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Biomedical subjects

M Heer

Publications and source records attributed to M Heer.

At least 37 records · Page 2Linked to original sources
PubMed2001

Revised hypothesis and future perspectives.

Results from space have been unexpected and not predictable from the results of ground-based simulations. Therefore, the concept of how weightlessness and gravity modulates the regulation of body fluids must be revised and a new simulation model developed. The main questions to ask in the future are the following: Does weightlessness induce a diuresis and natriuresis during the initial hours of space flight leading to an extracellular and intravascular fluid volume deficit? Can sodium in excess be stored in a hitherto unknown way, particularly during space flight? Why are fluid and sodium retaining systems activated by spaceflight? Why are the renal responses to saline and water stimuli in space attenuated compared with those of ground simulations? How can the effects of weightlessness on fluid and electrolyte regulation be correctly simulated on the ground? The information obtained from space may be of relevance to fluid and electrolyte balance in edematous patients.

Blood Volume↗
PubMed2001

Energy and fluid metabolism in microgravity.

Astronauts lose body mass when exploring space. The mechanism was considered to be an upward fluid shift inducing diuresis and natriuresis (the Henry-Gauer mechanism) during the first few days in microgravity. However, recent space missions have shown that neither diuresis nor natriuresis occurs in space missions. In contrast, a sodium-retaining status was shown, which led to positive metabolic sodium balances without fluid retention. Energy intake was consistently reduced whereas energy needs were unchanged, resulting in a negative energy balance of 20%. The reasons for this are many, although proper studies on appetite regulation have not been carried out. Despite numerous countermeasures, bone mass is lost in microgravity situations. These are body composition changes that need to be challenged before humans can be sent to space for extra-long missions.

Body Fluids↗
PubMed2001

Nitrogen metabolism and bone metabolism markers in healthy adults during 16 weeks of bed rest.

BACKGROUND: The associations between nitrogen metabolism and bone turnover during bed rest are still not completely understood. METHODS: We measured nitrogen balance (nitrogen intake minus urinary nitrogen excretion) and biochemical metabolic markers of calcium and bone turnover in six males before head-down tilt bed rest (baseline), during 2, 10, and 14 weeks of immobilization, and after reambulation. RESULTS: The changes in nitrogen balance were highest between baseline and week 2 (net change, -5.05 +/- 1.30 g/day; 3.6 +/- 0.6 g/day at baseline vs -1.45 +/- 1.3 g/day at week 2; P<0.05). In parallel, serum intact osteocalcin (a marker of bone formation) was already reduced and renal calcium and phosphorus excretions were increased at week 2 (P <0.05). Fasting serum calcium and phosphorus values and renal excretion of N-telopeptide (a bone resorption marker) were enhanced at weeks 10 and 14 (P <0.05-0.001), whereas serum concentrations of parathyroid hormone, calcitriol, and type I collagen propeptide (a marker of bone collagen formation) were decreased at week 14 (P <0.05-0.01). Significant associations were present between changes of serum intact osteocalcin and 24-h calcium excretion (P <0.001), nitrogen balance and 24-h phosphorus excretion (P <0.001), nitrogen balance and renal N-telopeptide excretion (P <0.05), and between serum osteocalcin and nitrogen balance (P <0.025). CONCLUSIONS: Bone formation decreases rapidly during immobilization in parallel with a higher renal excretion of intestinally absorbed calcium. These changes appear in association with the onset of a negative nitrogen balance, but decreased bone collagen synthesis and enhanced collagen breakdown occur after a time lag of several weeks.

Adult↗
PubMed2000

Unexpected renal responses in space.

Urine output in astronauts following ingestion of an oral water load was low in space on the Russian space station Mir and less than during simulation by 6 degrees head-down bed rest. This surprising observation shows that the effects of gravity and weightlessness on fluid volume regulation are not well understood and that the head-down bed-rest model does not simulate the effects of weightlessness on renal water handling.

Adult↗
PubMed2000

Nutrient supply during recent European missions.

An inadequate nutrient intake during space flight may compromise the crewmembers' health status. In fact, during recent European missions (D-2, EuroMIR 94 and EuroMIR 95), monitoring of the astronauts' food intake revealed that they had a deficient energy, fluid, and calcium intake and an excessive sodium consumption compared to the dietary reference intakes for earthbound conditions. Inappropriate amounts of these nutrients have a considerable impact on body fluid regulation, the cardiovascular system and on calcium and bone metabolism, especially bone mineral density, which are all stressed by the microgravity environment. Provision of adequate nutrition especially when facing long-term space flights is therefore one of the foremost challenges. Therefore, for the German MIR 97 mission, we considered the data obtained from previous European missions to devise a constant and controlled nutrient intake that matched the earthbound dietary reference intake values in our experiments. Specific markers indicated that bone formation continually declined and bone resorption increased in the MIR 97 astronaut. This suggests that the nutritional criteria chosen for the subjects remaining on Earth may be inadequate for extended space missions. Therefore, more emphasis has to be placed on investigating the effects of a deficient nutrient intake on astronauts during exposure to microgravity, to manage their nutritional care appropriately during long-term missions.

Adult↗
PubMed2000

Body fluid regulation in micro-gravity differs from that on Earth: an overview.

Similar to the response to central hypervolemic conditions on Earth, the shift of blood volume from the legs to the upper part of the body in astronauts entering micro-gravity should, in accordance with the Henry-Gauer mechanism, mediate diuresis and natriuresis. However, fluid balance and kidney function experiments during various space missions resulted in the surprising observation that the responses qualitatively differ from those observed during simulations of hypervolemia on Earth. There is some evidence that the attenuated responses of the kidney while entering weightlessness, and also later during space flight, may be caused by augmented fluid distribution to extravascular compartments compared to conditions on Earth. A functional decoupling of the kidney may also contribute to the observation that renal responses during exposure to micro-gravity are consistently weaker than those during simulation experiments before space flight. Deficits in body mass after landing have always been interpreted as an indication of absolute fluid loss early during space missions. However, recent data suggest that body mass changes during space flight are rather the consequences of hypocaloric nutrition and can be overcome by improved nutrition schemes. Finally, sodium-retaining humoral systems are activated during space flight and may contribute to a new steady-state of metabolic balances with a pronounced increase in body sodium compared to respective conditions on Earth. A revision of the classical "micro-gravity fluid shift" scheme is required.

Body Fluids↗
PubMed2000

Microgravity inhibits intestinal calcium absorption as shown by a stable strontium test.

BACKGROUND: Little is known about the onset and degree of biochemical and functional alterations in calcium metabolism during microgravity. OBJECTIVE: To evaluate the effect of microgravity on intestinal calcium absorption and calcium-regulating hormones under metabolic ward conditions. MATERIALS AND METHODS: Fractional calcium absorption (Fc240 in percentage of dose administered) was determined pre-flight, in-flight and post-flight, by use of a stable strontium test in one cosmonaut who spent 20 days in space. Moreover, a sequence of blood samples was collected for the determination of serum parathyroid hormone (PTH), 25-hydroxyvitamin D, calcitriol and serum C-telopeptide (CTx, biomarker of bone resorption) levels. During all periods of data collection, calcium intake was held constant at a minimum level of 1.000 mg day(-1) and a daily supplement of 16.6 microg vitamin D2 was given. Personal ultraviolet (UV) light exposure was measured during the whole mission using a biologically weighting UV dosimeter. RESULTS: Fc240 was markedly reduced on flight day 19 (4.4%) as compared to pre-flight and post-flight data (13.4% and 17.2%, respectively). Serum calcitriol levels fell from 40.6 pg mL(-1) (mean pre-flight level) to 1.3 pg mL(-1) on flight day 18 and returned into the normal range after recovery. Serum CTx increased during the flight, while serum PTH and 25-hydroxyvitamin D levels did not change significantly. CONCLUSIONS: Intestinal calcium absorption can be diminished after only three weeks of microgravity. Changes are associated with a severe suppression of circulating calcitriol levels, but are independent of exogenous vitamin D supply and serum PTH levels.

Adult↗
PubMed2000

Water and sodium balances and their relation to body mass changes in microgravity.

BACKGROUND: Since the very beginning of space physiology research, the deficit in body mass that is often observed after landing has always been interpreted as an indication of the absolute fluid loss early during space missions. However, in contrast to central hypervolemic conditions on Earth, the acute shift of blood volume from the legs to the upper part of the body in astronauts entering microgravity (microG) has neither stimulated diuresis and natriuresis nor resulted in negative water-and sodium-balances. DESIGN: We therefore examined the kinetics of body mass changes in astronauts (n = 3) during their several weeks aboard the space station MIR. A continuous diet monitoring was performed during the first mission (EuroMIR94, 30 days). The second mission (MIR97, 19 days) comprised a 15-day metabolic ward period (including predefined constant energy and sodium intake). Water and sodium balances were calculated and the kinetic of changes in basal concentrations of fluid-balance-related hormones during flight were determined. CONCLUSION: The data suggest firstly that loss of body mass during space flight is rather a consequence of hypocaloric nutrition. Secondly, microG provokes a sodium retaining hormonal status and may lead to sodium storage without an accompanying fluid retention.

Astronauts↗
PubMed2000

Lactose does not enhance calcium bioavailability in lactose-tolerant, healthy adults.

BACKGROUND: There is evidence from animal studies that lactose has a beneficial effect on intestinal calcium absorption. However, data concerning the effect of lactose on calcium absorption in lactose-tolerant adults are inconclusive. OBJECTIVE: Our objective was to investigate the effect of lactose on calcium bioavailability in humans by the use of a stable-strontium test under controlled metabolic conditions. DESIGN: Eleven healthy, lactose-tolerant subjects (8 women, 3 men) randomly received a bolus of 2.27 mmol strontium alone (load A), the bolus with 35 g lactose (load B), or the bolus with 17.5 g glucose and 17.5 g galactose (load C). Blood samples were drawn at 0, 15, 30, 60, 90, 180, 240, and 300 min. Urine specimens were collected during the time intervals -2 to 0, 0-2, 2-4, 4-6, and 6-24 h. RESULTS: Pharmacokinetic parameters of strontium bioavailability were comparable for all 3 loads. In detail, fractional absorption at 240 min for loads A, B, and C was 12.1 +/- 0.7%, 13.0 +/- 1.1%, and 12.2 +/- 0.7%, respectively. Areas under the curve for 0-240 min were 70.8 +/- 6.3, 69.6 +/- 3.5, and 65.8 +/- 5.1 micromol*h/L for loads A, B, and C, respectively (NS). Moreover, fractional strontium excretion values of 5.1 +/- 0.8% (load A), 5.8 +/- 0.4% (load B), and 5.2 +/- 0.8% (load C) were not significantly different. CONCLUSIONS: Lactose does not have a beneficial effect on calcium bioavailability in lactose-tolerant adults.

Adult↗
PubMed2000

High dietary sodium chloride consumption may not induce body fluid retention in humans.

A commonly accepted hypothesis is that a chronically high-sodium diet expands extracellular volume and finally reaches a steady state where sodium intake and output are balanced whereas extracellular volume is expanded. However, in a recent study where the main purpose was to investigate the role of natriuretic peptides under day-to-day sodium intake conditions (Heer M, Drummer C, Baisch F, and Gerzer R. Pflügers Arch 425: 390-394, 1993), our laboratory observed increases in plasma volume without any rise in extracellular volume. To scrutinize these results that were observed as a side effect, we performed a controlled, randomized study including 32 healthy male test subjects in a metabolic ward. The NaCl intake ranged from a low level of 50 meq NaCl/day to 200, 400, and 550 meq/day, respectively. Plasma volume dose dependently increased (P < 0.01), being elevated by 315 +/- 37 ml in the 550-meq-NaCl-intake group. However, in contrast to the increased plasma volume, comparable to study I, total body water did not increase. In parallel, body mass also did not increase. Mean corpuscular volume of erythrocytes, as an index for intracellular volume, was also unchanged. We conclude from the results of these two independently conducted studies that under the chosen study conditions, in contrast to present opinions, high sodium intake does not induce total body water storage but induces a relative fluid shift from the interstitial into the intravascular space.

Adult↗
PubMed2000

Space flight is associated with rapid decreases of undercarboxylated osteocalcin and increases of markers of bone resorption without changes in their circadian variation: observations in two cosmonauts.

BACKGROUND: Microgravity induces bone loss by mechanism(s) that remain largely unknown. METHODS: We measured biochemical markers related to bone remodeling in two cosmonauts before, during, and after 21- and 180-day space flights, respectively. RESULTS: During both flights, type I procollagen propeptide and bone alkaline phosphatase decreased as early as 8 days after launch. Undercarboxylated osteocalcin percentage increased early and remained high during both flights. Vitamin K supplementation restored carboxylation of osteocalcin during the long-term flight. Urinary and serum C-telopeptide of type I collagen (CTX) increased as early as day 8 of the flights; the increase was greater in serum than in urine. Pyridinoline, free deoxypyridinoline, and N-telopeptide increased less than CTX during the short-term space flight. The circadian rhythm of bone resorption assessed by urine CTX and free deoxypyridinoline was not altered by microgravity. CONCLUSION: Vitamin K metabolism or action and bone remodeling may be altered in cosmonauts.

Adult↗
PubMed2000

Regulation and distribution of body fluid during a 6-day head-down tilt study in a randomized cross-over design.

Head down tilt (-6 degrees HDT) examinations are commonly used simulation models for various microgravity induced changes in body functions. Body fluid distribution (by means of dye dilution and two independent multifrequency impedance techniques), water- and sodium-handling, and the plasma/serum concentrations of fluid balance related hormones have been determined in a randomized, controlled, cross-over study in 8 healthy test subjects. The comparison of responses to HDT and an upright control position with respective experiences from space shows some similarities but also various discrepancies between the terrestrial simulation and real microgravity.

Bed Rest↗
PubMed1999

Calcium metabolism in microgravity.

Unloading of weight bearing bones as induced by microgravity or immobilization has significant impacts on the calcium and bone metabolism and is the most likely cause for space osteoporosis. During a 4.5 to 6 month stay in space most of the astronauts develop a reduction in bone mineral density in spine, femoral neck, trochanter, and pelvis of 1%-1.6% measured by Dual Energy X-ray Absorption (DEXA). Dependent on the mission length and the individual turnover rates of the astronauts it can even reach individual losses of up to 14% in the femoral neck. Osteoporosis itself is defined as the deterioration of bone tissue leading to enhanced bone fragility and to a consequent increase in fracture risk. Thinking of long-term missions to Mars or interplanetary missions for years, space osteoporosis is one of the major concerns for manned spaceflight. However, decrease in bone density can be initiated differently. It either can be caused by increases in bone formation and bone resorption resulting in a net bone loss, as obtained in fast looser postmenopausal osteoporosis. On the other hand decrease in bone formation and increase in bone resorption also leads to bone losses as obtained in slow looser postmenopausal osteoporosis or in Anorexia Nervosa patients. Biomarkers of bone turnover measured during several missions indicated that the pattern of space osteoporosis is very similar to the pattern of Anorexia Nervosa patients or slow looser postmenopausal osteoporosis. However, beside unloading, other risk factors for space osteoporosis exist such as stress, nutrition, fluid shifts, dehydration and bone perfusion. Especially nutritional factors may contribute considerably to the development of osteoporosis. From earthbound studies it is known that calcium supplementation in women and men can prevent bone loss of 1% bone per year. Based on these results we studied the calcium intake during several European missions and performed an experiment during the German MIR 97 mission where we investigated the effects of high calcium intake (>1000 mg/d) and vitamin D supplementation (650 IU/d) on the calcium and bone metabolism during 21 days in microgravity. In the MIR 97 mission high calcium intake and vitamin D supplementation led to high ionized calcium levels and a marked decrease in calcitriol levels together with decreased bone formation and increased bone resorption markers. Our conclusion from the MIR 97 mission is that an adequate calcium intake and vitamin D supplementation during space missions is mandatory but, in contrast to terrestrial conditions, does not efficiently counteract the development of space osteoporosis.

Bone and Bones↗
PubMed1998

Biological dosimetry to determine the UV radiation climate inside the MIR station and its role in vitamin D biosynthesis.

The vitamin D synthesis in the human skin, is absolutely dependent on UVB radiation. Natural UVB from sunlight is normally absent in the closed environment of a space station like MIR. Therefore it was necessary to investigate the UV radiation climate inside the station resulting from different lamps as well as from occasional solar irradiation behind a UV-transparent quartz window. Biofilms, biologically weighting and integrating UV dosimeters successfully applied on Earth (e.g. in Antarctica) and in space (D-2, Biopan I) were used to determine the biological effectiveness of the UV radiation climate at different locations in the space station. Biofilms were also used to determine the personal UV dose of an individual cosmonaut. These UV data were correlated with the concentration of vitamin D in the cosmonaut's blood and the dietary vitamin D intake. The results showed that the UV radiation climate inside the Mir station is not sufficient for an adequate supply of vitamin D, which should therefore be secured either by vitamin D supplemental and/or by the regular exposure to special UV lamps like those in sun-beds. The use of natural solar UV radiation through the quartz window for 'sunbathing' is dangerous and should be avoided even for short exposure periods.

25-Hydroxyvitamin D 2↗
PubMed1998

Effects of elevated carbon dioxide environment on calcium metabolism in humans.

BACKGROUND: Chronic respiratory acidosis induced by an elevated carbon dioxide (CO2) environment should provoke hypercalciuria with related total body and subsequent bone calcium losses. We examined this hypothesis in four healthy male volunteers, who were exposed during a 25-d period to an 0.7% CO2 environment within a deep diving isolation chamber. Three months later the same subjects were reexamined during a second campaign being exposed to a 1.2% CO2 atmosphere. METHODS: The subjects received a constant calcium intake (1.4 g.d-1) and vitamin D supplement (1000 IU.d-1) during both campaigns. Calcium balance (oral calcium intake minus urinary and fecal calcium output) was evaluated. Serum calcium concentrations and biomarkers of bone metabolism were measured, in order to evaluate bone turnover. Additionally, the response to an acute oral calcium load was examined as a sensitive measure of changes in calcium metabolism. RESULTS: Both, urinary calcium excretion (from 245 +/- 38 to 199 +/- 31 mg.d-1; mean +/- SE, 0.7% and 1.2%, respectively) and fecal calcium losses (from 1229 +/- 128 to 996 +/- 62 mg.d-1) were significantly reduced in the higher (1.2%) CO2 atmosphere. Although more calcium was retained in the body during the 1.2% than during the 0.7% CO2 campaign, serum calcium concentrations and biomarkers of bone formation were significantly lower in the higher CO2 campaign. Furthermore, bone resorption was slightly increased in the 1.2% experiment. CONCLUSION: Elevated CO2 atmosphere may dose-dependently preserve body calcium without a parallel improvement of bone substance.

Acidosis, Respiratory↗
PubMed1997

Increased renal natriuretic peptide (urodilatin) excretion in heart failure patients.

Accumulating evidence suggests that urodilatin, a kidney-derived member of the natriuretic peptide family, contributes as a major mediator of sodium excretion to body fluid regulation in healthy men. In contrast to other members of the natriuretic peptide family, pathophysiological data for the renal natriuretic peptide have still been missing. The present study compares renal synthesis of urodilatin in patients with congestive heart failure (CHF) and healthy volunteers. Because urodilatin excretion, considerably increases with increasing nutritive sodium intake (p<0.004), the CHF patients (15 NYHA I/II, 8 NYHA III/IV) were kept on a 165 mmol/day sodium diet and 6 healthy volunteers on a identical nutritive sodium intake level were selected as proper controls. Although urodilatin excretion significantly increased (p<0.027) with increasing severity of CHF and was therefore significantly higher in mild CHF (40.7 +/- 2.5 fmol/min) and severe CHF (54.7 +/- 6.6 fmol/min) than in healthy controls (3.2 +/- 4.2 fmol/min), both groups of CHF patients retained sodium and had significantly lower sodium excretion rates (NYHA I/II 79.0 +/- 6.9 micromol/min, NYHA III/IV 97.9 +/- 12.7 micromol/min) than the healthy controls (139 +/- 3.4 micromol/min). Our data suggest that renal urodilatin synthesis, may not be involved in the etiology of sodium retention in CHF, but may rather be stimulated to counteract antinatriuresis during CHF.

Adolescent↗
PubMed1996

Local ischemia causes carcinoma-like changes of the rectum.

PURPOSE: Bioptic specimens of typical cancerous changes in the rectum usually reveal signs of malignancy. Our goal was to describe the clinical feature, histologic findings, and long-term outcome of patients in whom typical findings of carcinoma of the rectum were discovered by endoscopy, but whose histologic data did not confirm the diagnosis of a malignant disease. METHODS: We conducted a retrospective review of eight patients seen in our hospital with a clinical diagnosis of colorectal cancer. RESULTS: All patients had typical macroscopic findings of colorectal cancer. Endoscopic examination was performed because of chronic gastrointestinal symptoms (tenesmus, diarrhea, hematochezia, recurrent rectal prolapses; n = 5), incidental masses detected by rectal palpation (n = 2), or acute rectal bleeding (n = 1). Instead of confirming malignancy, all histologic specimens showed typical signs of intestinal ischemia. In three patients, tumors were removed by endoscopy; the other patients received symptomatic therapy. All patients were followed for an average period of 46 months. In five patients, symptoms disappeared completely. Three patients continued to suffer from intestinal discomfort. In one case, progression of ischemic damage led to subtotal stenosis, which necessitated proctectomy. CONCLUSIONS: Our results indicate that, despite its rarity, "ischemic pseudocarcinoma" is an important differential diagnosis to cancer of the rectum. Prognosis is generally good. Only patients suffering from chronic symptoms may require surgical treatment.

Adult↗