Atrial Arrhythmias in Astronauts - Summary of a NASA Summit

Background and Problem Definition: To evaluate NASA s current standards and practices related to atrial arrhythmias in astronauts, Space Medicine s Advanced Projects Section at the Johnson Space Center was tasked with organizing a summit to discuss the approach to atrial arrhythmias in the astronaut cohort. Since 1959, 11 cases of atrial fibrillation, atrial flutter, or supraventricular tachycardia have been recorded among active corps crewmembers. Most of the cases were paroxysmal, although a few were sustained. While most of the affected crewmembers were asymptomatic, those slated for long-duration space flight underwent radiofrequency ablation treatment to prevent further episodes of the arrhythmia. The summit was convened to solicit expert opinion on screening, diagnosis, and treatment options, to identify gaps in knowledge, and to propose relevant research initiatives. Summit Meeting Objectives: The Atrial Arrhythmia Summit brought together a panel of six cardiologists, including nationally and internationally renowned leaders in cardiac electrophysiology, exercise physiology, and space flight cardiovascular physiology. The primary objectives of the summit discussions were to evaluate cases of atrial arrhythmia in the astronaut population, to understand the factors that may predispose an individual to this condition, to understand NASA s current capabilities for screening, diagnosis, and treatment, to discuss the risks associated with treatment of crewmembers assigned to long-duration missions or extravehicular activities, and to discuss recommendations for prevention or management of future cases. Summary of Recommendations: The summit panel s recommendations were grouped into seven categories: Epidemiology, Screening, Standards and Selection, Treatment of Atrial Fibrillation Manifesting Preflight, Atrial Fibrillation during Flight, Prevention of Atrial Fibrillation, and Future Researc

Paroxysmal Atrial Fibrillation in a Mission-Assigned Astronaut

This presentation will explore the clinical and administrative conundrums faced by the flight surgeon upon discovering asymptomatic paroxysmal atrial fibrillation seven months prior to scheduled long duration spaceflight. The presenter will discuss the decision-making process as well as the clinical and operational outcomes

Trabecular Bone Orientation in Flexed Versus Extended Postures in Guinea Fowl: A Test of Wolff’s Law

Although bipedal locomotion is a hominin synapomorphy, disagreements persist about whether early hominin bipeds were capable of fully extended limb posture, or used a bent-knee, bent-hip gait. Several recent studies have used the orientation of trabecular bone in limb joints to infer posteral differences during bipedal locomotion between early bipeds and later Homo. There analyses depend on the assumption that the orientation of the trabeculae in joint corresponds to the orientation of compressive forces that are transmitted through the joints. However, the hypothesis that trabecular struts will differ in orientation because of differences in the orientation of loads they experience during growth have not been tested. This study experimentally tests the hypothesis that there is a quantifiable relationship between the orientations of trabeculae and joint posture. The experiment included 16 guinea fowl (Numida melegris): 6 extended-posture runners, 6 flexed-posture runners, and 4 sedentary controls. The exercised animals ran 6 days per week at 1.9 mph for 15 minutes, on either a flat treadmill or a treadmill inclined to 20°. Kinematic and ground reaction force data collected as the birds moved on horizontal and inclined substrates confirm that the degree of flexion at the knee at toe-off is 10° greater when moving up inclines relative to level running. Micro-CT scans were analyzed using image analysis software to relate this difference to trabecular and subchondral bone morphology within the distal femoral epiphysis, including subchondral bone thickness, and trabecular orientation, number, thickness, volume, and connectivity.AnthropologyHuman Evolutionary Biolog

Innovation in Medicine: It's Not Rocket Science

This slide presentation reviews some of the tenets and outcomes from the innovation that has come from NASA. In particular attention is paid to the innovations that NASA has produced in the field of health and medicine

Traditional Cardiovascular Risk Factors as Predictors of Cardiovascular Events in the U.S. Astronaut Corps

Risk prediction equations from the Framingham Heart Study are commonly used to predict the absolute risk of myocardial infarction (MI) and coronary heart disease (CHD) related death. Predicting CHD-related events in the U.S. astronaut corps presents a monumental challenge, both because astronauts tend to live healthier lifestyles and because of the unique cardiovascular stressors associated with being trained for and participating in space flight. Traditional risk factors may not hold enough predictive power to provide a useful indicator of CHD risk in this unique population. It is important to be able to identify individuals who are at higher risk for CHD-related events so that appropriate preventive care can be provided. This is of special importance when planning long duration missions since the ability to provide advanced cardiac care and perform medical evacuation is limited. The medical regimen of the astronauts follows a strict set of clinical practice guidelines in an effort to ensure the best care. The purpose of this study was to evaluate the utility of the Framingham risk score (FRS), low-density lipoprotein (LDL) and high-density lipoprotein levels, blood pressure, and resting pulse as predictors of CHD-related death and MI in the astronaut corps, using Cox regression. Of these factors, only two, LDL and pulse at selection, were predictive of CHD events (HR(95% CI)=1.12 (1.00-1.25) and HR(95% CI)=1.70 (1.05-2.75) for every 5-unit increase in LDL and pulse, respectively). Since traditional CHD risk factors may lack the specificity to predict such outcomes in astronauts, the development of a new predictive model, using additional measures such as electron-beam computed tomography and carotid intima-media thickness ultrasound, is planned for the future

Airbag-related chest wall burn as a marker of underlying injury: a case report

<p>Abstract</p> <p>Introduction</p> <p>This case of a man who sustained an airbag-induced thoracic injury and burn, highlights the potential harm that can be caused by airbags. It also serves to illustrate that a surface burn which looks small and benign can actually be a surface marker of a more serious injury. Staff working in emergency departments need to be aware of the risk of possible airbag-associated injuries.</p> <p>Case presentation</p> <p>A 65-year-old man was the driver in a frontal collision. He was wearing a seatbelt. The airbag was activated and caused a superficial chest wall burn. Initial chest x-rays were unremarkable but following deterioration in his condition, a computed tomography scan revealed a serious sternal fracture. The location of the fracture was marked on the surface by the burn.</p> <p>Conclusion</p> <p>Airbags can cause significant chest wall injuries and burns. Surface burns at the point of impact should not be dismissed as trivial as the forces involved can cause significant injury. We recommend that all people with chest wall injuries and/or burns due to airbags should have more detailed chest imaging as initial emergency radiographs can be falsely reassuring.</p

Atrial Fibrillation During an Exploration Class Mission

Background: A long-duration exploration class mission is fraught with numerous medical contingency plans. Herein, we explore the challenges of symptomatic atrial fibrillation (AF) occurring during an exploration class mission. The actions and resources required to ameliorate the situation, including the availability of appropriate pharmaceuticals, monitoring devices, treatment modalities, and communication protocols will be investigated. Challenges of Atrial Fibrillation during an Exploration Mission: Numerous etiologies are responsible for the initiation of AF. On Earth, we have the time and medical resources to evaluate and determine the causative situation for most cases of AF and initiate therapy accordingly. During a long-duration exploration class mission resources will be severely restricted. How is one to determine if new onset AF is due to recent myocardial infarction, pulmonary embolism, fluid overload, thyrotoxicosis, cardiac structural abnormalities, or CO poisoning? Which pharmaceutical therapy should be initiated and what potential side effects can be expected? Should anti-coagulation therapy be initiated? How would one monitor the therapeutic treatment of AF in microgravity? What training would medical officers require, and which communication strategies should be developed to enable the best, safest therapeutic options for treatment of AF during a long-duration exploration class mission? Summary: These questions will be investigated with expert opinion on disease elucidation, efficient pharmacology, therapeutic monitoring, telecommunication strategies, and mission cost parameters with emphasis on atrial fibrillation being just one illustration of the tremendous challenges that face a long-duration exploration mission. The limited crew training time, medical hardware, and drugs manifested to deal with such an event predicate that aggressive primary and secondary prevention strategies be developed to protect a multibillion-dollar asset like the International Space Station or a mission to the Moon or Mars. Learning Objectives: The audience will become familiar with the risks and challenges inherent to developing a therapeutic strategy for the treatment of atrial fibrillation during a long-term exploration class mission

Noninvasive Techniques for Intracranial Pressure Assessment: A Review from Aerospace Medicine Perspective

Microgravity-induced changes in fluid distribution and other physiological factors due to space flight have been implicated as the cause of increased intracranial pressure (ICP) in a number of space crewmembers. The modest levels of ICP elevation and absence of severe symptoms in this group do not warrant invasive diagnostic interventions. However, the long-term trends and residual or consequential changes secondary to the observed ICP elevation in this group are not yet known. Therefore, close attention is needed to evaluate the potential techniques of noninvasively assessing ICP, including those feasible for in-flight use. Of particular interest is continuity between ground and in-flight testing, whereby data from the same or different techniques allow reasonably dependable estimation of ICP trends and responses. Methods: A thorough review of current literature, analysis of NASA data, and interviews with subject matter experts were conducted to construct a presentation that reflects the state of the art for noninvasive ICP measurement and monitoring. Results: Multiple imaging and non-imaging modalities are available to assess ICP in terrestrial clinical and experimental environments. Imaging alternatives include magnetic resonance imaging (MRI) and high-resolution sonography. Non-imaging techniques include transcranial Doppler, certain audiological methods, and venous ophthalmodynamometry, among others. Special functional techniques have been proposed recently that allow the use of advanced MRI methods to calculate ICP in addition to the acquisition of high-resolution images. Our data include many of these applications, with several cases of correlation with lumbar puncture, the invasive "gold standard" measurement of ICP

Fast DNA translocation through a solid-state nanopore

We report translocation experiments on double-strand DNA through a silicon oxide nanopore. Samples containing DNA fragments with seven different lengths between 2000 to 96000 basepairs have been electrophoretically driven through a 10 nm pore. We find a power-law scaling of the translocation time versus length, with an exponent of 1.26 $\pm$ 0.07. This behavior is qualitatively different from the linear behavior observed in similar experiments performed with protein pores. We address the observed nonlinear scaling in a theoretical model that describes experiments where hydrodynamic drag on the section of the polymer outside the pore is the dominant force counteracting the driving. We show that this is the case in our experiments and derive a power-law scaling with an exponent of 1.18, in excellent agreement with our data.Comment: 5 pages, 2 figures. Submitted to PR

Trabecular Bone in the Bird Knee Responds with High Sensitivity to Changes in Load Orientation

Wolff’s law of trajectorial orientation proposes that trabecular struts align with the orientation of dominant compressive loads within a joint. Although widely considered in skeletal biology, Wolff’s law has never been experimentally tested while controlling for ontogenetic stage, activity level, and species differences, all factors that may affect trabecular bone growth. Here we report an experimental test of Wolff’s law using a within-species design in age-matched subjects experiencing physiologically normal levels of bone strain. Two age-matched groups of juvenile guinea fowl Numida meleagris ran on a treadmill set at either 0° (Level group) or 20° (Incline group), for 10·min per day over a 45-day treatment period. Birds running on the 20° inclined treadmill used more-flexed knees than those in the Level group at midstance (the point of peak ground reaction force). This difference in joint posture enabled us to test the sensitivity of trabecular alignment to altered load orientation in the knee. Using a new radon transform-based method for measuring trabecular orientation, our analysis shows that the fine trabecular bone in the distal femur has a high degree of correspondence between changes in joint angle and trabecular orientation. The sensitivity of this response supports the prediction that trabecular bone adapts dynamically to the orientation of peak compressive forces.Anthropolog