More than a Feeling: Dermatological Changes Impacted by Spaceflight

Spaceflight poses a unique set of challenges to humans and the hostile Spaceflight environment can induce a wide range of increased health risks, including dermatological issues. The biology driving the frequency of skin issues in astronauts is currently not well understood. To address this issue, we used a systems biology approach utilizing NASA's Open Science Data Repository (OSDR) on spaceflown murine transcriptomic datasets focused on the skin, biomedical profiles from fifty NASA astronauts, and confirmation via transcriptomic data from JAXA astronauts, the NASA Twins Study, and the first civilian commercial mission, Inspiration4. Key biological changes related to skin health, DNA damage & repair, and mitochondrial dysregulation were determined to be involved with skin health risks during Spaceflight. Additionally, a machine learning model was utilized to determine key genes driving Spaceflight response in the skin. These results can be used for determining potential countermeasures to mitigate Spaceflight damage to the skin.

Bone Metabolism During Strict Head-Down Tilt Bed Rest and CO2 Exposure

Objectives

Carbon dioxide (CO₂) levels on board the International Space Station reach 10× those of outdoor terrestrial levels. We report here studies assessing whether increased levels of ambient CO₂ contribute to elevated bone resorption characteristically observed with bed rest as an analog for skeletal unloading during spaceflight.

Methods

Data are reported from two ground-based studies which included 12 male and 7 female subjects placed in a strict −6° head-down tilt (HDT) position for 30 days at 0.5% ambient CO₂ or 60 days with nominal environment (0.04% CO₂). Subjects were neither afforded a pillow nor allowed to use an elbow while eating to increase headward fluid pressure. Bone mineral density (BMD) and bone mineral content (BMC) were measured with dual-energy X-ray absorptiometry. Blood and urine were collected before and during HDT for analysis.

Results

There was no change in BMD or BMC. Excretion of collagen crosslinks increased during HDT (p < 0.001) with no additive effect of CO₂. Serum and urine mineral concentrations were not affected by CO₂. Serum PTH and 1,25-deoxyhydroxyvitamin D were both reduced during bed rest (p < 0.0001), likely secondary to calcium efflux from bone, but with no additive effect of CO₂ exposure. These changes reinforce the impact of decreased mechanical loading on bone and mineral homeostasis and the efficacy of the strict HDT model.

Conclusions

Exposure to 0.5% CO₂ for 30 days did not exacerbate bone resorption during strict HDT bed rest. Future research on bone metabolism at varied CO₂ levels is needed to clarify a risk ceiling for bone resorption, especially as missions progress beyond low-Earth orbit.

Funding Sources

The data reported here were from the NASA Human Research Program Standard Measures Cross-Cutting Project. Funding was provided by the NASA Human Research Program's Human Health Countermeasures Element. ERM was funded through a NASA Summer Science Institute Fellowship.

Nutrition and Human Space Flight: Evidence From 4–6 Month Missions to the International Space Station

Objectives

2020 marked the 20th anniversary of a continuous human presence off the planet. Space flight is challenging, with environmental stressors, a closed food system, and adaptations affecting virtually all body systems. Our objective was to evaluate the time course of biochemical changes during flight, the effects of countermeasures, and the relationship between diet and physiological outcomes.

Methods

Blood and urine samples were collected before, during, and after flight from 65 astronauts. These were analyzed for a broad-based survey of physiological systems. Detailed diet records were available from 27 astronauts using an iPad App designed for use on ISS.

Results

The average intake of fruits and vegetables was lower than recommended (2.6 ± 0.9 servings per day), but intakes correlated with outcomes at landing. Specifically, higher intakes were positively correlated with vitamin C status (R2 = 0.43, P &lt; 0.05), and negatively correlated with inflammation (Interferon-γ, R2 = 0.76, P = 0.001) and oxidative stress (malondialdehyde, R2 = 0.51, P &lt; 0.05). Despite limited dietary sources and no UV light exposure, 800 IU vitamin D/d supplements maintained vitamin D status (serum 25OH-vitamin D was 78 ± 4 nmol/L during flight). Cholesterol (298 ± 163 mg/d) and saturated fat (26.1 ± 11 g/d, 10.4 ± 3.1% of kcals) intakes were associated with a 10% and 14% increase in circulating total and LDL cholesterol, respectively (P &lt; 0.001). Perhaps the most notable finding is that one-carbon biochemistry is altered in astronauts who experienced ophthalmic changes during and after flight, where circulating homocysteine concentrations were higher in affected astronauts compared to unaffected astronauts (P &lt; 0.001), and these differences existed before flight.

Conclusions

Evaluation of countermeasure effectiveness and individual and group responses to spaceflight will continue to be important on the ISS and will inform future space programs including Artemis and Gateway missions to the moon. Those efforts will require similar types of comprehensive assessments to allow the next steps in human exploration of space. By uniting nutrition with other disciplines, the importance of diet in heath can be further enlightened, with potential implications for both space explorers and for those remaining on Earth.

Funding Sources

This research was funded by the NASA Human Research Program and DLR.

Nutrition and Human Space Flight: Evidence from 4–6 Month Missions to the International Space Station

Objectives

2020 marks the 20th anniversary of a continuous human presence off the planet. Space flight is physically and physiologically challenging, with environmental stressors, a closed food system, and adaptations affecting virtually all body systems. Key objectives for this effort included evaluating the time course of biochemical changes that occur during flight, the effects of exercise countermeasures, and the relationship between dietary intake and physiological outcomes.

Methods

Blood and urine samples were collected before, during, and after flight from 65 astronauts. These were analyzed for a broad-based survey of physiological systems. Detailed diet records were available from 27 astronauts using an iPad App designed for use on ISS.

Results

The average intake of fruits and vegetables was lower than recommended (2.6 ± 0.9 servings per day), but intakes correlated with outcomes at landing. Specifically, higher intakes were positively correlated with vitamin C status (R2 = 0.43, P &lt; 0.05), and negatively correlated with inflammation (Interferon-γ, R2 = 0.76, P = 0.001) and oxidative stress (malondialdehyde, R2 = 0.51, P &lt; 0.05). Despite limited dietary sources and no UV light exposure, supplementing with 800 IU vitamin D/day maintained vitamin D status (serum 25OH-vitamin D was 78 ± 4 nmol/L during flight). Cholesterol (298 ± 163 mg/d) and saturated fat (26.1 ± 11 g/d, 10.4 ± 3.1% of kcals) intakes were associated with a 10% and 14% increase in circulating total and LDL cholesterol concentrations, respectively (P &lt; 0.001). Perhaps the most notable finding is evidence that one-carbon biochemistry is altered in astronauts who experienced ophthalmic changes during and after flight, where circulating homocysteine concentrations were higher in affected astronauts compared to unaffected astronauts (P &lt; 0.001), and these differences existed before flight.

Conclusions

Evaluation of countermeasure effectiveness and individual and group responses to spaceflight will continue to be important on the ISS, and will inform future space programs including Artemis and Gateway missions to the moon. Those efforts will require similar types of comprehensive assessments to allow the next steps in human exploration of space. By uniting nutrition with other disciplines, the importance of diet in heath can be further enlightened, with potential implications for both space explorers and for those remaining on Earth.

Funding Sources

This research was funded by the NASA Human Research Program and DLR.

MTRR 66 and SHMT1 1420 Variants Are Associated with Optic Disc Edema During 30-d Strict Head-down Tilt Bed Rest and CO2 Exposure (P24-036-19)

Objectives

Some astronauts returning from missions to the International Space Station (ISS) have developed ophthalmic structural changes, including optic disc edema. Incidence of optic disc edema among astronauts has been linked to one-carbon pathway genetic variants and B-vitamin status. A recent 30-d 6-degree head-down tilt bed rest study in which all subjects were exposed to 0.5% CO2 documented the occurrence of optic disc edema in 5 of 11 subjects. The objective of this study was to determine the effect of one-carbon pathway genetics and B-vitamin status on the incidence of optic disc edema in the bed rest subjects.

Methods

The study was conducted at the : envihab facility at the German Aerospace Center in Cologne, Germany. Subjects (6 M/5F) were healthy volunteers, 33 ± 8 y (mean ± SD), having a mean BMI of 23.4 ± 2.2 kg/m2. After a 14-d ambulatory phase in a standard environment (i.e., not hypercapnic), a blood sample was collected to assess vitamin status and single nucleotide polymorphisms (SNPs) associated with one carbon metabolism. We focused on two SNPs (rs1801394, MTRR 66 and rs1979227, SHMT1 1420) based on our earlier findings in astronauts (Zwart et al., FASEB J, 30:141–8, 2016). The 30-d bed rest began after collection of this sample. Optical coherence tomography images were collected before, during (days 15 and 30), and after (6 and 13 days after reambulation) bed rest, and the change in total retinal thickness (TRT) at various distances from Bruch's membrane opening (BMO) was evaluated against the number of MTRR A66G G alleles and SHMT1 C1420T C alleles.

Results

The change in TRT at various distances from the BMO in bed rest subjects exposed to mild hypercapnia and headward fluid shifts was strongly associated with the number of MTRR 66 G and SHMT1 1420 C alleles.

Conclusions

This finding may increase understanding of mechanisms involved in optic disc edema in astronauts and patients on Earth, and hence lead to development of targeted countermeasures.

Funding Sources

This work was funded by the NASA Human Health Countermeasures Element of the NASA Human Research Program.

[An elderly couple dies of natural causes on the same day]

BACKGROUND

A 77-year-old woman died of metastatic colorectal cancer. On that same day, her 82-year-old husband, who had stayed in bed next to her during the last days of her life, also died.

CASE DESCRIPTION

We describe their two separate trajectories to death: anticipated dying and unexpected death with diagnostic uncertainty. We analysed the general practitioner's role in this scenario. Existential suffering was partly the reason for commencing palliative sedation for the husband after his wife had died.

CONCLUSION

General practitioners might find it difficult to change their course in care management for terminal patients from "life preserving" to "letting go". An effective handover between physicians is essential in the palliative phase. No evidence was found in literature for the hypothesis that dying people can influence their own time of death.

[Summary of the practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners]

The second version of the practice guideline 'Sore throat' has been updated from the 1999 version. --Infections of the throat generally cure spontaneously within 7 days. In most cases the sore throat is caused by a virus. Group A beta-haemolytic streptococci (GABHS) are the most important bacterial cause ofa sore throat. --In diagnostics, the main focus is placed on evaluating how sick the patient is in general. --In adolescents who have had a sore throat for more than 7 days, the possibility of mononucleosis infectiosa should be borne in mind. This diagnosis can be verified by a test for IgM against Epstein-Barr-virus. --Additional investigations to detect GABHS are not recommended. --Prescribing antibiotics is only recommended for patients who have a severe throat infection or an increased risk of complications. Pheneticillin or phenoxymethylpenicillin remains first choice. --Referral for tonsillectomy should meet the following criteria: 5 or more episodes of sore throat per year or 3 or more episodes per year in the last 2 years.

Screening the foods of an endangered parrot, the kakapo (Strigops habroptilus), for oestrogenic activity using a recombinant yeast bioassay

In recent years the possibility of environmental oestrogens affecting the reproduction of vertebrates has become an issue of both public and scientific interest. Although the significance of such chemicals remains controversial there is clear evidence that, in some contexts, environmental oestrogens can influence the fertility of vertebrates. Highly endangered species represent a situation in which even modest reductions in the fertility of key individuals may have implications for the survival of the entire species. This paper reports the screening of both natural and supplementary foods of the kakapo (Strigops habroptilus), a critically endangered New Zealand nocturnal parrot, for oestrogenic activity using a recombinant yeast based bioassay. Low levels of oestrogenic activity were detected in one of the 'chick-raising' foods, but no oestrogenic activity was detected in the adult supplementary foods. The oestrogenicity of a range of phytochemicals possibly associated with the kakapo natural diet was also examined. Two such phytochemicals, podocarpic acid and its reduced derivative podocarpinol, showed weak oestrogenic activity (approximately 10(-6) and 10(-4) of the activity of 17-beta-oestradiol, respectively).

Potentially virulent strains and high colony counts of group A beta-haemolytic streptococci in pharyngitis patients having a delayed recovery or a complication

T serotyping and M and exotoxin genotyping were performed on strains from 367 streptococcal pharyngitis patients in Dutch general practice. Potentially virulent strains of group A beta-haemolytic streptococci, such as T1M1 and T3M3 subtypes and strains expressing speA and speC, and a high number of colony counts did not occur more frequently in the 166 (45%) more seriously ill patients, defined as those who showed a delayed recovery or a complication.

Beta-haemolytic streptococci isolated from acute sore-throat patients: cause or coincidence? A case-control study in general practice

As beta-haemolytic streptococci can be cultured in people with and in those without a sore throat, a case-control study was set up in 43 family practices in The Netherlands. The association was tested between the number of colony counts, specific T/M types and exotoxin genes and an acute sore throat. Duplicate throat swabs were taken from 663 sore-throat patients, selected by clinical criteria, and from 694 healthy controls. They were cultured for beta-haemolytic streptococci by combining several updated laboratory methods. Approximately 40% of the controls and 80% of the patients had beta-haemolytic streptococci-positive cultures. When focusing on cultures with high colony counts, not only group A (46%), but also non-group A streptococci (20%), predominated significantly in adult patients compared with controls. No T/M or exotoxin gene type was significantly more prevalent in patients than in controls. Thus, semiquantitative analysis, but not T/M and exotoxin gene typing, showed an association between beta-haemolytic streptococci and active disease. Groups A, C and G streptococci were found to be potentially pathogenic in adult sore-throat patients, and should be included in the discussion on the use of rapid antigen detection tests and penicillin treatment in primary care.

Isolated familial hyperparathyroidism with a novel mutation of the MEN1 gene

OBJECTIVE

To describe two cases of familial hyperparathyroidism with genetic analysis and report a new gene mutation.

METHODS

Clinical and laboratory details of a brother and sister with hyperparathyroidism and nephrolithiasis are presented. The family history is reviewed, and results of direct sequencing analysis for mutations in the MEN1 gene are discussed.

RESULTS

Isolated familial hyperparathyroidism is uncommon. Whether this condition is a partial expression of multiple endocrine neoplasia type I, a well-known genetic disorder, or an independent entity is being debated and studied. Two cases of hyperparathyroidism were diagnosed in a brother and a sister from a family that has expressed isolated hyperparathyroidism in several family members as the only manifestation thus far. A novel genetic mutation involving a CGG to CGT alteration in codon 219 of the MEN1 gene was discovered; to our knowledge, this particular variation has not been reported previously.

CONCLUSION

In patients with isolated familial hyperparathyroidism, a search for a mutation in the MEN1 gene may eventually help clarify this uncommon familial condition.

Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults

OBJECTIVE

To assess whether treatment with penicillin for three days and the traditional treatment for seven days were equally as effective at accelerating resolution of symptoms in patients with sore throat compared with placebo.

DESIGN

Randomised double blind placebo controlled trial.

SETTING

43 family practices in the Netherlands.

PARTICIPANTS

561 patients, aged 15-60 years, with sore throat for less than seven days and at least three of the four Centor criteria-that is, history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate. 142 patients were excluded for medical reasons and 73 needed penicillin.

INTERVENTIONS

Patients were randomly assigned to penicillin V for seven days, penicillin V for three days followed by placebo for four days, or placebo for seven days.

MAIN OUTCOME MEASURES

Resolution of symptoms in the first week, eradication of bacteria after two weeks, and recurrences of sore throat after two, four, and six months.

RESULTS

Symptoms resolved 1.9 and 1.7 days earlier in patients taking penicillin for seven days than in those taking penicillin for three days or placebo respectively. Symptoms resolved 2.5 days earlier in patients with group A streptococci and 1.3 days earlier in patients with high colony counts of non-group A streptococci. 23 (13%) of the placebo group had to be given antibiotics later in the week because of clinical deterioration; three developed a peritonsillar abscess. The eradication rate for group A streptococci was 72% in the seven day penicillin group, 41% in the three day penicillin group, and 7% in the placebo group. Sore throat recurred more often in the three day penicillin group than in the seven day penicillin or placebo groups.

CONCLUSION

Penicillin treatment for seven days was superior to treatment for three days or placebo in resolving symptoms of sore throat in patients with group A streptococcal pharyngitis and, possibly, in those with non-group A streptococcal pharyngitis.

Community health care and hospital attendance: a case study in rural Ghana

This study assesses the influence of coverage with a network of PHC clinics as well as private clinics in Dormaa District, Ghana on, hospital attendance. This influence is measured by analysing hospital attendance among inhabitants during 6 months in 1984 and 1986. Several conditioning factors are analysed: the type of modern health care present in the community and the experience of the community health worker (CHW); the distance between community and hospital; the time factor (1984 and 1986); the sex and age of the attendants; the diagnosis made at the hospital. It appears that fewer people attend the hospital if a community participates in the PHC programme and if the CHW is experienced. When people from these communities attend the hospital they do so less unnecessarily than those from other communities. Simple analysis of routine hospital data may contribute to any PHC assessment programme set up around the hospital.