title: Cerebral blood flow velocity by transcranial Doppler during a vertical-rotating table simulation of the push-pull effect.
abstract: BACKGROUND
  The push-pull effect (PPE) has been suspected of causing many aircraft accidents. The perfusion and then withdrawal of cerebral blood during the PPE may change the state of the cerebral blood vessel.
  
  
  OBJECTIVE
  During head-down tilt (HDT) cerebral vasoconstriction occurs in response to the elevated perfusion pressure to maintain cerebral blood flow, and during subsequent head-up tilt (HUT) the increased resistance of the cerebral blood vessel recovers slowly.
  
  
  METHODS
  Ten healthy male non-pilots were exposed to the following protocol using a rotating-table to simulate the push-pull maneuver: HUT (+1 Gz) for 1 min followed by transition to HDT (-1 Gz) 10 s followed by transition to HUT (+1 Gz) 1 min. Cerebral blood flow velocity and pulsatility indices in the left middle cerebral artery were continually measured with a transcranial Doppler (TCD) instrument.
  
  
  RESULTS
  Mean blood flow velocity (Vm) increased significantly by 10%, during the first 5 s of HDT, recovered to baseline during HDT 5 10 s, and remained unchanged during subsequent HUT. Systolic blood flow velocity (Vs) increased by 9% during HDT 5-10 s and 11% during HUT 0-5 s. Diastolic blood flow velocity (Vd) decreased by -9% during HDT 5-10 s, and -22% during HUT 0-5 s. Vs-Vd increased by 26% during HDT 5 10 s, and 41%, during HUT 0-5 s. Pulsatile indices (PI) and resistance index (RI) increased by 26%) and 15% during HDT 5-10 s, and by 40% and 27% during HUT 0-5 s, respectively. Vs, Vs-Vd, PI, and RI remained at the higher level, and Vd remained at the lower level to HDT 15-20 s.
  
  
  CONCLUSIONS
  The results indicate that cerebral vasoconstriction occurred to prevent brain over-perfusion during HDT. During HUT, the elevated resistance of the cerebral vessel remained at the higher level for about 20 s, and may have worsened the cerebral perfusion from exposure to +Gz. This may be one of the mechanisms of PPE.
authors.affiliation: 5th Department, Institute of Aviation Medicine, Air Force, PLA, Beijing, China. zhangwuxing@263.net
authors.forename: W X
authors.initials: WX
authors.lastname: Zhang
authors.forename: C L
authors.initials: CL
authors.lastname: Zhan
authors.forename: X C
authors.initials: XC
authors.lastname: Geng
authors.forename: X
authors.initials: X
authors.lastname: Lu
authors.forename: G D
authors.initials: GD
authors.lastname: Yan
authors.forename: X
authors.initials: X
authors.lastname: Chu
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D000337:Aerospace Medicine; D000401:Aircraft; D001783:Blood Flow Velocity; D002540:Cerebral Cortex / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D006801:Humans; D018471:Hypergravity; D008297:Male; D018667:Tilt-Table Test; D017585:Ultrasonography, Doppler, Transcranial; D016474:Weight-Bearing