Both whole-body rotation and visual flow induce cardiovascular autonomic response in human, but visual response is overridden by vestibular stimulation.

While the influence of the vestibular and extra-vestibular gravity signals on the cardiovascular system has been demonstrated, there is little evidence that visual stimuli can trigger cardiovascular responses. Furthermore, there is no evidence of interaction between visual and vestibular signals in autonomic control, as would be expected since they are highly integrated. The present study explored the cardiovascular responses to vestibular and visual stimuli in normal subjects. We hypothesized that the visual stimuli would modify the cardiovascular response to vestibular stimulation, especially when the latter is ambiguous with respect to gravity. Off-Vertical-Axis-Rotation (OVAR) was used to stimulate vestibular and extra-vestibular receptors of gravity in 36 healthy young adults while virtual reality was used for visual stimulation. Arterial pressure (AP), respiratory rate and ECG were measured. The analysis accounted for the respiratory modulation of AP and heart rate (HR). Vestibular stimulation by OVAR was shown to modulate both mean arterial pressure (MAP) and HR, while the visual stimulation was significantly affecting HR modulation, but not MAP. Moreover, the specific visual effect was present only when the subjects were not in rotation. Therefore, visual stimulation is able to modulate the heart rate, but is overridden by vestibular stimulation due to real movement.

Validation of e-Celsius gastrointestinal telemetry system as measure of core temperature.

The main objective of this study was to validate gastrointestinal measurement with the e-Celsius® system composed of an ingestible electronic capsule and a monitor. Twenty-three healthy volunteers aged 18-59 years stayed at the hospital for 24 h under fasting conditions. They were only allowed for quiet activity and were asked to keep their sleeping habits. Subjects ingested a Jonah capsule and an e-Celsius® capsule, and a rectal probe and an esophageal probe were inserted. Mean temperature measured by the e-Celsius® device was lower than that measured by Vitalsense® (-0.12 ± 0.22°C; p < 0.001) and the rectal probe (-0.11 ± 0.03°C; p = 0.003) and higher than that measured by the esophageal probe (0.17 ± 0.05; p = 0.006). Mean difference (bias) and 95% confidence intervals between temperature of e-Celsius capsule, Vitalsense Jonah capsule, esophageal probe, and rectal probe were computed using Bland and Altman procedure. The magnitude of the measurement bias is significantly greater when comparing the e-Celsius® and the Vitalsense® device pair with any other device pairs containing the esophageal probe. Amplitude of confidence interval between the e-Celsius® system and the Vitalsense® system was 0.67°C. This amplitude was significantly lower than those of the esophageal probe-e-Celsius® pairing (0.83°C; p = 0.027), of the esophageal probe-Vitalsense (0.78°C; p = 0.046) and of the esophageal probe-rectal probe (0.83°C; p = 0.002). The statistical analysis did not reveal any effect of time on the amplitude of bias, whatever the device concerned. When comparing missing data rate of the e-Celsius® system (0.23 ± 0.15%) and the Vitalsense® devices (0.70 ± 0.11%) during the whole experiment, no differences was observed (p = 0.09). The e-Celsius® system could be used when a continuous following of internal temperature is needed.

Vestibulo-sympathetic reflex in patients with bilateral vestibular loss.

This study assessed cardiovascular control during head-down neck flexion (HDNF) in a group of patients suffering from total bilateral idiopathic vestibular loss (BVL) for 7 ± 2 yr. Nine adult patients (age 54 ± 6 yr) with BVL were recruited. Calf blood flow (CBF), mean arterial pressure (MAP), and heart rate (HR) were measured with subjects' eyes closed in two lying body positions: ventral prone (VP) and lateral (LP) on the left side. Vascular resistance (CVR) was calculated as MAP/CBF. The HDNF protocol consisted in passively changing the head position: head up (HU)-head down (HD)-HU. Measurements were taken twice at each head position. In VP CBF significantly decreased in HD (3.65 ± 0.65 mL·min-1·100 mL-1) vs. HU (4.64 ± 0.71 mL·min-1·100 mL-1) (P < 0.002), whereas CVR in VP significantly rose in HD (31.87 ± 6.93 arbitrary units) vs. HU (25.61 ± 6.36 arbitrary units) (P < 0.01). In LP no change in CBF or CVR was found between the two head positions. MAP and HR presented no difference between HU and HD in both body positions. Age of patients did not significantly affect the results. The decrease in CBF of the BVL patients was similar to the decrease observed with the same HDNF protocol in normal subjects. This suggests a sensory compensation for the lost vestibular inputs that could originate from the integration of inputs from trunk graviceptors and proprioceptive and cutaneous receptors. Another possibility is that the HDNF vascular effect is evoked mostly by nonlabyrinthine sensors.NEW & NOTEWORTHY The so-called vestibulo-sympathetic reflex, as demonstrated by the head-down neck flexion (HDNF) protocol, is present in patients with total bilateral vestibular idiopathic loss, equally in young and old subjects. The origin of the sympathetic effect of HDNF is questioned. Moreover, the physiological significance of the vestibulo-sympathetic reflex remains obscure, because it acts in opposition to the orthostatic baroreflex. It may serve to inhibit the excessively powerful baroreflex.

Influence of graviceptor stimulation initiated by off-vertical axis rotation on ventilation.

NEW FINDINGS: What is the central question of this study? It is known that respiration is affected by graviceptors, but it remains unclear to what extent labyrinthine and non-labyrinthine graviceptors are involved in this process. What is the main finding and its importance? Our results suggest that the modulation of respiration is not a result of a simple reflex arc, but that it involves a higher integration of different types of receptors with variable contributions of either type of graviceptor among subjects. ABSTRACT: It has been suggested that the otolith system is involved in the physiological response to changes in body orientation with respect to gravity. In studies on animals, an otolith-respiratory reflex has been observed, but data on humans are scarce and inconclusive, mainly because pure otolithic stimulation is difficult to produce in humans. To assess the otolithic-respiratory reflex in humans, we used an off-vertical axis rotation (OVAR) that produces periodic and pure stimulation of graviceptors. The inspiratory flow was measured during earth vertical axis rotation (EVAR, control conditions) and OVAR in 21 subjects. To distinguish the effects of the labyrinthine and non-labyrinthine graviceptors on ventilation, these measurements were repeated with two different static head positions: head turned leftward and rightward in yaw. The velocity of rotation was individually selected to match spontaneous breathing rate (mean 11.4 cycles min-1 , 0.19 Hz). Average ventilatory flow was higher in OVAR than in EVAR, as was tidal volume. In OVAR, the transition between inspiration and expiration occurred mainly in the forward pitch position. The phase of this transition in most subjects was driven mostly by the body position rather than by the head position, suggesting that respiratory modifications during OVAR mainly involved non-labyrinthine receptors. However, the study demonstrated a high intersubject variability both in the ability of OVAR to synchronize breathing and in the influence of labyrinthine stimulation. We conclude that the respiratory response to changes in orientation of the body with respect to the vertical involves labyrinthine and non-labyrinthine stimulation, with the gain of each signal varying individually.

Non-invasive positive-pressure ventilation with positive end-expiratory pressure counteracts inward air leaks during preoxygenation: a randomised crossover controlled study in healthy volunteers.

BACKGROUND: During preoxygenation, the lack of tight fit between the mask and the patient's face results in inward air leak preventing effective preoxygenation. We hypothesized that non-invasive positive-pressure ventilation and positive end-expiratory pressure (PEEP) could counteract inward air leak. METHODS: Healthy volunteers were randomly assigned to preoxygenated through spontaneous breathing without leak (SB), spontaneous breathing with a calibrated air leak (T-shaped piece between the mouth and the breathing system; SB-leak), or non-invasive positive inspiratory pressure ventilation (inspiratory support +6 cm H2O; PEEP +5 cm H2O) with calibrated leak (PPV-leak). The volunteers breathed through a mouthpiece connected to an anaesthesia ventilator. The expired oxygen fraction (FeO2) and air-leak flow (ml s-1) were measured. The primary end point was the proportion of volunteers with FeO2 >90% at 3 min. The secondary end points were FeO2 at 3 min, time to reach FeO2 of 90%, and the inspiratory air-leak flow. RESULTS: Twenty healthy volunteers were included. The proportion of volunteers with FeO2 >90% at 3 min was 0% in the SB-leak group, 95% in the SB group, and 100% in the PPV-leak group (P<0.001). At 3 min, the mean [standard deviation (sd)] FeO2 was 89 (1)%, 76 (1)%, and 90 (0)% in the SB, SB-leak, and PPV-leak groups, respectively (P<0.001). The mean (sd) inward air leak was 59 (12) ml s-1 in the SB-leak group, but 0 (0) ml s-1 in the PPV-leak group (P<0.001). CONCLUSIONS: Preoxygenation through non-invasive positive-pressure ventilation and PEEP provided effective preoxygenation despite an inward air leak. CLINICAL TRIAL REGISTRATION: NCT03087825.

From commensal to pathogen: translocation of Enterococcus faecalis from the midgut to the hemocoel of Manduca sexta.

UNLABELLED: A dynamic homeostasis is maintained between the host and native bacteria of the gastrointestinal tract in animals, but migration of bacteria from the gut to other organs can lead to disease or death. Enterococcus faecalis is a commensal of the gastrointestinal tract; however, Enterococcus spp. are increasingly frequent causes of nosocomial infections with a high mortality rate. We investigated the commensal-to-pathogen switch undergone by E. faecalis OG1RF in the lepidopteran model host Manduca sexta associated with its location in the host. E. faecalis persists in the harsh midgut environment of M. sexta larvae without causing apparent illness, but injection of E. faecalis directly into the larval hemocoel is followed by rapid death. Additionally, oral ingestion of E. faecalis in the presence of Bacillus thuringiensis insecticidal toxin, a pore-forming toxin that targets the midgut epithelium, induces an elevated mortality rate. We show that the loss of gut integrity due to B. thuringiensis toxin correlates with the translocation of E. faecalis from the gastrointestinal tract into the hemolymph. Upon gaining access to the hemolymph, E. faecalis induces an innate immune response, illustrated by hemocyte aggregation, in larvae prior to death. The degree of hemocyte aggregation is dependent upon the route of E. faecalis entry. Our data demonstrate the efficacy of the M. sexta larval model system in investigating E. faecalis-induced sepsis and clarifies controversies in the field regarding the events leading to larval death following B. thuringiensis toxin exposure. IMPORTANCE: This study advances our knowledge of Enterococcus faecalis-induced sepsis following translocation from the gut and provides a model for mammalian diseases in which the spatial distribution of bacteria determines disease outcomes. We demonstrate that E. faecalis is a commensal in the gut of Manduca sexta and a pathogen in the hemocoel, resulting in a robust immune response and rapid death, a process we refer to as the "commensal-to-pathogen" switch. While controversy remains regarding Bacillus thuringiensis toxin-induced killing, our laboratory previously found that under some conditions, the midgut microbiota is essential for B. thuringiensis toxin killing of Lymantria dispar (N. A. Broderick, K. F. Raffa, and J. Handelsman, Proc. Natl. Acad. Sci. U. S. A. 103:15196-15199, 2006; B. Raymond, et al., Environ. Microbiol. 11:2556-2563, 2009; P. R. Johnston, and N. Crickmore, Appl. Environ. Microbiol. 75:5094-5099, 2009). We and others have demonstrated that the role of the midgut microbiota in B. thuringiensis toxin killing is dependent upon the lepidopteran species and formulation of B. thuringiensis toxin (N. A. Broderick, K. F. Raffa, and J. Handelsman, Proc. Natl. Acad. Sci. U. S. A. 103:15196-15199, 2006; N. A. Broderick, et al., BMC Biol. 7:11, 2009). This work reconciles much of the apparently contradictory previous data and reveals that the M. sexta-E. faecalis system provides a model for mammalian sepsis.

Effect of temporal relationship between respiration and body motion on motion sickness.

BACKGROUND: This study investigated the effect controlling the phase of respiration on the development of nausea provoked by periodic motion at 0.2 Hz which is maximal for provocation of motion sickness. METHODS: Subjects were exposed to 60 degrees peak-peak, pitch backwards from upright motion while viewing a video of the environment with 180 degrees phase delay. Motion duration was a maximum of 30 min and frequency was set to match individuals' spontaneous respiration. Conditions were: A, spontaneous breathing; B, inspiration cued to begin when head-down; C, inspiration cued to begin when upright; D, inspiration cued with a +/-18 degrees desynchronizing phase drift with respect to the tilt cycle. Nausea was rated and ventilation was recorded. RESULTS: Magnitudes of nausea ratings were ordered D

Clinical evaluation of a screen pneumotachograph as an in-line filter.

The American Thoracic Society/European Respiratory Society Task Force underlined that the use of in-line filters during respiratory function tests "is an area of controversy". The aim of the present study was to measure the contamination occurring during forced expiration downstream from a screen pneumotachograph (SP) with and without an in-line filter (Pall PF30S). A total of 40 healthy subjects performed eight consecutive maximal expiratory manoeuvres into four sterile apparatuses (A1: no filter, no SP; A2: filter-only; A3: SP-only; A4: filter and SP) in random order. A blood agar plate was fixed downstream from the apparatus. Colony-forming units (CFUs) were counted after 24 h incubation at 37 degrees C. Of the 40 plates obtained with each apparatus, 13 were sterile with A1 (range 0-679 CFUs), 25 with A2 (0-49 CFUs), 30 with A3 (0-35 CFUs) and 39 with A4 (one CFU in the only positive plate). A1 versus A2 and also A3 versus A4 gave different values for the CFU number, but A2 and A3 showed similar contamination levels. The authors conclude that: 1) the in-line filter does not perform better than a screen pneumotachograph; 2) it does not eliminate the need to decontaminate the pneumotachograph; and 3) equipment placed downstream from an in-line filter and a screen pneumotachograph is almost protected from contamination.

Single-breath transfer factor in young healthy adults: 21% or 17.5% inspired oxygen?

For the measurement of the single-breath transfer factor of the lung for carbon monoxide (TL,CO,sb), the American Thoracic Society (ATS) recommends using a test gas with a 21% inspired fraction of oxygen (FI,O2) whereas the European Respiratory Society (ERS) expressly recommends 17-18% FI,O2. The ERS committee argues that with a higher concentration (e.g. 21%) the alveolar fraction of oxygen (and accordingly TL,CO,sb) "varies with the volume of the test gas which is inspired", that is, presumably, in proportion to the volume of the test gas that is diluted in the alveolar volume. The current study measured TL,CO,sb and the transfer coefficient (KCO,sb) in duplicate in 67 healthy adults (age 17-23 yrs) using, in random order, an inspired gas containing either 17.5% or 21% oxygen. A correction was applied for carboxyhaemoglobin, in line with ATS recommendations. As expected, TL,CO,sb was higher with 17.5% FI,O2 test gas compared with 21% FI,O2 test gas (11.98 +/- 2.68 versus 11.38 +/- 2.56 mmol x min(-1) x kPa(-1), respectively) as well as KCO,sb (1.98 +/- 0.24 versus 1.90 +/- 0.23 mmol x min(-1) x kPa(-1), respectively). The ratio of TL,CO,sb measurements was strictly independent of the residual volume/total lung capacity ratio measured with plethysmography. Hence, the rationale used by the European Respiratory Society, which utilises a 17-18% inspired fraction of oxygen test gas for single-breath transfer of the lung for carbon monoxide measurements, would appear to be unwarranted in young healthy adults.

Effect of human head flexion on the control of peripheral blood flow in microgravity and in 1 g.

This study evaluated, in six healthy subjects, whether head flexion, which stimulates the vestibular system and the tonic neck receptors, interferes with cardiovascular regulation. Arterial parameters were measured continuously using a pulsed Doppler ultrasound probe during parabolic flights with subjects either in the supine craned-head position (control) or in the supine anterior neck flexion bent-neck position. Exposure to 0 g induced a fluid shift towards the head (stroke volume +8%, P<0.05). Compared to the control situation the mean (SD) blood flow in the femoral artery decreased [ -10 (9)% vs +1 (10)%; P<0.05], and the ratio cerebral artery:femoral artery blood flow ( : ) increased [+8 (14)% vs -4 (7)%; P<0.05], in the bent-neck position. Thus, neck flexion without otolith loading (subject in 0 g) favoured cerebral perfusion during the exposure to 0 g. The return to 1 g, even in the supine position, induced a fluid shift towards the lower limbs. From 0 to 1 g, reduced less [ +6 (8)% vs -1 (8)%; P<0.05], and the : decreased more [-11 (9)% vs 0 (10)%; P<0.05], in the bent-neck position than in the control position. Thus the redistribution of peripheral blood flow in response to the fluid shift towards the legs was less efficient in the bent-neck position. In 0 g environment the passive flexion of the neck (neck receptor stimulation only) increased resistance in the femoral artery [ R(fa) +20 (21)%; P<0.05] and reduced the [-15(10)%; P<0.07] which increased the redistribution of flow towards the brain [; +12 (7)%; P<0.07]. This response was of lower amplitude when both otoliths and neck muscle were stimulated (neck flexion in 1 g) [ R(fa)+9 (7)%, P<0.05; -9 (12), NS; : 0 (12), NS]. We suggest that otolith and neck muscle stimulation (by neck flexion) trigger opposite vascular effects in response to a fluid shift towards the legs.

Influence of otoliths and neck muscle receptors on peripheral hemodynamic regulation.

To evaluate the cardiovascular changes induced by otoliths and neck mechanoreceptors stimulation during head movements, nine subjects in supine prone position performed passive head-down neck flexion (P.Ext) and head up P.Extension (P.Flex) As the lower limbs vasoconstricted from P.Ext to P.Flex, it is suggested that the otoliths stimulation towards the base of the head (like in standing position) contribute to reduce the vasoconstriction whereas when stimulated towards the top of the head (head flexion) they increase it.

Calcyclin gene expression is increased by mechanical strain in fibroblasts and lung.

Mechanical tension extending throughout the structural elements of the lung is a potential stimulus for cell proliferation and gene expression. Pulmonary fibroblasts located in the interstitial space of the capillary wall throughout the lung parenchyma and within the large vessels and airways are uniquely situated to sense changes in mechanical force. Therefore, we used the polymerase chain reaction-based method of differential display analysis to screen for altered gene expression in fetal human lung fibroblasts exposed to increased cyclic stretch. IMR-90 cells were seeded at 3 x 10(4) cells/cm(2) on laminin-coated plates. Cells were subsequently exposed to mechanical strain on a Flexercell apparatus, resulting in a maximal elongation of 20% at a rate of 60 cycles/min over a period of 48 h. A complementary DNA corresponding to the cell cycle-regulated gene calcyclin was identified in mechanically strained fibroblasts. Increased calcyclin messenger RNA levels were confirmed by Northern blot analysis. Further, calcyclin gene expression was upregulated in isolated-perfused rat lungs exposed to increased mechanical strain by ventilation at high states of lung inflation for 4 h. These data suggest that calcyclin gene expression plays a role in the response of pulmonary fibroblasts to increased mechanical tension and may alter the regulation of the fibroblast cell cycle.

Low intensity galvanic vestibulo-ocular reflex in normal subjects.

An electrical stimulation in man applied between the two mastoids could facilitate the distinction between labyrinthine and retrolabyrinthine lesions by stimulating directly the primary vestibular afferences. However, for this test to be really effective in current medical practice, the results obtained in normal subjects must be symmetrical and reproducible one day to another. The ocular responses induced by a constant electrical stimulation of 2.5 mA, applied between the two mastoids for 30 s (electrically evoked vestibulo-ocular reflex [EVOR]), in one direction and the other, were quantified in ten healthy subjects. Each subject was studied in two different sessions separated by 1 week. Horizontal eye movements were recorded in darkness by an infrared light reflection eye-tracking system. Slow-phase velocity and nystagmus frequency were about 20% higher when the cathode was on the right mastoid than when it was on the left mastoid. This directional preponderance (DP) displayed large individual differences between the two sessions. The reproducibility of the reflectivity (mean of right and left EVOR) was high (r about 0.8). The weak reproducibility of the DP makes the EVOR at weak intensity inadequate to evaluate unilateral vestibular hypofunction. On the other hand, because of the high reproducibility of reflectivity, the EVOR should be effective in detecting bilateral vestibular hypofunction. Moreover, because of the weak intensity of stimulation, no local anaesthesia is needed so the manoeuvre is easy to repeat in case of chronic diseases.

Otolithic and tonic neck receptors control of limb blood flow in humans.

The aim of this study was to evaluate the role of otolithic receptors and neck mechanoreceptors on the control of the cardiovascular system. We measured calf (CBF) and forearm blood flow (FBF) by strain-gauge plethysmography, mean arterial pressure (MAP), and heart rate (HR) in 12 healthy subjects in two body positions (lying prone and on the left side) and three head positions (reference, flexion, and extension). When the subjects were lying prone, CBF and FBF were lower in head flexion (5.2 +/- 0.6 and 3.2 +/- 0.4 ml.min-1.100 ml-1, respectively) than in reference position (5.8 +/- 0.4 and 3.8 +/- 0.3 ml.min-1.100 ml-1; P < 0.05), with no significant difference in MAP and HR. When the subjects were lying on the side, changing the head position from reference to flexion significantly increased FBF (from 3.7 +/- 0.2 to 4.2 +/- 0.4 ml.min-1. 100 ml-1), MAP (from 97.2 +/- 3.3 to 102.4 +/- 5.8 mmHg), and HR (from 63.7 +/- 1.4 to 65.9 +/- 2.5 beats/min; P < 0.05). Because otolithic receptors and neck mechanoreceptors are involved when the subjects are lying prone, and otolithic receptors are not involved when the subjects are lying on the side, the results suggest that otolithic and neck mechanoreceptors exert significant influences over the cardiovascular system.

Fiber capillarization in flight muscle of pigeons native and flying at altitude.

We examined structural characteristics for fiber O2 supply in the highly aerobic flight muscle of 5 pigeons (Columbia livia; body mass 223--317 g) native and actively flying at altitude (La Paz, Bolivia; 3750 m). Whereas deep sites were significantly more aerobic and highly vascularized than superficial in altitude (A) but not sea-level (SL) group, both sites showed a number of similarities between the two groups. The cross-sectional area of aerobic fibers (> or = 90% of fiber number) linearly increased with body mass (r 0.84; P < 0.0005) but was not smaller in A for their body mass, and there was no reduction in the size of glycolytic fibers compared to SL. The relationships between fiber capillarization and the sectional area of aerobic fibers in transverse sections or mitochondrial volume density were not altered in A compared to SL. The results indicate that the factors which determine the relationships between fiber capillarization and ultrastructure in the muscles were not altered by the adaptation to altitude. Differences between samples were related to the relative sectional area of aerobic fibers and mitochondrial volume density, not the chronic exposure to altitude.

Sleep apneas in high altitude residents (3,800 m).

The question is: to what extent periodic breathing usually observed in translocated subjects at high altitude affects normal and polycythemic residents of high altitude? Standard sleep parameters, chest wall movements, temperature of ventilated gas and arterial O2 saturation (SaO2) were continuously recorded in 7 normal highlanders (mean hematocrit: 51%) and 14 polycythemic highlanders (mean hematocrit: 68%) during one night in La Paz, 3,850 m, Bolivia. The patterns of breathing instability were analysed by two ways: measuring duration of apneas and counting all the oscillations of SaO2 greater than 1%. Normal and polycythemic highlanders displayed a wide intersubject variability with regard to breathing instability, hence no significant difference in the total number of apneas and oscillations of SaO2 could be evidenced between the 2 groups. However, the longest apneas and the highest number of oscillations of SaO2 were found in the polycythemic highlanders.

Distribution of common carotid blood flow, measured by Doppler, in man at high altitude.

The aim of the work was to estimate the possible changes induced by high altitude in the distribution of the common carotid arterial blood flow towards the internal and external carotid arteries. Common carotid blood flow and internal and external blood velocities were measured in 20 lowlanders at sea level, in 5 of them over a 3-week period at 3800 m and in 20 permanent residents of this high altitude. Internal and external blood velocities were recorded with a continuous Doppler and blood flow was recorded by range-gated Doppler velocimeter. Common carotid blood flow was 15% higher in all subjects exposed to high altitude due to a lowering in downstream vascular resistance since systemic blood pressure did not change at high altitude. The increase of blood flow in the common carotid was the result of a rise mainly in the external carotid blood flow.

[Changes in the blood flow of the primary carotid and its branches during modifications of the O2 and CO2 composition of alveolar gas]. / Variations du débit de la carotide primitive et de ses branches lors de modifications de la composition en O2 et en CO2 du gaz alvéolaire.

We measured common carotid blood flow using a range gated Doppler velocimeter, and internal and external blood velocities using a continuous Doppler in 20 lowlanders at sea level, under normal barometric pressure, in 10 subjects in an altitude chamber under a barometric pressure of 462 Torr (61.6 KPa) and then in 5 of them over a 3-weeks period at 3850 m of elevation (475 Torr = 63.3 KPa). The same measurements were also performed in 20 permanent residents at 3850 m. Common carotid blood flow was 15% higher in all subjects exposed to high altitude, due to a lowering in downstream resistances since systemic blood pressure did not change at high altitude. The increase in common carotid blood flow was the result of an immediate increase in internal carotid blood velocities observed in the altitude chamber as well as after the arrival at high altitude, but a few days later those velocities in the internal carotid artery declined to values similar to those observed at sea level. In the same time velocities in external carotid artery rose at high altitude, remained steadily elevated and the result is a permanent increase in common carotid blood flow at altitude. In all subjects we performed the same measurements, during an acute inhalation of gas mixtures to try to quantify the mechanisms controlling the changes in common carotid blood flow while changing gas inhalation. In the limits of the variations in PO2 (60 to 400 Torr) and in PCO2 (30 to 50 Torr) the stimulation by CO2 is twice more efficient than the O2 stimulation on vasomotion.

Periodic breathing and O2 saturation in relation to sleep stages at high altitude.

This study was designed to compare sleep organization at high altitude (HA) and sea level (SL) and to estimate the extent periodic breathing (PB) negatively influences arterial O2 saturation (SaO2). Six lowlanders were studied at SL and after 3 weeks spent at 3,800 m (La Paz, Bolivia). Three EEG leads, EOG, submental EMG, chest and abdominal motion, temperature of ventilated gas, and SaO2 were polygraphically recorded. Comparison of HA and SL data disclosed that: 1) Sleep organization was identical, with the same percentage of REM and stage 4. 2) PB (cycle length: 20 s; central apnea: 9 s) occurred in three subjects during all stages of sleep except REM (43-60% of total sleep). A periodic lowering in heart rate occurred during ventilatory oscillation. 3) During PB, SaO2 oscillated very regularly from 78-90%, which resulted in a mean SaO2 value calculated during oscillations similar to that of the non-periodic breathers. We conclude that lung O2 uptake during PB is preserved.