[Medical provisions for non-career cosmonauts on short-duration flights to the International Space Station].

The paper presents the factual data about 6 participants in short-duration space flights of three age groups (according to the WHO classification). The scope of medical care for three young SFPs whose health status was qualified as good replicated the program adopted in Russia for crewmembers trained for short-duration orbital flights. To safeguard three SFPs of middle and elderly age among whom two had deviations in body functions, the standard medical care program was reinforced by prescription of corrective pharmaceuticals to be taken during space flight, supply of personal kits with preventive medicine, inclusion of additional examinations into the standard medical monitoring and modification of the in-flight countermeasure program, if necessary. As a result, all the SFPs missions were accomplished safely and successfully.

[Experience of an adaptation-assisting agent of animal origin during prolonged isolation and confinement].

The utility of pantohematogen, an adaptation-assisting agent of animal origin for mental performance and functioning of the body systems was assessed in volunteered subjects exposed to prolonged isolation and confinement. Pantohematogen was shown to be favorable for successful implementation of control operations tests without any side effects on the main body systems and, therefore, can be recommended as a way to improve mental performance and to treat asthenoneurotic disorders in extreme conditions.

[Testing and selection of equipment to simulate in-flight telemedicine-assisted medical examinations and researches on the ISS Russian segment].

Analysis of equipment and systems used in telemedicine consultation was fulfilled from the perspective of integration into the ISS RS.

[Several clinical aspects of a piloted Martian flight]. / Nekotorye klinicheskie aspekty pilotiruemogo marsianskogo poleta.

The authors consider factors and risk sources in long and superlong (interplanetary) missions, conceivable effects of extended exposures in microgravity, and probability of diseases in the crew. They also lay down the basic principles of medical care, including surgery, to be applied in the interplanetary mission, and propose a nomenclature of key means and equipment for the therapeutic and emergency medical care, and a configuration of a medical compartment.

[Peculiarities of anesthesia and systemic hemodynamics in experiment with 30 days head-down immobilization of monkeys]. / Osobennosti techeniia anestezii i sostoianiia sistemnoi gemodinamiki v éksperimente s 30-sutochnoi antiortostaticheskoi gipokineziei u obezi'ian.

Two series of surgery (biopsy) were performed before and after 30-d head-down immobilization (HDI) of monkeys. The animals were anaesthetized by inhaled isoflurane. Effects of immobilization on systemic hemodynamics and the progress of anesthesia were evaluated. The experiment showed that HDI reduces systemic arterial pressure and slightly increases heart rate (HR) irrespective of the use of anesthesia. However, comparison of systemic hemodynamics parameters before and after the 30-d immobilization also revealed a drop in systemic arterial pressure, both systolic and, to a less degree, diastolic but not a significant rise in HR during the second surgical operation.

[The pharmacodynamic and pharmacokinetic characteristics of furosemide and furesis]. / Osobennosti farmakodinamiki i farmakokinetiki furosemida i furezisa.

The object of the work was comparative study of the special features of the pharmacodynamic and pharmacokinetic properties of the diuretics furosemide and furesis in an ambulant regimen with the subject lying in an antiorthostatic position. Six practically healthy males were examined. They were given per os either 40 mg furosemide or one tablet of furesis (49 mg furosemide and 50 mg triamterine). Blood from the vein and urine were repeatedly tested.

Blunt trauma and operative care in microgravity: a review of microgravity physiology and surgical investigations with implications for critical care and operative treatment in space.

BACKGROUND: The assembly of the International Space Station in a low earth orbit will soon become a reality. The National Aeronautics and Space Administration envisions inhabited lunar bases and staffed missions to Mars in the future. Increasing numbers of astronauts, construction of high-mass structures, increased extra-vehicular activity, and prolonged if not prohibitive medical evacuation times to earth underscore the need to address requirements for trauma care in nonterrestrial environments. STUDY DESIGN: A search was carried out to review the relevant literature in the MEDLINE and SPACELINE databases. All related Technical, Corporate, and Flight Test Reports in the KRUG Life Sciences corporate library were also reviewed. Bibliographies of all articles were then reviewed from these papers to identify additional pertinent literature. Senior Russian investigators reviewed the Russian literature and translated Russian publications when appropriate. Personal communication and discussion with active microgravity investigators and ongoing microgravity research supplemented published reports. RESULTS: A large volume of data exist to document the multiple detrimental physiologic effects of microgravity exposure on human physiology. Organs systems such as cardiovascular, neurohumoral, immune, hematopoetic, and musculoskeletal systems may be particularly affected. These physiologic changes suggest an impaired ability to withstand major systemic trauma. Observational data also suggest adverse changes in numerous aspects of response to wounding and injury, and in areas such as the behavior of hemorrhage, microbiologic flora, and wound healing. In addition to an increased volume of ongoing and anticipated basic science research in microgravity physiology, preliminary studies of clinical diagnosis and therapy have been carried out in microgravity and microgravity laboratories. The feasibility of a wide range of ancillary critical care techniques has been verified in the parabolic flight model of microgravity. Although Russian investigators first performed laparotomies on rabbits in parabolic flight in 1967, only recently have American investigators demonstrated the reproducible feasibility of open and endoscopic surgical procedures under general anesthetic in animal models in a microgravity environment. CONCLUSIONS: With appropriate instrumentation and personnel, the majority of resuscitative and surgical interventions required to stabilize a severely injured astronaut are feasible in a microgravity environment. Onboard limitations in mass, volume, and power that are ever present in any spacecraft design will limit the realistic capabilities of the medical system. Standard proved and tested trauma and operative management protocols will constitute the basis for extra-terrestrial care. Surgeons should familiarize themselves with the microgravity environment and remain active in planning trauma care for the continued exploration of space.

[Modernization of methods amd technical means of information supply of piloted space flights]. / Modernizatsiia metodov i apparatnykh sredstv informatsionnogo obespecheniia pilotiruemykh kosmicheskikh poletov.

The goal was to lay basis for a change to modern, adequate to international standards technology of the biomedical data transfer to and from the orbital complex, and setting-up a computer network to link all partners in the medical care systems for space missions. Main sources of the board biomedical information were identified as well as associated restrictions on communication capabilities and upgrading the in-flight procedures. Advantages of INTERNET were analyzed and the need for high-speed digital downlink of the biomedical data was substantiated.

[A filtration study of erythrocyte deformability]. / Filtratsionnoe issledovanie deformiruemosti éritrotsitov.

The study of two flow methods (constant flow method and initial flow rate method) has been conducted to specify and compare methodological approaches to quantitation of red cell deformability. Washed red cells were resuspended in saline medium with glucose and albumin and examined for deformability by the above methods under different conditions. The parameters are presented to characterize flow curves obtained with the constant flow method. The authors have established optimal conditions for the measurements: the composition of the medium, the suspension HCT, leukocyte number, filtrate types, etc. With meeting of the above methodological requirements, both the methods permit quantitation of red cells deformability and can be utilized for stored blood and erythrocyte mass quality control.

[Hematological parameters of cosmonauts during space flight]. / Gematologicheskie pokazateli u kosmonavtov v usloviiakh kosmicheskogo poleta.

This paper present hematological data obtained during space flights of the third and the fourth prime crew flights (EO-3 and EO-4). In the EO-3 flight, RBCs, WBCs and blood formed elements were counted by the cosmonaut-researcher. In the EO-4 flight, blood was drawn by the cosmonaut-researcher and analyzed on the ground; also, blood smears treated in the Microview unit and videotaped were used. Blood parameters in EO-3 and EO-4 crewmembers were close or equal to the normal. However there were cases with changes in bends, myelocytes, neutrophils, lymphocytes; also anisocytosis, hypochromia, target-like erythrocytes, and single acanthocytes were seen. Comparison of blood smears on unstained and stained glass slides revealed significant differences in the amount of target-like erythrocytes in the same cosmonaut at the same time (on the prestained glass slide only 4 erythrocytes and no aggregates in single fields of vision were detected while on the unstained glass slide aggregates in single fields of vision were seen). Pre- and postflight examinations of bone marrow revealed polymorphocellular marrow and mature hemopoietic cells.

[Changes in the rheological indicators of the blood and hemodynamics during 14-day anti-orthostatic hypokinesia]. / Izmeneniia reologicheskikh pokazatelei krovi i gemodinamiki v usloviiakh 14-sutochnoi antiortostaticheskoi gipokinezii.

Nine essentially healthy subjects, aged 25 to 42 years, were exposed to head-down bed rest (-8 degrees). On bed rest days 3, 7 and 14 the following rheological and hemodynamic parameters were measured: blood dynamic viscosity, Caisson viscosity, yield limit, red blood cell aggregation, stroke volume, cardiac output, and total peripheral resistance. Rheological parameters were measured by means of a rotation viscosimeter at 25 degrees C +/- 0.1. Hemodynamic parameters were measured by the method of integrated rheography. Blood was withdrawn from the cubital vein. The results give evidence that dynamic and Caisson viscosity increased significantly, reaching a peak by bed rest day 14. The sequence of hemodynamic changes followed the same pattern as rheological changes. Analysis of the results shows that there is a good correlation between the above parameters, especially by bed rest day 14. Thus, it can be concluded that there is a vascular mechanism involved in the compensatory restructuring of the vascular system at the tissue level in response to blood redistribution and fluid loss during bed rest.

[Anti-bacterial protection of patients during rendering of specialized medical services]. / Bakterial'naia zashchita patsienta pri okazanii spetsializirovannoi meditsinskoi pomoshchi.

This paper surveys the available equipment and techniques to provide bacterial protection of out-patients given medical aid. It presents a classification of the medical equipment in terms of the design, spectrum of application and type of aid. It is emphasized that patients treated outside a hospital need bacterial protection. Methods for purifying and sterilizing the equipment as well as procedures for maintaining the preset environmental parameters are described. The paper outlines technical problems the solution of which may help the development and use of bacterial protection devices to be applied in special conditions.

[Changes in regional pulmonary hemodynamics and levels of vasoactive substances in man in a state of antiorthostatic hypokinesia]. / Izmeneniia regionarnoi legochnoi gemodinamiki i urovnia vazoaktivnykh veshchestv u cheloveka v usloviiakh antiortostaticheskoi gipokinezii.

A comparative evaluation of rheographic changes in regional pulmonary hemodynamics and renin-angiotensin and kinin-kallikrein activities was carried out on 9 volunteers exposed to antiorthostatic hypokinesia (-8 degrees) for 14 days. It was found that pulmonary circulation shifted in the apical direction due to increase in arterial tonicity and phasic variations of venous lumen. During the study blood renin increased significantly (P less than 0.05) whereas prekallikrein and kallikrein inhibitor varied insignificantly. It was concluded that the renin-angiotensin system played and important role in the changes of functional topography of pulmonary circulation in simulated microgravity conditions.

[Evaluation of the effect of enterosorption on the human body in a changed gaseous medium]. / Otsenka vliianiia énterosorbtsii na organizm cheloveka v usloviiakh izmenennoi gazovoi sredy.

The effect of enterosorption on biochemical and physiological parameters of 18 normal men was studied. The test subjects spent 7 days in an enclosed environment where the content of CO2 reached 3% and that of CO-40 mg/l3 during the last 8 hours of isolation. Beginning with the first day of enclosure 12 test subjects were given an enterosorbent at a dose of 0.75 g/kg 3 times a day. It is shown that a regular intake of an enterosorbent during exposure to increased concentrations of CO2 and CO affects beneficially central hemodynamics, reduces significantly plasma toxicity, content of C2-C5 hydrocarbons in the exhaled air and carboxyhemoglobin in blood. These findings may be very important for space and marine medicine because they demonstrate the efficacy of enterosorbents in protecting the human body from stress effects of an extreme environment.

[Effect of hemosorption on rheological indicators of blood during 7-day anti-orthostatic hypokinesia and in in vitro tests]. / Vliianie gemosorbtsii na reologicheskie pokazateli krovi v usloviiakh 7-sutochnoi ANOG i stendovykh issledovaniiakh.

The effect of hemosorption of blood rheology was examined in 9 healthy men exposed to headdown tilt (-8 degrees). Venous-venous hemosorption was performed on tilt day 7 using activated charcoal SKN-2M. It was found that by tilt day 7 rheological parameters increased significantly and returned to the norm after 2-hour hemoperfusion through activated charcoal. This shows that hemosorption produces a beneficial effect on blood rheology and microcirculation which is indicated by a direct examination of eye microvessels. Experimental in vitro studies using oxygenated and nonoxygenated donor's blood demonstrated that hemosorption combined with blood oxygenation can noticeably increase the effectiveness of perfusion on the whole.

[Paramecium test for toxic substances in the blood of humans exposed to conditions simulating weightlessness]. / Parametsiinyi test na toksicheskie veshchestva v krovi cheloveka, nakhodiashchegosia v usloviiakh, modeliruiushchikh nevesomost'.

The Paramecium test was for the first time used to measure the build-up of toxic substances in the healthy man exposed to simulated weightlessness. The most distinct changes were seen on bed rest days 3 and 7-8 in all test subjects (41 subjects). After bed rest day 8 the parameter reached a plateau, the toxicity level stopped to increase, but the Paramecium test time remained shorter than normal. It can therefore be suggested that the prognosis of any disease that may develop in this situation will be worse. In view of this it is important to improve the prophylaxis and treatment of endogenous and exogenous intoxications during space flight and to provide active detoxication based on the purification of biological fluids by sorption.

[Rheological blood indicators during motor activity of various degrees]. / Reologicheskie pokazateli krovi pri razlichnoi stepeni dvigatel'noi aktivnosti.

Blood rheological parameters of essentially healthy people were examined during exercises of a maximal workload and 14-day head-down tilt. The results obtained indicate that in the people performing normal and increased motor activity some rheological parameters were different. Changes in the rheological parameters of blood after head-down tilt and exercises with a maximal workload suggest the existence of a blood viscosity threshold above which physical work capacity declines significantly. The capacity can be restored through a correction of blood viscosity in the recovery period. The basic rheological properties of blood can be improved by regular physical training.