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Blottner D, Moriggi M, Trautmann G, Furlan S, Block K, Gutsmann M, Torretta E, Barbacini P, Capitanio D, Rittweger J, Limper U, Volpe P, Gelfi C, Salanova M. Nitrosative Stress in Astronaut Skeletal Muscle in Spaceflight. Antioxidants (Basel) 2024; 13:432. [PMID: 38671880 PMCID: PMC11047620 DOI: 10.3390/antiox13040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Long-duration mission (LDM) astronauts from the International Space Station (ISS) (>180 ISS days) revealed a close-to-normal sarcolemmal nitric oxide synthase type-1 (NOS1) immunoexpression in myofibers together with biochemical and quantitative qPCR changes in deep calf soleus muscle. Nitro-DIGE analyses identified functional proteins (structural, metabolic, mitochondrial) that were over-nitrosylated post- vs. preflight. In a short-duration mission (SDM) astronaut (9 ISS days), s-nitrosylation of a nodal protein of the glycolytic flux, specific proteins in tricarboxylic acid (TCA) cycle, respiratory chain, and over-nitrosylation of creatine kinase M-types as signs of impaired ATP production and muscle contraction proteins were seen. S-nitrosylation of serotransferrin (TF) or carbonic anhydrase 3 (CA3b and 3c) represented signs of acute response microgravity muscle maladaptation. LDM nitrosoprofiles reflected recovery of mitochondrial activity, contraction proteins, and iron transporter TF as signs of muscle adaptation to microgravity. Nitrosated antioxidant proteins, alcohol dehydrogenase 5/S-nitrosoglutathione reductase (ADH5/GSNOR), and selenoprotein thioredoxin reductase 1 (TXNRD1) levels indicated signs of altered redox homeostasis and reduced protection from nitrosative stress in spaceflight. This work presents a novel spaceflight-generated dataset on s-nitrosylated muscle protein signatures from astronauts that helps both to better understand the structural and molecular networks associated to muscular nitrosative stress and to design countermeasures to dysfunction and impaired performance control in human spaceflight missions.
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Affiliation(s)
- Dieter Blottner
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (G.T.); (K.B.); (M.G.); (M.S.)
- NeuroMuscular System and Signaling Group, Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany
| | - Manuela Moriggi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (M.M.); (P.B.); (D.C.); (C.G.)
| | - Gabor Trautmann
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (G.T.); (K.B.); (M.G.); (M.S.)
| | - Sandra Furlan
- C.N.R. Neuroscience Institute, I-35121 Padova, Italy;
| | - Katharina Block
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (G.T.); (K.B.); (M.G.); (M.S.)
| | - Martina Gutsmann
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (G.T.); (K.B.); (M.G.); (M.S.)
| | - Enrica Torretta
- Laboratory of Proteomics and Lipidomics, IRCCS Orthopedic Institute Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy;
| | - Pietro Barbacini
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (M.M.); (P.B.); (D.C.); (C.G.)
| | - Daniele Capitanio
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (M.M.); (P.B.); (D.C.); (C.G.)
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany; (J.R.); (U.L.)
| | - Ulrich Limper
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany; (J.R.); (U.L.)
- Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Witten/Herdecke University, 51109 Cologne, Germany
| | - Pompeo Volpe
- Department of Biomedical Sciences, Università di Padova, I-35121 Padova, Italy;
| | - Cecilia Gelfi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (M.M.); (P.B.); (D.C.); (C.G.)
- Laboratory of Proteomics and Lipidomics, IRCCS Orthopedic Institute Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy;
| | - Michele Salanova
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany; (G.T.); (K.B.); (M.G.); (M.S.)
- NeuroMuscular System and Signaling Group, Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany
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2
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Ward J, Reynolds RJ, Connell E, Anton W, Kabeel A, Charvat JM, Nartey N, Marotta K, Abukmail A, Buckland DM, Van Baalen M, Antonsen E. Levels of evidence for human system risk evaluation. NPJ Microgravity 2024; 10:33. [PMID: 38509136 PMCID: PMC10954631 DOI: 10.1038/s41526-024-00372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
NASA uses a continuous risk management process to seek out new knowledge of spaceflight-induced risk to human health and performance. The evidence base that informs the risk assessments in this domain is constantly changing as more information is gleaned from a continuous human presence in space and from ongoing research. However, the limitations of this evidence are difficult to characterize because fewer than 700 humans have ever flown in space, and information comes from a variety of sources that span disciplines, including engineering, medicine, food and nutrition, and many other life sciences. The Human System Risk Board (HSRB) at NASA is responsible for assessing risk to astronauts and communicating this risk to agency decision-makers. A critical part of that communication is conveying the uncertainty regarding the understanding of the changes that spaceflight induces in human processes and the complex interactions between humans and the spacecraft. Although the strength of evidence grades is common in the academic literature, these scores are often not useful for the problems of human spaceflight. The HSRB continues to update the processes used to report the levels of evidence. This paper describes recent updates to the methods used to assign the level of evidence scores to the official risk postures and to the causal diagrams used by the HSRB.
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Affiliation(s)
- Jessica Ward
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | | | | | | | | | | | | | - Kristina Marotta
- NASA Pathways Intern, NASA Johnson Space Center, Houston, TX, USA
| | | | | | | | - Erik Antonsen
- Department of Emergency Medicine, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
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3
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Sarma MS, Shelhamer M. The human biology of spaceflight. Am J Hum Biol 2024; 36:e24048. [PMID: 38337152 PMCID: PMC10940193 DOI: 10.1002/ajhb.24048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
To expand the human exploration footprint and reach Mars in the 2030s, we must explore how humans survive and thrive in demanding, unusual, and novel ecologies (i.e., extreme environments). In the extreme conditions encountered during human spaceflight, there is a need to understand human functioning and response in a more rigorous theoretically informed way. Current models of human performance in space-relevant environments and human space science are often operationally focused, with emphasis on acute physiological or behavioral outcomes. However, integrating current perspectives in human biology allows for a more holistic and complete understanding of how humans function over a range of time in an extreme environment. Here, we show how the use of evolution-informed frameworks (i.e., models of life history theory to organize the adaptive pressures of spaceflight and biocultural perspectives) coupled with the use of mixed-methodological toolkits can shape models that better encompass the scope of biobehavioral human adjustment to long-duration space travel and extra-terrestrial habitation. Further, we discuss how we can marry human biology perspectives with the rigorous programmatic structures developed for spaceflight to model other unknown and nascent extremes.
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Affiliation(s)
- Mallika S. Sarma
- Human Spaceflight Lab, Johns Hopkins School of Medicine, Baltimore, MD 21215
| | - Mark Shelhamer
- Human Spaceflight Lab, Johns Hopkins School of Medicine, Baltimore, MD 21215
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4
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Rahimzadeh V, Fogarty J, Caulfield T, Auñón-Chancellor S, Borry P, Candia J, Cohen IG, Covington M, Lynch HF, Greely HT, Hanlon M, Hatt J, Low L, Menikoff J, Meslin EM, Platts S, Ravitsky V, Ruttley T, Seidler RD, Sugarman J, Urquieta E, Williams MA, Wolpe PR, Donoviel D, McGuire AL. Ethically cleared to launch? Science 2023; 381:1408-1411. [PMID: 37769066 DOI: 10.1126/science.adh9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Rules are needed for human research in commercial spaceflight.
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Affiliation(s)
- Vasiliki Rahimzadeh
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Fogarty
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jessica Candia
- Component Office of Human Research Protections, Air Force Medical Readiness Agency, Department of the Air Force, Falls Church, VA, USA
| | - I Glenn Cohen
- The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Cambridge, MA, USA
| | - Marisa Covington
- Office of Research Assurance, Office of the Chief Health and Medical Officer, National Aeronautics and Space Administration, Houston, TX, USA
| | - Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Henry T Greely
- The Center for Law and the Biosciences, Stanford University, Stanford, CA, USA
| | - Michelle Hanlon
- Center for Air and Space Law, University of Mississippi, Oxford, MS, USA
| | - James Hatt
- Space Policy Division, Office of Commercial Space Transportation, Federal Aviation Administration, Washington, DC, USA
| | | | - Jerry Menikoff
- Centre for Biomedical Ethics, National University of Singapore, Republic of Singapore
| | | | - Steven Platts
- Human Research Program, NASA Johnson Space Center, Houston, TX, USA
| | - Vardit Ravitsky
- School of Public Health, University of Montreal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | | | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Emmanuel Urquieta
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Williams
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Dorit Donoviel
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Antonsen EL, Connell E, Anton W, Reynolds RJ, Buckland DM, Van Baalen M. Updates to the NASA human system risk management process for space exploration. NPJ Microgravity 2023; 9:72. [PMID: 37679359 PMCID: PMC10485075 DOI: 10.1038/s41526-023-00305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023] Open
Abstract
This paper describes updates to NASA's approach for assessing and mitigating spaceflight-induced risks to human health and performance. This approach continues to evolve to meet dynamically changing risk environments: lunar missions are currently being designed and the ultimate destination will be Mars. Understanding the risks that astronauts will face during a Mars mission will depend on building an evidence base that informs not only how the humans respond to the challenges of the spaceflight environment, but also how systems and vehicles can be designed to support human capabilities and limitations. This publication documents updates to the risk management process used by the Human System Risk Board at NASA and includes changes to the likelihood and consequence matrix used by the board, the design reference mission categories and parameters, and the standardized evaluation of the levels of evidence that the board accepts when setting risk posture. Causal diagramming, using directed acyclic graphs, provides all stakeholders with the current understanding of how each risk proceeds from a spaceflight hazard to a mission-level outcome. This standardized approach enables improved communication among stakeholders and delineates how and where more knowledge can improve perspective of human system risks and which countermeasures can best mitigate these risks.
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Affiliation(s)
- Erik L Antonsen
- Center for Space Medicine, Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
| | | | | | | | - Daniel M Buckland
- Duke University, Durham, NC, USA
- NASA Johnson Space Center, Houston, TX, USA
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6
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Stepaniak PC, Blue RS, Gilmore S, Beven GE, Chough NG, Tsung A, McMonigal KA, Mazuchowski EL, Bytheway JA, Lindgren KN, Barratt MR. Operational Considerations for Crew Fatality on the International Space Station. Aerosp Med Hum Perform 2023; 94:705-714. [PMID: 37587636 DOI: 10.3357/amhp.6300.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND: While catastrophic spaceflight events resulting in crew loss have occurred, human spaceflight has never suffered an on-orbit fatality with survival of other crewmembers on board. Historical plans for management of an on-orbit fatality have included some consideration for forensic documentation and sample collection, human remains containment, and disposition of remains; however, such plans have not included granular detailing of crew or ground controller actions. The NASA Johnson Space Center Contingency Medical Operations Group, under authority from the Space and Occupational Medicine Branch, the Space Medicine Operations Division, and the Human Health and Performance Directorate, undertook the development of a comprehensive plan, including an integrated Mission Control Center response for flight control teams and Flight Surgeons for a single on-orbit crew fatality on the International Space Station (ISS) and subsequent events. Here we detail the operational considerations for a crew fatality should it occur during spaceflight onboard the ISS, including forensic and timeline constraints, behavioral health factors, and considerations for final disposition of decedent remains. Future considerations for differential survival and crewmember fatality outside of low-Earth orbit operations will additionally be discussed, including consideration of factors unique to planetary and surface operations and disposition limitations in exploration spaceflight. While the efforts detailed herein were developed within the constraints of the ISS concept of operations, future platforms may benefit from the procedural validation and product verifications steps described. Ultimately, any response to spaceflight fatality must preserve the goal of handling decedent remains and disposition with dignity, honor, and respect.Stepaniak PC, Blue RS, Gilmore S, Beven GE, Chough NG, Tsung A, McMonigal KA, Mazuchowski EL II, Bytheway JA, Lindgren KN, Barratt MR. Operational considerations for crew fatality on the International Space Station. Aerosp Med Hum Perform. 2023; 94(9):705-714.
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7
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Zheng M, Charvat J, Zwart SR, Mehta SK, Crucian BE, Smith SM, He J, Piermarocchi C, Mias GI. Time-resolved molecular measurements reveal changes in astronauts during spaceflight. Front Physiol 2023; 14:1219221. [PMID: 37520819 PMCID: PMC10376710 DOI: 10.3389/fphys.2023.1219221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
From the early days of spaceflight to current missions, astronauts continue to be exposed to multiple hazards that affect human health, including low gravity, high radiation, isolation during long-duration missions, a closed environment and distance from Earth. Their effects can lead to adverse physiological changes and necessitate countermeasure development and/or longitudinal monitoring. A time-resolved analysis of biological signals can detect and better characterize potential adverse events during spaceflight, ideally preventing them and maintaining astronauts' wellness. Here we provide a time-resolved assessment of the impact of spaceflight on multiple astronauts (n = 27) by studying multiple biochemical and immune measurements before, during, and after long-duration orbital spaceflight. We reveal space-associated changes of astronauts' physiology on both the individual level and across astronauts, including associations with bone resorption and kidney function, as well as immune-system dysregulation.
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Affiliation(s)
- Minzhang Zheng
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, United States
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, United States
| | | | - Sara R. Zwart
- University of Texas Medical Branch, Galveston, TX, United States
| | | | | | | | - Jin He
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, United States
| | - Carlo Piermarocchi
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI, United States
| | - George I. Mias
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, United States
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, United States
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI, United States
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8
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Russell BK, Burian BK, Hilmers DC, Beard BL, Martin K, Pletcher DL, Easter B, Lehnhardt K, Levin D. The value of a spaceflight clinical decision support system for earth-independent medical operations. NPJ Microgravity 2023; 9:46. [PMID: 37344482 DOI: 10.1038/s41526-023-00284-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
As NASA prepares for crewed lunar missions over the next several years, plans are also underway to journey farther into deep space. Deep space exploration will require a paradigm shift in astronaut medical support toward progressively earth-independent medical operations (EIMO). The Exploration Medical Capability (ExMC) element of NASA's Human Research Program (HRP) is investigating the feasibility and value of advanced capabilities to promote and enhance EIMO. Currently, astronauts rely on real-time communication with ground-based medical providers. However, as the distance from Earth increases, so do communication delays and disruptions. Moreover, resupply and evacuation will become increasingly complex, if not impossible, on deep space missions. In contrast to today's missions in low earth orbit (LEO), where most medical expertise and decision-making are ground-based, an exploration crew will need to autonomously detect, diagnose, treat, and prevent medical events. Due to the sheer amount of pre-mission training required to execute a human spaceflight mission, there is often little time to devote exclusively to medical training. One potential solution is to augment the long duration exploration crew's knowledge, skills, and abilities with a clinical decision support system (CDSS). An analysis of preliminary data indicates the potential benefits of a CDSS to mission outcomes when augmenting cognitive and procedural performance of an autonomous crew performing medical operations, and we provide an illustrative scenario of how such a CDSS might function.
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Affiliation(s)
- Brian K Russell
- Auckland University of Technology, Auckland, New Zealand.
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA.
| | - Barbara K Burian
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - David C Hilmers
- NASA Johnson Space Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Bettina L Beard
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - Kara Martin
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - David L Pletcher
- NASA Ames Research Center, Moffett Field, Mountain View, CA, USA
| | - Ben Easter
- NASA Johnson Space Center, Houston, TX, USA
| | - Kris Lehnhardt
- NASA Johnson Space Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Dana Levin
- NASA Johnson Space Center, Houston, TX, USA
- Columbia University, New York, NY, USA
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9
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Thoolen SJJ, Kuypers MI. External Hemorrhage Control Techniques for Human Space Exploration: Lessons from the Battlefield. Wilderness Environ Med 2023; 34:231-242. [PMID: 36906432 DOI: 10.1016/j.wem.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/11/2023]
Abstract
The past few decades of military experience have brought major advances in the prehospital care of patients with trauma. A focus on early hemorrhage control with aggressive use of tourniquets and hemostatic gauze is now generally accepted. This narrative literature review aims to discuss external hemorrhage control and the applicability of military concepts in space exploration. In space, environmental hazards, spacesuit removal, and limited crew training could cause significant time delays in providing initial trauma care. Cardiovascular and hematological adaptations to the microgravity environment are likely to reduce the ability to compensate, and resources for advanced resuscitation are limited. Any unscheduled emergency evacuation requires a patient to don a spacesuit, involves exposure to high G-forces upon re-entry into Earth's atmosphere, and costs a significant amount of time until a definitive care facility is reached. As a result, early hemorrhage control in space is critical. Safe implementation of hemostatic dressings and tourniquets seems feasible, but adequate training will be essential, and tourniquets are preferably converted to other methods of hemostasis in case of a prolonged medical evacuation. Other emerging approaches such as early tranexamic acid administration and more advanced techniques have shown promising results as well. For future exploration missions to the Moon and Mars, when evacuation is not possible, we look into what training or assistance tools would be helpful in managing the bleed at the point of injury.
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Affiliation(s)
- Stijn J J Thoolen
- Neural Systems Group, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA; Centre for Human and Applied Physiological Sciences, King's College London, United Kingdom.
| | - Maybritt I Kuypers
- European Astronaut Centre, European Space Agency, Cologne, Germany; Department of Emergency Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands
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10
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Meer E, Grob S, Antonsen EL, Sawyer A. Ocular conditions and injuries, detection and management in spaceflight. NPJ Microgravity 2023; 9:37. [PMID: 37193709 DOI: 10.1038/s41526-023-00279-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Ocular trauma or other ocular conditions can be significantly debilitating in space. A literature review of over 100 articles and NASA evidence books, queried for eye related trauma, conditions, and exposures was conducted. Ocular trauma and conditions during NASA space missions during the Space Shuttle Program and ISS through Expedition 13 in 2006 were reviewed. There were 70 corneal abrasions, 4 dry eyes, 4 eye debris, 5 complaints of ocular irritation, 6 chemical burns, and 5 ocular infections noted. Unique exposures on spaceflight, such as foreign bodies, including celestial dust, which may infiltrate the habitat and contact the ocular surface, as well as chemical and thermal injuries due to prolonged CO2 and heat exposure were reported. Diagnostic modalities used to evaluate the above conditions in space flight include vision questionnaires, visual acuity and Amsler grid testing, fundoscopy, orbital ultrasound, and ocular coherence tomography. Several types of ocular injuries and conditions, mostly affecting the anterior segment, are reported. Further research is necessary to understand the greatest ocular risks that astronauts face and how better we can prevent, but also diagnose and treat these conditions in space.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- University of California Space Health Program, San Francisco, CA, USA
| | - Seanna Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Erik L Antonsen
- Department of Emergency Medicine and Center for Space Medicine, Baylor College of Medicine, Houstan, Texas, USA
| | - Aenor Sawyer
- University of California Space Health Program, San Francisco, CA, USA.
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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11
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Scott RT, Sanders LM, Antonsen EL, Hastings JJA, Park SM, Mackintosh G, Reynolds RJ, Hoarfrost AL, Sawyer A, Greene CS, Glicksberg BS, Theriot CA, Berrios DC, Miller J, Babdor J, Barker R, Baranzini SE, Beheshti A, Chalk S, Delgado-Aparicio GM, Haendel M, Hamid AA, Heller P, Jamieson D, Jarvis KJ, Kalantari J, Khezeli K, Komarova SV, Komorowski M, Kothiyal P, Mahabal A, Manor U, Garcia Martin H, Mason CE, Matar M, Mias GI, Myers JG, Nelson C, Oribello J, Parsons-Wingerter P, Prabhu RK, Qutub AA, Rask J, Saravia-Butler A, Saria S, Singh NK, Snyder M, Soboczenski F, Soman K, Van Valen D, Venkateswaran K, Warren L, Worthey L, Yang JH, Zitnik M, Costes SV. Biomonitoring and precision health in deep space supported by artificial intelligence. NAT MACH INTELL 2023. [DOI: 10.1038/s42256-023-00617-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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12
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Zheng M, Charvat J, Zwart SR, Mehta S, Crucian BE, Smith SM, He J, Piermarocchi C, Mias GI. Time-resolved molecular measurements reveal changes in astronauts during spaceflight. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.17.530234. [PMID: 36993537 PMCID: PMC10055136 DOI: 10.1101/2023.03.17.530234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
From the early days of spaceflight to current missions, astronauts continue to be exposed to multiple hazards that affect human health, including low gravity, high radiation, isolation during long-duration missions, a closed environment and distance from Earth. Their effects can lead to adverse physiological changes and necessitate countermeasure development and/or longitudinal monitoring. A time-resolved analysis of biological signals can detect and better characterize potential adverse events during spaceflight, ideally preventing them and maintaining astronauts' wellness. Here we provide a time-resolved assessment of the impact of spaceflight on multiple astronauts (n=27) by studying multiple biochemical and immune measurements before, during, and after long-duration orbital spaceflight. We reveal space-associated changes of astronauts' physiology on both the individual level and across astronauts, including associations with bone resorption and kidney function, as well as immune-system dysregulation.
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13
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Capri M, Conte M, Ciurca E, Pirazzini C, Garagnani P, Santoro A, Longo F, Salvioli S, Lau P, Moeller R, Jordan J, Illig T, Villanueva MM, Gruber M, Bürkle A, Franceschi C, Rittweger J. Long-term human spaceflight and inflammaging: Does it promote aging? Ageing Res Rev 2023; 87:101909. [PMID: 36918115 DOI: 10.1016/j.arr.2023.101909] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Spaceflight and its associated stressors, such as microgravity, radiation exposure, confinement, circadian derailment and disruptive workloads represent an unprecedented type of exposome that is entirely novel from an evolutionary stand point. Within this perspective, we aimed to review the effects of prolonged spaceflight on immune-neuroendocrine systems, brain and brain-gut axis, cardiovascular system and musculoskeletal apparatus, highlighting in particular the similarities with an accelerated aging process. In particular, spaceflight-induced muscle atrophy/sarcopenia and bone loss, vascular and metabolic changes, hyper and hypo reaction of innate and adaptive immune system appear to be modifications shared with the aging process. Most of these modifications are mediated by molecular events that include oxidative and mitochondrial stress, autophagy, DNA damage repair and telomere length alteration, among others, which directly or indirectly converge on the activation of an inflammatory response. According to the inflammaging theory of aging, such an inflammatory response could be a driver of an acceleration of the normal, physiological rate of aging and it is likely that all the systemic modifications in turn lead to an increase of inflammaging in a sort of vicious cycle. The most updated countermeasures to fight these modifications will be also discussed in the light of their possible application not only for astronauts' benefit, but also for older adults on the ground.
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Affiliation(s)
- Miriam Capri
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
| | - Maria Conte
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy.
| | - Erika Ciurca
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Chiara Pirazzini
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Paolo Garagnani
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy; Clinical Chemistry Department of Laboratory Medicine, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden; CNR Institute of Molecular Genetics, Unit of Bologna, Bologna, Italy; Center for Applied Biomedical Research (CRBA), St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Aurelia Santoro
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
| | - Federica Longo
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Stefano Salvioli
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Patrick Lau
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Ralf Moeller
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Medical Faculty, University of Cologne, Cologne, Germany
| | - Thomas Illig
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Maria-Moreno Villanueva
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
| | - Markus Gruber
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
| | - Alexander Bürkle
- Department of Biology, University of Konstanz, Konstanz, Germany
| | - Claudio Franceschi
- Department of Applied Mathematics of the Institute of ITMM, National Research Lobachevsky State University of Nizhny Novgorod, the Russian Federation
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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Levin DR, Steller J, Anderson A, Lemery J, Easter B, Hilmers DC, Lehnhardt KR. Enabling Human Space Exploration Missions Through Progressively Earth Independent Medical Operations (EIMO). IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:162-167. [PMID: 38274774 PMCID: PMC10810302 DOI: 10.1109/ojemb.2023.3255513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 01/27/2024] Open
Abstract
Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and crews to reduce risk and increase mission success. Terrestrial assets will continue to provide pre-mission screening, planning, health maintenance, and prevention, while onboard medical care will increasingly be the purview of the crew. Conclusions: This paper defines and describes the key components of EIMO.
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Affiliation(s)
- Dana R. Levin
- Department of Emergency MedicineBaylor College of MedicineHoustonTX77030USA
- Department of Preventive Medicine Division of Aerospace MedicineUniversity of Texas Medical BranchGalvestonTX77555USA
| | - Jon Steller
- Department of Maternal Fetal Medicine and Obstetrics and GynecologyUniversity of California IrvineIrvineCA92697USA
| | - Arian Anderson
- Department of Emergency MedicineSchool of Medicine, University of Colorado Anschutz Medical CampusAuroraCO80045USA
| | - Jay Lemery
- Department of Emergency Medicine, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- NASA Johnson Space CenterHoustonTX77058USA
| | - Benjamin Easter
- Department of Emergency Medicine, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- NASA Johnson Space CenterHoustonTX77058USA
| | - David C. Hilmers
- Department of Internal Medicine and PediatricsBaylor College of MedicineHoustonTX77030USA
- Center for Space Medicine, Baylor College of MedicineHoustonTX77030USA
| | - Kris R. Lehnhardt
- Department of Emergency MedicineBaylor College of MedicineHoustonTX77030USA
- Center for Space Medicine, Baylor College of MedicineHoustonTX77030USA
- NASA Johnson Space CenterHoustonTX77058USA
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Blottner D, Moriggi M, Trautmann G, Hastermann M, Capitanio D, Torretta E, Block K, Rittweger J, Limper U, Gelfi C, Salanova M. Space Omics and Tissue Response in Astronaut Skeletal Muscle after Short and Long Duration Missions. Int J Mol Sci 2023; 24:ijms24044095. [PMID: 36835504 PMCID: PMC9962627 DOI: 10.3390/ijms24044095] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
The molecular mechanisms of skeletal muscle adaptation to spaceflight are as yet not fully investigated and well understood. The MUSCLE BIOPSY study analyzed pre and postflight deep calf muscle biopsies (m. soleus) obtained from five male International Space Station (ISS) astronauts. Moderate rates of myofiber atrophy were found in long-duration mission (LDM) astronauts (~180 days in space) performing routine inflight exercise as countermeasure (CM) compared to a short-duration mission (SDM) astronaut (11 days in space, little or no inflight CM) for reference control. Conventional H&E scout histology showed enlarged intramuscular connective tissue gaps between myofiber groups in LDM post vs. preflight. Immunoexpression signals of extracellular matrix (ECM) molecules, collagen 4 and 6, COL4 and 6, and perlecan were reduced while matrix-metalloproteinase, MMP2, biomarker remained unchanged in LDM post vs. preflight suggesting connective tissue remodeling. Large scale proteomics (space omics) identified two canonical protein pathways associated to muscle weakness (necroptosis, GP6 signaling/COL6) in SDM and four key pathways (Fatty acid β-oxidation, integrin-linked kinase ILK, Rho A GTPase RHO, dilated cardiomyopathy signaling) explicitly in LDM. The levels of structural ECM organization proteins COL6A1/A3, fibrillin 1, FBN1, and lumican, LUM, increased in postflight SDM vs. LDM. Proteins from tricarboxylic acid, TCA cycle, mitochondrial respiratory chain, and lipid metabolism mostly recovered in LDM vs. SDM. High levels of calcium signaling proteins, ryanodine receptor 1, RyR1, calsequestrin 1/2, CASQ1/2, annexin A2, ANXA2, and sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA1) pump, ATP2A, were signatures of SDM, and decreased levels of oxidative stress peroxiredoxin 1, PRDX1, thioredoxin-dependent peroxide reductase, PRDX3, or superoxide dismutase [Mn] 2, SOD2, signatures of LDM postflight. Results help to better understand the spatiotemporal molecular adaptation of skeletal muscle and provide a large scale database of skeletal muscle from human spaceflight for the better design of effective CM protocols in future human deep space exploration.
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Affiliation(s)
- Dieter Blottner
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
- NeuroMuscular System & Signaling Group, Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-528-347
| | - Manuela Moriggi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Gabor Trautmann
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Maria Hastermann
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
- NeuroMuscular System & Signaling Group, Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany
| | - Daniele Capitanio
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | | | - Katharina Block
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Joern Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
- Department of Pediatrics and Adolescence Medicine, University Hospital Cologne, 50937 Cologne, Germany
| | - Ulrich Limper
- Department of Anaesthesiology and Intensive Care Medicine, Merheim Medical Center, Witten/Herdecke University, 51109 Cologne, Germany
| | - Cecilia Gelfi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Michele Salanova
- Institute of Integrative Neuroanatomy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
- NeuroMuscular System & Signaling Group, Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany
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16
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Overlin M, Iannucci S, Wilkins B, McBain A, Provancher J. Reinforcement learned adversarial agent (ReLAA) for active fault detection and prediction in space habitats. NPJ Microgravity 2023; 9:15. [PMID: 36781914 PMCID: PMC9925772 DOI: 10.1038/s41526-023-00252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/10/2023] [Indexed: 02/15/2023] Open
Abstract
With growing interest for human space tourism in the twenty-first century, much attention has been directed to the robust engineering of Environmental Control and Life Support Systems in space habitats. The stable, reliable operation of such a habitat is partly achieved with an ability to recognize and predict faults. For these two purposes, a reinforcement learning adversarial agent (ReLAA) is utilized in this work. A ReLAA is trained with experimental data to actively recognize and predict faults. These capabilities are achieved by proposing actions that activate known faults in a system. Instead of issuing these harmful actions to the actual hardware, a digital twin of the mock space habitat is simulated to discover vulnerabilities that would lead to faulted operation. The methods developed in this work will allow for the discovery of damaging latent behavior, and the reduction of false positive and negative fault identification.
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Affiliation(s)
- Matthew Overlin
- Department of Autonomy and Data Science, PacMar Technologies, Honolulu, HI, USA.
| | - Steven Iannucci
- Department of Autonomy and Data Science, PacMar Technologies, Honolulu, HI, USA.
| | - Bradly Wilkins
- Department of Autonomy and Data Science, PacMar Technologies, Honolulu, HI USA
| | - Alexander McBain
- Department of Autonomy and Data Science, PacMar Technologies, Honolulu, HI USA
| | - Jason Provancher
- Department of Autonomy and Data Science, PacMar Technologies, Honolulu, HI USA
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Lerner DJ, Pohlen MS, Apland RC, Parivash SN. Just-in-time Training with Remote Guidance for Ultrasound-Guided Percutaneous Intervention. Aerosp Med Hum Perform 2022; 93:882-886. [PMID: 36757240 DOI: 10.3357/amhp.6152.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND: Management of surgical emergencies in spaceflight will pose a challenge as the era of exploration class missions dawns, requiring increased crew autonomy at a time when training and supplies will be limited. Ultrasound-guided percutaneous intervention would allow for the management of a variety of pathologies with largely shared equipment and training. This proof-of-concept work attempts to determine the feasibility of "just-in-time" remote teaching and guidance of a sample procedure of this type.METHODS: Subjects naïve to ultrasound-guided intervention were instructed via a short video regarding the technique for placement of a percutaneous drain into a simulated abscess within a gel phantom. Subjects were then guided through the performance of the procedure via two-way audiovisual communication with an experienced remote assistant. Technical success was determined by the successful aspiration or expression of fluid from the simulated abscess following drain placement. This was then performed by and compared with staff experienced with such procedures. Time to completion and number of needle redirections required were also measured.RESULTS: All 29 subjects naïve to interventional work and the 4 experienced control subjects achieved technical success. There was a statistically significant difference in the time to completion between the two groups, with the experienced subjects averaging 2 min to completion and the inexperienced 5.8 min. There was no statistically significant difference in the number of redirections.DISCUSSION: This proof-of-concept work demonstrates high rates of technical success of percutaneous ultrasound-guided intervention in previously inexperienced personnel when provided with brief just-in-time training and live two-way audiovisual guidance.Lerner DJ, Pohlen MS, Apland RC, Parivash SN. Just-in-time training with remote guidance for ultrasound-guided percutaneous intervention. Aerosp Med Hum Perform. 2022; 93(12):882-886.
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18
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Overbeek R, Schmitz J, Rehnberg L, Benyoucef Y, Dusse F, Russomano T, Hinkelbein J. Effectiveness of CPR in Hypogravity Conditions-A Systematic Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121958. [PMID: 36556323 PMCID: PMC9785883 DOI: 10.3390/life12121958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
(1) Background: Cardiopulmonary resuscitation (CPR), as a form of basic life support, is critical for maintaining cardiac and cerebral perfusion during cardiac arrest, a medical condition with high expected mortality. Current guidelines emphasize the importance of rapid recognition and prompt initiation of high-quality CPR, including appropriate cardiac compression depth and rate. As space agencies plan missions to the Moon or even to explore Mars, the duration of missions will increase and with it the chance of life-threatening conditions requiring CPR. The objective of this review was to examine the effectiveness and feasibility of chest compressions as part of CPR following current terrestrial guidelines under hypogravity conditions such as those encountered on planetary or lunar surfaces; (2) Methods: A systematic literature search was conducted by two independent reviewers (PubMed, Cochrane Register of Controlled Trials, ResearchGate, National Aeronautics and Space Administration (NASA)). Only controlled trials conducting CPR following guidelines from 2010 and after with advised compression depths of 50 mm and above were included; (3) Results: Four different publications were identified. All studies examined CPR feasibility in 0.38 G simulating the gravitational force on Mars. Two studies also simulated hypogravity on the Moon with a force of 0.17 G/0,16 G. All CPR protocols consisted of chest compressions only without ventilation. A compression rate above 100/s could be maintained in all studies and hypogravity conditions. Two studies showed a significant reduction of compression depth in 0.38 G (-7.2 mm/-8.71 mm) and 0.17 G (-12.6 mm/-9.85 mm), respectively, with nearly similar heart rates, compared to 1 G conditions. In the other two studies, participants with higher body weight could maintain a nearly adequate mean depth while effort measured by heart rate (+23/+13.85 bpm) and VO2max (+5.4 mL·kg-1·min-1) increased significantly; (4) Conclusions: Adequate CPR quality in hypogravity can only be achieved under increased physical stress to compensate for functional weight loss. Without this extra effort, the depth of compression quickly falls below the guideline level, especially for light-weight rescuers. This means faster fatigue during resuscitation and the need for more frequent changes of the resuscitator than advised in terrestrial guidelines. Alternative techniques in the straddling position should be further investigated in hypogravity.
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Affiliation(s)
- Remco Overbeek
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Correspondence:
| | - Jan Schmitz
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), 51149 Cologne, Germany
| | - Lucas Rehnberg
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- InnovaSpace, London SE28 0LZ, UK
| | - Yacine Benyoucef
- Spacemedex, Valbonne Sophia-Antipolis, 06560 Valbonne, France
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, 50009 Zaragoza, Spain
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | | | - Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), 51149 Cologne, Germany
- Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes-Wesling-Universitätsklinikum Minden, Ruhr-Universität Bochum, 32429 Minden, Germany
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19
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Reynolds RJ, Scott RT, Turner RT, Iwaniec UT, Bouxsein ML, Sanders LM, Antonsen EL. Validating Causal Diagrams of Human Health Risks for Spaceflight: An Example Using Bone Data from Rodents. Biomedicines 2022; 10:2187. [PMID: 36140288 PMCID: PMC9496259 DOI: 10.3390/biomedicines10092187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022] Open
Abstract
As part of the risk management plan for human system risks at the US National Aeronautics and Space Administration (NASA), the NASA Human Systems Risk Board uses causal diagrams (in the form of directed, acyclic graphs, or DAGs) to communicate the complex web of events that leads from exposure to the spaceflight environment to performance and health outcomes. However, the use of DAGs in this way is relatively new at NASA, and thus far, no method has been articulated for testing their veracity using empirical data. In this paper, we demonstrate a set of procedures for doing so, using (a) a DAG related to the risk of bone fracture after exposure to spaceflight; and (b) four datasets originally generated to investigate this phenomenon in rodents. Tests of expected marginal correlation and conditional independencies derived from the DAG indicate that the rodent data largely agree with the structure of the diagram. Incongruencies between tests and the expected relationships in one of the datasets are likely explained by inadequate representation of a key DAG variable in the dataset. Future directions include greater tie-in with human data sources, including multiomics data, which may allow for more robust characterization and measurement of DAG variables.
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Affiliation(s)
- Robert J. Reynolds
- KBR Wyle Services, LLC, NASA Johnson Space Center, Houston, TX 77058, USA
| | - Ryan T. Scott
- KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94043, USA
| | - Russell T. Turner
- Skeletal Biology Laboratory, Oregon State University, Corvallis, OR 97331, USA
| | - Urszula T. Iwaniec
- Skeletal Biology Laboratory, Oregon State University, Corvallis, OR 97331, USA
| | - Mary L. Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Lauren M. Sanders
- Blue Marble Space Institute of Science, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA 94043, USA
| | - Erik L. Antonsen
- Department of Emergency Medicine, Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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20
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Simmons P, Corley C, Allen AR. Fractionated Proton Irradiation Does Not Impair Hippocampal-Dependent Short-Term or Spatial Memory in Female Mice. TOXICS 2022; 10:toxics10090507. [PMID: 36136472 PMCID: PMC9503909 DOI: 10.3390/toxics10090507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 05/14/2023]
Abstract
The environment outside the Earth's protective magnetosphere is a much more threatening and complex space environment. The dominant causes for radiation exposure, solar particle events and galactic cosmic rays, contain high-energy protons. In space, astronauts need healthy and highly functioning cognitive abilities, of which the hippocampus plays a key role. Therefore, understanding the effects of 1H exposure on hippocampal-dependent cognition is vital for developing mitigative strategies and protective countermeasures for future missions. To investigate these effects, we subjected 6-month-old female CD1 mice to 0.75 Gy fractionated 1H (250 MeV) whole-body irradiation at the NASA Space Radiation Laboratory. The cognitive performance of the mice was tested 3 months after irradiation using Y-maze and Morris water maze tests. Both sham-irradiated and 1H-irradiated mice significantly preferred exploration of the novel arm compared to the familiar and start arms, indicating intact spatial and short-term memory. Both groups statistically spent more time in the target quadrant, indicating spatial memory retention. There were no significant differences in neurogenic and gliogenic cell counts after irradiation. In addition, proteomic analysis revealed no significant upregulation or downregulation of proteins related to behavior, neurological disease, or neural morphology. Our data suggests 1H exposure does not impair hippocampal-dependent spatial or short-term memory in female mice.
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Affiliation(s)
- Pilar Simmons
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, 4301 W Markham, Little Rock, AR 72205, USA
| | - Christa Corley
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, 4301 W Markham, Little Rock, AR 72205, USA
| | - Antiño R. Allen
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, 4301 W Markham, Little Rock, AR 72205, USA
- Correspondence: ; Tel.: +1-501-686-7553
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21
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Mian A, Aamir Mian M. Space Medicine: Inspiring a new generation of physicians. Postgrad Med J 2022:7150864. [PMID: 37137531 DOI: 10.1136/pmj-2022-141875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/18/2022] [Indexed: 11/03/2022]
Abstract
Space medicine is critical in enabling safe human exploration of space. The discipline focuses on supporting human survival, health, and performance in the austere environment of space. It is set to grow ever more important as significant transitions in the standard of space operations in the suborbital, low earth orbit (LEO) and beyond LEO domains will take place in the coming years. NASA along with their international and commercial partners have committed to returning to the Moon through the Artemis missions in this decade with the aim of achieving a permanent sustainable human presence on the lunar surface. Additionally, the development of reusable rockets is set to increase the number and frequency of humans going to space by making space travel more accessible. Commercial spaceflight and missions beyond LEO present many new challenges which space medicine physicians and researchers will need to address. Space medicine operates at the frontier of exploration, engineering, science and medicine. Aviation and Space Medicine (ASM) is the latest specialty to be recognised by the Royal College of Physicians and the General Medical Council in the UK. In this paper, we provide an introduction to space medicine, review the effects of spaceflight on human physiology and health along with countermeasures, medical and surgical issues in space, the varied roles of the ASM physician, challenges to UK space medicine practice and related research, and finally we explore the current representation of space medicine within the undergraduate curriculum.
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Affiliation(s)
- Areeb Mian
- Department of Surgery, University of Cambridge, Cambridge, UK
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