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Elias A, Weber T, Green DA, Harris KM, Laws JM, Greaves DK, Kim DS, Mazzolai-Duchosal L, Roberts L, Petersen LG, Limper U, Bergauer A, Elias M, Winnard A, Goswami N. Systematic review of the use of ultrasound for venous assessment and venous thrombosis screening in spaceflight. NPJ Microgravity 2024; 10:14. [PMID: 38316814 PMCID: PMC10844233 DOI: 10.1038/s41526-024-00356-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: 08/06/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
The validity of venous ultrasound (V-US) for the diagnosis of deep vein thrombosis (DVT) during spaceflight is unknown and difficult to establish in diagnostic accuracy and diagnostic management studies in this context. We performed a systematic review of the use of V-US in the upper-body venous system in spaceflight to identify microgravity-related changes and the effect of venous interventions to reverse them, and to assess appropriateness of spaceflight V-US with terrestrial standards. An appropriateness tool was developed following expert panel discussions and review of terrestrial diagnostic studies, including criteria relevant to crew experience, in-flight equipment, assessment sites, ultrasound modalities, and DVT diagnosis. Microgravity-related findings reported as an increase in internal jugular vein (IJV) cross-sectional area and pressure were associated with reduced, stagnant, and retrograde flow. Changes were on average responsive to venous interventions using lower body negative pressure, Bracelets, Valsalva and Mueller manoeuvres, and contralateral IJV compression. In comparison with terrestrial standards, spaceflight V-US did not meet all appropriateness criteria. In DVT studies (n = 3), a single thrombosis was reported and only ultrasound modality criterion met the standards. In the other studies (n = 15), all the criteria were appropriate except crew experience criterion, which was appropriate in only four studies. Future practice and research should account for microgravity-related changes, evaluate individual effect of venous interventions, and adopt Earth-based V-US standards.
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Affiliation(s)
- Antoine Elias
- Cardiology and Vascular Medicine, Sainte Musse Hospital, Toulon Hospital Centre, Toulon, France.
- Clinical Research and Innovation, Sainte Musse Hospital, Toulon Hospital Centre, Toulon, France.
- Investigation Network On Venous Thrombo-Embolism | French Clinical Research Infrastructure Network (INNOVTE | F-CRIN), Toulon, France.
| | - Tobias Weber
- Space Medicine Team (HRE-OM), European Astronaut Center (EAC), European Space Agency (ESA), Cologne, Germany
- KBR, Cologne, Germany
| | - David A Green
- Space Medicine Team (HRE-OM), European Astronaut Center (EAC), European Space Agency (ESA), Cologne, Germany
- KBR, Cologne, Germany
- Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Katie M Harris
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jonathan M Laws
- University of Northumbria at Newcastle, Newcaslte-upon-Tyne, United Kingdom
- Space Biomedicine Systematic Review Methods Group, Wylam, United Kingdom
| | | | - David S Kim
- Space Medicine Team (HRE-OM), European Astronaut Center (EAC), European Space Agency (ESA), Cologne, Germany
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Lara Roberts
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Lonnie G Petersen
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ulrich Limper
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- University of Witten / Herdecke, Department of Anaesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Cologne, Germany
| | - Andrej Bergauer
- Department of Surgery, LKH Südsteiermark, Wagna, Austria
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Michael Elias
- Critical Care Medicine, St. Vincent's Medical Center, Hartford Healthcare, Bridgeport, CT, USA
- The Frank H. Netter MD School of Medicine, North Haven, CT, USA
| | - Andrew Winnard
- Space Biomedicine Systematic Review Methods Group, Wylam, United Kingdom
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
- Mohammed Bin Rashid University of Medicine and Applied Health Sciences, Dubai, United Arab Emirates
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Levasseur S, Purvis N, Trozzo S, Chung SH, Ades M, Drudi LM. Venous Thromboembolism in Exploration Class Human Spaceflight. Aerosp Med Hum Perform 2024; 95:45-53. [PMID: 38158572 DOI: 10.3357/amhp.6290.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION: A recent finding of a deep venous thrombosis during spaceflight has prompted the need to clarify mechanisms and risks of venous thromboembolism (VTE). In turn, mitigation countermeasures, diagnostic modalities, and treatment options must be explored. The objective of this review was to synthesize current evidence on VTE in spaceflight.METHODS: A literature review was performed from inception to April 2023 pertaining to VTE in the context of spaceflight or ground-based analogs with human participants. PubMed was searched for papers written in English using the terms "spaceflight" or "weightlessness" and "thrombotic" or "embolism" or "thromboembolism" in "venous" or "veins". Papers using cellular or animal models were excluded.RESULTS: There were 63 papers captured; 7 original scientific studies, 3 narrative reviews, 2 systematic reviews, and 3 commentaries discussed VTE in spaceflight. Reference lists were screened. Important themes included: altered venous hemodynamics, increased fibrinogen and coagulation markers, hypoalbuminemia, and immune dysfunction. Additional risk factors may be seen in women, such as the use of oral contraceptives.DISCUSSION: Venous stasis and decreased shear stress secondary to fluid shifts may induce inflammatory changes in the venous system, resulting in endothelial damage and upregulation of the coagulation cascade. Additionally, women in space are subject to physiological factors increasing their VTE risk, such as the use of oral contraceptives, inducing increased blood viscosity and hypoalbuminemia. Efforts should also be placed in optimizing sensitivity and specificity of imaging markers, payload, and training ability, notably the use of vector flow imaging, and improving point-of-testing biomarkers, such as albumin and p-selectin.Levasseur S, Purvis N, Trozzo S, Chung SH, Ades M, Drudi LM. Venous thromboembolism in exploration class human spaceflight. Aerosp Med Hum Perform. 2024; 95(1):45-53.
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Zuccarelli L, Baldassarre G, Winnard A, Harris KM, Weber T, Green DA, Petersen LG, Kamine TH, Roberts L, Kim DS, Greaves DK, Arya R, Laws JM, Elias A, Rittweger J, Grassi B, Goswami N. Effects of whole-body vibration or resistive-vibration exercise on blood clotting and related biomarkers: a systematic review. NPJ Microgravity 2023; 9:87. [PMID: 38057333 DOI: 10.1038/s41526-023-00338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
Whole-body vibration (WBV) and resistive vibration exercise (RVE) are utilized as countermeasures against bone loss, muscle wasting, and physical deconditioning. The safety of the interventions, in terms of the risk of inducing undesired blood clotting and venous thrombosis, is not clear. We therefore performed the present systematic review of the available scientific literature on the issue. The review was conducted following the guidelines by the Space Biomedicine Systematic Review Group, based on Cochrane review guidelines. The relevant context or environment of the studies was "ground-based environment"; space analogs or diseased conditions were not included. The search retrieved 801 studies; 77 articles were selected for further consideration after an initial screening. Thirty-three studies met the inclusion criteria. The main variables related to blood markers involved angiogenic and endothelial factors, fibrinolysis and coagulation markers, cytokine levels, inflammatory and plasma oxidative stress markers. Functional and hemodynamic markers involved blood pressure measurements, systemic vascular resistance, blood flow and microvascular and endothelial functions. The available evidence suggests neutral or potentially positive effects of short- and long-term interventions with WBV and RVE on variables related to blood coagulation, fibrinolysis, inflammatory status, oxidative stress, cardiovascular, microvascular and endothelial functions. No significant warning signs towards an increased risk of undesired clotting and venous thrombosis were identified. If confirmed by further studies, WBV and RVE could be part of the countermeasures aimed at preventing or attenuating the muscular and cardiovascular deconditioning associated with spaceflights, permanence on planetary habitats and ground-based simulations of microgravity.
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Affiliation(s)
| | | | | | - Katie M Harris
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - David A Green
- Space Medicine Team, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany
- KBR GmbH, Cologne, Germany
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Lonnie G Petersen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tovy Haber Kamine
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Baystate Medical Center, Springfield, MA, USA
| | - Lara Roberts
- Kings College Hospital, NHS Foundation Trust, London, UK
| | - David S Kim
- Space Medicine Team, European Astronaut Centre, European Space Agency (ESA), Cologne, Germany
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Kelowna, Canada
| | - Danielle K Greaves
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Roopen Arya
- Kings College Hospital, NHS Foundation Trust, London, UK
| | | | - Antoine Elias
- Department of Vascular Medicine, Sainte Musse Hospital, Toulon La Seyne Hospital Centre, Toulon, France
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Bruno Grassi
- Department of Medicine, University of Udine, Udine, Italy.
| | - Nandu Goswami
- Division of Physiology, Otto Löwi Research Center for Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria
- Mohammed Bin Rashid University of Medicine and Applied Health Sciences, Dubai, UAE
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4
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Saloň A, Çiftci GM, Zubac D, Šimunič B, Pišot R, Narici M, Fredriksen PM, Nkeh-Chungag BN, Sourij H, Šerý O, Schmid-Zalaudek K, Steuber B, De Boever P, Goswami N. Retinal venular vessel diameters are smaller during ten days of bed rest. Sci Rep 2023; 13:19258. [PMID: 37935771 PMCID: PMC10630473 DOI: 10.1038/s41598-023-46177-x] [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: 05/26/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023] Open
Abstract
Older individuals experience cardiovascular dysfunction during extended bedridden hospital or care home stays. Bed rest is also used as a model to simulate accelerated vascular deconditioning occurring during spaceflight. This study investigates changes in retinal microcirculation during a ten-day bed rest protocol. Ten healthy young males (22.9 ± 4.7 years; body mass index: 23.6 ± 2.5 kg·m-2) participated in a strictly controlled repeated-measures bed rest study lasting ten days. High-resolution images were obtained using a hand-held fundus camera at baseline, daily during the 10 days of bed rest, and 1 day after re-ambulation. Retinal vessel analysis was performed using a semi-automated software system to obtain metrics for retinal arteriolar and venular diameters, central retinal artery equivalent and central retinal vein equivalent, respectively. Data analysis employed a mixed linear model. At the end of the bed rest period, a significant decrease in retinal venular diameter was observed, indicated by a significantly lower central retinal vein equivalent (from 226.1 µm, CI 8.90, to 211.4 µm, CI 8.28, p = .026), while no significant changes in central retinal artery equivalent were noted. Prolonged bed rest confinement resulted in a significant (up to 6.5%) reduction in retinal venular diameter. These findings suggest that the changes in retinal venular diameter during bedrest may be attributed to plasma volume losses and reflect overall (cardio)-vascular deconditioning.
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Affiliation(s)
- Adam Saloň
- Division of Physiology & Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology, and Inflammation, Medical University of Graz, Graz, Austria
- Research Unit "Gravitational Physiology and Medicine", Physiology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6/D.05, 8010, Graz, Austria
| | - Göktuğ Mert Çiftci
- Division of Physiology & Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology, and Inflammation, Medical University of Graz, Graz, Austria
- Department of Psychiatry, University Hospital Münster, Münster, Germany
| | - Damir Zubac
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department 1 of Internal Medicine, Centre for Integrated Oncology, Aachen, Bonn, Cologne, Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - Boštjan Šimunič
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Rado Pišot
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
| | - Marco Narici
- Institute for Kinesiology Research, Science and Research Centre Koper, Koper, Slovenia
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Per Morten Fredriksen
- Faculty of Applied Ecology, Agricultural Sciences and Biotechnology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Benedicta Ngwenchi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Health Sciences, Walter Sisulu University PBX1, Mthatha, 5117, South Africa
| | - Harald Sourij
- Internal Medicine, Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Omar Šerý
- Laboratory of Neurobiology and Molecular Psychiatry, Department of Biochemistry, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic
- Laboratory of Neurobiology and Pathological Physiology, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Veveří 97, 602 00, Brno, Czech Republic
| | - Karin Schmid-Zalaudek
- Division of Physiology & Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology, and Inflammation, Medical University of Graz, Graz, Austria
- Research Unit "Gravitational Physiology and Medicine", Physiology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6/D.05, 8010, Graz, Austria
| | - Bianca Steuber
- Division of Physiology & Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology, and Inflammation, Medical University of Graz, Graz, Austria
- Research Unit "Gravitational Physiology and Medicine", Physiology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6/D.05, 8010, Graz, Austria
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Nandu Goswami
- Division of Physiology & Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology, and Inflammation, Medical University of Graz, Graz, Austria.
- Research Unit "Gravitational Physiology and Medicine", Physiology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6/D.05, 8010, Graz, Austria.
- Integrative Health, Alma Mater Europaea Maribor, Maribor, Slovenia.
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
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5
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Shimizu R, Hirano I, Hasegawa A, Suzuki M, Otsuki A, Taguchi K, Katsuoka F, Uruno A, Suzuki N, Yumoto A, Okada R, Shirakawa M, Shiba D, Takahashi S, Suzuki T, Yamamoto M. Nrf2 alleviates spaceflight-induced immunosuppression and thrombotic microangiopathy in mice. Commun Biol 2023; 6:875. [PMID: 37626149 PMCID: PMC10457343 DOI: 10.1038/s42003-023-05251-w] [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: 02/26/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Spaceflight-related stresses impact health via various body systems, including the haematopoietic and immune systems, with effects ranging from moderate alterations of homoeostasis to serious illness. Oxidative stress appears to be involved in these changes, and the transcription factor Nrf2, which regulates expression of a set of cytoprotective and antioxidative stress response genes, has been implicated in the response to spaceflight-induced stresses. Here, we show through analyses of mice from the MHU-3 project, in which Nrf2-knockout mice travelled in space for 31 days, that mice lacking Nrf2 suffer more seriously from spaceflight-induced immunosuppression than wild-type mice. We discovered that a one-month spaceflight-triggered the expression of tissue inflammatory marker genes in wild-type mice, an effect that was even more pronounced in the absence of Nrf2. Concomitant with induction of inflammatory conditions, the consumption of coagulation-fibrinolytic factors and platelets was elevated by spaceflight and further accelerated by Nrf2 deficiency. These results highlight that Nrf2 mitigates spaceflight-induced inflammation, subsequent immunosuppression, and thrombotic microangiopathy. These observations reveal a new strategy to relieve health problems encountered during spaceflight.
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Affiliation(s)
- Ritsuko Shimizu
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
- Department of Molecular Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan.
- The Advanced Research Center for Innovations in Next-Generation Medicine (INGEM) Tohoku University, Sendai, Japan.
| | - Ikuo Hirano
- Department of Molecular Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Hasegawa
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Mikiko Suzuki
- Department of Molecular Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan
- The Advanced Research Center for Innovations in Next-Generation Medicine (INGEM) Tohoku University, Sendai, Japan
| | - Akihito Otsuki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Keiko Taguchi
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- The Advanced Research Center for Innovations in Next-Generation Medicine (INGEM) Tohoku University, Sendai, Japan
| | - Fumiki Katsuoka
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- The Advanced Research Center for Innovations in Next-Generation Medicine (INGEM) Tohoku University, Sendai, Japan
| | - Akira Uruno
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Norio Suzuki
- Division of Oxygen Biology, New Industry Creation hatchery Center (NICHe), Tohoku University, Sendai, Japan
| | - Akane Yumoto
- Japanese Experiment Module (JEM) Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency (JAXA), Tsukuba, Japan
| | - Risa Okada
- Japanese Experiment Module (JEM) Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency (JAXA), Tsukuba, Japan
| | - Masaki Shirakawa
- Japanese Experiment Module (JEM) Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency (JAXA), Tsukuba, Japan
| | - Dai Shiba
- Japanese Experiment Module (JEM) Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency (JAXA), Tsukuba, Japan
| | - Satoru Takahashi
- Department of Anatomy and Embryology and Laboratory Animal Resource Center in Transborder Medical Research Center, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takafumi Suzuki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
- The Advanced Research Center for Innovations in Next-Generation Medicine (INGEM) Tohoku University, Sendai, Japan.
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6
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Harris KM, Arya R, Elias A, Weber T, Green DA, Greaves DK, Petersen LG, Roberts L, Kamine TH, Mazzolai L, Bergauer A, Kim DS, Olde Engberink RH, zu Eulenberg P, Grassi B, Zuccarelli L, Baldassarre G, Tabury K, Baatout S, Jordan J, Blaber AP, Choukér A, Russomano T, Goswami N. Pathophysiology, risk, diagnosis, and management of venous thrombosis in space: where are we now? NPJ Microgravity 2023; 9:17. [PMID: 36797288 PMCID: PMC9935502 DOI: 10.1038/s41526-023-00260-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
The recent incidental discovery of an asymptomatic venous thrombosis (VT) in the internal jugular vein of an astronaut on the International Space Station prompted a necessary, immediate response from the space medicine community. The European Space Agency formed a topical team to review the pathophysiology, risk and clinical presentation of venous thrombosis and the evaluation of its prevention, diagnosis, mitigation, and management strategies in spaceflight. In this article, we discuss the findings of the ESA VT Topical Team over its 2-year term, report the key gaps as we see them in the above areas which are hindering understanding VT in space. We provide research recommendations in a stepwise manner that build upon existing resources, and highlight the initial steps required to enable further evaluation of this newly identified pertinent medical risk.
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Affiliation(s)
- Katie M. Harris
- grid.25055.370000 0000 9130 6822Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - Roopen Arya
- grid.429705.d0000 0004 0489 4320Kings College Hospital, NHS Foundation Trust, London, UK
| | - Antoine Elias
- Vascular Medicine, Toulon Hospital Centre, Toulon, France
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany. .,KBR, Cologne, Germany.
| | - David A. Green
- grid.461733.40000 0001 2375 6474Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany ,KBR, Cologne, Germany ,grid.13097.3c0000 0001 2322 6764Centre for Human and Applied Physiological Sciences, King’s College London, London, UK
| | - Danielle K. Greaves
- grid.46078.3d0000 0000 8644 1405Faculty of Health, University of Waterloo, Waterloo, Canada
| | - Lonnie G. Petersen
- grid.5254.60000 0001 0674 042XDepartment of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.116068.80000 0001 2341 2786Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, USA
| | - Lara Roberts
- grid.429705.d0000 0004 0489 4320Kings College Hospital, NHS Foundation Trust, London, UK
| | - Tovy Haber Kamine
- grid.281162.e0000 0004 0433 813XDivision of Trauma, Acute Care Surgery, and Surgical Critical Care, Baystate Medical Center, Springfield, MA USA
| | - Lucia Mazzolai
- grid.9851.50000 0001 2165 4204Department of Angiology, Lausanne University, Lausanne, Switzerland
| | | | - David S. Kim
- grid.461733.40000 0001 2375 6474Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany ,grid.17091.3e0000 0001 2288 9830Department Emergency Medicine, University British Columbia, Vancouver, Canada
| | - Rik H. Olde Engberink
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Amsterdam, The Netherlands ,Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Peter zu Eulenberg
- grid.5252.00000 0004 1936 973XInstitute for Neuroradiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bruno Grassi
- grid.5390.f0000 0001 2113 062XDepartment of Medicine, University of Udine, Udine, Italy
| | - Lucrezia Zuccarelli
- grid.5390.f0000 0001 2113 062XDepartment of Medicine, University of Udine, Udine, Italy
| | - Giovanni Baldassarre
- grid.5390.f0000 0001 2113 062XDepartment of Medicine, University of Udine, Udine, Italy
| | - Kevin Tabury
- grid.8953.70000 0000 9332 3503Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Sarah Baatout
- grid.8953.70000 0000 9332 3503Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Jens Jordan
- grid.7551.60000 0000 8983 7915Institute of Aerospace Medicine, German Aerospace Center and University of Cologne, Köln, Germany
| | - Andrew P. Blaber
- grid.61971.380000 0004 1936 7494Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC Canada
| | - Alexander Choukér
- grid.411095.80000 0004 0477 2585Translational Research Stress & Immunity, Klinik für Anästhesiologie/Forschungslabors, LMU Klinikum, München, Germany
| | - Thais Russomano
- grid.411095.80000 0004 0477 2585Translational Research Stress & Immunity, Klinik für Anästhesiologie/Forschungslabors, LMU Klinikum, München, Germany ,InnovaSpace UK, London, UK
| | - Nandu Goswami
- grid.11598.340000 0000 8988 2476Division of Physiology, Otto Löwi Research Center for Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria ,Mohammed Bin Rashid University of Medicine and Applied Health Sciences, Dubai, United Arab Emirates
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