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The Shuttle and its importance to space medicine

The physiological effects of space flights on humans are reviewed, and the opportunities offered by frequent and repetitive Space Shuttle flights for space medical research are discussed. The most significant changes encountered in the vestibular, cardiopulmonary, musculoskeletal and hematopoietic systems during and after past space missions are indicated, and the time courses of the physiological shifts associated with space acclimatization and readaptation to a 1-g environment are summarized. Effects directly attributable to the absence of gravity, including postural changes and fluid shifts, are considered, and additional contributing factors to physiological changes imposed by the spacecraft operational environment are pointed out. Differences between the Space Shuttle missions and all previous missions in the areas of reentry profiles and varied crew composition are discussed, and results of experiments on the relative acceleration tolerances of men and women of different ages and the usefulness of the anti-g suit are presented. Directions for future research in space medicine available with the Shuttle are examined, with particular emphasis on the neurovestibular system cardiopulmonary dynamics, calcium metabolism, the erythropoietic system and the effects of space radiation.

Nicogossian, A.↗

Orthostatic fluid-electrolyte and endocrine responses in fainters and nonfainters

The responses to orthostasis of fluid-electrolyte and endocrine indicators in persons subject and not subject to fainting during tilting are investigated, along with the effects of heat acclimatization and physical training on those responses. Plasma volume and electrolytes and plasma vasopressin and renin activity were determined in tilt-table tests conducted before and after an eight-day period of daily heat acclimation during exercise at 50% maximal oxygen uptake at 40 C, or a control period of exercise at 24 C. Half of the 10 subjects in the study, regardless of exercise regime, showed improved orthostatic reactions in the second tilting test, related to increases in post-tilt plasma volume and potassium concentration, particularly in the nonfainters. In the first test, plasma renin activity is observed to increase fivefold and plasma vasopressin 50 times after the transition from the supine to the orthostatic positions; the respective increases were reduced by 50 and 75% in the second test. The fainters also exhibit a greater increase in vasopressin and a lower increase in renin activity upon tilting than the nonfainters. Results indicate the orthostatic-induced vasopressin increase to be related to volume control independent of renin activity.

Shvartz, E.↗

Water and electrolytes

It has been found that the performance of the strongest and fittest people will deteriorate rapidly with dehydration. The present paper is concerned with the anatomy of the fluid spaces in the body, taking into account also the fluid shifts and losses during exercise and their effects on performance. Total body water is arbitrarily divided into that contained within cells (cellular) and that located outside the cells (extracellular). The anatomy of body fluid compartments is considered along with the effects of exercise on body water, fluid shifts with exercise, the consequences of sweating, dehydration and exercise, heat acclimatization and endurance training, the adverse effects of dehydration, thirst and drinking during exercise, stimuli for drinking, and water, electrolyte, and carbohydrate replacement during exercise. It is found that the deterioration of physical exercise performance due to dehydration begins when body weight decreases by about 1 percent.

Greenleaf, J. E.↗

Effects of prolonged head-down bed rest on physiological responses to moderate hypoxia

To determine the effects of hypoxia on physiological responses to simulated zero-gravity cardiopulmonary and fluid balance measurements were made in 6 subjects before and during 5-degree head-down bed rest (HDBR) over 8 d at 10,678 ft and a second time at this altitude as controls (CON). The V-dot(O2)(max) increased by 9 percent after CON, but fell 3 percent after HDBR. This reduction in work capacity during HDBR could be accounted for by inactivity. The heart rate response to a head-up tilt was greatly enhanced following HDBR, while mean blood pressure was lower. No significant negative impact of HDBR was noted on the ability to acclimatize to hypoxia in terms of pulmonary mechanics, gas exchange, circulatory or mental function measurements. No evidence of pulmonary interstitial edema or congestion was noted during HDBR at the lower PIO2 and blood rheology properties were not negatively altered. Symptoms of altitude illness were more prevalent, but not marked, during HDBR and arterial blood gases and oxygenation were not seriously effected by simulated microgravity. Declines in base excess with altitude were similar in both conditions. The study demonstrated a minimal effect of HDBR on the ability to adjust to this level of hypoxia.

Loeppky, J. A.↗

Modifications to an interactive model of the human body during exercise: With special emphasis on thermoregulation

Since 1988 an interactive computer model of the human body during exercise has been under development by a number of undergraduate students in the Department of Chemical Engineering at Iowa State University. The program, written under the direction of Dr. Richard C. Seagrave, uses physical characteristics of the user, environmental conditions and activity information to predict the onset of hypothermia, hyperthermia, dehydration, or exhaustion for various levels and durations of a specified exercise. The program however, was severely limited in predicting the onset of dehydration due to the lack of sophistication with which the program predicts sweat rate and its relationship to sensible water loss, degree of acclimatization, and level of physical training. Additionally, it was not known whether sweat rate also depended on age and gender. For these reasons, the goal of this creative component was to modify the program in the above mentioned areas by applying known information and empirical relationships from literature. Furthermore, a secondary goal was to improve the consistency with which the program was written by modifying user input statements and improving the efficiency and logic of the program calculations.

Scherb, Megan Kay↗

Determinants of erythropoietin release in response to short-term hypobaric hypoxia

We measured blood erythropoietin (EPO) concentration, arterial O(2) saturation (Sa(O(2))), and urine PO(2) in 48 subjects (32 men and 16 women) at sea level and after 6 and 24 h at simulated altitudes of 1,780, 2,085, 2,454, and 2,800 m. Renal blood flow (Doppler) and Hb were determined at sea level and after 6 h at each altitude (n = 24) to calculate renal O(2) delivery. EPO increased significantly after 6 h at all altitudes and continued to increase after 24 h at 2,454 and 2,800 m, although not at 1,780 or 2,085 m. The increase in EPO varied markedly among individuals, ranging from -41 to 400% after 24 h at 2,800 m. Similar to EPO, urine PO(2) decreased after 6 h at all altitudes and returned to baseline by 24 h at the two lowest altitudes but remained decreased at the two highest altitudes. Urine PO(2) was closely related to EPO via a curvilinear relationship (r(2) = 0.99), although also with prominent individual variability. Renal blood flow remained unchanged at all altitudes. Sa(O(2)) decreased slightly after 6 h at the lowest altitudes but decreased more prominently at the highest altitudes. There were only modest, albeit statistically significant, relationships between EPO and Sa(O(2)) (r = 0.41, P < 0.05) and no significant relationship with renal O(2) delivery. These data suggest that 1) the altitude-induced increase in EPO is "dose" dependent: altitudes > or =2,100-2,500 m appear to be a threshold for stimulating sustained EPO release in most subjects; 2) short-term acclimatization may restore renal tissue oxygenation and restrain the rise in EPO at the lowest altitudes; and 3) there is marked individual variability in the erythropoietic response to altitude that is only partially explained by "upstream" physiological factors such as those reflecting O(2) delivery to EPO-producing tissues.

Non-NASA Center↗

cAMP levels in fast- and slow-twitch skeletal muscle after an acute bout of aerobic exercise

The present study examined whether exercise duration was associated with elevated and/or sustained elevations of postexercise adenosine 3',5'-cyclic monophosphate (cAMP) by measuring cAMP levels in skeletal muscle for up to 4 h after acute exercise bouts of durations that are known to either produce (60 min) or not produce (10 min) mitochondrial proliferation after chronic training. Treadmill-acclimatized, but untrained, rats were run at 22 m/min for 0 (control), 10, or 60 min and were killed at various postexercise (0, 0.5, 1, 2, and 4 h) time points. Fast-twitch white and red (quadriceps) and slow-twitch (soleus) muscles were quickly excised, frozen in liquid nitrogen, and assayed for cAMP with a commercial kit. Unexpectedly, cAMP contents in all three muscles were similar to control (nonexercise) at most (21 of 30) time points after a single 10- or 60-min run. Values at 9 of 30 time points were significantly different from control (P < 0.05); i.e., 3 time points were significantly higher than control and 6 were significantly less than control. These data suggest that the cAMP concentration of untrained skeletal muscle after a single bout of endurance-type exercise is not, by itself, associated with exercise duration.

NASA Discipline Musculoskeletal↗

Artificial Gravity as a Multi-System Countermeasure to Bed Rest Deconditioning: Pilot Study Overview

Efficient, effective, multi-system countermeasures will likely be required to protect the health, safety, and performance of crews aboard planned exploration-class space flight missions to Mars and beyond. To that end, NASA, DLR, and IMBP initiated a multi-center international project to begin systematically exploring the utility of artificial gravity (AG) as a multi-system countermeasure in ground based venues using test subjects deconditioned by bed rest. The goal of this project is to explore the efficacy of short-radius, intermittent AG as a countermeasure to bone, muscle, cardiovascular, and sensory-motor adaptations to hypogravity. This session reports the results from a pilot study commissioned to validate a standardized protocol to be used by all centers involved in the project. Subject selection criteria, medical monitoring requirements, medical care procedures, experiment control procedures, and standardized dependent measures were established jointly. Testing was performed on 15 rigorously screened male volunteers subjected to 21 days of 6deg HDT bed rest. (All provided written consent to volunteer after the nature of the study and its hazards were clearly explained to them.) Eight were treated with daily 1hr AG exposures (2.5g at the feet decreasing to 1.0g at the heart) aboard a short radius (3m) centrifuge, while the other seven served as controls. Multiple tests of multiple dependent measures were made in each of the primary physiological systems of interest during a 10 day acclimatization period prior to HDT bed rest and again during an 8 day recovery period after the bed rest period was complete. Analyses of these data (presented in other papers in this session) suggest the AG prescription had salutary effects on aspects of the bone, muscle, and cardiovascular systems, with no untoward effects on the vestibular system, the immune system, or cognitive function. Furthermore, treatment subjects were able to tolerate 153/160 centrifuge sessions over the 21 day deconditioning protocol, suggesting that tolerance was unaffected by deconditioning. These positive results set the stage for full implementation of the planned multi-center international AG project. Future work will be devoted to developing optimization techniques for AG prescriptions (likely supplemented by exercise) to provide maximum physiological protection across all systems subject to space flight deconditioning in both men and women with minimum time and/or side effects. While a continuous AG solution (rotating vehicle) would likely be more efficient, this study suggests that intermittent AG could be an effective multi-system countermeasure.

Paloski, William H.↗

Multi-System Effects of Daily Artificial Gravity Exposures in Humans Deconditioned by Bed Rest

We have begun to explore the utility of intermittent artificial gravity (AG) as a multi-system countermeasure to the untoward health and performance effects of adaptation to decreased gravity during prolonged space flight. The first study in this exploration was jointly designed by an international, multi-disciplinary team of scientists interested in standardizing an approach so that comparable data could be obtained from follow-on studies performed in multiple international locations. Fifteen rigorously screened male volunteers participated in the study after providing written informed consent. All were subjected to 21 days of 6deg head-down-tilt (HDT) bed rest. Eight were treated with daily 1hr AG exposures (2.5g at the feet decreasing to 1.0g at the heart) aboard a short radius (3m) centrifuge, while the other seven served as controls. Multiple observations were made of dependent measures in the bone, muscle, cardiovascular, sensory-motor, immune, and behavioral systems during a 10 day acclimatization period prior to HDT bed rest and again during an 8 day recovery period after the bed rest period. Comparisons between the treatment and control subjects demonstrated salutary effects of the AG exposure on aspects of the muscle and cardiovascular systems, with no untoward effects on the vestibular system, the immune system, or cognitive function. Bone deconditioning was similar between the treatment and control groups, suggesting that the loading provided by this specific AG paradigm was insufficient to protect that system from deconditioning. Future work will be devoted to varying the loading duty cycle and/or coupling the AG loading with exercise to provide maximum physiological protection across all systems. Testing will also be extended to female subjects. The results of this study suggest that intermittent AG could be an effective multi-system countermeasure.

Paloski, William H.↗

Environmental Physiology at the Johnson Space Center: Past, Present, and Future

This viewgraph presentation reviews the work in environmental physiology done at Johnson Space Center (JSC). The work is aimed at keeping astronauts healthy. This is a different approach than treating the sick, and is more of an occupational health model. The reduction of risks is the main emphasis for this work. They emphasis is to reduce the risk of decompression sickness (DCS) and acute mountain sickness (AMS). The work in environmental physiology encompasses the following areas: (1) Pressure: hypobaric and hyperbaric (2) Gases: hypoxia and hyperoxia, hypercapnia--closed space issues, inert gas physiology / respiration (3) Temperature: hypothermia and hyperthermia, thermal comfort, Protective clothing diving, aviation, mountaineering, and space (4) Acceleration (5) Noise and Vibration (6) Exercise / Performance (6) Acclimatization / Adaptation: engineering solutions when necessary. This presentation reviews the work done at JSC in the areas of DCS and AMS.

Conkin, Johnny↗

High Resolution ECG for Evaluation of Heart Function During Exposure to Subacute Hypobaric Hypoxia

High altitude climbing presents a wide spectrum of health risks, including exposure to hypobaric hypoxia. Risks are also typically exacerbated by the difficulty in appropriately monitoring for early signs of organ dysfunction in remote areas. We investigated whether high resolution advanced ECG analysis might be helpful as a non-invasive and easy-to-use tool (e.g., instead of Doppler echocardiography) for evaluating early signs of heart overload in hypobaric hypoxia. Nine non-acclimatized healthy trained alpine rescuers (age 43.7 plus or minus 7.3 years) climbed in four days to the altitude of 4,200 m on Mount Ararat. Five-minute high-resolution 12-lead electrocardiograms (ECGs) were recorded (Cardiosoft) in each subject at rest in the supine position on different days but at the same time of day at four different altitudes: 400 m (reference altitude), 1,700 m, 3,200 m and 4,200 m. Changes in conventional and advanced resting ECG parameters, including in beat-to-beat QT and RR variability, waveform complexity, signal-averaged, high-frequency and spatial/spatiotemporal ECG was estimated by calculation of the regression coefficients in independent linear regression models. A p-value of less than 0.05 was adopted as statistically significant. As expected, the RR interval and its variability both decreased with increasing altitude, with trends k = -96 ms/1000 m with p = 0.000 and k = -9 ms/1000 m with p = 0.001, respectively. Significant changes were found in P-wave amplitude, which nearly doubled from the lowest to the highest altitude (k = 41.6 microvolt/1000 m with p = 0.000), and nearly significant changes in P-wave duration (k = 2.9 ms/1000 m with p = 0.059). Changes were less significant or non-significant in other studied parameters including those of waveform complexity, signal-averaged, high-frequency and spatial/spatiotemporal ECG. High resolution ECG analysis, particularly of the P wave, shows promise as a tool for monitoring early changes in heart function due to exposure to high altitude.

Zupet, Petra↗

High Resolution ECG for Evaluation of QT Interval Variability during Exposure to Acute Hypoxia

Ventricular repolarization instability as quantified by the index of QT interval variability (QTVI) is one of the best predictors for risk of malignant ventricular arrhythmias and sudden cardiac death. Because it is difficult to appropriately monitor early signs of organ dysfunction at high altitude, we investigated whether high resolution advanced ECG (HR-ECG) analysis might be helpful as a non-invasive and easy-to-use tool for evaluating the risk of cardiac arrhythmias during exposure to acute hypoxia. 19 non-acclimatized healthy trained alpinists (age 37, 8 plus or minus 4,7 years) participated in the study. Five-minute high-resolution 12-lead electrocardiograms (ECGs) were recorded (Cardiosoft) in each subject at rest in the supine position breathing room air and then after breathing 12.5% oxygen for 30 min. For beat-to-beat RR and QT variability, the program of Starc was utilized to derive standard time domain measures such as root mean square of the successive interval difference (rMSSD) of RRV and QTV, the corrected QT interval (QTc) and the QTVI in lead II. Changes were evaluated with paired-samples t-test with p-values less than 0.05 considered statistically significant. As expected, the RR interval and its variability both decreased with increasing altitude, with p = 0.000 and p = 0.005, respectively. Significant increases were found in both the rMSSDQT and the QTVI in lead II, with p = 0.002 and p = 0.003, respectively. There was no change in QTc interval length (p = non significant). QT variability parameters may be useful for evaluating changes in ventricular repolarization caused by hypoxia. These changes might be driven by increases in sympathetic nervous system activity at ventricular level.

Zupet, P.↗

Effects of 30-, 60-, and 90-Day Bed Rest on Postural Control in Men and Women

INTRODUCTION Head-down-tilt bed rest (HDT) has been used as a safe gr ound-based analog to mimic and develop countermeasures for the physiological effects of spaceflight, including decrements in postural stability. The purpose of this investigation was to characterize the effects of 30-, 60-, and 90-day bed rest on postural control in men and women. METHODS Twenty-nine subjects (18M,11F) underwent 13 days of ambula tory acclimatization and were placed in 6? HDT for 30 (n=12), 60 (n=8), or 90 (n=9) days, followed by 14 days of ambulatory recovery. Computerized dynamic posturography (CDP) was used to assess changes in sensory and motor components of postural control, and recovery after HDT. Sensory Organization Tests (SOTs) objectively evaluate one?s ability to effectively use or suppress visual, vestibular, and proprioceptive information for postural control. Stability during the SOTs was assessed using peak-to-peak sway and convergence toward stability limits to derive an equilibrium score. Motor Control Tests (MCTs) evaluate one?s ability to recover from unexpected support surface perturbations, with performance determined by center-of-pressure path length. Whole-body kinematic data were collected to determine body-sway strategy used to maintain stability during each condition. Baselines were determined pre-HDT. Recovery was tracked post-HDT on days 0, 1, 2, and 4. RESULTS Immediately after HDT, subjects showed decreased performance on most SOTs, primarily on sway-referenced support conditions, typically returning to baseline levels within 4 days. MCT performance was not significantly affected. There were no significant gender or duration differences in performance. Kinematic data revealed a tendency to use ankle strategy to maintain an upright stance during most SOT conditions. Interestingly, six subjects (2M,4F) experienced orthostatic intolerance and were unable to complete day 0 testing. CONCLUSION HDT mimics some un loading mechanisms of spaceflight and elicits orthostatic issues present post-spaceflight (contributing to instability); however, it does not sufficiently address the vestibular dysfunction which occurs post-spaceflight.

Esteves, Julie↗

Temperature-Related Death and Illness

Based on present-day sensitivity to heat, an increase of thousands to tens of thousands of premature heat-related deaths in the summer and a decrease of premature cold-related deaths in the winter are projected each year as a result of climate change by the end of the century. Future adaptation will very likely reduce these impacts (see Changing Tolerance to Extreme Heat Finding). The reduction in cold-related deaths is projected to be smaller than the increase in heat-related deaths in most regions. Days that are hotter than usual in the summer or colder than usual in the winter are both associated with increased illness and death. Mortality effects are observed even for small differences from seasonal average temperatures. Because small temperature differences occur much more frequently than large temperature differences, not accounting for the effect of these small differences would lead to underestimating the future impact of climate change. An increase in population tolerance to extreme heat has been observed over time. Changes in this tolerance have been associated with increased use of air conditioning, improved social responses, and or physiological acclimatization, among other factors. Expected future increases in this tolerance will reduce the projected increase in deaths from heat. Older adults and children have a higher risk of dying or becoming ill due to extreme heat. People working outdoors, the socially isolated and economically disadvantaged, those with chronic illnesses, as well as some communities of color, are also especially vulnerable to death or illness.

winter↗

HABITABILITY IN SPACE STATIONS

What does habitability mean? This word is commonly used and is bandied about as a thing which is necessary and desirable for all manned flight vehicles. But what does it really mean? A serious examination of the meaning of the term soon leads to attempts at definition into discussions of the interplay of such factors as the mission, the size and makeup of the crew, the jobs within the mission, the flight duration, the stress loads, the vehicle to be used, the comfort, and the deprivations inherent in the mission, the flight environment, et cetera. In other words, habitability might be considered the resultant of the interplay of all of the factors related to the man, his machine, his environment, and the mission to be accomplished. It is more easily visualized as the state of being at the completion of the interaction of all of the-factors rather than a discrete entity itself. Therefore, the provisions made to meet the habitability requirements can contribute to or be detrimental in meeting the program objectives. The requirement placed upon the space vehicle may be eased if necessary through the proper selection and training of the crewmen, The motivation of the crew may be an additional aid in providing a satisfactory solution to the habitability needs. The design and development of the space vehicle should avoid depending upon special selection and unusual training to meet the basic provisions needed to support the men in the space environment. The vehicle provisions should stand upon their own merit. Difficult and hazardous missions can he made more tolerable through augmentation of the provisions for habitability. For the sake of this discussion of habitability in a space station, this concept will be considered. This paper will emphasize a discussion of the interplay of some of these broader and little discussed factors as they reflect themselves in the development and operation of the space stations, rather than represent a list of items which have been established as essential for crew provisions. Ignoring these allied factors can lead to a successful mechanical system that will operate in space, yet a complete failure in providing the working, relaxing, and living areas so necessary for man if he is to maintain his productivity.

Space station↗

Plant adaptation to low atmospheric pressures: potential molecular responses

There is an increasing realization that it may be impossible to attain Earth normal atmospheric pressures in orbital, lunar, or Martian greenhouses, simply because the construction materials do not exist to meet the extraordinary constraints imposed by balancing high engineering requirements against high lift costs. This equation essentially dictates that NASA have in place the capability to grow plants at reduced atmospheric pressure. Yet current understanding of plant growth at low pressures is limited to just a few experiments and relatively rudimentary assessments of plant vigor and growth. The tools now exist, however, to make rapid progress toward understanding the fundamental nature of plant responses and adaptations to low pressures, and to develop strategies for mitigating detrimental effects by engineering the growth conditions or by engineering the plants themselves. The genomes of rice and the model plant Arabidopsis thaliana have recently been sequenced in their entirety, and public sector and commercial DNA chips are becoming available such that thousands of genes can be assayed at once. A fundamental understanding of plant responses and adaptation to low pressures can now be approached and translated into procedures and engineering considerations to enhance plant growth at low atmospheric pressures. In anticipation of such studies, we present here the background arguments supporting these contentions, as well as informed speculation about the kinds of molecular physiological responses that might be expected of plants in low-pressure environments.

NASA Discipline Plant Biology↗