight/obese individuals.

Hormonal responses of pilots flying high-performance aircraft during seven repetitive flight missions.

Hormonal responses during seven repetitive flight missions (7RFM) were evaluated on F-4EJ fighter pilots. The following biochemical constituents were measured: 1) cortisol in saliva; 2) 17-OHCS; 3) unbound cortisol; 4) catecholamines in urine; and 5) electrolytes in urine. Samples were collected at about 30 min before the mission, 20 min after each flight, and in a nonflight day for control. The levels of saliva and urine corticosteroids slightly increased during 7RFM when compared with controls. The concentrations of urine catecholamines during 7RFM were significantly higher than those of preflight and control. These data suggest that flight stresses were moderate for the pilots flying 7RFM.     

Short-term retention effect of rehabilitation using head position-based electrotactile feedback to the tongue: Influence of vestibular loss and old-age

Our objective was to evaluate whether the severity of vestibular loss and old-age (>65) affect a patient's ability to benefit from training using head-position based, tongue-placed electrotactile feedback. Seventy-one chronic dizzy patients, who had reached a plateau with their conventional rehabilitation, followed six 1-h training sessions during 4 consecutive days (once on days 1 and 4, twice on days 2 and 3). They presented bilateral vestibular areflexia (BVA), bilateral vestibular losses (BVL), unilateral vestibular areflexia or unilateral vestibular losses and were divided into two age-subgroups (≤65 and >65). Posturographic assessments were performed without the device, 4 h before and after the training. Patients were tested with eyes opened and eyes closed (EC) on static and dynamic (passively tilting) platforms. The studied posturographic scores improved significantly, especially under test conditions restricting either visual or somatosensory input. This 4-h retention effect was greater in older compared to younger patients and was proportional to the degree of vestibular loss, patients with increased vestibular losses showing greater improvements. In bilateral patients, who constantly fell under dynamic-EC condition at the baseline, the therapy effect was expressed by disappearance of falls in BVL and significant prolongation in time-to-fall in BVA subgroups.Globally, our data showed that short training with head-position based, tongue-placed electrotactile biofeedback improves balance in chronic vestibulopathic patients some 16.74% beyond that achieved with standard balance physiotherapy. Further studies with longer use of this biofeedback are needed to investigate whether this approach could have long-lasting retention effect on balance and quality of life.