[Medical monitoring and maintaining safety of cosmonauts on long-duration missions].

The paper considers key methodical, logistics and tactical aspects of enhancing cosmonaut's medical monitoring to ensure crew safety in long-duration space mission. Activities toward extension of the diagnostic capabilities included hardware development, choice of examination procedures and defining the content of physiological information that would be necessary and sufficient for evaluation, including in real-time, of the cardiovascular system function and capacity, planning functional tests procedures as close as possible to the generally accepted clinical protocols used in selection of candidates for cosmonauts, and pre- and post-flight examination; refining the objective criteria of test tolerance and termination, and end-of-mission LBNP training tolerance and effectiveness; constructing a fundamentally new structure for medical telemetry data acquisition and processing at the Moscow Mission Control Center (MCC-M).

[Some of the aspects of comparative analysis of the hemodynamic reactions to LBNP in cosmonauts of different age groups].

This was the first study of age-related differences of the cardiovascular system functioning and reactions to the LBNP test in career cosmonauts. Results of 174 LBNP tests performed within the standard medical monitoring program using Gamma-01 (orbital station Mir) and Gamma-lM (ISS) were subjected to comparative analysis. Thirty eight cosmonauts--members of 25 long-duration Mir and ISS missions were divided into two age groups, i.e. 30-39 y.o. (mean 36 & 0.7, 39% of all subjects) and 40-55 y.o. (mean 46 & 0.8, 61% of all subjects). The testing was performed before launch and in flight (typically on FD-120). Age-specifc changes in the hemodynamic status were recorded in resting cosmonauts pre-flight and in spaceflight microgravity; relative dynamics of the CV parameters in response to standing posture imitation was on one and the same patterns and yet demonstrated unequal intensity before and in flight. Test results implicate that analysis and interpretation of cosmonauts' medical monitoring data should take into account individual age, which is of particular practical importance when dealing with the LBNP test data obtained in different periods of space flight.

[Medical provisions for non-career cosmonauts on short-duration flights to the International Space Station].

The paper presents the factual data about 6 participants in short-duration space flights of three age groups (according to the WHO classification). The scope of medical care for three young SFPs whose health status was qualified as good replicated the program adopted in Russia for crewmembers trained for short-duration orbital flights. To safeguard three SFPs of middle and elderly age among whom two had deviations in body functions, the standard medical care program was reinforced by prescription of corrective pharmaceuticals to be taken during space flight, supply of personal kits with preventive medicine, inclusion of additional examinations into the standard medical monitoring and modification of the in-flight countermeasure program, if necessary. As a result, all the SFPs missions were accomplished safely and successfully.

[Medical care for Russian cosmonauts' health on the ISS].

Established with the personal participation of O.G. Gazenko, the Russian system of medical care for cosmonauts' health has been largely preserved till this day. The system was fully functional on board the orbital complex MIR and, with appropriate modifications, has been adopted as a core of the medical care for Russian members of the ISS crews. In the period of 2000-2008, 22 cosmonauts were members of 17 ISS increments from 140 to 216 days in duration. The main functions of the medical care system were to control health, physical and mental performance, and to support implementation of space researches. The flow of readaptation to the normal gravity was, in most cases similar to what has been typical on return from the Russian orbital stations; some deviations are accounted for by application of the in-flight countermeasures. The paper familiarizes reader with some aspects of the theoretical work of academician O.G. Gazenko in the field of medical care in space flight. It outlines the principles of ISS medical management. The integrated medical support system combines medical equipment and items available on the Russian and US segments; the integrated medical group consists of flight surgeons, medical experts and biomedical engineers of the international partners and coordinates planning and implementation of medical operations. Also, challenges of health care on the phase of ISS utilization are defined.

[Cell wall teichoic acids from Streptomyces daghestanicus VKM Ac-1722T and Streptomyces murinus INA-00524T].

The structure of cell wall teichoic acids was studied by chemical methods and NMR spectroscopy in the type strains of two actinomycete species of the "Streptomyces griseoviridis" phenetic cluster: Streptomyces daghestanicus and Streptomyces murinus. S. daghestanicus VKM Ac-1722T contained two polymers having a 1,5-poly(ribitol phosphate) structure. In one of them, the ribitol units had alpha-rhamnopyranose and 3-O-methyl-alpha-rhamnopyranose substituents; in the other, each ribitol unit was carrying 2,4-ketal-bound pyruvic acid. Such polymers were earlier found in the cell walls of Streptomyces roseolus and Nocardiopsis albus, respectively; however, their simultaneous presence in the cell wall has never been reported. The cell wall teichoic acid of Streptomyces murinus INA-00524T was is a 1,5-poly(glucosylpolyol phosphate), whose repeating unit was [-6)-beta-D-glucopyranosyl-(1 --> 2)-glycerol phosphate-(3-P-]. Such a teichoic acid was earlier found in Spirilliplanes yamanashiensis. The 13C NMR spectrum of this polymer is presented for the first time. The results of the present investigation, together with earlier published data, show that the type strains of four species of the "Streptomyces griseoviridis" phenetic cluster differ in the composition and structure of their teichoic acids; thus, teichoic acids may serve as chemotaxonomic markers of the species.

Some changes of the heart bioelectric activity at the cosmonauts under the influence of LBNP in the long duration flights.

There was selected the group of the cosmonauts, who carry out long duration flights on the orbital complex "Mir", in which the tolerance of LBNP test was evaluated as poor (by hemodynamic indices--heart rate, arterial pressure, rheoencephalographic indices). The in-depth analysis of the electrocardiogram (in DS leads) indices was carry oiled on possible disturbances of conductivity and dynamics of temporary or amplitude characteristics. Furthermore is carry oiled the comparative estimation of these indices with the results of ECG analysis at the cosmonauts, who tolerance test good. Studies showed that the most informative ECG indices are the R, T-amplitudes and QT-interval. Under the influence of LBNP, especially during rarefactions on 45 and 50 mm Hg was noted reduction in the R, T-amplitude and the relative extension of QT-interval. The directivity of changes in these indices are identical for the cosmonauts with good and poor tolerance of the test; however in flight manifestation of the changes is more significant for the cosmonauts with poor tolerance of LBNP test. Thus, in the formation of orthostatic stability together with the hemodynamic influences take part the bioelectric processes, which are formed in the myocardium.

[Dynamics of some electrocardiographic parameters in cosmonauts during long-term Mir mission]. / Dinamika nekotorykh élektrokardiograficheskikh pokazatelei u kosmonavtov v dlitel'nykh kosmicheskikh poletakh na orbital'nom komplekse "Mir".

The paper deals with the results of electrocardiographic investigations of relatively resting 59 cosmonauts at the age of 30 to 52 during long-term space missions. Heart rate (HR), T-wave amplitude and an electric systole interval were analyzed. During their missions, the cosmonauts consistently combined HR rises with aggravated repolarization manifested by a relative elongation of the phase and T-depression. All alterations were statistically significant (p < 0.05); however, no pathology was detected in the myocardial bioelectrical activity. With this dynamics, values of the parameters under study did not, as a rule, leave the boundaries of the physiological norm.

[The application of succession analysis in combination with extremely high-frequency irradiation to the selective isolation of actinomycetes from soil]. / Primenenie suktsessionnogo analiza v kombinatsii s KVCH-islucheniem dlia selektivnogo vydeleniia aktinomitsetov iz pochvy.

A new method employing succession analysis and extremely high-frequency (EHF) irradiation is proposed for the selective isolation of actinomycetes from soil. Total actinomycetes were efficiently isolated from soil suspensions irradiated in the wavelength band 4.6-5.8 mm on the 14th and 45th days of succession initiated by soil wetting and from soil suspensions irradiated in the wavelength band 8-11.5 mm on the 7th day of succession. The rare actinomycete genera Actinomadura, Micromonospora, Nonomuraea, Microbispora, Amycolatopsis, Pseudonocardia, Saccharothrix, Streptosporangium, Actinosynnema, Nocardioides, and Saccharopolyspora were isolated by either of the two approaches (succession analysis and EHF irradiation); however, the range of isolated rare actinomycetes was considerably wider when the combination of the two approaches was used. For instance, actinomycetes of the rare genera Actinocorallia, Promicromonospora, Actinoplanes, and Kibdelosporangium were isolated only when EHF irradiation was employed at the early stages of succession.

[Functional state of the cardiovascular system of cosmonauts at rest in long-term space flight]. / Funktsional'noe sostoianie serdechno-sosudistoi sistemy kosmonavtov v pokoe v dlitel'nykh kosmicheskikh poletakh]

Analyzed were data of investigation of a group of cosmonauts who participated in long-term Mir missions (125 to 438 days). The scope of investigations made in resting cosmonauts (279 before and 234 in flight) allowed classification of the cardiovascular system functioning in three types depending on the cardiac index. Correlation between circulation type and genetic factors, age and conditions of investigations (at rest or prior to a functional test) has been established. In flight, most often the cosmonauts pointed to intensification of the chronotropic function of the heart, increase in minute volume, rises in the end-systolic blood pressure (BPes) and systolic pressure in the pulmonary artery, hyperkinetic circulation, particularly before functional testing. However, values of the parameters under study did not leave the borderlines of the physiological and, as a rule, age norms. An in-depth analysis revealed three types of reaction to microgravity. Increase in minute volume due to the stroke volume and heart rate was concurrent with the BPes rise. Diminution of the volumes of hemocirculation and development of eukinetic circulation were not found to significantly alter BPes. There were several cosmonauts who did not display any proved shifts in the parameters.

Clinical effects of thigh cuffs during a 7-day 6 degrees head-down bed rest.

Thigh cuffs are used by Russian cosmonauts to limit the fluid shift induced by space flight. A ground simulation using the head-down bed rest (HDBR) model was performed to assess the effects of thigh cuffs on clinical tolerance and orthostatic adaptation. 8 male healthy volunteers (32.4 +/- 1.9 years) participated twice in a 7-day HDBR--one time with thigh cuffs (worn daily from 9 am to 7 pm) (TC) and one time without (WTC). Orthostatic tolerance was assessed by a 10 minute stand test and by a LBNP test (5 min at -15, -30, -45 mmHg) before (BDC-1) and at the end of the HDBR period (R+1). Plasma volume was measured before and at the end of HDBR by the Evans blue dye dilution technique. Thigh cuffs limits headache due to fluid shift, as well as the loss in plasma volume (TC: -5.85 +/- 0.95%; WTC: -9.09 +/- 0.82%, p<0.05). The mean duration of the stand test (R+1) did not differ in the two group (TC 7.1 +/- 1.3 min; WTC 7.0 +/- 1.0 min). The increase in HR and decrease in diastolic blood pressure were slightly but significantly larger without thigh cuffs. Duration of the LBNP tests did not differ with thigh cuffs. Thigh cuffs limit the symptoms due to fluid shift and the loss in plasma volume. They partly reduced the increase in HR during orthostatic stress but had no effect on duration of orthostatic stress tests.

Effect of the thigh-cuffs on the carotid artery diameter jugular vein section and facial skin edema: HDT study.

OBJECTIVE: To evaluate the distal arterial, venous and skin changes in a group using thigh cuffs during daytime and in a control group. METHOD: Cardiac, arterial, venous parameters were measured by echography and Doppler. Skin thickness was measured by high frequency echography. RESULTS & DISCUSSION: Head down position induced plasma volume reduction, increased cerebral resistance, reduced lower limb resistance. The jugular vein increased whereas the femoral and popliteal veins decreased. All these changes were already observed in previous HDT. Common carotid diameter decreased, Front head skin thickness increased and Tibial skin thickness decreased. Eight hours with thigh cuffs increased the cardiac and carotid sizes which is in agreement with the plasma volume increase. Conversely they reduced the cerebral vascular resistance, jugular section and front head edema which may explain the sensation of comfort reported by the subjects. At the lower limb level the thigh cuffs restored the skin thickness to pre-HDT level but enlarged markedly the femoral and popliteal veins. HR, BP, CO, TPR did not change.

Cardiac, cerebral & lower limb hemodynamic changes, during HDT (5 days to 42 d) & space flights (7 days to 6 months).

The objective was to identify the major cardiovascular changes induced by exposure to real or simulated 0 g (spaceflights: 6 days, 14 d, 21 d, 25 d, 6 months; Head Down Tilt: 10 h, 4 d, 5 d, 7 d, 30 d, 42 d), with a minimum of countermeasure (Daily exercise in space, no exercise in HDT).

Adaptation of the left heart, cerebral and femoral arteries, and jugular and femoral veins during short- and long-term head-down tilt and spaceflights.

The objective of this investigation was to identify the major cardiovascular changes induced by exposure to real or simulated Og (spaceflights: 6, 14, 21 and 25 days, and 6 months; head down tilt, HDT: 10 h, 4, 5, 7, 30 and 42 days), with a minimum of counter-measures. The following cardiovascular data were measured by echocardiography and Doppler ultrasonography: left ventricle end-diastolic volume (LVDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), middle cerebral artery flow velocity (Qca), femoral artery flow velocity (Qfa), cerebral vascular resistance (Rca), femoral vascular resistance (Rfa), jugular vein cross-sectional area (Ajv), femoral vein cross-sectional area (Afv), heart rate (HR), and mean blood pressure (MBP). LVDV remained decreased compared to pre-HDT or pre-flight levels after 1 week of spaceflight or HDT (-8 to -13%, P<0.05), EF did not change. HR tended to increase (5-10%) during spaceflight and HDT, whereas MBP tended to decrease during flight, but did not change in HDT. These findings are consistent with the existence of a moderate and stable hypovolemia. Qca and Rca fluctuated between +10 and -10% from pre-HDT or pre-flight values, and always showed opposing variations. There was no significant decrease in cerebral perfusion. Lower-limb resistance (Rfa) remained decreased (-5% to -18%, P<0.05) throughout the flights or HDT after week 1. Ajv remained significantly enlarged (+40% P < 0.05) after 1 week in spaceflight or in HDT. Afv was enlarged in spaceflight after week 1 (+15% to +35%, P<0.05), whereas it decreased after 4-5 days of HDT (-20% to -35%, P<0.05). The cardiovascular system reached a new and stable equilibrium during flight and HDT within less than 1 week. With the exception of the femoral vein, there was no significant difference in either the amplitude or the time course of the cardiovascular changes in both situations after 1 week.

Cardiac, arterial and venous adaptation to weightlessness during 6-month MIR spaceflights with and without thigh cuffs (bracelets).

The objectives of this investigation were to study the effects of thigh cuffs (bracelets) on cardiovascular adaptation and deconditioning in 0 g. The cardiovascular parameters of six cosmonauts were measured by echocardiography, Doppler, and plethysmography, during three 6-month MIR spaceflights. Measurements were made at rest during preflight (-30 days), inflight (1, 3-4, and 5-5.5 months) without cuffs (morning) and after 5 h with cuffs, and during postflight (+3 and +7 days). Lower-body negative pressure (LBNP) measurements were performed 1 day after each resting session. Inflight values of left ventricle end-diastolic volume and stroke volume measured without the thigh cuffs (-8 to -24% and -10 to -16%, respectively, both P < 0.05) were lower than corresponding preflight values. The jugular and femoral vein cross-sectional areas (Ajv and Afv, respectively) were enlarged (Ajv: by 23-30%, P < 0.001; Afv: by 33-70% P < 0.01). The renal and femoral vascular resistances (Rra and Rfa, respectively) decreased (Rra: by -15 to -16%, P < 0.01; Rfa: by -5 to -11%, P < 0.01). Inflight, the thigh cuffs reduced the Ajv (by -12 to -20%, P < 0.02), but enlarged the Afv (Afv: by 9-20%, P < 0.02) and increased the vascular resistance (Rra: by 8-13%, P < 0.05; Rfa: by 10-16%, P < 0.01) compared to corresponding inflight, without-cuffs values. During LBNP (-45 mmHg, where 1 mmHg = 133.3 N/ m2), Rfa and the ratio between cerebral and femoral blood flow (Qca/Qfa) increased less inflight and postflight (+25% for Rfa and +30% for Qca/Qfa) than during preflight (60% for Rfa and 75% for Qca/Qfa, P < 0.01). This reduced vasoconstrictive response and less efficient flow redistribution toward the brain was associated with orthostatic intolerance during postflight stand tests in all of the cosmonauts. The calf circumference increased less inflight and postflight (6% P < 0.05) than preflight (9% P < 0.05). The vascular response to LBNP remained similarly altered throughout the flight. The thigh cuffs compensated partially for the cardiovascular changes induced by exposure to 0 g, but did not interfere with 0 g deconditioning.

Influences of thigh cuffs on the cardiovascular system during 7-day head-down bed rest.

Thigh cuffs, presently named "bracelets," consist of two straps fixed to the upper part of each thigh, applying a pressure of 30 mmHg. The objective was to evaluate the cardiac, arterial, and venous changes in a group of subjects in head-down tilt (HDT) for 7 days by using thigh cuffs during the daytime, and in a control group not using cuffs. The cardiovascular parameters were measured by echography and Doppler. Seven days in HDT reduced stroke volume in both groups (-10%; P < 0.05). Lower limb vascular resistance decreased more in the cuff group than in the control group (-29 vs. -4%; P < 0.05). Cerebral resistance increased in the control group only (+6%; P < 0.05). The jugular vein increased (+45%; P < 0.05) and femoral and popliteal veins decreased in cross-sectional area in both groups (-45 and -8%, respectively; P < 0.05). Carotid diameter tended to decrease (-5%; not significant) in both groups. Heart rate, blood pressure, cardiac output, and total resistance did not change significantly. After 8 h with thigh cuffs, the cardiac and arterial parameters had recovered their pre-HDT level except for blood pressure (+6%; P < 0.05). Jugular vein size decreased from the pre-HDT level (-21%; P < 0.05), and femoral and popliteal vein size increased (+110 and +136%, respectively; P < 0.05). The thigh cuffs had no effect on the development of orthostatic intolerance during the 7 days in HDT.

Effect of the thigh-cuffs on the carotid artery diameter jugular vein section and facial skin edema: HDT study.

Thigh cuffs, currently named "bracelets", consist of 2 straps fixed to the upper part of each thigh, applying a pressure of approximately 30 mmHg. Initially the thigh cuffs were designed and used to improve th comfort of the cosmonauts during their stay in zero g. Except a reduction of the "puffy face" aspect no other morphological nor hemodynamic significant change was reported even when the cosmonauts weared these thigh cuffs inflight for 10h per day during several weeks or months. The objective was to evaluate the distal arterial, venous and skin changes in a group of 8 subjects in HDT for 7 days and using thigh cuffs 8h during daytime, and in a control group also in HDT for 7d but not using cuff.

PHYSIOLAB: a cardiovascular laboratory.

PHYSIOLAB is a cardio-vascular laboratory designed by CNES in cooperation with IMBP, with double scientific and medical goals: -a better understanding of the basic mechanisms involved in blood pressure and heart rate regulation, in order to predict and control the phenomenon of cardio-vascular deconditionning. -a real-time monitoring of cosmonauts during functional tests. Launched to the MIR station in 1996, this laboratory was set up and used for the first time by Claudie Andre-Deshays during the French mission "Cassiopeia". The scientific program is performed pre, post and in-flight to study phenomena related to the transition to microgravity as well as the return to the earth conditions. Particular emphasis was placed on the development of the real-time telemetry to monitor LBNP test. This function was successful during the Cassiopeia mission, providing the medical team at TSOUP (MIR Control Center in Moscow) with efficient means to control the physiological state of the cosmonaut. Based on the results of this first mission, IMBP and CNES will go on using Physiolab with Russian crews. CNES will take advantage of the upcoming French missions on MIR to improve the system, and intends to develop a new laboratory for the International Space Station.

Monitoring of the cardiac and vascular response to LBNP during the 14 day spaceflight "Cassiopee".

The objective of the present experiment was to monitor in real time the cardiac and the peripheral response to inflight LBNP. The second objective was to detect and quantify hemodynamic signs of orthostatic tolerance inflight by measuring the heart rate, blood pressure, cardiac and regional hemodynamics during LBNP.

[Work capacity evaluation and orthostatic tolerance in experiments with long-term isolation]. / Fizicheskaia rabotosposobnost' i ortostaticheskaia ustoichivost' v éksperimentakh s dlitel'noi izoliatsiei.

Orthostatic tolerance (OT) and physical performance were tested against the ground simulation of several spaceflight factors. Before and after prolonged isolation and confinement three human subjects were tested by tilting, LBNP, and graded incremental aerobic exercise in the sitting position. Results suggested good OT in all the subjects. However, the pattern of orthostatic reaction was modified depending on the initial functional state of each subject. This was especially distinct in subjects 002 and 003 whose OT was slightly reduced by the experimental conditions. Orthostatic reactions in subject 004 showed greater stability in the baseline data collection period and was not much affected by isolation and confinement. HR variations at rest carried an individual character. On the whole, HR tended downward, particularly in 002. Indices of AP and, to a higher degree, its systolic constituent wandered outside the region of baseline values and even the norm limits in 002 and 004. Maximum variations were documented at the end of the second (003 and 004) and the third (002) months in experiment. ECG parameters in all the operators displayed different patterns of the norm. Diffusive repolarization, especially in the left chest leads, was noted to decline in the experiment. Tolerance of LBNP was qualified as good. Meanwhile, subject 003 developed symptoms of strained functioning of compensatory/adaptive mechanisms responsible for the OT maintenance. Repeated testing by LBNP was found to raise HR. Hence, prolonged simulation of space flight causes some reduction of orthostatic and LBNP tolerance, and degradation of physical performance.