Collagen cross-link excretion during space flight and bed rest.

Extended exposure to weightlessness results in bone loss. However, little information exists as to the precise nature or time course of this bone loss. Bone resorption results in the release of collagen breakdown products, including N-telopeptide and the pyridinium (PYD) cross-links, pyridinoline and deoxypyridinoline. Urinary pyridinoline and deoxypyridinoline are known to increase during bed rest. We assessed excretion of PYD cross-links and N-telopeptide before, during, and after long (28-day, 59-day, and 84-day) Skylab missions, as well as during short (14-day) and long (119-day) bed-rest studies. During space flight, the urinary cross-link excretion level was twice those observed before flight. Urinary excretion levels of the collagen breakdown products were also 40-50% higher, during short and long bed rest, than before. These results clearly show that the changes in bone metabolism associated with space flight involve increased resorption. The rate of response (i.e. within days to weeks) suggests that alterations in bone metabolism are an early effect of weightlessness. These studies are important for a better understanding of bone metabolism in space crews and in those who are bedridden.

Regulation of body fluid volume and electrolyte concentrations in spaceflight.

Despite a number of difficulties in performing experiments during weightlessness, a great deal of information has been obtained concerning the effects of spaceflight on the regulation of body fluid and electrolytes. Many paradoxes and questions remain, however. Although body mass, extracellular fluid volume, and plasma volume are reduced during spaceflight and remain so at landing, the changes in total body water are comparatively small. Serum or plasma sodium and osmolality have generally been unchanged or reduced during the spaceflight, and fluid intake is substantially reduced, especially during the first of flight. The diuresis that was predicted to be caused by weightlessness, has only rarely been observed as an increased urine volume. What has been well established by now, is the occurrence of a relative diuresis, where fluid intake decreases more than urine volume does. Urinary excretion of electrolytes has been variable during spaceflight, but retention of fluid and electrolytes at landing has been consistently observed. The glomerular filtration rate was significantly elevated during the SLS missions, and water and electrolyte loading tests have indicated that renal function is altered during readaptation to Earth's gravity. Endocrine control of fluid volumes and electrolyte concentrations may be altered during weightlessness, but levels of hormones in body fluids do not conform to predictions based on early hypotheses. Antidiuretic hormone is not suppressed, though its level is highly variable and its secretion may be affected by space motion sickness and environmental factors. Plasma renin activity and aldosterone are generally elevated at landing, consistent with sodium retention, but inflight levels have been variable. Salt intake may be an important factor influencing the levels of these hormones. The circadian rhythm of cortisol has undoubtedly contributed to its variability, and little is known yet about the influence of spaceflight on circadian rhythms. Atrial natriuretic peptide does not seem to play an important role in the control of natriuresis during spaceflight. Inflight activity of the sympathetic nervous system, assessed by measuring catecholamines and their metabolites and precursors in body fluids, generally seems to be no greater than on Earth, but this system is usually activated at landing. Collaborative experiments on the Mir and the International Space Station should provide more of the data needed from long-term flights, and perhaps help to resolve some of the discrepancies between U.S. and Russian data. The use of alternative methods that are easier to execute during spaceflight, such as collection of saliva instead of blood and urine, should permit more thorough study of circadian rhythms and rapid hormone changes in weightlessness. More investigations of dietary intake of fluid and electrolytes must be performed to understand regulatory processes. Additional hormones that may participate in these processes, such as other natriuretic hormones, should be determined during and after spaceflight. Alterations in body fluid volume and blood electrolyte concentrations during spaceflight have important consequences for readaptation to the 1-G environment. The current assessment of fluid and electrolyte status during weightlessness and at landing and our still incomplete understanding of the processes of adaptation to weightlessness and readaptation to Earth's gravity have resulted in the development of countermeasures that are only partly successful in reducing the postflight orthostatic intolerance experienced by astronauts and cosmonauts. More complete knowledge of these processes can be expected to produce countermeasures that are even more successful, as well as expand our comprehension of the range of adaptability of human physiologic processes.

Regulation of body fluid compartments during short-term spaceflight.

The fluid and electrolyte regulation experiment with seven subjects was designed to describe body fluid, renal, and fluid regulatory hormone responses during the Spacelab Life Sciences-1 (9 days) and -2 (14 days) missions. Total body water did not change significantly. Plasma volume (PV; P < 0.05) and extracellular fluid volume (ECFV; P < 0.10) decreased 21 h after launch, remaining below preflight levels until after landing. Fluid intake decreased during weightlessness, and glomerular filtration rate (GFR) increased in the first 2 days and on day 8 (P < 0.05). Urinary antidiuretic hormone (ADH) excretion increased (P < 0.05) and fluid excretion decreased early in flight (P < 0.10). Plasma renin activity (PRA; P < 0.10) and aldosterone (P < 0.05) decreased in the first few hours after launch; PRA increased 1 wk later (P < 0.05). During flight, plasma atrial natriuretic peptide concentrations were consistently lower than preflight means, and urinary cortisol excretion was usually greater than preflight levels. Acceleration at launch and landing probably caused increases in ADH and cortisol excretion, and a shift of fluid from the extracellular to the intracellular compartment would account for reductions in ECFV. Increased permeability of capillary membranes may be the most important mechanism causing spaceflight-induced PV reduction, which is probably maintained by increased GFR and other mechanisms. If the Gauer-Henry reflex operates during spaceflight, it must be completed within the first 21 h of flight and be succeeded by establishment of a reduced PV set point.

Short-term space flight on nitrogenous compounds, lipoproteins, and serum proteins.

Biochemical variables in blood were measured in venous blood samples from 38 to 72 Space Shuttle astronauts before and immediately after flights of 2 to 11 days. Mean pre- and postflight values were compared using the paired t-test or the Wilcoxon signed-rank test. The largest change in serum enzymes was a 21% increase (P = .0014) in gamma-glutamyl-transpeptidase, which may have been related to stress. The median value of apolipoprotein (apo) A-I decreased from 152 to 127 mg/dL (P < .0001), but the change in apo B (77 to 73 mg/dL) was not statistically significant, and the mean apo A-I/apo B ratio remained well above 1.5. A decrease in dietary fat and cholesterol intake during shuttle missions may have been a cause of the change in apo A-I. Twelve of the 16 nonenzyme serum proteins measured were significantly elevated (P < .05), possibly because of hemoconcentration and increased protein catabolism. The 56% increase in haptoglobin may be related to release of suppressed erythropoiesis at landing.

Biochemical and hematologic changes after short-term space flight.

Clinical laboratory data from blood samples obtained from astronauts before and after 28 flights (average duration = 6 days) of the Space Shuttle were analyzed by the paired t-test and the Wilcoxon signed-rank test and compared with data from the Skylab flights (duration approximately 28, 59, and 84 days). Angiotensin I and aldosterone were elevated immediately after short-term space flights, but the response of angiotensin I was delayed after Skylab flights. Serum calcium was not elevated after Shuttle flights, but magnesium and uric acid decreased after both Shuttle and Skylab. Creatine phosphokinase in serum was reduced after Shuttle but not Skylab flights, probably because exercises to prevent deconditioning were not performed on the Shuttle. Total cholesterol was unchanged after Shuttle flights, but low density lipoprotein cholesterol increased and high density lipoprotein cholesterol decreased. The concentration of red blood cells was elevated after Shuttle flights and reduced after Skylab flights. Reticulocyte count was decreased after both short- and long-term flights, indicating that a reduction in red blood cell mass is probably more closely related to suppression of red cell production than to an increase in destruction of erythrocytes. Serum ferritin and number of platelets were also elevated after Shuttle flights. In determining the reasons for postflight differences between the shorter and longer flights, it is important to consider not only duration but also countermeasures, differences between spacecraft, and procedures for landing and egress.

Changes in total body water during spaceflight.

This experiment represents the first time that it has been possible to measure a body fluid compartment by direct means during spaceflight. Based on the results observed in the five crewmen in this study, it is concluded that TBW decreases by 3.4% after 1 to 3 days of exposure to microgravity in the Space Shuttle. Some individuals appear to undergo this decrease within 24 hours. This effect may be enhanced by decreased water intake due to nausea associated with SMS.

Metabolic changes observed in astronauts.

Study of metabolic alterations that occur during space flight can provide insight into mechanisms of physiologic regulation. Results of medical experiments with astronauts reveal rapid loss of volume (2 L) from the legs and a transient early increase in left ventricular volume index. These findings indicate that, during space flight, fluid is redistributed from the legs toward the head. In about 2 days, total body water decreases 2 to 3%. Increased levels of plasma renin activity and antidiuretic hormone while blood sodium and plasma volume are reduced suggest that space flight-associated factors are influencing the regulatory systems. In addition to fluid and electrolyte loss. Skylab astronauts lost an estimated 0.3 kg of protein. Endocrine factors, including increased cortisol and thyroxine and decreased insulin, are favorable for protein catabolism. The body appears to adapt to weightlessness at some physiologic cost. Readaptation to Earth's gravity at landing becomes another physiologic challenge.

Metabolism and biochemistry in hypogravity.

The headward shift of body fluid and increase in stress-related hormones that occur in hypogravity bring about a number of changes in metabolism and biochemistry of the human body. Such alterations may have important effects on health during flight and during a recovery period after return to Earth. Body fluid and electrolytes are lost, and blood levels of several hormones that control metabolism are altered during space flight. Increased serum calcium may lead to an increased risk of renal stone formation during flight, and altered drug metabolism could influence the efficacy of therapeutic agents. Orthostatic intolerance and an increased risk of fracturing weakened bones are concerns at landing. It is important to understand biochemistry and metabolism in hypogravity so that clinically important developments can be anticipated and prevented or ameliorated.

Congenital hairy polyp of the nasopharynx associated with cleft palate: report of two cases.

Congenital hairy polyp of the nasopharynx is an unusual but well-recognized entity. These benign lesions have not been reported in the modern literature in association with cleft palate. We report two cases of hairy polyp in association with cleft palate, and discuss the pathology of the tumor with emphasis on embryology and pathogenesis.

Medical considerations for extending human presence in space.

The prospects for extending the length of time that humans can safely remain in space depend partly on resolution of a number of medical issues. Physiologic effects of weightlessness that may affect health during flight include loss of body fluid, functional alterations in the cardiovascular system, loss of red blood cells and bone mineral, compromised immune system function, and neurosensory disturbances. Some of the physiologic adaptations to weightlessness contribute to difficulties with readaptation to Earth's gravity. These include cardiovascular deconditioning and loss of body fluids and electrolytes; red blood cell mass; muscle mass, strength, and endurance; and bone mineral. Potentially harmful factors in space flight that are not related to weightlessness include radiation, altered circadian rhythms and rest/work cycles, and the closed, isolated environment of the spacecraft. There is no evidence that space flight has long-term effects on humans, except that bone mass lost during flight may not be replaced, and radiation damage is cumulative. However, the number of people who have spent several months or longer in space is still small. Only carefully-planned experiments in space preceded by thorough ground-based studies can provide the information needed to increase the amount of time humans can safely spend in space.

Cholesterol in serum lipoprotein fractions after spaceflight.

Cholesterol, triglycerides, very low density lipoprotein cholesterol (VLDL-C), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) were measured in blood samples from 125 crewmembers on the first 24 space shuttle flights. Samples were obtained before, immediately after, and 3-23 days after spaceflight. On landing day, only HDL-C was significantly changed from its preflight level; it had decreased 12.8%. Later in the postflight period, total cholesterol and LDL-C as well as HDL-C decreased significantly. Possible causes of these decreases in estimated cholesterol content of lipoprotein fractions include increased levels of thyroxine during flight and reduced physical activity. The postflight decrease in HDL-C is not considered to have clinical significance for shuttle astronauts, but lipoproteins and apolipoproteins should be measured in blood drawn during longer missions.

The endocrine system in space flight.

Hormones are important effectors of the body's response to microgravity in the areas of fluid and electrolyte metabolism, erythropoiesis, and calcium metabolism. For many years antidiuretic hormone, cortisol and aldosterone have been considered the hormones most important for regulation of body fluid volume and blood levels of electrolytes, but they cannot account totally for losses of fluid and electrolytes during space flight. We have now measured atrial natriuretic factor (ANF), a hormone recently shown to regulate sodium and water excretion, in blood specimens obtained during flight. After 30 or 42 h of weightlessness, mean ANF was elevated. After 175 or 180 h, ANF had decreased by 59%, and it changed little between that time and soon after landing. There is probably an increase in ANF early inflight associated with the fluid shift, followed by a compensatory decrease in blood volume. Increased renal blood flow may cause the later ANF decrease. Erythropoietin (Ep), a hormone involved in the control of red blood cell production, was measured in blood samples taken during the first Spacelab mission and was significantly decreased on the second day of flight, suggesting also an increase in renal blood flow. Spacelab-2 investigators report that the active vitamin D metabolite 1 alpha, 25-dihydroxyvitamin D3 increased early in the flight, indicating that a stimulus for increased bone resorption occurs by 30 h after launch.

Fluid control mechanisms in weightlessness.

Experiments performed on Space Shuttle flights have emphasized study of the earliest effects of the cephalad fluid shift resulting from microgravity. Analysis of one subject's urine collected during flight showed that a sharp increase in antidiuretic hormone occurred within 2 h of launch, followed by an increase in cortisol excretion. Although this subject had symptoms of the space adaptation syndrome (SAS), inflight data from Spacelab missions suggested that these transient changes were not caused by SAS. Unpaired t-tests and Mann-Whitney tests showed that before and after flight, plasma thyroxine and urine osmolality were significantly higher in Shuttle crewmembers who exhibited more severe symptoms of SAS than in asymptomatic crewmembers. Collection of inflight data from more crewmembers should allow distinction between the effects of SAS and effects of weightlessness, and in the future several additional fluid regulation hormones will be measured in samples from crewmembers for a more complete understanding of fluid control during weightlessness.

Methods for repetitive measurements of multiple hematological parameters in individual rats.

Methods have been developed which permit frequent repetitive blood sampling of rats without perturbing physiological parameters of interest. These techniques allow a comprehensive hematological study over several weeks, in individual rats, thus permitting full documentation of selected parameters during growth and development.

Influence of spaceflight on erythrokinetics in man.

A significant postflight reduction in the circulating red cell mass has been observed in both the American and Soviet manned programs. The mechanism and etiology of this loss were studied in blood samples from the four payload crewmen of Spacelab 1 taken before, during, and after flight. These samples and samples from control groups on the ground were analyzed for selected hematological and biochemical parameters, which were chosen on the basis of data previously collected, the restraints imposed by the use of human subjects, and the guidelines established for the first Spacelab mission. Twenty-two hours after weightless exposure, there was an increase in hemoglobin and hematocrit. On day 7 in flight, the hemoglobin and hematocrit remained high and there was a slight decrease in reticulocyte number. On landing, red cell mass, plasma volume, hematocrit, and reticulocyte number were decreased. Throughout the 2-week postflight sampling period, hemoglobin, hematocrit, and reticulocyte number remained below the preflight value. Since this crew was not exposed to 100 percent oxygen these results are viewed as evidence that other spaceflight factors cause the measured red cell mass reduction.

Serum erythropoietin titers during prolonged bedrest; relevance to the "anaemia" of space flight.

The overall objective of these studies was to test the hypothesis that the suppression of erythropoiesis, which occurs during both spaceflight and bedrest, was mediated by reduction in circulating levels of erythropoietin. In each of two 7-day studies, groups of subjects were exposed to either horizontal or 6 degrees head-down tilt bedrest and no evidence was obtained to suggest that the erythropoietic effects were dependent on the angle of recumbency. An additional study involved six men who were exposed to horizontal bedrest for 28 days. Serum erythropoietin titers were not significantly depressed in any of the subjects but total red cell volume was decreased. Absolute increases in red cell numbers and reductions in plasma volume both elevate the haematocrit, but our data suggest that the mechanism of erythrosuppression in these two instances may be different.

[Principles of NASA longitudinal medical studies]. / Printsipy perspektivnykh meditsinskikh issledovanii NASA.

This paper describes approaches to longitudinal studies of the changes in the health status of the US astronauts. The methods include acquisition and analysis of biomedical data accumulated in one and repeated space missions, detection of potential occupational diseases inflight and evaluation of mortality cases associated with them. It is suggested to use pilots and flight controllers as controls. It is indicated that annual physical examinations can be an important source of relevant scientific information.