Comprehensive assessment of physiological responses in women during the ESA dry immersion VIVALDI microgravity simulation.

Astronauts in microgravity experience multi-system deconditioning, impacting their inflight efficiency and inducing dysfunctions upon return to Earth gravity. To fill the sex gap of knowledge in the health impact of spaceflights, we simulate microgravity with a 5-day dry immersion in 18 healthy women (ClinicalTrials.gov Identifier: NCT05043974). Here we show that dry immersion rapidly induces a sedentarily-like metabolism shift mimicking the beginning of a metabolic syndrome with a drop in glucose tolerance, an increase in the atherogenic index of plasma, and an impaired lipid profile. Bone remodeling markers suggest a decreased bone formation coupled with an increased bone resorption. Fluid shifts and muscular unloading participate to a marked cardiovascular and sensorimotor deconditioning with decreased orthostatic tolerance, aerobic capacity, and postural balance. Collected datasets provide a comprehensive multi-systemic assessment of dry immersion effects in women and pave the way for future sex-based evaluations of countermeasures.

Neurocognitive assessment in microgravity: review of tools and benefits of increasing their clinical validity for long duration missions.

INTRODUCTION: Clinical complications are not expected in current space missions; however, for future long-duration missions to the Moon and Mars, a new perspective may be needed - a more clinical approach. Different risks, both environmental, such as radiation, accidents, and biopsychological, including neurological problems, represent potential sources of subsequent neurocognitive deficits. AIMS: This study aims to review research studies published to this date in microgravity conditions using existing spaceflight neurocognitive assessment batteries. This study also discusses the different risks of neuropsychological impairment in spaceflight and the potential benefits of increasing the clinical validity of these tools with neurological clinical samples on Earth for future long-duration missions. METHOD: A PRISMA guidelines-based review of specialized literature on neurocognitive assessment batteries and human spaceflight was performed. Different factors including type of tool or battery used, sample size, mission duration, etc. were included in this review. After the scrutiny of 192 articles, a total of 27 studies were detailed in the review outcome. RESULTS: Results showed that neuropsychological function research target has changed over the years, with working memory and perception studies being predominant in the 80s and 90s while reaction time being more frequent in recent research. We also found a lack of language-related research in microgravity and the predominance of two neurocognitive assessment batteries in microgravity research. CONCLUSIONS: With this study, we want to emphasize the importance of increasing the clinical validity of neurocognitive or neuropsychological assessment tools to be used in space, especially in long-duration missions because in this type of mission the risk of suffering a brain injury or neurological condition increases due to multiple factors. Testing these tools with neurological clinical samples and using machine learning, predictive systems may help crews in early detection of potential clinical, neurological, or neurocognitive problems during these long-duration missions to Mars and beyond.

Long-Term Space Nutrition: A Scoping Review.

This scoping review aimed to identify current evidence and gaps in the field of long-term space nutrition. Specifically, the review targeted critical nutritional needs during long-term manned missions in outer space in addition to the essential components of a sustainable space nutrition system for meeting these needs. The search phrase "space food and the survival of astronauts in long-term missions" was used to collect the initial 5432 articles from seven Chinese and seven English databases. From these articles, two independent reviewers screened titles and abstracts to identify 218 articles for full-text reviews based on three themes and 18 keyword combinations as eligibility criteria. The results suggest that it is possible to address short-term adverse environmental factors and nutritional deficiencies by adopting effective dietary measures, selecting the right types of foods and supplements, and engaging in specific sustainable food production and eating practices. However, to support self-sufficiency during long-term space exploration, the most optimal and sustainable space nutrition systems are likely to be supported primarily by fresh food production, natural unprocessed foods as diets, nutrient recycling of food scraps and cultivation systems, and the establishment of closed-loop biospheres or landscape-based space habitats as long-term life support systems.

Assessment of Jugular Venous Blood Flow Stasis and Thrombosis During Spaceflight.

Importance: Exposure to a weightless environment during spaceflight results in a chronic headward blood and tissue fluid shift compared with the upright posture on Earth, with unknown consequences to cerebral venous outflow. Objectives: To assess internal jugular vein (IJV) flow and morphology during spaceflight and to investigate if lower body negative pressure is associated with reversing the headward fluid shift experienced during spaceflight. Design, Setting, and Participants: This prospective cohort study included 11 International Space Station crew members participating in long-duration spaceflight missions . Internal jugular vein measurements from before launch and approximately 40 days after landing were acquired in 3 positions: seated, supine, and 15° head-down tilt. In-flight IJV measurements were acquired at approximately 50 days and 150 days into spaceflight during normal spaceflight conditions as well as during use of lower body negative pressure. Data were analyzed in June 2019. Exposures: Posture changes on Earth, spaceflight, and lower body negative pressure. Main Outcomes and Measures: Ultrasonographic assessments of IJV cross-sectional area, pressure, blood flow, and thrombus formation. Results: The 11 healthy crew members included in the study (mean [SD] age, 46.9 [6.3] years, 9 [82%] men) spent a mean (SD) of 210 (76) days in space. Mean IJV area increased from 9.8 (95% CI, -1.2 to 20.7) mm2 in the preflight seated position to 70.3 (95% CI, 59.3-81.2) mm2 during spaceflight (P < .001). Mean IJV pressure increased from the preflight seated position measurement of 5.1 (95% CI, 2.5-7.8) mm Hg to 21.1 (95% CI, 18.5-23.7) mm Hg during spaceflight (P < .001). Furthermore, stagnant or reverse flow in the IJV was observed in 6 crew members (55%) on approximate flight day 50. Notably, 1 crew member was found to have an occlusive IJV thrombus, and a potential partial IJV thrombus was identified in another crew member retrospectively. Lower body negative pressure was associated with improved blood flow in 10 of 17 sessions (59%) during spaceflight. Conclusions and Relevance: This cohort study found stagnant and retrograde blood flow associated with spaceflight in the IJVs of astronauts and IJV thrombosis in at least 1 astronaut, a newly discovered risk associated with spaceflight. Lower body negative pressure may be a promising countermeasure to enhance venous blood flow in the upper body during spaceflight.

[HEART RHYTHM VARIABILITY ANALYSIS AND ASSESSMENT OF THE SPINAL PAIN SYNDROME DURING DRY IMMERSION].

The spinal pain syndrome appears in cosmonauts on both short and long-duration missions. This untoward factor may affect body systems functioning and complicate the successful accomplishment of space mission. Purpose of the investigation was to examine the lumbar spine and to elucidate whether its condition relates to the spinal pain development and changes in heart rate variability (HRV) in the microgravity environment. The experiment was conducted in dry immersion as a method of microgravity effects simulation. It was shown that in dry immersion locomotion reproduces the patterns peculiar for significant gravitational unloading. Spinal pain intensity, angles and heights of the lumbar intervertebral discs and HRV were measured in 19 selected volunteers. During the experiment, all the volunteers developed pains in the back that abated gradually. Pain dependence on the height of intervertebral discs and cardiac regulatory mechanisms were investigated.

Measurements of jugular, portal, femoral, and calf vein cross-sectional area for the assessment of venous blood redistribution with long duration spaceflight (Vessel Imaging Experiment).

PURPOSE: To determine if 6 months in microgravity resulted in significant changes in the major central and peripheral veins indicating a redistribution of venous blood flow. METHODS: Ten astronauts participated in the study. Jugular vein (JV), portal vein (PV), femoral vein (FV), tibial vein (TibV), and gastrocnemius vein (Gast V) were assessed by echography for the measurement of vessel cross-sectional area. Inflight exams were conducted by astronauts using a volume capture method in which images collected were processed to produce a 3D reconstruction of the vessel which was later analyzed by a trained sonographer. Measurements were conducted pre-flight, at the beginning of the flight (day 15), near the end of the flight (4-5.5 months), and post-flight. RESULTS: During the flight, JV, PV, JV/PV ratio, and FV were found significantly increased from pre-flight at 15 days and 4-5.5 months (JV: 178 and 225%, p < 0.05; PV: 36 and 45%, p < 0.05; JV/PV ratio: 102 and 120%, p < 0.05; FV: 124 and 169%, p < 0.05). Conversely, calf veins decreased at day 15 and at 4-5.5 months (TibV: -45 and-52 %, p < 0.05; Gast V: -68 and -55%, p < 0.05). All veins returned to base line conditions 4 days after returning to Earth. CONCLUSIONS: The increase in JV, PV, and FV cross-sectional area during spaceflight confirmed that there was venous blood pooling in the cephalic, splanchnic, and pelvic regions. Further investigation is needed to determine the consequences of this fluid stagnation on the brain, eye, splanchnic, and pelvic organ morphology and or function.

Feasibility of monitoring muscle health in microgravity environments using Myoton technology.

Physical exercise is important for people living under extreme environmental conditions to stay healthy. Particularly in space, exercise can partially counteract the loss of muscle mass and muscle strength caused by microgravity. Monitoring the adaptation of the musculoskeletal system to assess muscle quality and devise individual training programmes is highly desirable but is restricted by practical, technical and time constraints on board the International Space Station. This study aimed to test the feasibility of using myometric measurements to monitor the mechanical properties of skeletal muscles and tendons in weightlessness during parabolic flights. The mechanical properties (frequency, decrement, stiffness relaxation time and creep) of the m. gastrocnemius, m. erector spinae and Achilles tendon were assessed using the hand-held MyotonPRO device in 11 healthy participants (aged 47 ± 9 years) in normal gravity as well as in microgravity during two parabolic flight campaigns. Results showed significant (p < .05-.001) changes in all mechanical properties of both muscles and the Achilles tendon, indicating a more relaxed tissue state in microgravity. Recordings from a phantom rubber material with the device in a test rig confirmed that the device itself was not affected by gravity, as changes between gravity conditions that were too small (<1 %) to explain the changes observed in the tissues. It is concluded that myometric measurements are a feasible, easy-to-use and non-invasive approach to monitor muscle health in extreme conditions that prohibit many other methods. Real-time assessment of the quality of a muscle being exposed to the negative effect of microgravity and also the positive effects of muscular training could be achieved using Myoton technology.

Skeletal health in long-duration astronauts: nature, assessment, and management recommendations from the NASA Bone Summit.

Concern about the risk of bone loss in astronauts as a result of prolonged exposure to microgravity prompted the National Aeronautics and Space Administration to convene a Bone Summit with a panel of experts at the Johnson Space Center to review the medical data and research evidence from astronauts who have had prolonged exposure to spaceflight. Data were reviewed from 35 astronauts who had served on spaceflight missions lasting between 120 and 180 days with attention focused on astronauts who (1) were repeat fliers on long-duration missions, (2) were users of an advanced resistive exercise device (ARED), (3) were scanned by quantitative computed tomography (QCT) at the hip, (4) had hip bone strength estimated by finite element modeling, or (5) had lost >10% of areal bone mineral density (aBMD) at the hip or lumbar spine as measured by dual-energy X-ray absorptiometry (DXA). Because of the limitations of DXA in describing the effects of spaceflight on bone strength, the panel recommended that the U.S. space program use QCT and finite element modeling to further study the unique effects of spaceflight (and recovery) on bone health in order to better inform clinical decisions.

Nutritional status assessment before, during, and after long-duration head-down bed rest.

INTRODUCTION: Bed rest is a valuable ground-based model for many of the physiological changes that are associated with spaceflight. Nutritional changes during and after 60 or 90 d of head-down bed rest were evaluated. METHODS: A total of 13 subjects (8 men, 5 women; ages 26-54 yr) participated in either 60 or 90 d of bed rest. Blood and urine were collected twice before bed rest and about once per month during bed rest. Samples were stored frozen and batch analyzed. Data were analyzed using repeated-measures analysis of variance. RESULTS: During bed rest, markers of bone resorption (such as N-telopeptide excretion, P < 0.001) increased and serum concentration of parathyroid hormone decreased (P < 0.001). Also, oxidative damage markers such as superoxide dismutase increased (P < 0.05), and after 90 d of bed rest, total antioxidant capacity decreased (P < 0.05). During bed rest, iron status indices showed patterns of increased iron stores with a decreased concentration of transferrin receptors (P < 0.01). DISCUSSION: These changes are similar to some of those observed during spaceflight, and further document the utility of bed rest as a model of spaceflight.

Trauma sonography for use in microgravity.

Sonography is the only medical imaging modality aboard the ISS, and is likely to remain the leading imaging modality in future human spaceflight programs. While trauma sonography (TS) has been well recognized for terrestrial trauma settings, the technique had to be evaluated for suitability in spaceflight prior to adopting it as an operational capability. The authors found the following four-phased evaluative approach applicable to this task: 1) identifying standard or novel terrestrial techniques for potential use in space medicine; 2) developing and testing these techniques with suggested modifications on the ground (1 G) either in clinical settings or in animal models, as appropriate; 3) evaluating and refining the techniques in parabolic flight (0 G); and 4) validating and implementing for clinical use in space. In Phase I of the TS project, expert opinion and literature review suggested TS to be a potential screening tool for trauma in space. In Phase II, animal models were developed and tested in ground studies, and clinical studies were carried out in collaborating trauma centers. In Phase III, animal models were flight-tested in the NASA KC-135 Reduced Gravity Laboratory. Preliminary results of the first three phases demonstrated the potential clinical utility of TS in microgravity. Phase IV studies have begun to address crew training issues, onboard imaging protocols, and data transfer procedures necessary to offer the modified TS technique for space use.

The carbon or silicon colonization of the universe?

At the time of the Apollo Programme, a first human mission to Mars was proposed as early as 1984 with the argument that the higher costs of human exploration would be more than justified by the increased effectiveness of human explorers. This was based on the Apollo experience, where "ground truth" measurements and sampling provided the basis for subsequent unmanned exploration of the Solar System. A human Mars mission is now not seen until 2030, at the end of a series of increasingly sophisticated unmanned probes. Each robot mission not only teaches us something about Mars, but also through experience increases our capabilities for the unmanned exploration of that planet. As a consequence, what a human mission would have to do becomes progressively more demanding. Any extended plan for the human exploration of Space will tend to be overtaken by advances in technology, and if this is not factored into the scenario the proposals will become progressively unrealistic.

The physical price of a ticket into space.

As a direct consequence of exposure to microgravity astronauts experience a number of physiological changes, which can have serious medical implications when they return to Earth. Most immediate and significant are the head-ward shift of body fluids and the removal of gravitational loading from bone and muscles, which lead to progressive changes in the cardiovascular and musculoskeletal systems. Cardiovascular adaptations result in an increased incidence of orthostatic intolerance (fainting) post-flight, decreased cardiac output and reduced exercise capacity. Changes in the musculoskeletal system contribute significantly to the impaired functions experienced in the post-flight period. The underlying factor producing these changes is the absence of gravity. Countermeasures, therefore, are designed primarily to simulate Earth-like movements, stresses and system interactions. Exercise is one approach that has received wide operational use and acceptance in both the US and Russian space programmes, and has enabled humans to stay relatively healthy in space for well over a year. Although it remains the most effective countermeasure currently available, significant physiological degradation still occurs. The development of other countermeasures will therefore be necessary for longer duration missions, such as the human exploration of Mars.

Bone architecture assessment with measures of complexity.

Architectural changes in trabecular bone by osteoporosis were utilized as a model for the changes which probably occur in human bone while exposed to microgravity conditions. Although there are many concerns about microgravity-induced bone loss, little is known about the impact of microgravity on the three-dimensional architecture of the skeleton. 50 (level L3) and 57 (level L4) vertebral bones harvested from human cadavers were investigated by computed tomography (CT) and quantified in terms of bone mineral density (BMD). Based on the symbol-encoded transformed CT-images, five measures of complexity were developed which quantify the structural composition of the trabecular bone. This quantification determines the bone architecture as a whole. Depending on the specific measure of complexity and its relation to BMD, a 5-10% change of BMD is related to a 5-90% change in structural composition. The method requires a non-invasive CT-procedure of the lumbar spine resulting in a radiation exposure of about 30 microSv effective dose. The technique is useful for the evaluation of the bone status of space-flying, personnel as well as for patients on ground. Grant numbers: BMH1-CT92-0296.

Nutritional status assessment in semiclosed environments: ground-based and space flight studies in humans.

Adequate nutrition is critical during long-term spaceflight, as is the ability to easily monitor dietary intake. A comprehensive nutritional status assessment profile was designed for use before, during and after flight. It included assessment of both dietary intake and biochemical markers of nutritional status. A spaceflight food-frequency questionnaire (FFQ) was developed to evaluate intake of key nutrients during spaceflight. The nutritional status assessment protocol was evaluated during two ground-based closed-chamber studies (60 and 91 d; n = 4/study), and was implemented for two astronauts during 4-mo stays on the Mir space station. Ground-based studies indicated that the FFQ, administered daily or weekly, adequately estimated intake of key nutrients. Chamber subjects maintained prechamber energy intake and body weight. Astronauts tended to eat 40--50% of WHO-predicted energy requirements, and lost >10% of preflight body mass. Serum ferritin levels were lower after the chamber stays, despite adequate iron intake. Red blood cell folate concentrations were increased after the chamber studies. Vitamin D stores were decreased by > 40% on chamber egress and after spaceflight. Mir crew members had decreased levels of most nutritional indices, but these are difficult to interpret given the insufficient energy intake and loss of body mass. Spaceflight food systems can provide adequate intake of macronutrients, although, as expected, micronutrient intake is a concern for any closed or semiclosed food system. These data demonstrate the utility and importance of nutritional status assessment during spaceflight and of the FFQ during extended-duration spaceflight.

Medical concerns for exploration-class missions.

The Space Exploration Initiative will challenge life scientists with a diverse set of crew medical risks. The varied sources of this cumulative risk are identified and briefly discussed in terms of risk assessment and preliminary plans for risk management. The roles of Space Station Freedom and other flight programs are discussed in the context of exploration medical objectives; and the significant differences between Space Station era (second generation) and exploration medical support systems (third generation) are reviewed.