Determinants of endurance exercise capacity in the heat in prepubertal boys.

The goal of this study was to identify factors which limit exercise endurance in hot ambient conditions in prepubertal boys. Eight healthy non-acclimatized, highly physically active prepubertal boys performed steady load cycling at approximately 65 % peak VO (2) to exhaustion in both cool (19.6 +/- 0.6 degrees C, 66.4 +/- 11.0 % relative humidity) and hot (31.0 +/- 0.3 degrees C, 56.9 +/- 2.0 % relative humidity) environmental conditions. Cardiac output, oxygen uptake, rectal temperature (T (re)), rating of perceived exertion (RPE), blood pressure, and calculated arterial venous oxygen difference were obtained serially in each testing session, and percent dehydration was calculated from body weight loss. Endurance time was significantly shorter in the hot condition (29.30 +/- 6.19 minutes versus 41.38 +/- 6.30 minutes in the cool room). No significant differences in circulatory markers or hydration status were observed either during testing or between cycling thermal conditions. Rate of rise of T (re) was greater during exercise in the heat, but no significant difference in T (re) between conditions was observed at exhaustion. Mean values of RPE were consistently greater during exercise in the heat, but these differences did not reach statistical significance. These findings support the concept that rises in core temperature and/or brain perception (RPE) rather than circulatory insufficiency may be the critical factors defining limits to exercise in the heat.

MRI measures of perfusion-related changes in human skeletal muscle during progressive contractions.

Although skeletal muscle perfusion is fundamental to proper muscle function, in vivo measurements are typically limited to those of limb or arterial blood flow, rather than flow within the muscle bed itself. We present a noninvasive functional MRI (fMRI) technique for measuring perfusion-related signal intensity (SI) changes in human skeletal muscle during and after contractions and demonstrate its application to the question of occlusion during a range of contraction intensities. Eight healthy men (aged 20-31 yr) performed a series of isometric ankle dorsiflexor contractions from 10 to 100% maximal voluntary contraction. Axial gradient-echo echo-planar images (repetition time = 500 ms, echo time = 18.6 ms) were acquired continuously before, during, and following each 10-s contraction, with 4.5-min rest between contractions. Average SI in the dorsiflexor muscles was calculated for all 240 images in each contraction series. Postcontraction hyperemia for each force level was determined as peak change in SI after contraction, which was then scaled to that obtained following a 5-min cuff occlusion of the thigh (i.e., maximal hyperemia). A subset of subjects (n = 4) performed parallel studies using venous occlusion plethysmography to measure limb blood flow. Hyperemia measured by fMRI and plethysmography demonstrated good agreement. Postcontraction hyperemia measured by fMRI scaled with contraction intensity up to approximately 60% maximal voluntary contraction. fMRI provides a noninvasive means of quantifying perfusion-related changes during and following skeletal muscle contractions in humans. Temporal changes in perfusion can be observed, as can the heterogeneity of perfusion across the muscle bed.

The future of space medicine.

In November 2000, the National Aeronautics and Space Administration (NASA) and its partners in the International Space Station (ISS) ushered in a new era of space flight: permanent human presence in low-Earth orbit. As the culmination of the last four decades of human space flight activities. the ISS focuses our attention on what we have learned to date. and what still must be learned before we can embark on future exploration endeavors. Space medicine has been a primary part of our past success in human space flight, and will continue to play a critical role in future ventures. To prepare for the day when crews may leave low-Earth orbit for long-duration exploratory missions, space medicine practitioners must develop a thorough understanding of the effects of microgravity on the human body, as well as ways to limit or prevent them. In order to gain a complete understanding and create the tools and technologies needed to enable successful exploration. space medicine will become even more of a highly collaborative discipline. Future missions will require the partnership of physicians, biomedical scientists, engineers, and mission planners. This paper will examine the future of space medicine as it relates to human space exploration: what is necessary to keep a crew alive in space, how we do it today, how we will accomplish this in the future, and how the National Aeronautics and Space Administration (NASA) plans to achieve future goals.

Evolution of telemedicine in the space program and earth applications.

Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth.