Dynamic Range of Luminance Perception in Acute Hypobaric Hypoxia.

Rizzi, Alessandro, Alice Plutino, Diego Vecchi, Anton Giulio Guadagno, and Marco Lucertini. Dynamic range of luminance perception in acute hypobaric hypoxia. High Alt Med Biol. 23:313-318, 2022.-The effects of acute hypobaric hypoxia, as potentially experienced in high altitude flight, on the detection of low contrast targets within a high dynamic range (DR) of luminance were investigated. The tests were performed after 10 minutes of adaptation to an ambient luminance level of 0.2 lx. Twenty-four individuals were exposed to hypobaric hypoxia at an altitude of 18,000 ft (5,490 m) inside a hypobaric chamber and were asked to identify the darkest one perceived from a grid of progressively less luminous patches. The results were compared with those obtained by the same subjects at sea level. The results indicate a global reduction of the DR perception during hypoxia, with a mean decrease of 0.023 cd/m2 (standard deviation ±0.064), which resulted statistically significant (p < 0.05). No significant correlations with oxygen saturation levels were observed. These findings might have practical applications in the design of cockpit's instruments, especially those dedicated to night-time flight missions at high altitudes.

Space flight and central nervous system: Friends or enemies? Challenges and opportunities for neuroscience and neuro-oncology.

Space environment provides many challenges to pilots, astronauts, and space scientists, which are constantly subjected to unique conditions, including microgravity, radiations, hypoxic condition, absence of the day and night cycle, etc. These stressful stimuli have the potential to affect many human physiological systems, triggering physical and biological adaptive changes to re-establish the homeostatic state. A particular concern regards the risks for the effects of spaceflight on the central nervous system (CNS), as several lines of evidence reported a great impact on neuroplasticity, cognitive functions, neurovestibular system, short-term memory, cephalic fluid shift, reduction in motor function, and psychological disturbances, especially during long-term missions. Aside these potential detrimental effects, the other side of the coin reflects the potential benefit of applicating space-related conditions on Earth-based life sciences, as cancer research. Here, we focused on examining the effect of real and simulated microgravity on CNS functions, both in humans and in cellular models, browsing the different techniques to experience or mime microgravity on-ground. Increasing evidence demonstrate that cancer cells, and brain cancer cells in particular, are negatively affected by microgravity, in terms of alteration in cell morphology, proliferation, invasion, migration, and apoptosis, representing an advancing novel side of space-based investigations. Overall, deeper understandings about the mechanisms by which space environment influences CNS and tumor biology may be promisingly translated into many clinical fields, ranging from aerospace medicine to neuroscience and oncology, representing an enormous pool of knowledge for the implementation of countermeasures and therapeutic applications.

Hearing Aids Performance in Hypobaric Environments.

OBJECTIVE: High altitudes imply exposure to a decreased ambient air pressure. Such a situation may also alter the performance of acoustic transducers using vibrating diaphragms due to air rarefaction. This study aimed at analyzing the performance at high altitude of hearing aids (HAs) where mechano-electric and electro-mechanic transducers are used. METHODS: A hypobaric chamber was used to perform two separated experimental sessions. In the first one two commercial models of HAs were exposed to a simulated altitude of 25,000 ft (7620 m) and to a subsequent rapid decompression profile, with a rapid climb (< 3 s) from 8000 (2438 m) to 25,000 ft. The second session separately analyzed the performance of microphone and receiver at an altitude of 9000 and 15,000 ft (2743 and 4572 m). Before and after the first session, the HAs were tested with an electronic ear while a dedicated recording system was used in the second session. RESULTS: No HA damage or dysfunction was detected during the first session. In the second one, the microphone showed a mild decrease of its output, while the receiver exhibited a much higher reduction of its output. CONCLUSION: Our findings highlight the safe use of HAs even under extreme environmental pressure changes. For altitudes exceeding 10,000 ft (3048 m), a recalibration of the HAs output via a dedicated program may be suggested. Lucertini M, Sanjust F, Manca R, Cerini L, Lucertini L, Sisto R. Hearing aids performance in hypobaric environments. Aerosp Med Hum Perform. 2021; 92(9):738743.

Lack of Significant Audiometric Changes Under Hypobaric Hypoxia at 15,000 ft.

BACKGROUND: The aim of this study was pure tone audiometry (PTA) evaluation in normal individuals exposed to hypobaric hypoxia, taking into account the influence of air rarefaction on sound transmission via a standard earphone.METHODS: The study was conducted in a hypobaric chamber using a standard audiometer and a TDH-39P earphone whose performance at altitudes was analyzed in a previous research. Eight male volunteers underwent PTA testing at ground level and at 15,000 ft under normoxia (via an oxygen mask) and after 20 min of hypoxia. Auditory threshold at 500, 1000, 2000, and 4000 Hz was recorded from the right ear while monitoring arterial oxygen saturation (Sao2). The PTA data obtained at high altitude were corrected according to a specific recalibration table.RESULTS: During hypoxia, a significant threshold shift was observed only at 4000 Hz, with respect to ground level recording, for the sole not-corrected data. At the same frequency a significant threshold shift was also observed between the ground level recording and normoxia at 15,000 ft, confirming the presence of a hypobaric effect not related to hypoxia. After the recalibration procedure, this hearing impairment was not significant. No correlation with Sao2 levels was observed.DISCUSSION: The mild and not significant presence of high altitude-induced PTA derangements in healthy normal individuals was documented, although a stimulus recalibration was needed for a correct interpretation of our data.Lucertini M, Lancia S, Sanjust F, Guadagno AG, Lucertini L, Sisto R. Lack of significant audiometric changes under hypobaric hypoxia at 15,000 ft. Aerosp Med Hum Perform. 2020; 91(1):32-36.

High Altitude Performance of Loudspeakers and Potential Impact on Audiometric Findings.

BACKGROUND: The evaluation of how air rarefaction can affect a loudspeaker performance at altitude implies the need for characterization of earphones during hypobaric conditions. The aim of this study was phonometric analysis at different altitudes of the acoustic output of a widely used earphone model, along with its consequences on audiological investigations conducted under such environmental conditions.METHODS: The transfer function of a TDH-39P earphone was analyzed with an artificial ear under nine different altitude levels, from sea level up to 35,000 ft, inside a hypobaric chamber. A specific phonometric system not sensitive to environmental pressure changes was used. Other potentially confounding factors, such as environmental temperature and humidity, were continuously monitored.RESULTS: No relevant temperature or humidity changes were detected. The sound pressure level generated by the earphone under hypobaric conditions was found considerably affected by air density changes. These data produced a correction table aiming at recalibrating the earphone's output at each audiometric octave test frequency within the 250-8000 Hz range. Quite different characteristics of response were observed at different audiometric frequencies. Such findings were particularly evident for altitudes exceeding 12,000 ft.DISCUSSION: The development of a frequency-selective and altitude-related correction factor for acoustic stimuli is an essential aspect when hearing threshold measurements in hypobaric environments are performed.Lucertini M, Botti T, Sanjust F, Cerini L, Autore A, Lucertini L, Sisto R. High altitude performance of loudspeakers and potential impact on audiometric findings. Aerosp Med Hum Perform. 2019; 90(7):655-659.

Adaptive Changes in the Perception of Fast and Slow Movement at Different Head Positions.

BACKGROUND: This paper examines the subjective sense of orientation during asymmetric body rotations in normal subjects. METHODS: Self-motion perception was investigated in 10 healthy individuals during asymmetric whole-body rotation with different head orientations. Both on-vertical axis and off-vertical axis rotations were employed. Subjects tracked a remembered earth-fixed visual target while rotating in the dark for four cycles of asymmetric rotation (two half-sinusoidal cycles of the same amplitude, but of different duration). RESULTS: The rotations induced a bias in the perception of velocity (more pronounced with fast than with slow motion). At the end of rotation, a marked target position error (TPE) was present. For the on-vertical axis rotations, the TPE was no different if the rotations were performed with a 30° nose-down, a 60° nose-up, or a 90° side-down head tilt. With off-vertical axis rotations, the simultaneous activation of the semicircular canals and otolithic receptors produced a significant increase of TPE for all head positions. DISCUSSIONS: This difference between on-vertical and off-vertical axis rotation was probably partly due to the vestibular transfer function and partly due to different adaptation to the speed of rotation. Such a phenomenon might be generated in different components of the vestibular system. The adaptive process enhancing the perception of dynamic movement around the vertical axis is not related to the specific semicircular canals that are activated; the addition of an otolithic component results in a significant increase of the TPE.Panichi R, Occhigrossi C, Ferraresi A, Faralli M, Lucertini M, Pettorossi VE. Adaptive changes in the perception of fast and slow movement at different head positions. Aerosp Med Hum Perform. 2017; 88(5):463-468.

Eustachian tube evaluation in aviators.

The aim of the study is to evaluate the Eustachian tube functionality in a group of aviators to underline a subclinical dysfunction and the related risk of ear fullness or barotitis. Hypobaric chamber allows to simulate the pressure variation of the flight. This prospective study enrolled 42 aviation pilots, members of the Italian Air Force, to whom were evaluated Eustachian tube functionality by Tubomanometry, patients subjective assessments concerning feasibility of Valsalva's and Toynbee's clinical symptoms, tympanometry, and objective Valsalva before and after exposure to hypobaric chamber. The new Eustachian tube score (ETS-7) was also calculated for each pilot before and after exposure to hypobaric chamber. Results of our examination showed that: before chamber exposition, in 92.8 % of pilots, an ETS-7 of eight or more was found bilaterally. In three (7.2 %) cases, a unilateral ETS-7 ≤ 7 was found and two of those had a positive history. After undergoing the hypobaric chamber session, the evaluation of ETS-7 showed only 19 % of pilots with an ETD score ≤7, in particular three bilateral and five unilateral cases. Three of those pilots were clinically positive: two airmen reported persistent fullness, while the other one had a barotitis. Therefore, the combined use of TMM and ETS-7 before and after hypobaric chamber exposure appears to be a reliable method for assessing the functional capacity of the Eustachian tube in aviators, the stressful effect of flight on it, to exclude subjects at increased risk of ear pain, fullness, or barotrauma.

Motion Sickness Prediction in Aeromedical Evacuation of Patients with Ebola.

INTRODUCTION: Aeromedical evacuation of patients affected by severe infectious diseases inside an aircraft transit isolator (ATI) system is at potential risk of motion sickness (MS). A test flight was then conducted to quantify this risk during the transfer of an Ebola patient from West Africa to Italy. CASE REPORT: A mannequin was inserted inside an ATI and instrumented to provide acceleration parameters throughout the test flight. The analysis of the data predicted a MS incidence of about 2% for a 6-h flight, so the decision to use anti-MS drugs only in selected cases was taken (i.e., those with positive past history of MS, gastrointestinal disorders, or residual carsickness due to previous ambulance run). On this basis, an actual aeromedical evacuation of an Ebola patient was successfully performed without the use of any anti-MS drugs. DISCUSSION: During aeromedical evacuation with ATI systems, the patient's risk of MS should be evaluated on an individual basis and calibrated according to the specific exposure to motion evoked by the flight platform used. Due to the possible onset of untoward effects, prevention with anti-MS drugs in these patients should be limited to selected cases.

Visual function at altitude under night vision assisted conditions.

INTRODUCTION: Hypoxia, even mild, is known to produce negative effects on visual function, including decreased visual acuity and sensitivity to contrast, mostly in low light. This is of special concern when night vision devices (NVDs) are used during flight because they also provide poor images in terms of resolution and contrast. METHODS: While wearing NVDs in low light conditions, 16 healthy male aviators were exposed to a simulated altitude of 12,500 ft in a hypobaric chamber. RESULTS: Snellen visual acuity decreased in normal light from 28.5 +/- 4.2/20 (normoxia) to 37.2 +/- 7.4/20 (hypoxia) and, in low light, from 33.8 +/- 6.1/20 (normoxia) to 42.2 +/- 8.4/20 (hypoxia), both at a significant level. An association was found between blood oxygen saturation and visual acuity without significance. No changes occurred in terms of sensitivity to contrast. DISCUSSION: Our data demonstrate that mild hypoxia is capable of affecting visual acuity and the photopic/high mesopic range of NVD-aided vision. This may be due to several reasons, including the sensitivity to hypoxia of photoreceptors and other retinal cells. Contrast sensitivity is possibly preserved under NVD-aided vision due to its dependency on the goggles' gain.

Rehabilitation from airsickness in military pilots: long-term treatment effectiveness.

BACKGROUND: Airsickness (AS) still represents a major issue in aviation medicine and affects many student pilots and aircrew members. This study aimed at producing an update of the Italian Air Force rehabilitation program for AS, including data on a prolonged follow-up (> 8 yr). METHODS: Data from 20 military pilots with a past history of rehabilitation for incapacitating AS were compared to those of 65 normal controls. All individuals from both samples were categorized as dropouts or successfully employed in fast jets, multiengine air carriers, or helicopters. All AS individuals were analyzed before and after their treatment with the Coriolis Stress test (CST). RESULTS: The AS sample showed similar results with respect to the control group, with the same incidence of dropouts (15% vs. 14%) and destination to rotary wing flight lines (15% vs. 17%). All dropouts were observed within the first year after rehabilitation. A statistically non-significant trend of being employed in transport aircraft (50% of individuals vs. 34% in the control group) rather than in fast jets (20% vs. 35%) was observed in the AS sample. DISCUSSION: Within the AS sample, the rehabilitation protocol had a success rate of 85%. The effects of rehabilitation were long lasting (mean follow up: 8.3 +/- 2.5 yr). Moreover, the flight career of AS treated individuals did not significantly differ from controls. The pretreatment CST was helpful in calibrating the initial intensity and duration of the nauseogenic stimulation, while it was useless as a post-treatment analysis of the outcome from training.

Subjective visual vertical in erect/supine subjects and under microgravity: effects of lower body negative pressure.

Perception of the subjective visual vertical (SVV) is mainly based on the contributions from the visual, vestibular, and proprioceptive systems, and participates to the process of spatial orientation in relation to the surrounding environment and to the gravito-inertial force. The SVV can be significantly influenced by the presence of a displaced visual field, as in the case of the rod and frame test (RFT). A series of studies showed the effects of haematic mass shifts to and from the lower limbs on SVV, due to visceral mechanoreceptors (VM) located at the level of the kidneys and of the thorax. These sensors may be artificially activated with a lower body negative pressure (LBNP) device. In this study, the role of visual and VM cues to orientation perception have been evaluated using the RFT and the LBNP devices under a microgravity environment. A preliminary investigation was conducted in a sample of military pilots to develop a RFT protocol to be used in microgravity environments. This protocol was adopted to evaluate the contribution of VM to the SVV in a cosmonaut before, during and after a 10 day space flight, with and without concurrent activation of LBNP. The same test sequence, including LBNP exposure, was repeated a few months later on Earth on the same subject. As expected, the influence of the frame on rod positioning was statistically significant in all test conditions. During the in-flight experimental step, a substantial lack of significant changes compared to the pre-flight condition was observed. Moreover, substantially no effects due to LBNP were observed. A mild rod displacement from the body axis was detected under microgravity compared to the pre-flight recording. Such a finding was in part reduced during LBNP. The same findings were observed during the post-flight repetition of the experiment. Our results showed an absence in this subject of significant effects on the RFT due to microgravity. In conclusion, no effects from his VM on the RFT and minor changes in the SVV could be detected.

Effects of airsickness in male and female student pilots: adaptation rates and 4-year outcomes.

INTRODUCTION: Airsickness (AS) often affects aircrew members, especially at the beginning of their flight careers. In this study the AS incidence in 376 Italian Air Force student pilots (336 men and 40 women) was investigated during their initial flight activity. METHODS: The study was separated into two parts. In part 1, the AS incidence was analyzed in the whole sample to determine the overall characteristics of AS and the hypothetical differences between men and women during the first flight certification (Basic). Part 2 analyzed a subpopulation of 102 individuals (86 men, 16 women) over 4 subsequent years throughout the first 4 flight certifications (for a total of about 60 flight hours). In all cases, AS was evaluated according to the number of flight missions affected by vomiting episodes. RESULTS: The overall AS incidence during Basic was 34.8%, without significant gender differences. However, within AS individuals, a significantly higher percentage of women were slow adaptors (12.5% of the whole female sample vs. 3.3% in men). AS overall affected the likelihood of reaching Basic certification, but this was not significantly related to the number of AS episodes. The 1-yr interval between two subsequent flight certifications caused a loss of adaptation to the flight environment in most cases. DISCUSSION: The absolute incidence of AS in our study resulted within the expected range, without significant differences between men and women. In a minor number of individuals (11 out of 336 men and 5 out of 40 women) a slow capability of adaptation to AS was observed. Such a finding was statistically more prevalent in women. In contrast to previous literature data, when prolonged interruptions from flight activity are planned, the retention of adaptation in our study did not play a significant role in avoiding future episodes of AS.

The effect of cinnarizine and cocculus indicus on simulator sickness.

Pensacola Simulator Sickness Questionnaire (SSQ) is a valuable method to analyse symptoms evoked by exposure to a flight simulator environment that can also be adopted to evaluate the effectiveness of preventive tools, aiming at reducing simulator sickness (SS). In this study we analysed SSQ data in subjects undergoing a standard ground based spatial disorientation training inside a flight simulator, in order to evaluate the SS prevention obtained with two different pharmacological tools. Twelve males volunteers participated to an experimental design based on a double-blind, balanced administration of either 30 mg cinnarizine (CIN), or Cocculus Indicus 6CH (COC), or placebo (PLC) before one trial of about one hour spent inside a spatial disorientation trainer. All subjects underwent the three different conditions (CIN, COC, PLC) during 3 non-consecutive days separated by at least 2 weeks. During each experimental day, all subjects filled in SSQ. In addition, both postural instability (with the use of a static stabilometric platform), and sleepiness symptoms were evaluated. All the tests were performed before and after the simulated flight, at different times, in one-and-half-hour intervals. Results indicated a strong increase of sickness after flight simulation that linearly decreased, showing pre-simulator scores after 1.30 hours. In contrast to both PLC and COC, CIN showed significant side effects immediately following flight simulation, with no benefit at the simultaneous SSQ scores. Globally, no highly significant differences between COC and PLC were observed, although a minor degree of postural instability could be detected after COC administration. As far as the present exposure to a simulator environment is concerned, none of the pharmacological tools administered in this study resulted effective in reducing SS symptoms as detected by the SSQ. Moreover, CIN significantly increased sleepiness and postural instability in most subjects.

Human auditory steady-state responses during repeated exposure to hypobaric hypoxia.

This study was aimed at evaluating the time course of auditory steady-state response (SSR) variations during two consecutive exposures to hypobaric hypoxia. Six normal subjects were examined in a hypobaric chamber at ground level. Then, they climbed to a simulated altitude of 17000 ft (5182 m), where SSRs were recorded after 6, 12, 18, 24 and 30 min. Thereafter, they breathed 100% O2 and SSRs were recorded after 2 min of reoxygenation. A second exposure to hypoxia followed, with SSR recordings after 6 and 12 min. Finally, the subjects returned to ground level for recovery recording. A phase shift of SSR sinus wave was observed at the beginning of both exposures to hypoxia, although in the first recording (i.e. at 6 min) during the first exposure, the result was not statistically significant. A slight SSR phase shift was still detectable on return to ground level. The central acoustic pathway involved in SSR genesis was probably the area which was found to be most sensitive to hypoxia, compared to other parts of the auditory apparatus (e.g. the cochlea). This data could suggest an impairment of compensation mechanisms when consecutive exposures to hypoxia are performed.