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  • 1
    Publication Date: 2019-07-19
    Description: What is the risk? Given that astronauts exposed to microgravity experience a cephalad fluid shift, and that both symptomatic and asymptomatic astronauts have exhibited optic nerve sheath edema on MRI, there is a high probability that all astronauts have some degree of increased intracranial pressure (ICP; intracranial hypertension), and that those susceptible (via eye architecture, anatomy, narrow optic disc) have a high likelihood of developing papilledema (optic disc edema, globe flattening), choroidal folds, and/or hyperopic shifts and that the degree of edema may determine long-term or permanent vision impairment or loss. Back to back panels on this topic have been developed to address this emerging risk. The first panel will focus on the 6 clinical cases with emphasis on ophthalmic findings and imaging techniques used pre-, in-, and post-flight. The second panel will discuss the operational mitigation and medical requirements, the potential role of CO2 on ISS, and the research approach being developed. In total these back to back panels will explore what is known about this risk, what has been done immediately to address it, and how an integrated research model is being developed.
    Keywords: Aerospace Medicine
    Type: JSC-CN-21948 , 82nd Annual Scientific Meeting of the Aerospace Medical Association; May 08, 2011 - May 12, 2011; Anchorage, AK; United States
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  • 2
    Publication Date: 2019-07-19
    Description: Intermediates of the one-carbon metabolic pathway are altered in astronauts who experience vision-related issues during and after space flight. Serum concentrations of homocysteine, cystathionine, 2-methylcitric acid, and methylmalonic acid were higher in astronauts with ophthalmic changes than in those without (Zwart et al., J Nutr, 2012). These differences existed before, during, and after flight. Potential confounding factors did not explain the differences. Genetic polymorphisms could contribute to these differences, and could help explain why crewmembers on the same mission do not all have ophthalmic issues, despite the same environmental factors (e.g., microgravity, exercise, diet). A follow-up study was conducted to evaluate 5 polymorphisms of enzymes in the one-carbon pathway, and to evaluate how these relate to vision and other ophthalmic changes after flight. Preliminary evaluations of the genetic data indicate that all of the crewmembers with the MTRR GG genotype had vision issues to one degree or another. However, not everyone who had vision issues had this genetic polymorphism, so the situation is more complex than the involvement of this single polymorphism. Metabolomic and further data analyses are underway to clarify these findings, but the preliminary assessments are promising.
    Keywords: Aerospace Medicine
    Type: JSC-CN-32354 , Experimental Biology; Mar 28, 2015 - Apr 01, 2015; Boston, MA; United States
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  • 3
    Publication Date: 2019-08-13
    Description: Carbon dioxide (CO2) levels on board the International Space Station (ISS) have typically averaged 2.3 to 5.3 mmHg, with large fluctuations occurring over periods of hours and days. CO2 has effects on cerebral vascular tone, resulting in vasodilation and alteration of cerebral blood flow (CBF). Increased CBF leads to elevated intracranial pressure (ICP), a factor leading to visual disturbances, headaches, and other central nervous system symptoms. Ultrasound of the optic nerve and optical coherence tomography (OCT) provide surrogate measurements of ICP; in-flight measurements of both were implemented as enhanced screening tools for the Visual Impairment/Intracranial Pressure (VIIP) syndrome. This analysis examines the relationships between ambient CO2 levels on ISS, ultrasound and OCT measures of the eye in an effort to understand how CO2 may possibly be associated with VIIP and to inform future analysis of in-flight VIIP data.
    Keywords: Aerospace Medicine
    Type: JSC-CN-38407 , 2017 NASA Human Research Program Investigators'' Workshop (HRP IWS 2017); Jan 23, 2017 - Jan 26, 2017; Galveston, TX; United States
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  • 4
    Publication Date: 2019-08-13
    Description: The Visual Impairment Intracranial Pressure (VIIP) syndrome is currently NASA's number one human space flight risk. The syndrome, which is related to microgravity exposure, manifests with changes in visual acuity (hyperopic shifts, scotomas), changes in eye structure (optic disc edema, choroidal folds, cotton wool spots, globe flattening, and dilated optic nerve sheaths), and in some cases with documented increased intracranial pressure (ICP) postflight. While the eye appears to be the main affected end organ of this syndrome, the ocular effects are thought to be related to underlying changes in the vascular system and the central nervous system. The leading hypotheses for the development of VIIP involve microgravity-induced head-ward fluid shifts along with a loss of gravity-assisted drainage of venous blood from the brain, leading to cephalic congestion, decreased CSF resorption and increased ICP. Since 70% of ISS crewmembers have manifested clinical signs or symptoms of the VIIP syndrome, it is assumed that the majority have some degree of ICP elevation in-flight compared to the ground. Prolonged elevations of ICP can cause long-term reduced visual acuity and loss of peripheral visual fields, and have been reported to cause mild cognitive impairment in the analog terrestrial population of Idiopathic Intracranial Hypertension (IIH). These potentially irreversible health consequences underscore the importance of identifying the factors that lead to this syndrome and mitigating them.
    Keywords: Aerospace Medicine
    Type: JSC-CN-32164 , NASA Human Research Program Investigators'' Workshop; Jan 13, 2015 - Jan 15, 2015; Galveston, TX; United States
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  • 5
    Publication Date: 2019-08-13
    Description: No abstract available
    Keywords: Aerospace Medicine
    Type: JSC-CN-38572 , NASA Human Research Program Investigators'' Workshop; Jan 23, 2017 - Jan 26, 2017; Galveston, TX; United States
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  • 6
    Publication Date: 2019-08-13
    Description: Data from the Nutritional Status Assessment protocol provided biochemical evidence that the one-carbon metabolic pathway may be altered in individuals experiencing vision-related issues during and after space flight (1, 2). Briefly, serum concentrations of homocysteine, cystathionine, 2-methylcitric acid, and methylmalonic acid were significantly (P〈0.001) higher (25-45%) in astronauts with ophthalmic changes than in those without such changes (1). These differences existed before, during, and after flight. Serum folate was lower (P〈0.01) during flight in individuals with ophthalmic changes. Preflight serum concentrations of cystathionine and 2-methylcitric acid, and mean in-flight serum folate, were significantly (P〈0.05) correlated with postflight changes in refraction (1). A follow-up study was conducted to evaluate a small number of known polymorphisms of enzymes in the one-carbon pathway, and to evaluate how these relate to vision and other medical aspects of the eye. Specifically, we investigated 5 polymorphisms in MTRR, MTHFR, SHMT, and CBS genes and their association with ophthalmic changes after flight in 49 astronauts. The number of G alleles of MTRR 66 and C alleles of SHMT1 1420 both contributed to the odds of visual disturbances (3). Block regression showed that B-vitamin status at landing and genetics were significant predictors for many of the ophthalmic outcomes studied (3). In conclusion, we document an association between MTRR 66 and SHMT1 1420 polymorphisms and space flightinduced vision changes. These data document that individuals with an altered 1-carbon metabolic pathway may be predisposed to anatomic and/or physiologic changes that render them susceptible to ophthalmic damage during space flight.
    Keywords: Aerospace Medicine
    Type: JSC-CN-34670 , HRP Investigator Workshop; Feb 08, 2016 - Feb 11, 2016; Galveston, TX; United States
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  • 7
    Publication Date: 2019-07-12
    Description: Spontaneous venous pulsations seen on the optic nerve head (optic disc) are presumed to be caused by fluctuations in the pressure gradient between the intraocular and retrolaminar venous systems. The disappearance of previously documented spontaneous venous pulsations is a wellrecognized clinical sign usually associated with a rise in intracranial pressure and a concomitant bilateral elevation of pressure in the subarachnoid space surrounding the optic nerves. In this correspondence we report the unilateral loss of spontaneous venous pulsations in an astronaut 5 months into a long duration space flight. We documented a normal lumbar puncture opening pressure 8 days post mission. The spontaneous venous pulsations were also documented to be absent 21 months following return to Earth.. We hypothesize that these changes may have resulted from a chronic unilateral rise in optic nerve sheath pressure caused by a microgravityinduced optic nerve sheath compartment syndrome.
    Keywords: Aerospace Medicine
    Type: JSC-CN-31779
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  • 8
    Publication Date: 2019-07-13
    Description: The emphasis of this research is on the Human Research Program (HRP) Exploration Medical Capabilities (ExMC) "Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-flight Medical Capabilities". Specifically, this project aims to contribute to the closure of gap ExMC 2.02: We do not know how the inclusion of a physician crew medical officer quantitatively impacts clinical outcomes during exploration missions. The experiments are specifically designed to address clinical outcome differences between physician and non-physician cohorts in both near-term and longer-term (mission impacting) outcomes.
    Keywords: Aerospace Medicine
    Type: JSC-CN-32138 , 2015 Human Research Program (HRP) Investigators'' Workshop; Jan 13, 2015 - Jan 15, 2015; Galveston, TX; United States
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  • 9
    Publication Date: 2019-07-13
    Description: No abstract available
    Keywords: Aerospace Medicine
    Type: JSC-CN-30485 , 2014 NASA Human Research Program Investigators'' Workshop (HRP 2014); Feb 12, 2014 - Feb 13, 2014; Galveston, TX; United States
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