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Mendes Zambetta R, Signini ÉDF, Ocamoto GN, Catai AM, Uliam NR, Santarnecchi E, Russo TL. Effects of weightlessness on the cardiovascular system: a systematic review and meta-analysis. Front Physiol 2024; 15:1438089. [PMID: 39129756 PMCID: PMC11310543 DOI: 10.3389/fphys.2024.1438089] [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: 05/25/2024] [Accepted: 07/02/2024] [Indexed: 08/13/2024] Open
Abstract
Background: The microgravity environment has a direct impact on the cardiovascular system due to the fluid shift and weightlessness that results in cardiac dysfunction, vascular remodeling, and altered Cardiovascular autonomic modulation (CAM), deconditioning and poor performance on space activities, ultimately endangering the health of astronauts. Objective: This study aimed to identify the acute and chronic effects of microgravity and Earth analogues on cardiovascular anatomy and function and CAM. Methods: CINAHL, Cochrane Library, Scopus, Science Direct, PubMed, and Web of Science databases were searched. Outcomes were grouped into cardiovascular anatomic, functional, and autonomic alterations, and vascular remodeling. Studies were categorized as Spaceflight (SF), Chronic Simulation (CS), or Acute Simulation (AS) based on the weightlessness conditions. Meta-analysis was performed for the most frequent outcomes. Weightlessness and control groups were compared. Results: 62 articles were included with a total of 963 participants involved. The meta-analysis showed that heart rate increased in SF [Mean difference (MD) = 3.44; p = 0.01] and in CS (MD = 4.98; p < 0.0001), whereas cardiac output and stroke volume decreased in CS (MD = -0.49; p = 0.03; and MD = -12.95; p < 0.0001, respectively), and systolic arterial pressure decreased in AS (MD = -5.20; p = 0.03). According to the qualitative synthesis, jugular vein cross-sectional area (CSA) and volume were greater in all conditions, and SF had increased carotid artery CSA. Heart rate variability and baroreflex sensitivity, in general, decreased in SF and CS, whereas both increased in AS. Conclusion: This review indicates that weightlessness impairs the health of astronauts during and after spaceflight, similarly to the effects of aging and immobility, potentially increasing the risk of cardiovascular diseases. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42020215515.
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Affiliation(s)
| | - Étore De Favari Signini
- Physical Therapy Department, Federal University of São Carlos, UFSCar, São Carlos, SP, Brazil
| | - Gabriela Nagai Ocamoto
- Physical Therapy Department, Federal University of São Carlos, UFSCar, São Carlos, SP, Brazil
- Brain4care Inc., São Carlos, SP, Brazil
| | - Aparecida Maria Catai
- Physical Therapy Department, Federal University of São Carlos, UFSCar, São Carlos, SP, Brazil
| | - Nicoly Ribeiro Uliam
- Physical Therapy Department, Federal University of São Carlos, UFSCar, São Carlos, SP, Brazil
| | | | - Thiago Luiz Russo
- Physical Therapy Department, Federal University of São Carlos, UFSCar, São Carlos, SP, Brazil
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Caddy HT, Kelsey LJ, Parker LP, Green DJ, Doyle BJ. Modelling large scale artery haemodynamics from the heart to the eye in response to simulated microgravity. NPJ Microgravity 2024; 10:7. [PMID: 38218868 PMCID: PMC10787773 DOI: 10.1038/s41526-024-00348-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: 05/24/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
We investigated variations in haemodynamics in response to simulated microgravity across a semi-subject-specific three-dimensional (3D) continuous arterial network connecting the heart to the eye using computational fluid dynamics (CFD) simulations. Using this model we simulated pulsatile blood flow in an upright Earth gravity case and a simulated microgravity case. Under simulated microgravity, regional time-averaged wall shear stress (TAWSS) increased and oscillatory shear index (OSI) decreased in upper body arteries, whilst the opposite was observed in the lower body. Between cases, uniform changes in TAWSS and OSI were found in the retina across diameters. This work demonstrates that 3D CFD simulations can be performed across continuously connected networks of small and large arteries. Simulated results exhibited similarities to low dimensional spaceflight simulations and measured data-specifically that blood flow and shear stress decrease towards the lower limbs and increase towards the cerebrovasculature and eyes in response to simulated microgravity, relative to an upright position in Earth gravity.
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Affiliation(s)
- Harrison T Caddy
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, WA, Australia
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, WA, Australia
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, WA, Australia
- School of Engineering, The University of Western Australia, Perth, WA, Australia
| | - Louis P Parker
- FLOW, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, WA, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, WA, Australia.
- School of Engineering, The University of Western Australia, Perth, WA, Australia.
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Levasseur S, Purvis N, Trozzo S, Chung SH, Ades M, Drudi LM. Venous Thromboembolism in Exploration Class Human Spaceflight. Aerosp Med Hum Perform 2024; 95:45-53. [PMID: 38158572 DOI: 10.3357/amhp.6290.2024] [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: 01/03/2024]
Abstract
INTRODUCTION: A recent finding of a deep venous thrombosis during spaceflight has prompted the need to clarify mechanisms and risks of venous thromboembolism (VTE). In turn, mitigation countermeasures, diagnostic modalities, and treatment options must be explored. The objective of this review was to synthesize current evidence on VTE in spaceflight.METHODS: A literature review was performed from inception to April 2023 pertaining to VTE in the context of spaceflight or ground-based analogs with human participants. PubMed was searched for papers written in English using the terms "spaceflight" or "weightlessness" and "thrombotic" or "embolism" or "thromboembolism" in "venous" or "veins". Papers using cellular or animal models were excluded.RESULTS: There were 63 papers captured; 7 original scientific studies, 3 narrative reviews, 2 systematic reviews, and 3 commentaries discussed VTE in spaceflight. Reference lists were screened. Important themes included: altered venous hemodynamics, increased fibrinogen and coagulation markers, hypoalbuminemia, and immune dysfunction. Additional risk factors may be seen in women, such as the use of oral contraceptives.DISCUSSION: Venous stasis and decreased shear stress secondary to fluid shifts may induce inflammatory changes in the venous system, resulting in endothelial damage and upregulation of the coagulation cascade. Additionally, women in space are subject to physiological factors increasing their VTE risk, such as the use of oral contraceptives, inducing increased blood viscosity and hypoalbuminemia. Efforts should also be placed in optimizing sensitivity and specificity of imaging markers, payload, and training ability, notably the use of vector flow imaging, and improving point-of-testing biomarkers, such as albumin and p-selectin.Levasseur S, Purvis N, Trozzo S, Chung SH, Ades M, Drudi LM. Venous thromboembolism in exploration class human spaceflight. Aerosp Med Hum Perform. 2024; 95(1):45-53.
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Macionis V. Fetal head-down posture may explain the rapid brain evolution in humans and other primates: An interpretative review. Brain Res 2023; 1820:148558. [PMID: 37634686 DOI: 10.1016/j.brainres.2023.148558] [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: 08/05/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
Evolutionary cerebrovascular consequences of upside-down postural verticality of the anthropoid fetus have been largely overlooked in the literature. This working hypothesis-based report provides a literature interpretation from an aspect that the rapid evolution of the human brain has been promoted by fetal head-down position due to maternal upright and semi-upright posture. Habitual vertical torso posture is a feature not only of humans, but also of monkeys and non-human apes that spend considerable time in a sitting position. Consequently, the head-down position of the fetus may have caused physiological craniovascular hypertension that stimulated expansion of the intracranial vessels and acted as an epigenetic physiological stress, which enhanced neurogenesis and eventually, along with other selective pressures, led to the progressive growth of the anthropoid brain and its organization. This article collaterally opens a new insight into the conundrum of high cephalopelvic proportions (i.e., the tight fit between the pelvic birth canal and fetal head) in phylogenetically distant lineages of monkeys, lesser apes, and humans. Low cephalopelvic proportions in non-human great apes could be accounted for by their energetically efficient horizontal nest-sleeping and consequently by their larger body mass compared to monkeys and lesser apes that sleep upright. One can further hypothesize that brain size varies in anthropoids according to the degree of exposure of the fetus to postural verticality. The supporting evidence for this postulation includes a finding that in fossil hominins cerebral blood flow rate increased faster than brain volume. This testable hypothesis opens a perspective for research on fetal postural cerebral hemodynamics.
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Mastrandrea CJ, Hedge ET, Robertson AD, Heckman GA, Ho J, Granados Unger F, Hughson RL. High-intensity exercise does not protect against orthostatic intolerance following bedrest in 55- to 65-yr-old men and women. Am J Physiol Regul Integr Comp Physiol 2023; 325:R107-R119. [PMID: 37184226 DOI: 10.1152/ajpregu.00315.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
Prolonged bedrest provokes orthostatic hypotension and intolerance of upright posture. Limited data are available on the cardiovascular responses of older adults to head-up tilt following bedrest, with no studies examining the potential benefits of exercise to mitigate intolerance in this age group. This randomized controlled trial of head-down bedrest (HDBR) in 55- to 65-yr-old men and women investigated if exercise could avert post-HDBR orthostatic intolerance. Twenty-two healthy older adults (11 female) underwent a strict 14-day HDBR and were assigned to either an exercise (EX) or control (CON) group. The exercise intervention included high-intensity, aerobic, and resistance exercises. Head-up tilt-testing to a maximum of 15 minutes was performed at baseline (Pre-Bedrest) and immediately after HDBR (R1), as well as 6 days (R6) and 4 weeks (R4wk) later. At Pre-Bedrest, three participants did not complete the full 15 minutes of tilt. At R1, 18 did not finish, with no difference in tilt end time between CON (422 ± 287 s) and EX (409 ± 346 s). No differences between CON and EX were observed at R6 or R4wk. At R1, just 1 participant self-terminated the test with symptoms, while 12 others reported symptoms only after physiological test termination criteria were reached. Finishers on R1 protected arterial pressure with higher total peripheral resistance relative to Pre-Bedrest. Cerebral blood velocity decreased linearly with reductions in arterial pressure, end-tidal CO2, and cardiac output. High-intensity interval exercise did not benefit post-HDBR orthostatic tolerance in older adults. Multiple factors were associated with the reduction in cerebral blood velocity leading to intolerance.
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Affiliation(s)
| | - Eric T Hedge
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- Department of Kinesiology and Health Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew D Robertson
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- Department of Kinesiology and Health Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - George A Heckman
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Joanne Ho
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Federico Granados Unger
- Department of Kinesiology and Health Studies, University of Waterloo, Waterloo, Ontario, Canada
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Stern C, Yücel YH, Zu Eulenburg P, Pavy-Le Traon A, Petersen LG. Eye-brain axis in microgravity and its implications for Spaceflight Associated Neuro-ocular Syndrome. NPJ Microgravity 2023; 9:56. [PMID: 37474624 PMCID: PMC10359255 DOI: 10.1038/s41526-023-00300-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/02/2023] [Indexed: 07/22/2023] Open
Abstract
Long-duration human spaceflight can lead to changes in both the eye and the brain, which have been referred to as Spaceflight Associated Neuro-ocular Syndrome (SANS). These changes may manifest as a constellation of symptoms, which can include optic disc edema, optic nerve sheath distension, choroidal folds, globe flattening, hyperopic shift, and cotton wool spots. Although the underpinning mechanisms for SANS are not yet known, contributors may include intracranial interstitial fluid accumulation following microgravity induced headward fluid shift. Development and validation of SANS countermeasures contribute to our understanding of etiology and accelerate new technology including exercise modalities, Lower Body Negative Pressure suits, venous thigh cuffs, and Impedance Threshold Devices. However, significant knowledge gaps remain including biomarkers, a full set of countermeasures and/or treatment regimes, and finally reliable ground based analogs to accelerate the research. This review from the European Space Agency SANS expert group summarizes past research and current knowledge on SANS, potential countermeasures, and key knowledge gaps, to further our understanding, prevention, and treatment of SANS both during human spaceflight and future extraterrestrial surface exploration.
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Affiliation(s)
- Claudia Stern
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.
- ISS Operations and Astronauts Group, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany.
| | - Yeni H Yücel
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physics, Faculty of Science, Toronto Metropolitan University, Toronto, ON, Canada
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Zu Eulenburg
- Institute for Neuroradiology & German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Anne Pavy-Le Traon
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
- MEDES, Institute for Space Physiology and Medicine, Toulouse, France
- UMR INSERM U1297, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Lonnie Grove Petersen
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, USA
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Li J, Zhang F, Lan X, Li F, Tan C, Cao W. Novel risk prediction models for deep vein thrombosis after thoracotomy and thoracoscopic lung cancer resections, involving coagulation and immune function. Open Life Sci 2023; 18:20220617. [PMID: 37250843 PMCID: PMC10224613 DOI: 10.1515/biol-2022-0617] [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: 02/10/2023] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
The main focus of this study was to compare the predictive value of coagulation, fibrinolysis, thromboelastography, stress response, and immune function in predicting the incidence of deep venous thrombosis (DVT) in lung cancer (LC) patients undergoing thoracoscopic LC resection vs thoracotomy LC resection. To do that, a prospective, single-center, case-control study involving 460 LC patients was conducted. The risk indicators affecting patients with DVT after LC resection in the testing cohort were determined using logistic regression and receiver operator characteristic (ROC) analyses. One validation cohort was used to assess the risk prediction models. DVT incidence was higher in the thoracoscopic group (18.7%) than in the thoracotomy group (11.2%) in the testing cohort (χ 2 = 4.116, P = 0.042). The final model to predict the incidence of DVT after thoracoscopic LC excision (1 day after surgery) was as follows: Logit(P) = 9.378 - 0.061(R-value) - 0.109(K value) + 0.374(α angle) + 0.403(MA) + 0.298(FIB) + 0.406(D-D) + 0.190(MDA) - 0.097(CD4+/CD8+). For thoracotomy LC resection, the final model (3 days after operation) was: Logit(P) = -2.463 - 0.026(R-value) - 0.143(K value) + 0.402(α angle) + 0.198(D-D) + 0.237(MDA) + 0.409(SOD). In the validation cohort, this risk prediction model continued to demonstrate good predictive performance. As a result, the predictive accuracy of postoperative DVT in patients who underwent thoracoscopic LC resection and thoracotomy LC resection was improved by risk prediction models.
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Affiliation(s)
- Jianhua Li
- Department of Thoracic Surgery, Chengyang District People’s Hospital, Qingdao, Shandong, China
| | - Futao Zhang
- Department of Thoracic Surgery, Chengyang District People’s Hospital, Qingdao, Shandong, China
| | - Xinyan Lan
- Department of Thoracic Surgery, Chengyang District People’s Hospital, Qingdao, Shandong, China
| | - Feifei Li
- Weifang Second People’s Hospital, Weifang, Shandong, China
| | - Chunrui Tan
- People’s Hospital of Jimo District, Qingdao, Shandong, China
| | - Wangkai Cao
- Weifang Second People’s Hospital, Weifang, Shandong, China
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Gerasimova-Meigal L, Meigal A, Gerasimova M, Sklyarova A, Sirotinina E. Cerebral Circulation and Brain Temperature during an Ultra-Short Session of Dry Immersion in Young Subjects. PATHOPHYSIOLOGY 2023; 30:209-218. [PMID: 37218916 DOI: 10.3390/pathophysiology30020018] [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: 04/10/2023] [Revised: 04/22/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
The primary aim of the study was to assess cerebral circulation in healthy young subjects during an ultra-short (45 min) session of ground-based microgravity modeled by "dry" immersion (DI), with the help of a multifunctional Laser Doppler Flowmetry (LDF) analyzer. In addition, we tested a hypothesis that cerebral temperature would grow during a DI session. The supraorbital area of the forehead and forearm area were tested before, within, and after a DI session. Average perfusion, five oscillation ranges of the LDF spectrum, and brain temperature were assessed. Within a DI session, in the supraorbital area most of LDF parameters remained unchanged except for a 30% increase in respiratory associated (venular) rhythm. The temperature of the supraorbital area increased by up to 38.5 °C within the DI session. In the forearm area, the average value of perfusion and its nutritive component increased, presumably due to thermoregulation. In conclusion, the results suggest that a 45 min DI session does not exert a substantial effect on cerebral blood perfusion and systemic hemodynamics in young healthy subjects. Moderate signs of venous stasis were observed, and brain temperature increased during a DI session. These findings must be thoroughly validated in future studies because elevated brain temperature during a DI session can contribute to some reactions to DI.
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Affiliation(s)
- Liudmila Gerasimova-Meigal
- Department of Physiology and Pathophysiology, Petrozavodsk State University, 33, Lenin Pr., 185910 Petrozavodsk, Russia
| | - Alexander Meigal
- Department of Physiology and Pathophysiology, Petrozavodsk State University, 33, Lenin Pr., 185910 Petrozavodsk, Russia
| | - Maria Gerasimova
- Department of Physiology and Pathophysiology, Petrozavodsk State University, 33, Lenin Pr., 185910 Petrozavodsk, Russia
| | - Anna Sklyarova
- Department of Physiology and Pathophysiology, Petrozavodsk State University, 33, Lenin Pr., 185910 Petrozavodsk, Russia
| | - Ekaterina Sirotinina
- Department of Physiology and Pathophysiology, Petrozavodsk State University, 33, Lenin Pr., 185910 Petrozavodsk, Russia
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Boschert AL, Gauger P, Bach A, Gerlach D, Johannes B, Jordan J, Li Z, Elmenhorst D, Bauer A, Marshall-Goebel K, Tank J, Zange J, Rittweger J. External to internal cranial perfusion shifts during simulated weightlessness: Results from a randomized cross-over trial. NPJ Microgravity 2023; 9:25. [PMID: 36977696 PMCID: PMC10050182 DOI: 10.1038/s41526-023-00267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
The exact pathophysiology of the spaceflight-associated neuro-ocular syndrome (SANS) has so far not been completely elucidated. In this study we assessed the effect of acute head-down tilt position on the mean flow of the intra- and extracranial vessels. Our results suggest a shift from the external to the internal system that might play an important role in the pathomechanism of SANS.
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Affiliation(s)
- Alessa L Boschert
- Department of Muscle and Bone Metabolism, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.
- Institute of Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
| | - Peter Gauger
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Anja Bach
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Darius Gerlach
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Bernd Johannes
- Department of Muscle and Bone Metabolism, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR) and Chair of Aerospace Medicine, Cologne, Germany
| | - Zhili Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - David Elmenhorst
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine (INM-2), Jülich, Germany
| | - Andreas Bauer
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine (INM-2), Jülich, Germany
| | | | - Jens Tank
- Department of Cardiovascular Aerospace Medicine, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Jochen Zange
- Department of Muscle and Bone Metabolism, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Jörn Rittweger
- Department of Muscle and Bone Metabolism, German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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Whittle RS, Diaz-Artiles A. Gravitational effects on carotid and jugular characteristics in graded head-up and head-down tilt. J Appl Physiol (1985) 2023; 134:217-229. [PMID: 36476158 PMCID: PMC9870583 DOI: 10.1152/japplphysiol.00248.2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Altered gravity affects hemodynamics and blood flow in the neck. At least one incidence of jugular venous thrombosis has been reported in an astronaut on the International Space Station. This investigation explores the impact of changes in the direction of the gravitational vector on the characteristics of the neck arteries and veins. Twelve subjects underwent graded tilt from 45° head-up to 45° head-down in 15° increments in both supine and prone positions. At each angle, the cross-sectional area of the left and right common carotid arteries (ACCA) and internal jugular veins (AIJV) were measured by ultrasound. Internal jugular venous pressure (IJVP) was also measured by compression sonography. Gravitational dose-response curves were generated from experimental data. ACCA did not show any gravitational dependence. Conversely, both AIJV and IJVP increased in a nonlinear fashion with head-down tilt. AIJV was significantly larger on the right side than the left side at all tilt angles. In addition, IJVP was significantly elevated in the prone position compared with the supine position, most likely because of raised intrathoracic pressure while prone. Dose-response curves were compared with existing experimental data from parabolic flight and spaceflight studies, showing good agreement on an acute timescale. The quantification of jugular hemodynamics as a function of changes in the gravitational vector presented here provides a terrestrial model to reference spaceflight-induced changes, contributes to the assessment of the pathogenesis of spaceflight venous thromboembolism events, and informs the development of countermeasures.NEW & NOTEWORTHY Flow stasis and thrombosis have been identified in the jugular vein during spaceflight. We measured the area and pressure of the internal jugular vein and the area of the common carotid artery in graded head-up and head-down tilt. Experimental data are used to generate gravitational dose-response curves for the measured variables, demonstrating that jugular vein area and pressure exhibit a nonlinear response to altered gravity. Gravitational dose-response curves show good agreement with spaceflight and parabolic flight studies.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
- Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas
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11
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Ogoh S, Hirasawa A, Shibata S. Influence of head-up tile and lower body negative pressure on the internal jugular vein. Physiol Rep 2022; 10:e15248. [PMID: 35581747 PMCID: PMC9114655 DOI: 10.14814/phy2.15248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 06/15/2023] Open
Abstract
Head-up tilt (HUT)-induced gravitational stress causes collapse of the internal jugular vein (IJV) by decreasing central blood volume and through mass-effect from the surrounding tissues. Besides HUT, lower body negative pressure (LBNP) is used to stimulate orthostatic stress as an experimental model. Compared to HUT, LBNP has less of a gravitational effect because of the supine position; therefore, we hypothesized that LBNP causes less of a decrease in the cross-sectional area of the IJV compared to HUT. We tested the hypothesis by measuring the cross-sectional area of the IJV using B-mode ultrasonography while inducing orthostatic stress at levels of -40 mmHg LBNP and 60° HUT. The cross-sectional area of IJV decreased from the resting baseline during both LBNP and HUT trials, but the LBNP-induced decrease in the cross-sectional area of IJV was smaller than that of HUT (right, -45% ± 49% vs. -78% ± 27%, p = 0.008; left, -49% ± 27% vs. -78% ± 20%, p = 0.004). Since changes in venous outflow may affect cerebral arterial circulation, the findings of the present study suggest that orthostatic stress induced by different techniques modulates cerebral blood flow regulation through its effect on venous outflow.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical EngineeringToyo UniversitySaitamaJapan
- Neurovascular Research LaboratoryFaculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Ai Hirasawa
- Department of Health and WelfareFaculty of Health SciencesKyorin UniversityTokyoJapan
| | - Shigeki Shibata
- Department of Physical TherapyFaculty of Health ScienceKyorin UniversityTokyoJapan
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12
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Harris KM, Weber T, Greaves D, Green DA, Goswami N, Petersen LG. Going against the flow: are venous thromboembolism and impaired cerebral drainage critical risks for spaceflight? J Appl Physiol (1985) 2022; 132:270-273. [PMID: 34672768 PMCID: PMC8759966 DOI: 10.1152/japplphysiol.00425.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Katie M. Harris
- 1Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Tobias Weber
- 2European Astronaut Centre, European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany,3KBR GmbH, Cologne, Germany
| | - Danielle Greaves
- 4Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - David Andrew Green
- 2European Astronaut Centre, European Space Agency, Space Medicine Team (HRE-OM), Cologne, Germany,3KBR GmbH, Cologne, Germany,5Centre of Human & Applied Physiological Sciences, King’s College London, London, United Kingdom
| | - Nandu Goswami
- 6Division of Physiology, Otto Löwi Research Center for Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
| | - Lonnie G. Petersen
- 7Department of Mechanical and Aerospace Engineering, University of California, San Diego, California,8Department of Radiology, University of California, San Diego, California
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13
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Ogoh S, Sato K, de Abreu S, Denise P, Normand H. Effect of jump exercise training on long-term head-down bed rest-induced cerebral blood flow responses in arteries and veins. Exp Physiol 2021; 106:1549-1558. [PMID: 33866619 DOI: 10.1113/ep089102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/29/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the effect of an exercise countermeasure on microgravity-induced change in cerebral blood flow? What is the main finding and its importance? Jump exercise training as a countermeasure did not modify the heterogeneous cerebral blood flow response to head-down bed rest, suggesting that this method is effective in preventing cardiovascular system deconditioning but is not good for cerebral haemodynamics. ABSTRACT This study aimed to examine the effect of an exercise countermeasure on cerebral blood flow (CBF) response to long-term -6° head-down bed rest (HDBR) in all cerebral arteries and veins. Twenty male volunteers were exposed to HDBR for 60 days with (training group, n = 10) or without (control group, n = 10) jump exercise training as a countermeasure to spaceflight. The blood flow in the neck conduit arteries (internal carotid and vertebral artery; ICA and VA) and veins (internal jugular and vertebral veins; IJV and VV) was measured, using ultrasonography before (baseline) HDBR, on the 30th and 57th day of HDBR. Long-term HDBR causes a heterogeneous CBF response between the anterior and the posterior brain or between arteries and veins. Long-term HDBR decreased anterior cerebral arterial and venous blood flow, while posterior cerebral arterial and venous blood flows were well maintained. However, exercise jump training did not change each arterial and venous CBF responses to HDBR (control vs. training; ICA, P = 0.643; VA, P = 0.542; external carotid artery, P = 0.644; IJV, P = 0.980; VV, P = 0.999). These findings suggest that jump exercise training did not modify the heterogeneous CBF response to long-term HDBR.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | | | - Steven de Abreu
- Unicaen, Inserm Comete, GIP Cyceron, Normandie University, Caen, France
| | - Pierre Denise
- Unicaen, Inserm Comete, GIP Cyceron, Normandie University, Caen, France
| | - Hervé Normand
- Unicaen, Inserm Comete, GIP Cyceron, Normandie University, Caen, France
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14
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Kim DS, Vaquer S, Mazzolai L, Roberts LN, Pavela J, Watanabe M, Weerts G, Green DA. The effect of microgravity on the human venous system and blood coagulation: a systematic review. Exp Physiol 2021; 106:1149-1158. [PMID: 33704837 DOI: 10.1113/ep089409] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022]
Abstract
NEW FINDINGS What is the central question of this study? Recently, an internal jugular venous thrombus was identified during spaceflight: does microgravity induce venous and/or coagulation pathophysiology, and thus an increased risk of venous thromboembolism (VTE)? What is the main finding and its importance? Whilst data are limited, this systematic review suggests that microgravity and its analogues may induce an enhanced coagulation state due to venous changes most prominent in the cephalad venous system, as a consequence of changes in venous flow, distension, pressures, endothelial damage and possibly hypercoagulability in microgravity and its analogues. However, whether such changes precipitate an increased VTE risk in spaceflight remains to be determined. ABSTRACT Recently, an internal jugular venous thrombus was identified during spaceflight, but whether microgravity induces venous and/or coagulation pathophysiology, and thus, an increased risk of venous thromboembolism (VTE) is unclear. Therefore, a systematic (Cochrane compliant) review was performed of venous system or coagulation parameters in actual spaceflight (microgravity) or ground-based analogues in PubMed, MEDLINE, Ovid EMBASE, Cochrane Library, European Space Agency, National Aeronautics and Space Administration, and Deutsches Zentrum für Luft-und Raumfahrt databases. Seven-hundred and eight articles were retrieved, of which 26 were included for evaluation with 21 evaluating venous, and five coagulation parameters. Nine articles contained spaceflight data, whereas the rest reported ground-based analogue data. There is substantial variability in study design, objectives and outcomes. Yet, data suggested cephalad venous system dilatation, increased venous pressures and decreased/reversed flow in microgravity. Increased fibrinogen levels, presence of thrombin generation markers and endothelial damage were also reported. Limited human venous and coagulation system data exist in spaceflight, or its analogues. Nevertheless, data suggest spaceflight may induce an enhanced coagulation state in the cephalad venous system, as a consequence of changes in venous flow, distension, pressures, endothelial damage and possibly hypercoagulability. Whether such changes precipitate an increased VTE risk in spaceflight remains to be determined.
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Affiliation(s)
- David S Kim
- Space Medicine Team, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany.,Department of Emergency Medicine, University of British Columbia, British Columbia, Vancouver, Canada
| | - Sergi Vaquer
- Space Medicine Team, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany.,KBR, WyleLabs GmbH, Cologne, Germany
| | - Lucia Mazzolai
- Angiology division, Heart and Vessel Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lara N Roberts
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - James Pavela
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Guillaume Weerts
- Space Medicine Team, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany
| | - David A Green
- Space Medicine Team, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany.,KBR, WyleLabs GmbH, Cologne, Germany.,Centre of Human and Applied Physiological Sciences, King's College London, London, UK
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15
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Du J, Cui J, Yang J, Wang P, Zhang L, Luo B, Han B. Alterations in Cerebral Hemodynamics During Microgravity: A Literature Review. Med Sci Monit 2021; 27:e928108. [PMID: 33446627 PMCID: PMC7814510 DOI: 10.12659/msm.928108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Most reported neurological symptoms that happen after exposure to microgravity could be originated from alterations in cerebral hemodynamics. The complicated mechanisms involved in the process of hemodynamics and the disparate experimental protocols designed to study the process may have contributed to the discrepancies in results between studies and the lack of consensus among researchers. This literature review examines spaceflight and ground-based studies of cerebral hemodynamics and aims to summarize the underlying physiological mechanisms that are altered in cerebral hemodynamics during microgravity. We reviewed studies that were published before July 2020 and sought to provide a comprehensive summary of the physiological or pathological theories of hemodynamics and to arrive at firm conclusions from incongruous results that were reported in those related articles. We give plausible explanations of inconsistent results on factors including intracranial pressure, cerebral blood flow, and cerebrovascular autoregulation. Although there are no definitive data to confirm how cerebral hemodynamics changes during microgravity, every discrepancy in results was interpreted by existing theories, which were derived from physiological and pathological processes. We conclude that microgravity-induced alterations of hemodynamics at the brain level are multifaceted. Factors including duration, partial pressures of carbon dioxide, and individual adaptability contribute to this process and are unpredictable. With a growing understanding of this hemodynamics model, additional factors will likely be considered. Aiming for a full understanding of the physiological and/or pathological changes of hemodynamics will enable researchers to investigate its cellular and molecular mechanisms in future studies, which are desperately needed.
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Affiliation(s)
- Jichen Du
- Department of Neurology, Aerospace Center Hospital, Beijing, China (mainland)
| | - Jiangbo Cui
- Aerospace Clinic Academy, Peking University Health Science Center, Beijing, China (mainland)
| | - Jing Yang
- Department of Neurology, Aerospace Center Hospital, Beijing, China (mainland)
| | - Peifu Wang
- Department of Neurology, Aerospace Center Hospital, Beijing, China (mainland)
| | - Lvming Zhang
- Department of Neurology, Aerospace Center Hospital, Beijing, China (mainland)
| | - Bin Luo
- Department of Neurology, Aerospace Center Hospital, Beijing, China (mainland)
| | - Bailin Han
- Department of Neurology, Aerospace Center Hospital, Beijing, China (mainland)
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Buoite Stella A, Ajčević M, Furlanis G, Manganotti P. Neurophysiological adaptations to spaceflight and simulated microgravity. Clin Neurophysiol 2020; 132:498-504. [PMID: 33450569 DOI: 10.1016/j.clinph.2020.11.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023]
Abstract
Changes in physiological functions after spaceflight and simulated spaceflight involve several mechanisms. Microgravity is one of them and it can be partially reproduced with models, such as head down bed rest (HDBR). Yet, only a few studies have investigated in detail the complexity of neurophysiological systems and their integration to maintain homeostasis. Central nervous system changes have been studied both in their structural and functional component with advanced techniques, such as functional magnetic resonance (fMRI), showing the main involvement of the cerebellum, cortical sensorimotor, and somatosensory areas, as well as vestibular-related pathways. Analysis of electroencephalography (EEG) led to contrasting results, mainly due to the different factors affecting brain activity. The study of corticospinal excitability may enable a deeper understanding of countermeasures' effect, since greater excitability has been shown being correlated with better preservation of functions. Less is known about somatosensory evoked potentials and peripheral nerve function, yet they may be involved in a homeostatic mechanism fundamental to thermoregulation. Extending the knowledge of such alterations during simulated microgravity may be useful not only for space exploration, but for its application in clinical conditions and for life on Earth, as well.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Miloš Ajčević
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio, 6/1, 34127 Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
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