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Barnhart H, Aviles F, Pannunzio J, Sirkis N, Hubbard C, Hardigan P, Ginsburg S, Mayrovitz H, Eckert KA, Melin MM. Using noninvasive imaging to assess manual lymphatic drainage on lymphatic/venous responses in a spaceflight analog. NPJ Microgravity 2024; 10:93. [PMID: 39362907 PMCID: PMC11450199 DOI: 10.1038/s41526-024-00429-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: 09/03/2023] [Accepted: 09/19/2024] [Indexed: 10/05/2024] Open
Abstract
This retrospective case series (clinicaltrials.gov NCT06405282) used noninvasive imaging devices (NIID) to assess the effect of manual lymphatic drainage (MLD) on dermal/venous fluid distribution, perfusion, and temperature alterations of the head, neck, upper torso, and legs while in the 6-degree head-down tilt validated spaceflight analog. A lymphatic fluid scanner measured tissue dielectric constant levels. Near-infrared spectroscopy assessed perfusion, by measuring tissue oxygenation saturation. Long-wave infrared thermography measured tissue temperature gradients. Fifteen healthy, university students participated. NIID assessments were taken 1 minute after assuming the HDT position and then every 30 minutes, with MLD administered from 180 to 195 minutes. Subjects returned to the sitting position and were assessed at post-225 min NIID demonstrated significant changes from baseline (p < 0.01), although these changes at areas of interest varied. MLD had a reverse effect on all variables. NIID assessment supported the potential use of MLD to mitigate fluid shifts during a spaceflight analog.
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Affiliation(s)
- Heather Barnhart
- Department of Physical Therapy, Dr. Pallavi Patel College of Health Care Science, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Frank Aviles
- Hyperbaric Physicians of Georgia, Cumming, GA, USA
| | - Johanna Pannunzio
- Department of Physical Therapy, Dr. Pallavi Patel College of Health Care Science, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Nathan Sirkis
- Department of Physical Therapy, Dr. Pallavi Patel College of Health Care Science, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Chantel Hubbard
- Department of Physical Therapy, Dr. Pallavi Patel College of Health Care Science, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Patrick Hardigan
- Research Department; Dr. Kiran C Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Sabrina Ginsburg
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Harvey Mayrovitz
- Department of Medical Education, Dr. Kiran C Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - M Mark Melin
- Gonda Vascular Center, Wound Clinic, Mayo Clinic, Rochester, MN, USA.
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Caddy HT, Fujino M, Vahabli E, Voigt V, Kelsey LJ, Dilley RJ, Carvalho LS, Takahashi S, Green DJ, Doyle BJ. Simulation of murine retinal hemodynamics in response to tail suspension. Comput Biol Med 2024; 182:109148. [PMID: 39298883 DOI: 10.1016/j.compbiomed.2024.109148] [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: 04/12/2024] [Revised: 09/03/2024] [Accepted: 09/08/2024] [Indexed: 09/22/2024]
Abstract
The etiology of spaceflight-associated neuro-ocular syndrome (SANS) remains unclear. Recent murine studies indicate there may be a link between the space environment and retinal endothelial dysfunction. Post-fixed control (N = 4) and 14-day tail-suspended (TS) (N = 4) mice eye samples were stained and imaged for the vessel plexus and co-located regions of endothelial cell death. A custom workflow combined whole-mounted and tear reconstructed three-dimensional (3D) spherical retinal plexus models with computational fluid dynamics (CFD) simulation that accounted for the Fåhræus-Lindqvist effect and boundary conditions that accommodated TS fluid pressure measurements and deeper capillary layer blood flow distribution. TS samples exhibited reduced surface area (4.6 ± 0.5 mm2 vs. 3.5 ± 0.3 mm2, P = 0.010) and shorter lengths between branches in small vessels (<10 μm, 69.5 ± 0.6 μm vs. 60.4 ± 1.1 μm, P < 0.001). Wall shear stress (WSS) and pressure were higher in TS mice compared to controls, particularly in smaller vessels (<10 μm, WSS: 6.57 ± 1.08 Pa vs. 4.72 ± 0.67 Pa, P = 0.034, Pressure: 72.04 ± 3.14 mmHg vs. 50.64 ± 6.74 mmHg, P = 0.004). Rates of retinal endothelial cell death were variable in TS mice compared to controls. WSS and pressure were generally higher in cell death regions, both within and between cohorts, but significance was variable and limited to small to medium-sized vessels (<20 μm). These findings suggest a link may exist between emulated microgravity and retinal endothelial dysfunction that may have implications for SANS development. Future work with increased sample sizes of larger species or spaceflight cohorts should be considered.
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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, Australia; School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Australia
| | - Mitsunori Fujino
- Department of Anatomy and Embryology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Ph.D. Program in Human Biology, School of Integrative and Global Majors, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ebrahim Vahabli
- 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, Australia; School of Engineering, The University of Western Australia, Perth, Australia; T3mPLATE, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and UWA Centre for Medical Research, The University of Western Australia, Perth, Australia
| | - Valentina Voigt
- Centre for Experimental Immunology, Lions Eye Institute, Nedlands, 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, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Rodney J Dilley
- T3mPLATE, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and UWA Centre for Medical Research, The University of Western Australia, Perth, Australia
| | - Livia S Carvalho
- Retinal Genomics and Therapy Group, Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Perth, Australia; Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Satoru Takahashi
- Department of Anatomy and Embryology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Laboratory Animal Resource Center, University of Tsukuba, Tsukuba, Ibaraki, Japan; Life Science Center, Tsukuba Advanced Research Alliance (TARA), University of Tsukuba, Tsukuba, Ibaraki, Japan; International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan; Transborder Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, 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, Australia; School of Engineering, The University of Western Australia, Perth, Australia.
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Suh A, Ditelberg S, Szeto JJ, Kumar D, Ong J, Robert Gibson C, Mader TH, Waisberg E, Lee AG. Safety protocols, precautions, and countermeasures aboard the International Space Station (ISS) to prevent ocular injury. Surv Ophthalmol 2024:S0039-6257(24)00097-3. [PMID: 39236988 DOI: 10.1016/j.survophthal.2024.08.005] [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: 04/22/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
The International Space Station (ISS) is a $100 billion epicenter of human activity in the vacuum of space, displaying mankind's collective endeavor to explore the cosmic frontier. Even within the marvels of technological sophistication aboard the ISS, the human eye remains a highly vulnerable structure. In the absence of multiple layers of protection and risk assessments, crewmembers would face a substantial increase in vulnerability to ocular injury. Aside from stringent preflight screening criteria for astronauts, the ISS is equipped with ophthalmic medications, environmental control and life support systems (e.g., humidity regulation, carbon dioxide removal, pressurized device regulators), and radiation protection to reduce ocular injury. Moreover, additional countermeasures are currently being developed to mitigate the effects of spaceflight-associated neuro-ocular syndrome (SANS) and lunar dust toxicity for the Artemis Program missions. The success of future endeavors hinges not only on continued technological innovation, but also respecting the intricate interplay between human physiology and the extraterrestrial environments. Establishing habitations on the Moon and Mars, as well as NASA's Gateway Program (humanity's first space station around the Moon), will introduce a new set of challenges, underscoring the necessity for continuous insights into ocular health in space. We discuss the safety protocols, precautions, and countermeasures implemented on the ISS to prevent ocular injury - an aspect often overshadowed by the grandeur of space exploration.
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Affiliation(s)
- Alex Suh
- Tulane University School of Medicine, New Orleans, Louisiana, United States.
| | - Sarah Ditelberg
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
| | - Jonathan J Szeto
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Divy Kumar
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States
| | - C Robert Gibson
- KBR, NASA Johnson Space Center, Houston, Texas, United States
| | - Thomas H Mader
- NASA Ophthalmology Consultant, Moab, Utah, United States
| | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, United Kingdom
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States; University of Texas MD Anderson Cancer Center, Houston, Texas, United States; Texas A&M College of Medicine, Texas, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
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Iftime A, Tofolean IT, Pintilie V, Călinescu O, Busnatu S, Papacocea IR. Differential Functional Changes in Visual Performance during Acute Exposure to Microgravity Analogue and Their Potential Links with Spaceflight-Associated Neuro-Ocular Syndrome. Diagnostics (Basel) 2024; 14:1918. [PMID: 39272703 PMCID: PMC11394298 DOI: 10.3390/diagnostics14171918] [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: 06/17/2024] [Revised: 08/23/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Spaceflight-Associated Neuro-Ocular Syndrome (SANS) is a complex pathology threatening the health of astronauts, with incompletely understood causes and no current specific functional diagnostic or screening test. We investigated the use of the differential performance of the visual system (central vs. perimacular visual function) as a candidate marker of SANS-related pathology in a ground-based microgravity analogue. METHODS We used a simple reaction time (SRT) task to visual stimuli, presented in the central and perimacular field of view, as a measure of the overall performance of the visual function, during acute settings (first 10 min) of vertical, bed rest (BR), -6°, and -15° head-down tilt (HDT) presentations in healthy participants (n = 8). We built dose-response models linking the gravitational component to SRT distribution parameters in the central vs. perimacular areas. RESULTS Acute exposure to microgravity induces detectable changes between SRT distributions in the perimacular vs. central retina (increased mean, standard deviation, and tau component of the ex-Gaussian function) in HDT compared with vertical presentation. CONCLUSIONS Functional testing of the perimacular retina might be beneficial for the earlier detection of SANS-related ailments in addition to regular testing of the central vision. Future diagnostic tests should consider the investigation of the extra-macular areas, particularly towards the optic disc.
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Affiliation(s)
- Adrian Iftime
- Biophysics Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioana Teodora Tofolean
- Ophthalmology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Eye Hospital, 010464 Bucharest, Romania
| | - Victor Pintilie
- Biophysics Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Octavian Călinescu
- Biophysics Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Stefan Busnatu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Emergency Hospital "Bagdasar-Arseni", 050474 Bucharest, Romania
- Center for Innovation and eHealth, Carol Davila University of Medicine and Pharmacy, 010451 Bucharest, Romania
| | - Ioana Raluca Papacocea
- Center for Innovation and eHealth, Carol Davila University of Medicine and Pharmacy, 010451 Bucharest, Romania
- Physiology III Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Mendes Zambetta R, Signini ÉDF, Catai AM, Santos TCRD, Michaliski ES, Nazario AK, Ocamoto GN, Frigieri G, Russo TL. Is the ICP pulse waveform P2/P1 ratio during -6° head-down tilt associated with relative VO 2 peak? A non-invasive intracranial compliance monitoring approach. BRAIN & SPINE 2024; 4:103327. [PMID: 39281851 PMCID: PMC11402318 DOI: 10.1016/j.bas.2024.103327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/15/2024] [Accepted: 08/27/2024] [Indexed: 09/18/2024]
Abstract
Background Spaceflights influence intracranial compliance (ICC). P2/P1 ratio, from the intracranial pressure (ICP) waveform, provides information about ICC. Additionally, non-invasive methods for ICC monitoring are needed for spaceflights. Furthermore, astronauts try to maintain good levels of cardiorespiratory fitness before and during spaceflights, not only to sustain exploratory missions, but also to prevent diseases in extreme environments. Objective to correlate cardiorespiratory fitness levels with the P2/P1 ratio during a microgravity analog [-6° head-down tilt (HDT)]. Method 34 individuals (11 women), mean age of 31.7 (±6.3) years and BMI 24.2 (±3.2) performed a cardiopulmonary exercise testing (CPET) with an incremental protocol on a cycle ergometer to determine the cardiopulmonary fitness through peak relative oxygen uptake (VO2 peak) of each individual. On the second test, which was conducted in an interval of 15 days of the CPET, participants remained for 30 min at HDT with P2/P1 ratio acquired using a non-invasive strain gauge sensor. The average of the last 5 min was used for analysis. The mean P2/P1 ratio and relative VO2 peak were correlated using the Spearman test. Results Volunteers presented 1.05 ± 0.2 of P2/P1 ratio and VO2 peak of 47.5 ± 7.6 mL/kg/min. The Spearman test indicated a negative and low correlation between the P2/P1 ratio and VO2 peak (ρ = -0.388; p = 0.023). Conclusion The study suggests that the better the cardiorespiratory fitness, the better ICC in a weightlessness simulation.
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Affiliation(s)
- Rafaella Mendes Zambetta
- Physical Therapy Department, Federal University of São Carlos, UFSCar, Rodovia Washington Luís, Km 235, São Carlos, SP, Brazil
| | - Étore De Favari Signini
- Physical Therapy Department, Federal University of São Carlos, UFSCar, Rodovia Washington Luís, Km 235, São Carlos, SP, Brazil
| | - Aparecida Maria Catai
- Physical Therapy Department, Federal University of São Carlos, UFSCar, Rodovia Washington Luís, Km 235, São Carlos, SP, Brazil
| | | | - Eloisa Soares Michaliski
- Physical Therapy Department, Federal University of São Carlos, UFSCar, Rodovia Washington Luís, Km 235, São Carlos, SP, Brazil
| | - Ana Karoline Nazario
- Physical Therapy Department, Federal University of São Carlos, UFSCar, Rodovia Washington Luís, Km 235, São Carlos, SP, Brazil
| | | | | | - Thiago Luiz Russo
- Physical Therapy Department, Federal University of São Carlos, UFSCar, Rodovia Washington Luís, Km 235, São Carlos, SP, Brazil
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Masood MT, Wang JWW, Zoumi EA, Jain K, Suh A, Ong J, Waisberg E, Masalkhi M, Lee AG. Impedance threshold device as a countermeasure for spaceflight associated neuro-ocular syndrome (SANS): Mitigating mechanisms in proposed pathophysiology. LIFE SCIENCES IN SPACE RESEARCH 2024; 42:99-107. [PMID: 39067998 DOI: 10.1016/j.lssr.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024]
Abstract
Long-duration spaceflight (LDSF) is associated with unique hazards and linked with numerous human health risks including Spaceflight Associated Neuro-ocular Syndrome (SANS). The proposed mechanisms for SANS include microgravity induced cephalad fluid shift and increased Intracranial Pressure (ICP). SANS is a disorder seen only after LDSF and has no direct terrestrial pathologic counterpart as the zero G environment cannot be completely replicated on Earth. Head-down tilt, bed rest studies however have been used as a terrestrial analog and produce the cephalad fluid shift. Some proposed countermeasures for SANS include vasoconstrictive thigh cuffs and lower body negative pressure. Another potential researched countermeasure is the impedance threshold device (ITD) which can reduce ICP. We review the mechanisms of the ITD and its potential use as a countermeasure for SANS.
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Affiliation(s)
| | | | | | | | - Alex Suh
- Tulane University School of Medicine, New Orleans, LA, United States
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States
| | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, United Kingdom
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States; University of Texas MD Anderson Cancer Center, Houston, Texas, United States; Texas A&M College of Medicine, Bryan, Texas, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States.
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Memon H, Ong J, Waisberg E, Panzo N, Sarker P, Zaman N, Tavakkoli A, Lee AG. Biophysics of ophthalmic medications during spaceflight: Principles of ocular fluid dynamics and pharmacokinetics in microgravity. LIFE SCIENCES IN SPACE RESEARCH 2024; 42:53-61. [PMID: 39067991 DOI: 10.1016/j.lssr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 07/30/2024]
Abstract
As spaceflight becomes increasingly accessible and expansive to humanity, it is becoming ever more essential to consider the treatment of various eye diseases in these challenging environments. This paper delves into the increasing fascination with interplanetary travel and its implications for health management in varying environments. It specifically discusses the pharmacological management of ocular diseases, focusing on two key delivery methods: topical eye drops and intravitreal injections. The paper explores how microgravity impacts the administration of these treatments, a vital aspect in understanding drug delivery in space. An extensive analysis is presented on the pharmacokinetics of eye medications, examining the interaction between pharmaceuticals and ocular tissues in zero gravity. The goal of the paper is to bridge the understanding of fluid dynamics, microgravity and the human physiological systems to pave the way for innovative solutions faced by individuals in microgravity.
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Affiliation(s)
- Hamza Memon
- Texas A&M School of Medicine, Bryan, TX, United States
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States
| | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, United Kingdom
| | | | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Andrew G Lee
- Texas A&M School of Medicine, Bryan, TX, United States; Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States; University of Texas MD Anderson Cancer Center, Houston, Texas, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States.
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Soares B, Ong J, Waisberg E, Sarker P, Zaman N, Tavakkoli A, Lee AG. Imaging in spaceflight associated neuro-ocular syndrome (SANS): Current technology and future directions in modalities. LIFE SCIENCES IN SPACE RESEARCH 2024; 42:40-46. [PMID: 39067989 DOI: 10.1016/j.lssr.2024.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 07/30/2024]
Abstract
With plans for future long-duration crewed exploration, NASA has identified several high priority potential health risks to astronauts in space. One such risk is a collection of neurologic and ophthalmic findings termed spaceflight associated neuro-ocular syndrome (SANS). The findings of SANS include optic disc edema, globe flattening, retinal nerve fiber layer thickening, chorioretinal folds, hyperopic shifts, and cotton-wool spots. The cause of SANS was initially thought to be a cephalad fluid shift in microgravity leading to increased intracranial pressure, venous stasis and impaired CSF outflow, but the precise etiology of SANS remains ill defined. Recent studies have explored multiple possible pathogenic mechanisms for SANS including genetic and hormonal factors; a cephalad shift of fluid into the orbit and brain in microgravity; and disruption to the brain glymphatic system. Orbital, ocular, and cranial imaging, both on Earth and in space has been critical in the diagnosis and monitoring of SANS (e.g., fundus photography, optical coherence tomography (OCT), magnetic resonance imaging (MRI), and orbital/cranial ultrasound). In addition, we highlight near-infrared spectroscopy and diffusion tensor imaging, two newer modalities with potential use in future studies of SANS. In this manuscript we provide a review of these modalities, outline their current and potential use in space and on Earth, and review the reported major imaging findings in SANS.
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Affiliation(s)
- Benjamin Soares
- Boston University Chobanian & Avedisian School of Medicine, Boston, United States.
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, United States
| | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, United Kingdom
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Andrew G Lee
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States; Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St #450, Houston, Texas 77030, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States; University of Texas MD Anderson Cancer Center, Houston, Texas, United States; Texas A&M School of Medicine, Bryan, Texas, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States.
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Kamran SA, Hossain KF, Ong J, Waisberg E, Zaman N, Baker SA, Lee AG, Tavakkoli A. FA4SANS-GAN: A Novel Machine Learning Generative Adversarial Network to Further Understand Ophthalmic Changes in Spaceflight Associated Neuro-Ocular Syndrome (SANS). OPHTHALMOLOGY SCIENCE 2024; 4:100493. [PMID: 38682031 PMCID: PMC11046204 DOI: 10.1016/j.xops.2024.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 05/01/2024]
Abstract
Purpose To provide an automated system for synthesizing fluorescein angiography (FA) images from color fundus photographs for averting risks associated with fluorescein dye and extend its future application to spaceflight associated neuro-ocular syndrome (SANS) detection in spaceflight where resources are limited. Design Development and validation of a novel conditional generative adversarial network (GAN) trained on limited amount of FA and color fundus images with diabetic retinopathy and control cases. Participants Color fundus and FA paired images for unique patients were collected from a publicly available study. Methods FA4SANS-GAN was trained to generate FA images from color fundus photographs using 2 multiscale generators coupled with 2 patch-GAN discriminators. Eight hundred fifty color fundus and FA images were utilized for training by augmenting images from 17 unique patients. The model was evaluated on 56 fluorescein images collected from 14 unique patients. In addition, it was compared with 3 other GAN architectures trained on the same data set. Furthermore, we test the robustness of the models against acquisition noise and retaining structural information when introduced to artificially created biological markers. Main Outcome Measures For GAN synthesis, metric Fréchet Inception Distance (FID) and Kernel Inception Distance (KID). Also, two 1-sided tests (TOST) based on Welch's t test for measuring statistical significance. Results On test FA images, mean FID for FA4SANS-GAN was 39.8 (standard deviation, 9.9), which is better than GANgio model's mean of 43.2 (standard deviation, 13.7), Pix2PixHD's mean of 57.3 (standard deviation, 11.5) and Pix2Pix's mean of 67.5 (standard deviation, 11.7). Similarly for KID, FA4SANS-GAN achieved mean of 0.00278 (standard deviation, 0.00167) which is better than other 3 model's mean KID of 0.00303 (standard deviation, 0.00216), 0.00609 (standard deviation, 0.00238), 0.00784 (standard deviation, 0.00218). For TOST measurement, FA4SANS-GAN was proven to be statistically significant versus GANgio (P = 0.006); versus Pix2PixHD (P < 0.00001); and versus Pix2Pix (P < 0.00001). Conclusions Our study has shown FA4SANS-GAN to be statistically significant for 2 GAN synthesis metrics. Moreover, it is robust against acquisition noise, and can retain clear biological markers compared with the other 3 GAN architectures. This deployment of this model can be crucial in the International Space Station for detecting SANS. Financial Disclosures The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada
| | - Khondker Fariha Hossain
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan
| | - Ethan Waisberg
- Department of Ophthalmology, University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada
| | - Salah A. Baker
- Department of Physiology and Cell Biology, University of Nevada School of Medicine, Reno, Nevada
| | - Andrew G. Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas
- Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Ophthalmology, Texas A&M College of Medicine, Texas
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada
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10
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Soares B, Ong J, Osteicoechea D, Kadipasaoglu CM, Waisberg E, Sarker P, Zaman N, Tavakkoli A, Vizzeri G, Lee AG. A potential compensatory mechanism for spaceflight associated neuro-ocular changes from microgravity: current understanding and future directions. Eye (Lond) 2024; 38:1605-1607. [PMID: 38332375 PMCID: PMC11156849 DOI: 10.1038/s41433-024-02952-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Benjamin Soares
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | | | | | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, UK
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Gianmarco Vizzeri
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrew G Lee
- Texas A&M School of Medicine, Bryan, TX, USA.
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA.
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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11
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Ong J, Waisberg E, Masalkhi M, Suh A, Kamran SA, Paladugu P, Sarker P, Zaman N, Tavakkoli A, Lee AG. "Spaceflight-to-Eye Clinic": Terrestrial advances in ophthalmic healthcare delivery from space-based innovations. LIFE SCIENCES IN SPACE RESEARCH 2024; 41:100-109. [PMID: 38670636 DOI: 10.1016/j.lssr.2024.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/08/2024] [Indexed: 04/28/2024]
Abstract
The phrase "Bench-to-Bedside" is a well-known phrase in medicine, highlighting scientific discoveries that directly translate to impacting patient care. Key examples of translational research include identification of key molecular targets in diseases and development of diagnostic laboratory tests for earlier disease detection. Bridging these scientific advances to the bedside/clinic has played a meaningful impact in numerous patient lives. The spaceflight environment poses a unique opportunity to also make this impact; the nature of harsh extraterrestrial conditions and medically austere and remote environments push for cutting-edge technology innovation. Many of these novel technologies built for the spaceflight environment also have numerous benefits for human health on Earth. In this manuscript, we focus on "Spaceflight-to-Eye Clinic" and discuss technologies built for the spaceflight environment that eventually helped to optimize ophthalmic health on Earth (e.g., LADAR for satellite docking now utilized in eye-tracking technology for LASIK). We also discuss current technology research for spaceflight associated neuro-ocular syndrome (SANS) that may also be applied to terrestrial ophthalmic health. Ultimately, various advances made to enable to the future of space exploration have also advanced the ophthalmic health of individuals on Earth.
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Affiliation(s)
- Joshua Ong
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States.
| | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, United Kingdom
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Alex Suh
- Tulane University School of Medicine, New Orleans, LA, United States
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, United States
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, United States
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, United States
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, United States
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, United States; University of Texas MD Anderson Cancer Center, Houston, TX, United States; Texas A&M College of Medicine, TX, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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12
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Kamran SA, Hossain KF, Ong J, Zaman N, Waisberg E, Paladugu P, Lee AG, Tavakkoli A. SANS-CNN: An automated machine learning technique for spaceflight associated neuro-ocular syndrome with astronaut imaging data. NPJ Microgravity 2024; 10:40. [PMID: 38548790 PMCID: PMC10978911 DOI: 10.1038/s41526-024-00364-w] [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: 07/19/2023] [Accepted: 02/12/2024] [Indexed: 04/01/2024] Open
Abstract
Spaceflight associated neuro-ocular syndrome (SANS) is one of the largest physiologic barriers to spaceflight and requires evaluation and mitigation for future planetary missions. As the spaceflight environment is a clinically limited environment, the purpose of this research is to provide automated, early detection and prognosis of SANS with a machine learning model trained and validated on astronaut SANS optical coherence tomography (OCT) images. In this study, we present a lightweight convolutional neural network (CNN) incorporating an EfficientNet encoder for detecting SANS from OCT images titled "SANS-CNN." We used 6303 OCT B-scan images for training/validation (80%/20% split) and 945 for testing with a combination of terrestrial images and astronaut SANS images for both testing and validation. SANS-CNN was validated with SANS images labeled by NASA to evaluate accuracy, specificity, and sensitivity. To evaluate real-world outcomes, two state-of-the-art pre-trained architectures were also employed on this dataset. We use GRAD-CAM to visualize activation maps of intermediate layers to test the interpretability of SANS-CNN's prediction. SANS-CNN achieved 84.2% accuracy on the test set with an 85.6% specificity, 82.8% sensitivity, and 84.1% F1-score. Moreover, SANS-CNN outperforms two other state-of-the-art pre-trained architectures, ResNet50-v2 and MobileNet-v2, in accuracy by 21.4% and 13.1%, respectively. We also apply two class-activation map techniques to visualize critical SANS features perceived by the model. SANS-CNN represents a CNN model trained and validated with real astronaut OCT images, enabling fast and efficient prediction of SANS-like conditions for spaceflight missions beyond Earth's orbit in which clinical and computational resources are extremely limited.
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Affiliation(s)
- Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, US
| | - Khondker Fariha Hossain
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, US
| | - Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, US
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, US
| | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge, UK
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, US
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, US
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, US
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, US
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, US
- University of Texas MD Anderson Cancer Center, Houston, TX, US
- Texas A&M College of Medicine, Bryan, TX, US
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, US
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, US.
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13
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Bateman GA, Bateman AR. A perspective on the evidence for glymphatic obstruction in spaceflight associated neuro-ocular syndrome and fatigue. NPJ Microgravity 2024; 10:23. [PMID: 38418508 PMCID: PMC10901896 DOI: 10.1038/s41526-024-00365-9] [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: 11/29/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024] Open
Abstract
Spaceflight associated neuro-ocular syndrome (SANS) alters the vision of astronauts during long-duration spaceflights. Previously, the current authors have discussed the similarities and differences between SANS and idiopathic intracranial hypertension to try to elucidate a possible pathophysiology. Recently, a theory has been advanced that SANS may occur secondary to failure of the glymphatic system caused by venous dilatation within the brain and optic nerves. There is recent evidence to suggest glymphatic obstruction occurs in childhood hydrocephalus, multiple sclerosis and syringomyelia due to venous outflow dilatation similar to that proposed in SANS. The purpose of the current paper is to discuss the similarities and differences between the known CSF and venous pathophysiology in SANS with these other terrestrial diseases, to see if they can shed any further light on the underlying cause of this microgravity-induced disease.
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Affiliation(s)
- Grant Alexander Bateman
- Department of Medical Imaging, John Hunter Hospital, Newcastle, NSW, Australia.
- Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia.
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14
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Fois M, Diaz-Artiles A, Zaman SY, Ridolfi L, Scarsoglio S. Linking cerebral hemodynamics and ocular microgravity-induced alterations through an in silico-in vivo head-down tilt framework. NPJ Microgravity 2024; 10:22. [PMID: 38413627 PMCID: PMC10899661 DOI: 10.1038/s41526-024-00366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
Head-down tilt (HDT) has been widely proposed as a terrestrial analog of microgravity and used also to investigate the occurrence of spaceflight-associated neuro-ocular syndrome (SANS), which is currently considered one of the major health risks for human spaceflight. We propose here an in vivo validated numerical framework to simulate the acute ocular-cerebrovascular response to 6° HDT, to explore the etiology and pathophysiology of SANS. The model links cerebral and ocular posture-induced hemodynamics, simulating the response of the main cerebrovascular mechanisms, as well as the relationship between intracranial and intraocular pressure to HDT. Our results from short-term (10 min) 6° HDT show increased hemodynamic pulsatility in the proximal-to-distal/capillary-venous cerebral direction, a marked decrease (-43%) in ocular translaminar pressure, and an increase (+31%) in ocular perfusion pressure, suggesting a plausible explanation of the underlying mechanisms at the onset of ocular globe deformation and edema formation over longer time scales.
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Affiliation(s)
- Matteo Fois
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, Turin, 10129, Italy.
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843-3141, USA
- Department of Kinesiology and Sport Management, Texas A&M University, 2929 Research Pkwy, College Station, TX, 77845, USA
| | - Syeda Yasmin Zaman
- Department of Aerospace Engineering, Texas A&M University, 3141 TAMU, College Station, TX, 77843-3141, USA
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, Turin, 10129, Italy
- PolitoBioMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi 24, Turin, 10129, Italy
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, Turin, 10129, Italy
- PolitoBioMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi 24, Turin, 10129, Italy
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15
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Mehare A, Chakole S, Wandile B. Navigating the Unknown: A Comprehensive Review of Spaceflight-Associated Neuro-Ocular Syndrome. Cureus 2024; 16:e53380. [PMID: 38435236 PMCID: PMC10907968 DOI: 10.7759/cureus.53380] [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: 10/29/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Spaceflight-associated neuro-ocular syndrome (SANS) is a complex and multifaceted condition that affects astronauts during and after their missions in space. This comprehensive review delves into the various aspects of SANS, providing a thorough understanding of its definition, historical context, clinical presentation, epidemiology, diagnostic techniques, preventive measures, and management strategies. Various ocular and neurological symptoms, including visual impairment, optic disc edema, choroidal folds, retinal changes, and increased intracranial pressure, characterize SANS. While microgravity is a primary driver of SANS, other factors like radiation exposure, genetic predisposition, and environmental conditions within spacecraft contribute to its development. The duration of space missions is a significant factor, with longer missions associated with a higher incidence of SANS. This review explores the diagnostic criteria and variability in SANS presentation, shedding light on early detection and management challenges. The epidemiology section provides insights into the occurrence frequency, affected astronauts' demographics, and differences between long-term and short-term missions. Diagnostic tools, including ophthalmological assessments and imaging techniques, are crucial in monitoring astronaut health during missions. Preventive measures are vital in mitigating the impact of SANS. Current strategies, ongoing research in prevention methods, lifestyle and behavioral factors, and the potential role of artificial gravity are discussed in detail. Additionally, the review delves into interventions, potential pharmacological treatments, rehabilitation, and long-term management considerations for astronauts with SANS. The conclusion underscores the importance of continued research in SANS, addressing ongoing challenges, and highlighting unanswered questions. With the expansion of human space exploration, understanding and managing SANS is imperative to ensure the health and well-being of astronauts during long-duration missions. This review is a valuable resource for researchers, healthcare professionals, and space agencies striving to enhance our knowledge and address the complexities of SANS.
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Affiliation(s)
- Abhidnya Mehare
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan Wandile
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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16
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Kermorgant M, Chedmail T, Varenne F, Bareille MP, Beck A, Billette de Villemeur R, Fournié P, Grondin L, Hélissen O, Membrives C, Nasr N, Pavy-Le Traon A, Soler V. Neuro-ophthalmological changes in healthy females exposed to a 5-day dry immersion: a pilot study. NPJ Microgravity 2024; 10:4. [PMID: 38212301 PMCID: PMC10784282 DOI: 10.1038/s41526-024-00344-0] [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: 06/22/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024] Open
Abstract
After exposure to microgravity, astronauts undergo microgravity-induced thoraco-cephalic fluid shift, which may lead to ocular changes called "spaceflight associated neuro-ocular syndrome" (SANS). The onset of SANS may be multifactorial, including a potential elevation in intracranial pressure. Moreover, little is known about the impact of spaceflight on SANS in women due to the fact that fewer female astronauts have spent time in long-term missions. The objective is to determine whether similar ophthalmological changes occur in healthy women after short-term exposure to microgravity. The auto-refractometer was used to determine objective refraction. The best corrected distance visual acuity was assessed with a Monoyer chart. The ocular axial length was assessed using optical biometry. The applanation tonometry was used to determine intraocular pressure. Peripapillary retinal nerve fibre layer thickness (pRNFLT), macular total retinal thickness, and ganglion cell complex (GCC) were measured using optical coherence tomography. Ocular axial length is reduced after DI. pRNFL is thickest after DI specifically in the temporal, temporal-inferior, and nasal-inferior quadrants. Macular total retinal at the inferior quadrant of the 6-mm ring is thickest after DI. Global GCC is thinnest after DI. In this study, 5 days of DI induces slight but significant ophthalmological changes in women. However, these subtle changes do not correspond to criteria defined in SANS.
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Affiliation(s)
- Marc Kermorgant
- UMR INSERM U1297, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | - Thibault Chedmail
- Department of Ophthalmology, University Hospital of Toulouse, Toulouse, France
| | - Fanny Varenne
- Department of Ophthalmology, University Hospital of Toulouse, Toulouse, France
| | | | - Arnaud Beck
- Institute for Space Medicine and Physiology (MEDES), Toulouse, France
| | | | - Pierre Fournié
- Department of Ophthalmology, University Hospital of Toulouse, Toulouse, France
| | - Lisa Grondin
- Department of Ophthalmology, University Hospital of Toulouse, Toulouse, France
| | - Ophélie Hélissen
- UMR INSERM U1297, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
| | | | - Nathalie Nasr
- UMR INSERM U1297, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Anne Pavy-Le Traon
- UMR INSERM U1297, Institute of Cardiovascular and Metabolic Diseases (I2MC), Toulouse, France.
- Department of Neurology, University Hospital of Toulouse, Toulouse, France.
| | - Vincent Soler
- Department of Ophthalmology, University Hospital of Toulouse, Toulouse, France.
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17
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Yu DY, Cringle SJ, Darcey D, Tien LYH, Vukmirovic AJ, Yu PK, Mehnert A, Morgan WH. Posture-Induced Changes in Intraocular, Orbital, Cranial, Jugular Vein, and Arterial Pressures in a Porcine Model. Invest Ophthalmol Vis Sci 2023; 64:22. [PMID: 38108688 PMCID: PMC10732089 DOI: 10.1167/iovs.64.15.22] [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: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose The purpose of this study was to determine posture-induced changes in arterial blood pressure (ABP), intraocular pressure (IOP), orbital pressure (Porb), intracranial pressure (ICP), and jugular vein pressure (JVP) at various tilt angles in an in vivo pig. Methods Anesthetized and ventilated pigs (n = 8) were placed prone on a tiltable operating table. ABP, IOP, Porb, ICP, and JVP were monitored while the table was tilted at various angles between 15 degrees head up tilt (HUT) and 25 degrees head down tilt (HDT) either in stepwise changes (5 degrees per step) or continuously. The mean pressure was calculated from digitized pressure waveforms from each compartment. For stepwise changes in tilt angle the pressures were plotted as a function of tilt angle. For continuous tilt changes, the pressures were plotted as a function of time. Results In the case of stepwise changes, ABP remained relatively stable whilst IOP, Porb, ICP, and JVP demonstrated significant differences between most angles (typically P < 0.0001). The difference was greatest for IOP (P < 0.0001) where the average IOP increased from 13.1 ± 1.23 mm Hg at 15 degrees HUT to 46.3 ± 2.03 mm Hg at 25 degrees HDT. The relationship between pressure and tilt angle was almost linear for ICP and JVP, and sigmoidal for IOP and Porb. Interestingly, the effect of changes in tilt angle occurred very rapidly, within a few seconds. Conclusions Our results in a pig model demonstrate that changes in posture (tilt angle) induce rapid changes in IOP, Porb, ICP, and JVP, with IOP affected most severely.
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Affiliation(s)
- Dao-Yi Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Stephen J. Cringle
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Dean Darcey
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Liam Y. H. Tien
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
| | - Aleksandar J. Vukmirovic
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Paula K. Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Andrew Mehnert
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - William H. Morgan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
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18
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Tidwell JB, Taylor JA, Collins HR, Chamberlin JH, Barisano G, Sepehrband F, Turner MD, Gauthier G, Mulder ER, Gerlach DA, Roberts DR. Longitudinal Changes in Cerebral Perfusion, Perivascular Space Volume, and Ventricular Volume in a Healthy Cohort Undergoing a Spaceflight Analog. AJNR Am J Neuroradiol 2023; 44:1026-1031. [PMID: 37562828 PMCID: PMC10494950 DOI: 10.3174/ajnr.a7949] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/25/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND PURPOSE A global decrease in brain perfusion has recently been reported during exposure to a ground-based spaceflight analog. Considering that CSF and glymphatic flow are hypothesized to be propelled by arterial pulsations, it is unknown whether a change in perfusion would impact these CSF compartments. The aim of the current study was to evaluate the relationship among changes in cerebral perfusion, ventricular volume, and perivascular space volume before, during, and after a spaceflight analog. MATERIALS AND METHODS Eleven healthy participants underwent 30 days of bed rest at 6° head-down tilt with 0.5% atmospheric CO2 as a spaceflight analog. For each participant, 6 MR imaging brain scans, including perfusion and anatomic-weighted T1 sequences, were obtained before, during, and after the analog period. Global perfusion, ventricular volume, and perivascular space volume time courses were constructed and evaluated with repeated measures ANOVAs. RESULTS Global perfusion followed a divergent time trajectory from ventricular and perivascular space volume, with perfusion decreasing during the analog, whereas ventricular and perivascular space volume increased (P < .001). These patterns subsequently reversed during the 2-week recovery period. CONCLUSIONS The patterns of change in brain physiology observed in healthy participants suggest a relationship between cerebral perfusion and CSF homeostasis. Further study is warranted to determine whether a causal relationship exists and whether similar neurophysiologic responses occur during spaceflight.
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Affiliation(s)
- J B Tidwell
- From the Department of Radiology and Radiological Science (J.B.T., J.A.T., H.R.C., J.H.C., M.D.T., G.G., D.R.R.), Medical University of South Carolina; Charleston, South Carolina
| | - J A Taylor
- From the Department of Radiology and Radiological Science (J.B.T., J.A.T., H.R.C., J.H.C., M.D.T., G.G., D.R.R.), Medical University of South Carolina; Charleston, South Carolina
| | - H R Collins
- From the Department of Radiology and Radiological Science (J.B.T., J.A.T., H.R.C., J.H.C., M.D.T., G.G., D.R.R.), Medical University of South Carolina; Charleston, South Carolina
| | - J H Chamberlin
- From the Department of Radiology and Radiological Science (J.B.T., J.A.T., H.R.C., J.H.C., M.D.T., G.G., D.R.R.), Medical University of South Carolina; Charleston, South Carolina
| | - G Barisano
- Laboratory of Neuroimaging (F.S.), University of Southern California, Los Angeles, California
| | - F Sepehrband
- Department of Neurosurgery (G.B.), Stanford University, Stanford, California
| | - M D Turner
- From the Department of Radiology and Radiological Science (J.B.T., J.A.T., H.R.C., J.H.C., M.D.T., G.G., D.R.R.), Medical University of South Carolina; Charleston, South Carolina
| | - G Gauthier
- From the Department of Radiology and Radiological Science (J.B.T., J.A.T., H.R.C., J.H.C., M.D.T., G.G., D.R.R.), Medical University of South Carolina; Charleston, South Carolina
| | - E R Mulder
- Department of Neurosurgery (G.B.), Stanford University, Stanford, California
| | - D A Gerlach
- Department of Neurosurgery (G.B.), Stanford University, Stanford, California
| | - D R Roberts
- From the Department of Radiology and Radiological Science (J.B.T., J.A.T., H.R.C., J.H.C., M.D.T., G.G., D.R.R.), Medical University of South Carolina; Charleston, South Carolina
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19
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Sarker P, Ong J, Zaman N, Kamran SA, Waisberg E, Paladugu P, Lee AG, Tavakkoli A. Extended reality quantification of pupil reactivity as a non-invasive assessment for the pathogenesis of spaceflight associated neuro-ocular syndrome: A technology validation study for astronaut health. LIFE SCIENCES IN SPACE RESEARCH 2023; 38:79-86. [PMID: 37481311 DOI: 10.1016/j.lssr.2023.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 07/24/2023]
Abstract
The National Aeronautics and Space Administration (NASA) has rigorously documented a group of neuro-ophthalmic findings in astronauts during and after long-duration spaceflight known as spaceflight associated neuro-ocular syndrome (SANS). For astronaut safety and mission effectiveness, understanding SANS and countermeasure development are of utmost importance. Although the pathogenesis of SANS is not well defined, a leading hypothesis is that SANS might relate to a sub-clinical increased intracranial pressure (ICP) from cephalad fluid shifts in microgravity. However, no direct ICP measurements are available during spaceflight. To further understand the role of ICP in SANS, pupillometry can serve as a promising non-invasive biomarker for spaceflight environment as ICP is correlated with the pupil variables under illumination. Extended reality (XR) can help to address certain limitations in current methods for efficient pupil testing during spaceflight. We designed a protocol to quantify parameters of pupil reactivity in XR with an equivalent time duration of illumination on each eye compared to pre-existing, non-XR methods. Throughout the assessment, the pupil diameter data was collected using HTC Vive Pro-VR headset, thanks to its eye-tracking capabilities. Finally, the data was used to compute several pupil variables. We applied our methods to 36 control subjects. Pupil variables such as maximum and minimum pupil size, constriction amplitude, average constriction amplitude, maximum constriction velocity, latency and dilation velocity were computed for each control data. We compared our methods of calculation of pupil variables with the non-XR methods existing in the literature. Distributions of the pupil variables such as latency, constriction amplitude, and velocity of 36 control data displayed near-identical results from the non-XR literature for normal subjects. We propose a new method to evaluate pupil reactivity with XR technology to further understand ICP's role in SANS and provide further insight into SANS countermeasure development for future spaceflight.
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Affiliation(s)
- Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Nevada, United States
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Nevada, United States
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Nevada, United States
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States; University of Texas MD Anderson Cancer Center, Houston, Texas, United States; Texas A&M College of Medicine, Texas, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Nevada, United States.
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Ong J, Mader TH, Gibson CR, Mason SS, Lee AG. Spaceflight associated neuro-ocular syndrome (SANS): an update on potential microgravity-based pathophysiology and mitigation development. Eye (Lond) 2023; 37:2409-2415. [PMID: 37072472 PMCID: PMC10397180 DOI: 10.1038/s41433-023-02522-y] [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: 09/20/2022] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
Long-duration spaceflight is associated with neurologic and ophthalmic clinical and imaging findings in astronauts termed spaceflight associated neuro-ocular syndrome (SANS). These microgravity-induced findings have been well documented by the National Aeronautics and Space Administration (NASA) and are clearly a potential risk for future human space exploration. The underlying pathogenesis of SANS is not well understood, although multiple hypotheses have emerged. Terrestrial analogues and potential countermeasures have also been studied to further understand and potentially mitigate SANS. In this manuscript, we review the current understanding of SANS, discuss the prevailing hypotheses for pathogenesis, and describe current developments in terrestrial analogues and potential countermeasures for SANS.
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Affiliation(s)
- Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - C Robert Gibson
- KBR, NASA Johnson Space Center, Houston, TX, USA
- South Shore Eye Center, League City, TX, USA
| | | | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA.
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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21
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Hoenemann JN, Moestl S, van Herwaarden AE, Diedrich A, Mulder E, Frett T, Petrat G, Pustowalow W, Arz M, Heusser K, Lee S, Jordan J, Tank J, Hoffmann F. Effects of daily artificial gravity training on orthostatic tolerance following 60-day strict head-down tilt bedrest. Clin Auton Res 2023; 33:401-410. [PMID: 37347452 PMCID: PMC10439060 DOI: 10.1007/s10286-023-00959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Orthostatic intolerance commonly occurs following immobilization or space flight. We hypothesized that daily artificial gravity training through short-arm centrifugation could help to maintain orthostatic tolerance following head-down tilt bedrest, which is an established terrestrial model for weightlessness. METHODS We studied 24 healthy persons (eight women; age 33.3 ± 9.0 years; BMI 24.3 ± 2.1 kg/m2) who participated in the 60-days head-down tilt bedrest (AGBRESA) study. They were assigned to 30 min/day continuous or 6 × 5 min intermittent short-arm centrifugation with 1Gz at the center of mass or a control group. We performed head-up tilt testing with incremental lower-body negative pressure until presyncope before and after bedrest. We recorded an electrocardiogram, beat-to-beat finger blood pressure, and brachial blood pressure and obtained blood samples from an antecubital venous catheter. Orthostatic tolerance was defined as time to presyncope. We related changes in orthostatic tolerance to changes in plasma volume determined by carbon dioxide rebreathing. RESULTS Compared with baseline measurements, supine and upright heart rate increased in all three groups following head-down tilt bedrest. Compared with baseline measurements, time to presyncope decreased by 323 ± 235 s with continuous centrifugation, by 296 ± 508 s with intermittent centrifugation, and by 801 ± 354 s in the control group (p = 0.0249 between interventions). The change in orthostatic tolerance was not correlated with changes in plasma volume. CONCLUSIONS Daily artificial gravity training on a short-arm centrifuge attenuated the reduction in orthostatic tolerance after 60 days of head-down tilt bedrest.
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Affiliation(s)
- J-N Hoenemann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Moestl
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - A E van Herwaarden
- Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, Netherlands
| | - A Diedrich
- Department of Medicine, Division of Clinical Pharmacology, Autonomic Dysfunction Service, Vanderbilt University, Nashville, TN, USA
| | - E Mulder
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - T Frett
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - G Petrat
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - W Pustowalow
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - M Arz
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - K Heusser
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
| | - S Lee
- NASA JSC KBR Wyle, Houston, TX, USA
| | - J Jordan
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Head of Aerospace Medicine, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
| | - J Tank
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany.
| | - F Hoffmann
- German Aerospace Center - DLR, Institute of Aerospace Medicine, Linder Hoehe, 51147, Cologne, Germany
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology, and Intensive Care, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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22
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Ong J, Waisberg E, Masalkhi M, Kamran SA, Lowry K, Sarker P, Zaman N, Paladugu P, Tavakkoli A, Lee AG. Artificial Intelligence Frameworks to Detect and Investigate the Pathophysiology of Spaceflight Associated Neuro-Ocular Syndrome (SANS). Brain Sci 2023; 13:1148. [PMID: 37626504 PMCID: PMC10452366 DOI: 10.3390/brainsci13081148] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Spaceflight associated neuro-ocular syndrome (SANS) is a unique phenomenon that has been observed in astronauts who have undergone long-duration spaceflight (LDSF). The syndrome is characterized by distinct imaging and clinical findings including optic disc edema, hyperopic refractive shift, posterior globe flattening, and choroidal folds. SANS serves a large barrier to planetary spaceflight such as a mission to Mars and has been noted by the National Aeronautics and Space Administration (NASA) as a high risk based on its likelihood to occur and its severity to human health and mission performance. While it is a large barrier to future spaceflight, the underlying etiology of SANS is not well understood. Current ophthalmic imaging onboard the International Space Station (ISS) has provided further insights into SANS. However, the spaceflight environment presents with unique challenges and limitations to further understand this microgravity-induced phenomenon. The advent of artificial intelligence (AI) has revolutionized the field of imaging in ophthalmology, particularly in detection and monitoring. In this manuscript, we describe the current hypothesized pathophysiology of SANS and the medical diagnostic limitations during spaceflight to further understand its pathogenesis. We then introduce and describe various AI frameworks that can be applied to ophthalmic imaging onboard the ISS to further understand SANS including supervised/unsupervised learning, generative adversarial networks, and transfer learning. We conclude by describing current research in this area to further understand SANS with the goal of enabling deeper insights into SANS and safer spaceflight for future missions.
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Affiliation(s)
- Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI 48105, USA
| | | | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV 89512, USA
| | | | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV 89512, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV 89512, USA
| | - Phani Paladugu
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV 89512, USA
| | - Andrew G. Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX 77030, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY 10065, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Texas A&M College of Medicine, Bryan, TX 77030, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA 50010, USA
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23
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Ong J, Tarver W, Brunstetter T, Mader TH, Gibson CR, Mason SS, Lee A. Spaceflight associated neuro-ocular syndrome: proposed pathogenesis, terrestrial analogues, and emerging countermeasures. Br J Ophthalmol 2023; 107:895-900. [PMID: 36690421 PMCID: PMC10359702 DOI: 10.1136/bjo-2022-322892] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 01/25/2023]
Abstract
Spaceflight associated neuro-ocular syndrome (SANS) refers to a distinct constellation of ocular, neurological and neuroimaging findings observed in astronauts during and following long duration spaceflight. These ocular findings, to include optic disc oedema, posterior globe flattening, chorioretinal folds and hyperopic shifts, were first described by NASA in 2011. SANS is a potential risk to astronaut health and will likely require mitigation prior to planetary travel with prolonged exposures to microgravity. While the exact pathogenesis of SANS is not completely understood, several hypotheses have been proposed to explain this neuro-ocular phenomenon. In this paper, we briefly discuss the current hypotheses and contributing factors underlying SANS pathophysiology as well as analogues used to study SANS on Earth. We also review emerging potential countermeasures for SANS including lower body negative pressure, nutritional supplementation and translaminar pressure gradient modulation. Ongoing investigation within these fields will likely be instrumental in preparing and protecting astronaut vision for future spaceflight missions including deep space exploration.
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Affiliation(s)
- Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - C Robert Gibson
- KBR, NASA Space Medicine Operations Division, Houston, Texas, USA
- South Shore Eye Center, League City, Texas, USA
| | | | - Andrew Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Texas A&M College of Medicine, Bryan, Texas, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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24
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Jiang A, Fang W, Liu J, Foing B, Yao X, Westland S, Hemingray C. The effect of colour environments on visual tracking and visual strain during short-term simulation of three gravity states. APPLIED ERGONOMICS 2023; 110:103994. [PMID: 36863907 DOI: 10.1016/j.apergo.2023.103994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 01/21/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
This study investigated the effects of nine colour environments on visual tracking accuracy and visual strain during normal sitting (SP), -12° head-down bed (HD) and 9.6° head-up tilt bed (HU). In a standard posture change laboratory study, fifty-four participants performed visual tracking tasks in nine colour environments while in the three postures. Visual strain was measured by means of a questionnaire. The results showed that in all colour environments, the -12° head-down bed rest posture significantly affected visual tracking accuracy and visual strain. During the three postures, the participants' visual tracking accuracy in the cyan environment was significantly higher than that in other colour environments, and their visual strain was the lowest. Overall, the study adds to our understanding of how environmental and postural factors impact on visual tracking and visual strain.
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Affiliation(s)
- Ao Jiang
- Ningbo Innovation Centre, Zhejiang University, China; Dyson School of Design Engineering, Imperial College London, UK; ILEWG EuroMoonMars at ESTEC European Space Agency, Netherlands; Euro Space Hub, Netherlands.
| | | | | | - Bernard Foing
- ILEWG EuroMoonMars at ESTEC European Space Agency, Netherlands; Euro Space Hub, Netherlands; Leiden University, Netherlands; Vrije Universiteit Amsterdam, Netherlands
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25
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Waisberg E, Ong J, Paladugu P, Kamran SA, Zaman N, Lee AG, Tavakkoli A. Dynamic visual acuity as a biometric for astronaut performance and safety. LIFE SCIENCES IN SPACE RESEARCH 2023; 37:3-6. [PMID: 37087177 DOI: 10.1016/j.lssr.2023.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 05/03/2023]
Abstract
Astronauts are exposed to an austere and constantly changing environment during space travel. To respond to these rapid environmental changes, high levels of dynamic visual acuity (DVA) are required. DVA is the ability to visualize objects that are in motion, or with head movement and has previously been shown to decrease significantly following spaceflight. Decreased DVA can potentially impact astronauts while performing mission critical tasks and drive space motion sickness. In this paper, we suggest that DVA assessment during spaceflight and during G-transitions should be considered to help further understand the vestibulo-ocular impacts of interplanetary spaceflight and ensure mission performance including potential manned missions to Mars.
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Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, United States
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States; Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States; University of Texas MD Anderson Cancer Center, Houston, Texas, United States; Texas A&M College of Medicine, Texas, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
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26
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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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27
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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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28
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Waisberg E, Ong J, Kamran SA, Paladugu P, Zaman N, Lee AG, Tavakkoli A. Transfer learning as an AI-based solution to address limited datasets in space medicine. LIFE SCIENCES IN SPACE RESEARCH 2023; 36:36-38. [PMID: 36682827 DOI: 10.1016/j.lssr.2022.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/03/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
The advent of artificial intelligence (AI) has a promising role in the future long-duration spaceflight missions. Traditional AI algorithms rely on training and testing data from the same domain. However, astronaut medical data is naturally limited to a small sample size and often difficult to collect, leading to extremely limited datasets. This significantly limits the ability of traditional machine learning methodologies. Transfer learning is a potential solution to overcome this dataset size limitation and can help improve training time and performance of a neural networks. We discuss the unique challenges of space medicine in producing datasets and transfer learning as an emerging technique to address these issues.
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Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, United States
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Phani Paladugu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States; The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States; University of Texas MD Anderson Cancer Center, Houston, Texas, United States; Texas A&M College of Medicine, Texas, United States; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, Nevada, United States
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The impact of a short-period head-down tilt on executive function in younger adults. Sci Rep 2022; 12:20888. [PMID: 36463320 PMCID: PMC9719537 DOI: 10.1038/s41598-022-25123-3] [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: 12/03/2021] [Accepted: 11/24/2022] [Indexed: 12/07/2022] Open
Abstract
Microgravity has been shown to be a significant stressor on the cardiovascular system and the brain due to the redistribution of fluids that occurs in the absence of gravitational force, but there is scarce literature surrounding the effects of microgravity on cerebral hemodynamics and cognition. Understanding the early effects that simulated gravity has on cognitive function is essential for developing proper physical and cognitive countermeasures to assure safe and effective cognitive/decisions making while astronauts prepare for the initial launch or when they arrive in a microgravity environment. Therefore, this study aims to determine how an acute simulation of microgravity would alter cerebral oxygenation and executive functions. Sixty-five young healthy participants (22 ± 6 years, 21 females) completed a thirty (30) minute horizontal (00 tilt) followed by a 90-min - 6° head-down-tilt (HDT) protocol. Cerebral oxygenation in the prefrontal cortex was monitored throughout the testing session using near-infrared spectroscopy. Cognition was also measured using a computerized Stroop Task. Our results demonstrate that cerebral oxygenation was higher during HDT compared to the horizontal supine position (9.11 ± 1.3 vs. 7.51 ± 1.8, p = 0.02). For the cognitive results, the non-executive performance of the Stroop task remained stable during HDT (652.46 ± 19.3 vs. 632.49 ± 14.5, p = 0.09). However, reaction time during the executive task performance was improved after the HDT (1058 ± 195-950 ± 158 ms, p < 0.01). Our results suggest that an acute bout of simulated microgravity can enhance executive functioning.
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30
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Ong J, Zaman N, Waisberg E, Kamran SA, Lee AG, Tavakkoli A. Head-mounted digital metamorphopsia suppression as a countermeasure for macular-related visual distortions for prolonged spaceflight missions and terrestrial health. WEARABLE TECHNOLOGIES 2022; 3:e26. [PMID: 38486901 PMCID: PMC10936292 DOI: 10.1017/wtc.2022.21] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/04/2022] [Accepted: 08/28/2022] [Indexed: 03/17/2024]
Abstract
During long-duration spaceflight, astronauts are exposed to various risks including spaceflight-associated neuro-ocular syndrome, which serves as a risk to astronaut vision and a potential physiological barrier to future spaceflight. When considering exploration missions that may expose astronauts to longer periods of microgravity, radiation exposure, and natural aging processes during spaceflight, more severe changes to functional vision may occur. The macula plays a critical role in central vision and disruptions to this key area in the eye may compromise functional vision and mission performance. In this article, we describe the development of a countermeasure technique to digitally suppress monocular central visual distortion with head-mounted display technology. We report early validation studies with this noninvasive countermeasure in individuals with simulated metamorphopsia. When worn by these individuals, this emerging wearable countermeasure technology has demonstrated a suppression of monocular visual distortion. We describe the considerations and further directions of this head-mounted technology for both astronauts and aging individuals on Earth.
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Affiliation(s)
- Joshua Ong
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, USA
| | - Ethan Waisberg
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, USA
| | - Andrew G. Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Ophthalmology, Texas A&M College of Medicine, College Station, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV, USA
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31
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Ong J, Tavakkoli A, Zaman N, Kamran SA, Waisberg E, Gautam N, Lee AG. Terrestrial health applications of visual assessment technology and machine learning in spaceflight associated neuro-ocular syndrome. NPJ Microgravity 2022; 8:37. [PMID: 36008494 PMCID: PMC9411571 DOI: 10.1038/s41526-022-00222-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
The neuro-ocular effects of long-duration spaceflight have been termed Spaceflight Associated Neuro-Ocular Syndrome (SANS) and are a potential challenge for future, human space exploration. The underlying pathogenesis of SANS remains ill-defined, but several emerging translational applications of terrestrial head-mounted, visual assessment technology and machine learning frameworks are being studied for potential use in SANS. To develop such technology requires close consideration of the spaceflight environment which is limited in medical resources and imaging modalities. This austere environment necessitates the utilization of low mass, low footprint technology to build a visual assessment system that is comprehensive, accessible, and efficient. In this paper, we discuss the unique considerations for developing this technology for SANS and translational applications on Earth. Several key limitations observed in the austere spaceflight environment share similarities to barriers to care for underserved areas on Earth. We discuss common terrestrial ophthalmic diseases and how machine learning and visual assessment technology for SANS can help increase screening for early intervention. The foundational developments with this novel system may help protect the visual health of both astronauts and individuals on Earth.
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Affiliation(s)
- Joshua Ong
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Nikhil Gautam
- Department of Computer Science, Rice University, Houston, TX, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA. .,Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA. .,The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA. .,Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA. .,Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA. .,University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Texas A&M College of Medicine, Bryan, TX, USA. .,Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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32
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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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33
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Arshad I, Ferrè ER. Express: Cognition in Zero Gravity: Effects of Non-Terrestrial Gravity on Human Behaviour. Q J Exp Psychol (Hove) 2022; 76:979-994. [PMID: 35786100 PMCID: PMC10119906 DOI: 10.1177/17470218221113935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As humanity prepares for deep space exploration, understanding the impact of spaceflight on bodily physiology is critical. While the effects of non-terrestrial gravity on the body are well established, little is known about its impact on human behaviour and cognition. Astronauts often describe dramatic alterations in sensorimotor functioning, including orientation, postural control and balance. Changes in cognitive functioning as well as in socio-affective processing have also been observed. Here we have reviewed the key literature and explored the impact of non-terrestrial gravity across three key functional domains: sensorimotor, cognition, and socio-affective processing. We have proposed a neuroanatomical model to account for the effects of non-terrestrial gravity in these domains. Understanding the impact of non-terrestrial gravity on human behaviour has never been more timely and it will help mitigate against risks in both commercial and non-commercial spaceflight.
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Affiliation(s)
- Iqra Arshad
- Department of Psychology, Royal Holloway University of London, Egham, UK 3162
| | - Elisa Raffaella Ferrè
- Department of Psychological Sciences, Birkbeck University of London, London, UK 3162
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34
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Ong J, Tavakkoli A, Strangman G, Zaman N, Kamran SA, Zhang Q, Ivkovic V, Lee AG. Neuro-ophthalmic Imaging and Visual Assessment Technology for Spaceflight Associated Neuro-ocular Syndrome (SANS). Surv Ophthalmol 2022; 67:1443-1466. [DOI: 10.1016/j.survophthal.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
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35
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A perspective on spaceflight associated neuro-ocular syndrome causation secondary to elevated venous sinus pressure. NPJ Microgravity 2022; 8:3. [PMID: 35169156 PMCID: PMC8847421 DOI: 10.1038/s41526-022-00188-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Spaceflight associated neuro-ocular syndrome (SANS) alters the vision of astronauts during long-duration spaceflights. There is controversy regarding SANS being similar to patients with idiopathic intracranial hypertension (IIH). IIH has been shown to be due to an elevation in venous sinus pressure. The literature suggests an increase in jugular vein pressure secondary to a headward shift of fluid occurs in SANS but this may not be enough to significantly alter the intracranial pressure (ICP). The literature regarding cardiac output and cerebral blood flow (CBF) in long-duration spaceflight is contradictory, however, more recent data suggests increased flow. Recent modelling has shown that an increase in CBF can significantly increase sinus pressure. The purpose of the present paper is to review the SANS vascular dynamics literature and through mathematical modelling suggest the possible underlying cause of SANS as an elevation in venous sinus pressure, secondary to the redistribution of fluids towards the head, together with a significant increase in pressure drop across the venous system related to the CBF.
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36
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Petersen LG, Whittle RS, Lee JH, Sieker J, Carlson J, Finke C, Shelton CM, Petersen JCG, Diaz-Artiles A. Gravitational effects on intraocular pressure and ocular perfusion pressure. J Appl Physiol (1985) 2022; 132:24-35. [PMID: 34762525 DOI: 10.1152/japplphysiol.00546.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Changes in the gravitational vector by postural changes or weightlessness induce fluid shifts, impacting ocular hemodynamics and regional pressures. This investigation explores the impact of changes in the direction of the gravitational vector on intraocular pressure (IOP), mean arterial pressure at eye level (MAPeye), and ocular perfusion pressure (OPP), which is critical for ocular health. Thirteen subjects underwent 360° of tilt (including both prone and supine positions) at 15° increments. At each angle, steady-state IOP and MAPeye were measured, and OPP calculated as MAPeye - IOP. Experimental data were also compared to a six-compartment lumped-parameter model of the eye. Mean IOP, MAPeye, and OPP significantly increased from 0° supine to 90° head-down tilt (HDT) by 20.7 ± 1.7 mmHg (P < 0.001), 38.5 ± 4.1 mmHg (P < 0.001), and 17.4 ± 3.2 mmHg (P < 0.001), respectively. Head-up tilt (HUT) significantly decreased OPP by 16.5 ± 2.5 mmHg (P < 0.001). IOP was significantly higher in prone versus supine position for much of the tilt range. Our study indicates that OPP is highly gravitationally dependent. Specifically, data show that MAPeye is more gravitationally dependent than IOP, thus causing OPP to increase during HDT and to decrease during HUT. In addition, IOP was elevated in prone position compared with supine position due to the additional hydrostatic column between the base of the rostral globe to the mid-coronal plane, supporting the notion that hydrostatic forces play an important role in ocular hemodynamics. Changes in OPP as a function of changes in gravitational stress and/or weightlessness may play a role in the pathogenesis of spaceflight-associated neuro-ocular syndrome.NEW & NOTEWORTHY Maintaining appropriate ocular perfusion pressure (OPP) is critical for ocular health. We measured the relative changes in intraocular and mean arterial pressures during 360° tilt and calculated OPP, which was elevated during head-down tilt and decreased during head-up tilt. Experimental data are also explained by our computational model. We demonstrate that OPP is more gravitationally dependent than previously recognized and may be a factor in the overall patho-etiology behind the weightlessness-induced spaceflight-associated neuro-ocular syndrome.
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Affiliation(s)
- Lonnie G Petersen
- Mechanical and Aerospace Engineering, Jacobs School of Engineering, University of California, San Diego, California.,Department of Radiology, School of Medicine, University of California, San Diego, California
| | - Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
| | - Justin H Lee
- Department of Radiology, School of Medicine, University of California, San Diego, California
| | - Jeremy Sieker
- Department of Radiology, School of Medicine, University of California, San Diego, California
| | - Joseph Carlson
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
| | - Colton Finke
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
| | - Cody M Shelton
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
| | - Johan C G Petersen
- Department of Anesthesiology, UC-Health, University of California, San Diego, California
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas.,Department of Health and Kinesiology, Texas A&M University, College Station, Texas
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37
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Calvaruso M, Militello C, Minafra L, La Regina V, Torrisi F, Pucci G, Cammarata FP, Bravatà V, Forte GI, Russo G. Biological and Mechanical Characterization of the Random Positioning Machine (RPM) for Microgravity Simulations. Life (Basel) 2021; 11:life11111190. [PMID: 34833068 PMCID: PMC8619501 DOI: 10.3390/life11111190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022] Open
Abstract
The rapid improvement of space technologies is leading to the continuous increase of space missions that will soon bring humans back to the Moon and, in the coming future, toward longer interplanetary missions such as the one to Mars. The idea of living in space is charming and fascinating; however, the space environment is a harsh place to host human life and exposes the crew to many physical challenges. The absence of gravity experienced in space affects many aspects of human biology and can be reproduced in vitro with the help of microgravity simulators. Simulated microgravity (s-μg) is applied in many fields of research, ranging from cell biology to physics, including cancer biology. In our study, we aimed to characterize, at the biological and mechanical level, a Random Positioning Machine in order to simulate microgravity in an in vitro model of Triple-Negative Breast Cancer (TNBC). We investigated the effects played by s-μg by analyzing the change of expression of some genes that drive proliferation, survival, cell death, cancer stemness, and metastasis in the human MDA-MB-231 cell line. Besides the mechanical verification of the RPM used in our studies, our biological findings highlighted the impact of s-μg and its putative involvement in cancer progression.
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Affiliation(s)
- Marco Calvaruso
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (M.C.); (C.M.); (F.P.C.); (V.B.); (G.I.F.); (G.R.)
| | - Carmelo Militello
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (M.C.); (C.M.); (F.P.C.); (V.B.); (G.I.F.); (G.R.)
| | - Luigi Minafra
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (M.C.); (C.M.); (F.P.C.); (V.B.); (G.I.F.); (G.R.)
- Correspondence:
| | | | - Filippo Torrisi
- Departments of Biomedical and BioTechnological Science (BIOMETEC), University of Catania, 95123 Catania, Italy;
| | - Gaia Pucci
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STeBiCeF), University of Palermo, 90128 Palermo, Italy;
| | - Francesco P. Cammarata
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (M.C.); (C.M.); (F.P.C.); (V.B.); (G.I.F.); (G.R.)
| | - Valentina Bravatà
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (M.C.); (C.M.); (F.P.C.); (V.B.); (G.I.F.); (G.R.)
| | - Giusi I. Forte
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (M.C.); (C.M.); (F.P.C.); (V.B.); (G.I.F.); (G.R.)
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (M.C.); (C.M.); (F.P.C.); (V.B.); (G.I.F.); (G.R.)
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