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Role of proprioceptive impulses during respiration with increased intrapulmonary pressure in regulating respiration and circulation
The majority of crewmembers who exhibited postflight decreases in the cardiac silhouette size also showed a decreased orthostatic tolerance to lower body negative pressure. Similar findings were also reported by the Soviet investigators following 30-day bedrest studies and in cosmonauts upon return from space missions. Further radiological data from all three Skylab manned missions are presented and the physiological factors possibly involved in the cardiac silhouette changes are discussed.
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The purpose of this study was to determine the similarity between the response of the THUMS model and the Hybrid III Anthropometric Test Device (ATD) given existing Wright-Patterson (WP) sled tests. There were four tests selected for this comparison with frontal, spinal, rear, and lateral loading. The THUMS was placed in a sled configuration that replicated the WP configuration and the recorded seat acceleration for each test was applied to model seat. Once the modeling simulations were complete, they were compared to the WP results using two methods. The first was a visual inspection of the sled test videos compared to the THUMS d3plot files. This comparison resulted in an assessment of the overall kinematics of the two results. The other comparison was a comparison of the plotted data recorded for both tests. The metrics selected for comparison were seat acceleration, belt forces, head acceleration and chest acceleration. These metrics were recorded in all WP tests and were outputs of the THUMS model. Once the comparison of the THUMS to the WP tests was complete, the THUMS model output was also examined for possible injuries in these scenarios. These outputs included metrics for injury risk to the head, neck, thorax, lumbar spine and lower extremities. The metrics to evaluate head response were peak head acceleration, HIC15, and HIC36. For the neck, N (sub ij) was calculated. The thorax response was evaluated with peak chest acceleration, the Combined Thoracic Index (CTI), sternal deflection, chest deflection, and chest acceleration- 3 ms clip. The lumbar spine response was evaluated with lumbar spine force. Finally the lower extremity response was evaluated by femur and tibia force. The results of the simulation comparisons indicate the THUMS model had a similar response to the Hybrid III dummy given the same input. The primary difference seen between the two was a more flexible response of the THUMS compared to the Hybrid III. This flexibility was most pronounced in the neck flexion, shoulder deflection and chest deflection. Due to the flexibility of the THUMS, the resulting head and chest accelerations tended to lag the Hybrid III acceleration trace and have a lower peak value. The results of the injury metric comparison identified possible injury trends between simulations. Risk of head injury was highest for the lateral simulations. The risk of chest injury was highest for the rear impact. However, neck injury risk was approximately the same for all simulations. The injury metric value for lumbar spine force was highest for the spinal impact. The leg forces were highest for the rear and lateral impacts. The results of this comparison indicate the THUMS model performs in a similar manner as the Hybrid III ATD. The differences in the responses of model and the ATD are primarily due to the flexibility of the THUMS. This flexibility of the THUMS would be a more human like response. Based on the similarity between the two models, the THUMS should be used in further testing to assess risk of injury to the occupant.
Cardiopulmonary resuscitation is required training for all astronauts. No studies thus far have investigated how chest compressions may be affected in lunar and Martian gravities. Therefore a theoretical quantitative study was performed. The maximum downward force an unrestrained person can apply is mg N (g(sub Earth) = 9.78 ms(sup -2), g(sub moon) = 1.63 ms(sup -2), g(sub Mars) = 3.69 ms(sup -2). Tsitlik et a1 (Critical Care Medicine, 1983) described the human sternal elastic force-displacement relationship (compliance) by: F = betaD(sub s) + gammaD(sub s)(sup 2) (beta = 54.9 plus or minus 29.4 Ncm(sup -1) and gamma = 10.8 plus or minus 4.1 Ncm(sup -2)). Maximum forces in the 3 gravitational fields produced by 76 kg (US population mean), 41 kg and 93 kg (masses derived from the limits for astronaut height), produced solutions for compression depth using Tsitlik equations for chests of: mean compliance (beta = 54.9, gamma = 10.8), low compliance (beta = 84.3, gamma = 14.9) and high compliance (beta = 25.5, gamma = 6.7). The mass for minimum adequate adult compression, 3.8 cm (AHA guidelines), was also calculated. 76 kg compresses the mean compliance chest by: Earth, 6.1 cm, Mars, 3.2 cm, Moon, 1.7 cm. In lunar gravity, the high compliance chest is compressed only 3.2 cm by 93 kg, 120 kg being required for 3.8 cm. In Martian gravity, on the mean chest, 93 kg compresses 3.6 cm; 99 kg is required for 3.8 cm. On Mars, the high compliance chest is compressed 4.8 cm with 76 kg, 5.5 cm with 93 kg, with 52 kg required for 3.8 cm.
BACKGROUND: Medical operations on the International Space Station will emphasize the stabilization and transport of critically injured personnel and so will need to be capable of advanced trauma life support (ATLS). METHODS: We evaluated the ATLS invasive procedures in the microgravity environment of parabolic flight using a porcine animal model. Included in the procedures evaluated were artificial ventilation, intravenous infusion, laceration closure, tracheostomy, Foley catheter drainage, chest tube insertion, peritoneal lavage, and the use of telemedicine methods for procedural direction. RESULTS: Artificial ventilation was performed and appeared to be unaltered from the 1-G environment. Intravenous infusion, laceration closure, percutaneous dilational tracheostomy, and Foley catheter drainage were achieved without difficulty. Chest tube insertion and drainage were performed with no more difficulty than in the 1-G environment due to the ability to restrain patient, operator and supplies. A Heimlich valve and Sorenson drainage system were both used to provide for chest tube drainage collection with minimal equipment, without the risk of atmospheric contamination, and with the capability to auto-transfuse blood drained from a hemothorax. The use of telemedicine in chest tube insertion was demonstrated to be useful and feasible. Peritoneal lavage using a percutaneous technique, although requiring less training to perform, was found to be dangerous in weightlessness due to the additional pressure of the bowel on the anterior abdominal wall creating a high risk of bowel perforation. CONCLUSIONS: The performance of ATLS procedures in microgravity appears to be feasible with the exception of diagnostic peritoneal lavage. Minor modifications to equipment and techniques are required in microgravity to effect surgical drainage in the presence of altered fluid dynamics, to prevent atmospheric contamination, and to provide for the restraint requirements. A parabolic simulation system was developed for equipment and procedure verification, physiological research, and possible crew medical officer training in the future.
Purpose In clinical practice, invasiveness is an important reference indicator for differentiating the malignant degree of subsolid pulmonary nodules. These nodules can be classified as atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IAC). The automatic determination of a nodule's invasiveness based on chest CT scans can guide treatment planning. However, it is challenging, owing to the insufficiency of training data and their interclass similarity and intraclass variation. To address these challenges, we propose a two‐stage deep learning strategy for this task: prior‐feature learning followed by adaptive‐boost deep learning. Methods The adaptive‐boost deep learning is proposed to train a strong classifier for invasiveness classification of subsolid nodules in chest CT images, using multiple 3D convolutional neural network (CNN)‐based weak classifiers. Because ensembles of multiple deep 3D CNN models have a huge number of parameters and require large computing resources along with more training and testing time, the prior‐feature learning is proposed to reduce the computations by sharing the CNN layers between all weak classifiers. Using this strategy, all weak classifiers can be integrated into a single network. Results Tenfold cross validation of binary classification was conducted on a total of 1357 nodules, including 765 noninvasive (AAH and AIS) and 592 invasive nodules (MIA and IAC). Ablation experimental results indicated that the proposed binary classifier achieved an accuracy of with an AUC of 81.3 . These results are superior compared to those achieved by three experienced chest imaging specialists who achieved an accuracy of , , and , respectively. About 200 additional nodules were also collected. These nodules covered 50 cases for each category (AAH, AIS, MIA, and IAC, respectively). Both binary and multiple classifications were performed on these data and the results demonstrated that the proposed method definitely achieves better performance than the performance achieved by nonensemble deep learning methods. Conclusions It can be concluded that the proposed adaptive‐boost deep learning can significantly improve the performance of invasiveness classification of pulmonary subsolid nodules in CT images, while the prior‐feature learning can significantly reduce the total size of deep models. The promising results on clinical data show that the trained models can be used as an effective lung cancer screening tool in hospitals. Moreover, the proposed strategy can be easily extended to other similar classification tasks in 3D medical images.
Personal thermoregulatory systems which provide chest cooling are used in the industrial and aerospace environments to alleviate thermal stress. However, little information is available regarding the physiologic and circulatory changes produced by routine operation of these systems. The objectives of this study were to document and compare the subjects' response to three cooling vests in their recommended configurations. The Life Enhancement Tech (LET) lightweight active cooling vest with cap, the MicroClimate Systems Change of Phase garment (MCS), and the Steele Vest were each used to cool the chest regions of 12 male and 8 female Healthy subjects (21 to 69 yr.) in this study. The subjects, seated in an upright position at normal room temperature (approx. 22 C), were tested for 60 min. with one of the cooling garments. The LET active garment had an initial coolant fluid inlet temperature of 60 F, and was ramped down to 50 F. Oral, right and left ear canal temperatures were logged manually every 5 min. Arm, leg, chest and rectal temperatures; heart rate; and respiration were recorded continuously on a U.F.I., Inc. Biolog ambulatory monitor. For men, all three vests had similar, significant cooling effects. Decreases in the average rectal temperature, oral temperature, and ear canal temperatures were approximately 0.2 C, 0.2 C and 0.1 C, respectively. In contrast to the men, the female subjects wearing the MCS and Steel vests had similar cooling responses in which the core temperature remained elevated and oral and ear canal temperatures did not drop. The LET active garment cooled most of the female subjects in this study; rectal, oral and ear temperature decreased about 0.2 C, 0.3 C and 0.3 C, respectively. These results show that the garment configurations tested do not elicit a similar thermal response in all subjects. A gender difference is evident. The LET active garment configuration was most effective in decreasing temperatures of the female subjects; the MCS vest was least effective. For male subjects, the three vests appear to be more nearly equivalent. The active garment system under study included a cooling cap, which may account for some of the difference in response.
Personal thermoregulatory systems which provide chest cooling are used in the industrial and aerospace environments to alleviate thermal stress. However, little information is available regarding the physiologic and circulatory changes produced by routine operation of these systems. The objectives of this study were to compare the effectiveness of two passive cooling vests, and to measure the body temperature and circulatory changes produced by each cooling vest configuration. A Life Enhancement Technologies, (LET) ice vest garment and a Steele, Inc. vest were used to cool the chest region of 11 male subjects (25 to 55 yr) in this study. Calf, forearm and finger blood flows were measured using a tetrapolar impedance rheograph. The subjects, seated in an upright position at normal room temperature (approximately 21 C) were tested for 60 min. with the cooling system operating at its maximum cooling capacity. Blood flows were recorded continuously using a computer data acquisition system with a sampling frequency of 250 Hz. Oral, right and left ear temperatures and cooling system parameters were logged manually every 5 min. Arm, leg, chest and rectal temperatures; heart rate; respiration; and an activity index were recorded continuously on a U.F.I., Inc. Biolog ambulatory monitor. No significant differences were found in either the oral or ear temperature responses to the two vests. However, the rectal and mean skin temperatures at the end of the cooling period were both significantly lower (P less than 0.05), approximately 0.2 and 1.9 C, respectively for the LET vest than for the Steele garment. These data show that different vest configurations may produce different thermal responses in healthy male subjects which should be considered in the use of these cooling garments.
Personal thermoregulatory systems which provide chest cooling are used in the industrial and aerospace environments to alleviate thermal stress. However, little information is available regarding the physiologic and circulatory changes produced by routine operation of these systems. The objectives of this study were to compare the effectiveness of two passive and two active cooling vests, and to measure the body temperature and circulatory changes produced by each cooling vest configuration. The MicroClimate Systems and the Life Enhancement Tech(LET) lightweight liquid cooling vests, the Steele Vest and LET's Zipper Front Garment were used to cool the chest region of 11 male and 10 female subjects (25 to 55 yr.) in this study. Calf, forearm and finger blood flows were measured using a tetrapolar impedance rheograph. The subjects, seated in an upright position at normal room temperature (approx.21 C), were tested for 60 min. with the cooling system operated at its maximum cooling capacity. Blood flows were recorded continuously using a computer data acquisition system with a sampling frequency of 250 Hz. Oral, right and left ear temperatures and cooling system parameters were logged manually every 5 min. Arm, leg, chest and rectal temperatures; heart rate; respiration; and an activity index were recorded continuously on a URI Inc. Biolog ambulatory monitor. In general, the male and female subjects' rectal and ear temperature responses to cooling were similar for all vest configurations tested. Oral temperatures during the recovery period were significantly (P<0.05) lower than during the control period, approx.0.2 - 0.5 C, for both men and women wearing any of the four different garments. The corresponding car temperatures were significantly (P<0.05) decreased approx.0.2 - 0.3 C by the end of the recovery period. Compared to the control period, no significant differences were found in rectal temperatures during cooling and recovery periods. These results show that all vest configurations elicit a similar thermal response in both male and female subject groups. However, subject population variance was rather large and may have masked differences between the vests. One vest may prove more effective than another for a given individual, and experience is the only means of determining this.
The objective evidence of silent myocardial ischemia--ischemia in the absence of classical chest pain--includes ST-segment shifts (usually depression), momentary left ventricular failure, and perfusion defects on scintigraphic studies. Assessment of angina patients with 24-hour ambulatory monitoring may uncover episodes of silent ischemia, the existence of which may give important information regarding prognosis and may help structure a more effective therapeutic regimen. The emerging recognition of silent ischemia as a significant clinical entity may eventually result in an expansion of current therapy--not only to ameliorate chest pain, but to minimize or eliminate ischemia in the absence of chest pain.
Balance control is disrupted following prolonged microgravity exposure, and to better understand this, both upper and lower body perturbations have been used to study postural control in space flight crewmembers. However, differences between several postural response indicators observed using the two techniques suggest that different sensory systems may be involved in organizing responses to these different perturbation approaches. The present study sought to compare differences in parameters of corrective postural responses between upper body perturbations (pushes to the chest) and forward translations of the support surface. Nine subjects participated in this study. Forward translations were performed using a NeuroCom EquiTest(TM) CDP system, which was synchronized with a Northern Digital OptoTrak motion tracking system (3 subjects). Chest pushes were applied using a hand-held force transducer device and were performed using a stabilometric system (6 subjects). Analysis of EMG has shown that: i) the earliest response of the leg muscles was registered significantly later during forward translation of the support surface than during chest pushes, and ii) there was a tendency for the different order of leg muscles activation during the translation tests. Analysis of the kinematic data showed a significant difference in the subject's body segments inclinations during corrective postural responses to upper and lower body perturbations. It appears that upper body perturbations likely engage the vestibular system more rapidly, while lower body perturbations likely engage somatosensory systems more rapidly. These differences must be taken into account when choosing the type of perturbation for testing postural function.
One of the goals of the NASA Occupant Protection Group is to understand the human tolerance to dynamic loading. This knowledge has to come through indirect approaches such as existing human response databases, anthropometric test devices (ATD), animal testing, post‐mortem human subjects, and models. This study investigated the biofidelity of the National Highway Traffic Safety Administration's ATD named the THOR (test device for human occupant restraint). If THOR responds comparably to humans, then it could potentially be used as a human surrogate to help validate space vehicle requirements for occupant protection. The THOR responses to frontal and spinal impacts (ranging from 8 to 12 G with rise times of 40, 70, and 100 ms) were measured and compared to human volunteer responses (95 trials in frontal and 58 in spinal) previously collected by the U. S. Air Force on the same horizontal impact accelerator. The impact acceleration profiles tested are within the expected range of multi‐purpose crew vehicle (MPCV) landing dynamics. A correlation score was calculated for each THOR to human comparison using CORA (CORrelation and Analysis) software. A two‐parameter beta distribution model fit was obtained for each dependent variable using maximum likelihood estimation. For frontal impacts, the THOR head x‐acceleration peak response correlated with the human response at 8 and 10‐G 100 ms but not 10‐G 70 ms. The phase lagged the human response. Head z‐acceleration was not correlated. Chest x‐acceleration was in phase, had a higher peak response, and was well correlated with lighter subjects (Cora = 0.8 for 46 kg vs. Cora = 0.4 for 126 kg). Head x‐displacement had a leading phase. Several subjects responded with the same peak displacement but the mean of the group was lower. The shoulder x‐displacement was in phase but had higher peaks than the human response. For spinal impacts, the THOR head x‐acceleration was not well correlated. Head and chest z‐acceleration was in phase but had a higher peak response. Chest z‐acceleration was highly correlated with heavier subjects at lower G pulses (Cora = 0.86 for 125 kg at 8 G). The human response was variable in shoulder z‐displacement but the THOR was in phase and was comparable to the mean peak response. Head xand z‐displacement was in phase but had higher peaks. Seat pan forces were well correlated, were in phase, but had a larger peak response than most subjects. The THOR does not respond to frontal and spinal impacts exactly the same way that a human does. Some responses are well matched and others are not. Understanding the strengths and weaknesses of this ATD is an important first step in determining its usefulness in occupant protection at NASA
One of the goals of the NASA Occupant Protection Group is to understand the human tolerance to dynamic loading. This knowledge has to come through indirect approaches such as existing human response databases, anthropometric test devices (ATD), animal testing, post-‐mortem human subjects, and models. This study investigated the biofidelity of the National Highway Traffic Safety Administration's ATD named the THOR (test device for human occupant restraint). If THOR responds comparably to humans, then it could potentially be used as a human surrogate to help validate space vehicle requirements for occupant protection. The THOR responses to frontal and spinal impacts (ranging from 8 to 12 G with rise times of 40, 70, and 100 ms) were measured and compared to human volunteer responses (95 trials in frontal and 58 in spinal) previously collected by the U. S. Air Force on the same horizontal impact accelerator. The impact acceleration profiles tested are within the expected range of multi-‐purpose crew vehicle (MPCV) landing dynamics. A correlation score was calculated for each THOR to human comparison using CORA (CORrelation and Analysis) software. A two-‐parameter beta distribution model fit was obtained for each dependent variable using maximum likelihood estimation. For frontal impacts, the THOR head x-‐acceleration peak response correlated with the human response at 8 and 10-‐G 100 ms but not 10-‐G 70 ms. The phase lagged the human response. Head z-‐acceleration was not correlated. Chest x-‐acceleration was in phase, had a higher peak response, and was well correlated with lighter subjects (Cora = 0.8 for 46 kg vs. Cora = 0.4 for 126 kg). Head x-‐displacement had a leading phase. Several subjects responded with the same peak displacement but the mean of the group was lower. The shoulder x-‐displacement was in phase but had higher peaks than the human response. For spinal impacts, the THOR head x-‐acceleration was not well correlated. Head and chest z-‐acceleration was in phase but had a higher peak response. Chest z-‐acceleration was highly correlated with heavier subjects at lower G pulses (Cora = 0.86 for 125 kg at 8 G). The human response was variable in shoulder z-‐displacement but the THOR was in phase and was comparable to the mean peak response. Head x-‐ and z-‐displacement was in phase but had higher peaks. Seat pan forces were well correlated, were in phase, but had a larger peak response than most subjects. The THOR does not respond to frontal and spinal impacts exactly the same way that a human does. Some responses are well matched and others are not. Understanding the strengths and weaknesses of this ATD is an important first step in determining its usefulness in occupant protection at NASA
Background: The behavior of desmoid tumors is unpredictable and varies from spontaneous remission to symptomatic and radiologic progression. This study aimed to evaluate the radiologic and symptomatic course of the disease in patients initially managed with active surveillance. Methods: Patients with a primary desmoid tumor at any anatomic location diagnosed between 1998 and 2016 were identified in a prospectively maintained database from a single sarcoma reference center in the United Kingdom. Inverse univariate Cox proportional hazard regression analyses were conducted to evaluate the course of the disease and indications for initiating treatment. Results: The study identified 168 patients with a primary desmoid tumor initially managed with active surveillance. The tumors were located in the abdominal wall (n = 61, 36%), an extremity (n = 51, 30%), chest wall (n = 30, 18%), intra-abdominal site (n = 15, 9%), or elsewhere (n = 11, 6%). Of all the patients, 36% experienced radiologic progressive disease, 36% had stable disease, and 27% regressed. The patients younger than 50 years were more likely to progress (p = 0.046), whereas the patients with chest wall or upper-extremity tumors reported significantly more pain (p = 0.01). Eventually, 46% of the patients proceeded to treatment. The median time to start of treatment after initial surveillance was 31 months, whereas the median follow-up time for the patients not receiving any treatment was 40.5 months. The indications for initiation of treatment were pain (32%), progression (31%), or both (13%). Conclusions: Patients with desmoid tumors can be managed with initial active surveillance, although almost half of patients may eventually need treatment. Pain, tumor progression, or both are the most common indications for the initiation of treatment.