ISS Crew Research Articles

Effect of Simulated Cosmic Radiation on Cytomegalovirus Reactivation and Lytic Replication.

Human exploration of the solar system will expose crew members to galactic cosmic radiation (GCR), with a potential for adverse health effects. GCR particles (protons and ions) move at nearly the speed of light and easily penetrate space station walls, as well as the human body. Previously, we have shown reactivation of latent herpesviruses, including herpes simplex virus, Varicella zoster virus, Epstein-Barr virus, and cytomegalovirus (CMV), during stays at the International Space Station. Given the prevalence of latent CMV and the known propensity of space radiation to cause alterations in many cellular processes, we undertook this study to understand the role of GCR in reactivating latent CMV. Latently infected Kasumi cells with CMV were irradiated with 137Cs gamma rays, 150 MeV protons, 600 MeV/n carbon ions, 600 MeV/n iron ions, proton ions, and simulated GCR. The CMV copy number increased significantly in the cells exposed to radiation as compared with the non-irradiated controls. Viral genome sequencing did not reveal significant nucleotide differences among the compared groups. However, transcriptome analysis showed the upregulation of transcription of the UL49 ORF, implicating it in the switch from latent to lytic replication. These findings support our hypothesis that GCR may be a strong contributor to the reactivation of CMV infection seen in ISS crew members.

Comparative Study between Percutaneous Ilioilial Fixator versus Percutaneous Iliosacral Screw in Managing Sacral Fractures

Abstract Background The sacrum is the mechanical nucleus of the axial skeleton, located at the base of the lumbar spine and acts as the keystone at the centre of the pelvic ring. Traumatic sacral fractures are an increasingly recognized diagnosis. Sacral fractures remain a relative uncommon entity in the general population. Objective The aim of this work is to compare between percutaneous iliosacral screw and ilioilial fixation in sacral fractures fixation as regard operative time, need of intraoperative fluoroscopy, blood loss & related transfusion, infection, neurovascular complication, hardware failure and screws miss- displacement, clinical and radiological outcomes, revision rate and rate of non-union. Patients and Methods After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients. This study was carried on 51 Patients with sacral fractures injuries through the period from August 2019 to November 2021. A prospective randomized controlled clinical trial was conducted to compare the functional and radiological outcome of closed reduction and percutaneous fixation of traumatic sacral fractures using iliosacral screw or ilioilial fixator. Results There is no statistically significant difference in functional outcome, radiological outcome operative time, blood loss, postoperative complication, union rate or follow up. There is statistically significant difference in incision length between the two groups as mean length of incision in iliosacral screw and Ilioilial fixator is 1.2 cm and 4.8 cm respectively. There is statistically significant relation between number of intraoperative fluoroscopic and fixation principles (P value <0.001) with higher risk for radiation exposure in IS screw group. Conclusion Iliosacral screw and ilioilial fixator have comparable functional and radiological outcome and similar biomechanical stability .We suggest the ilioilial fixator as an alternative to IS screw in sacral fracture management. The ilioilial fixator is a useful option in patients who do not qualify for IS screw fixation.

G-Tolerance of the ISS Crew during Ballistic Landing after Off-Nominal Launch of a Soyuz Space Vehicle

G-Tolerance of the ISS Crew during Ballistic Landing after Off-Nominal Launch of a Soyuz Space Vehicle

Minimally Invasive Percutaneous TightRope® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow‐up and Biomechanical Studies

ObjectiveTo evaluate the mechanical stability and clinical efficacy of minimally invasive percutaneous TightRope® systems applied via gun‐shaped reduction forceps for unstable posterior pelvic ring fractures.Materials and methodsThis study consists of two parts: a clinical retrospective study and a randomized controlled biomechanical test. For the clinical study, a retrospective analysis of posterior pelvic ring fractures was performed between June 2015 and May 2020. Eighteen patients underwent surgery using two TightRope® systems to fix a broken posterior pelvic ring because of unstable AO type C1 and C2 pelvic ring fractures. The patients were followed up for at least 2 years, and all patients were evaluated using the Majeed scoring system and vertical displacement. In the biomechanical tests, six embalmed adult pelvic specimens were used. The fractures were subjected to TightRope®, IS screw, and TBP fixation in a randomized block design. The specimens were placed in a biomechanical testing machine in a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and the displacement of the specimens was recorded by the testing machine. The ultimate load in each group of specimens was recorded. The displacement and ultimate load were compared and analyzed by statistical methods.ResultsAt a mean follow‐up of 38.89 ± 8.72 months, the functional Majeed score was excellent in 14 patients and good in four patients. The final radiological examinations showed that the outcome was excellent in 14 patients and good in four patients. In these patients, no serious clinical complications were found. Weight‐bearing was delayed in four patients. In biomechanical tests, the displacement of the specimens fixed with TightRope® was significantly lower than that of the specimens fixed with TBP (P < 0.05) when the load ranged from 300 to 500 N. The displacement in the IS screw group was significantly lower than that in either the TBP or TightRope® group (P < 0.05) when the load ranged from 0 to 500 N. The ultimate load in the IS screw group (1798 ± 83.53 N) was significantly greater than that in the TBP group (1352 ± 74.41 N) (t = 9.78, P < 0.0001) and the TightRope® group (1347 ± 54.28 N) (t = 11.11, P < 0.0001). However, no significant difference was observed between the TightRope® and TBP groups (t = 0.13, P = 0.90).ConclusionPercutaneous posterior TightRope® system shows strong stability in mechanical experiments and shows good results in clinical follow‐up while this system has certain advantages in lower surgical requirements and lower risk of related nerve and vascular structural damage.

Percutaneous Robot-Assisted versus Freehand S2 Iliosacral Screw Fixation in Unstable Posterior Pelvic Ring Fracture.

ObjectivesTo assess the efficiency, safety, and accuracy of S2 (IS) screw fixation using a robot‐assisted method compared with a freehand method.MethodsThis is a retrospective clinical study. We analyzed the patients treated with S2 IS screw fixation for unstable pelvic fractures from January 2016 to January 2019 in our institution. Sixty‐three patients (17 men and 46 women) aged between 21 and 55 years (with an average age of 39.22 ± 9.28) were included in this study. According to the Tile classification, there were 26 (41.3%) type B fractures and 37 (58.7%) type C fractures. All patients were divided into robot‐assisted (RA) group (38 patients) or the traditional freehand (FH) group (25 patients). In RA group, the S2 IS screws were implanted with a robot‐assisted technique. And S2 IS screws were implanted with a traditional freehand technique in FH group. The screw‐related complications were recorded during and after the surgery. The position of all screws and fracture reduction was assessed by postoperative CT scans according to the Gras classification. The number of guide wire attempts and the radiation exposure for S2 screw implantation during operation were also recorded. Finally, the Matta standard was used to evaluate the fracture reduction of the IS joint.ResultsA total of 89 IS screws were implanted into S2 iliosacral joint. Fifty‐four screws were placed by RA (38 patients) and 35 screws were by FH (25 patients). There was no difference between the two groups with respect to demographic data. There was no screw‐related complications or revision surgery in any group. In terms of screw placement, the excellent and good rate was 100% in the RA group, better than that in the FH group where it was only 85.7% (P < 0.001). The fluoroscopy time was 8.06 ± 3.54 s in RA group, which was much less than that in the FH group (27.37 ± 8.82 s, P < 0.001). The guide wire attempts in the RA group (0.685 ± 0.820) were much less than those in the FH group (5.77 ± 3.34) (P < 0.001). Both the fluoroscopy time per screw and the number of guide wire attempts in the RA group were much less than those in the FH group (P < 0.001). The overall postoperative excellent and good rate of Matta standard in RA and FH groups were 86.8% (34/4) and 90.0% (23/25), respectively (P = 0.750), and there was no statistical difference.ConclusionThe robot‐assisted surgery is an accurate and minimally invasive technique. S2 IS screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures, have a high success rate than the freehand technique. Percutaneous RA S2 IS screw fixation for unstable posterior pelvic ring injuries is safe and clinically feasible and has great clinical application value.

An alternative air distribution solution for better environmental quality in the ISS crew quarters

This article presents the study of a ventilation solution using cross-flow fans for the crew quarters (CQ) aboard the International Space Station. Currently the CQ uses two axial fans for ventilation, which occasionally generate insufficient flow rate or acoustic issues. A ventilation circuit using two cross-flow fans was designed, its acoustic performance was measured and the flow was investigated via CFD by using the measured cross-flow fan operating curves as boundary conditions. The acoustic performance of the fans was evaluated in isothermal conditions, under the assumption that the heat generated by the occupants and equipment would produce negligible thermal buoyancy effects in microgravity on the station. Future studies will investigate how the internal heat generated in the enclosure affects the thermal comfort conditions of the occupants. After a comparison between the axial and cross-flow fan systems, results indicate that the latter provides better acoustic parameters for the same flow rate with less energy consumption.

Main Results of Training and Activity of the Iss Crew for Expedition 63 When Carrying Out the Mission Plan.

The paper represents the ISS crew for Expedition 63, main training tasks, activ-ity of the crew aboard the Soyuz MS-16 manned transport vehicle (MTV) and the International Space Station (ISS). It also highlights the performance of EVA under the program of the US Segment and gives a preliminary analysis of the implementation of the Russian scientific-applied research and experiments.

Medical Aspects of Ensuring Flight Safety of the ISS Crew for Expedition 59/60 (Express Analysis).

The paper presents the results of medical support of the flight for the ISS-59/60 crew. It gives a brief description of the medical support system, shows the main results of the implementation of the monitoring program of crew health and environment on the ISS RS during the flight, as well as the use of onboard prophylaxis means to maintain cosmonauts’ performance and health in the flight.

Medical Aspects of Ensuring In-Flight Safety of the ISS Crew for Expedition 58/59 (Express Analysis)

The article presents the results of medical support of the ISS-58/59 expedition crew. It gives a brief description of the medical support system, shows the main results of the implementation of the program for monitoring cosmonauts’ health status and the ISS RS environment during the flight, as well as the use of onboard preventive means to maintain cosmonauts’ performance and health in the flight.

Calculation of Radiation Loads in a Space Station Compartment with Additional Protection of High-Pressure Polyethylene

The paper presents the results of the calculation of cosmic ionizing radiation doses for conditions that simulate ISS crew quarters outfitted with additional protection in the form of a “protective shutter” kit used in the Matryoshka-R experiment; the kit is filled with high-pressure polyethylene instead of regular means of cosmonaut personal hygiene (wet wipes and towels). The calculation was performed using the ray tracing method, which was previously verified using the experimental data on the dose loads in the space station sections. The protective shutter kit has a thickness of 10 cm and covers the exterior wall of the crew quarters; its volume is filled with high-pressure polyethylene. The calculation is performed for the locations of experimental dosimetric assemblies for typical ISS orbits in the phase of minimum and maximum solar activity. The effect from the use of the additional protection (AP) in the ISS crew quarters in terms of the equivalent dose varies between 22 and 60% depending on the orbital altitude, phase of solar activity cycle, and initial conditions of protection. The results indicate a higher efficiency of the additional protection of polyethylene in comparison with water-containing materials. This AP from cosmic radiation has the potential to be used in long-term and long-range spaceflights.

Medical Aspects of Ensuring Safety of the Flight of the ISS Crew for Expedition 55/56 (Express Analysis)

The paper shows the results of medical maintenance of the ISS-54/55 expedition and gives a brief description of operation of the medical support system and maintaining the stability of human environment aboard the ISS RS. Besides, the paper sums up results of implementing medical recommendations, program of medical monitoring and the use of onboard means designed to prevent the alteration of cosmonauts' health status in spaceflight.

Main Tasks of Training and Results of Activity of the ISS Crew for Expedition 55/56 When Carrying out the Mission Plan

The paper presents the members of the ISS-55/56 crew, main training tasks, activity of the crew aboard the Soyuz MC-08 spacecraft and the ISS. It also highlights the performance of EVA under the programs of the Russian and American Segments as well as the execution of scientific-applied research and experiments.

Self-Reported Skin Changes by a Selected Number of Astronauts after Long-Duration Mission on ISS as Part of the Skin B Project

Background: One of the most challenging and important factors of manned space missions is to keep astronauts healthy on orbit. In a study on 46 ISS crew members who were on 6-month (average) missions, skin rashes were the most self-reported event. Furthermore, among notable events, 40% were classified as skin rashes/hypersensitivities. Thus, especially skin conditions during space travel are of major clinical interest and require further research. Aims: The aim of the study was to determine skin conditions in space flight among US and European astronauts, especially taking into account the terrestrial skin conditions as well as on-orbit skin care habits. Methods: A preflight questionnaire was given to the astronauts asking about their terrestrial skin care habits and skin conditions/atopy before launch. In addition, they were asked to fill out a postflight questionnaire asking about their on-orbit skin care routine and whether any special observations regarding the skin were made during flight. Results: A total of 23 skin symptoms were recorded by 8 nonatopic astronauts (mean age: 41 years) during the mission. The symptoms were peeling (21.74%), rash (17.39%), dryness (13.04%), severe dryness (8.70%), reddening (8.70%), itchiness (8.70%), bruising (4.35%), skin sensitivity (4.34%), bumps (4.35%), acne (4.35%) and slow healing of contusions and lacerations (4.35%). Especially the hands and feet were affected by skin problems. As a result of this examination, it was shown that the skin symptoms correlate with poor hygiene on orbit, whereas the factor “environment” on the ISS plays a minor role. Surprisingly, 2 astronauts even experienced positive effects on their skin. Conclusion: Based on these preliminary data, it is important to pay more attention to skin hygiene and maintenance in space.

Can the possibility of transverse iliosacral screw fixation for first sacral segment be predicted preoperatively? Results of a computational cadaveric study

ObjectivesThe purpose of this study was to predict the possibility of transverse iliosacral (TIS) screw fixation into the first sacral segment (S1) and introduce practical anatomical variables using conventional computed tomography (CT) scans. Materials and methodsA total of 82 cadaveric sacra (42 males and 40 females) were used for continuous 1.0-mm slice CT scans, which were imported into Mimics® software to produce a three-dimensional pelvis model. The anterior height (BH) and superior width (BW) of the elevated sacral segment was measured, followed by verification of the safe zone (SZS1 and SZS2) in a true lateral view. Their vertical (VDS1 and VDS2) and horizontal (HDS1 and HDS2) distances were measured. VDS1 less than 7mm was classified as impossible sacrum, since the transverse fixation of 7.0 mm-sized IS screw could not be done safely. ResultsFourteen models (16.7%; six females, eight males) were assigned as the impossible sacrum. There was no statistical significance regarding gender (p=0.626) and height (p=0.419). The average values were as follows: BW, 31.4mm (SD 2.9); BH, 16.7mm (SD 6.8); VDS1, 13.4mm (SD 6.1); HDS1, 22.5mm (SD 4.5); SZS1, 239.5mm2 (SD 137.1); VDS2, 15.5mm (SD 3.0); HDS2, 18.3mm (SD 2.9); and SZS2, 221.1mm2 (SD 68.5). Logistic regression analysis identified BH (p=0.001) and HDS1 (p=0.02) as the only statistically significant variables to predict the possibility. Receiver operating characteristic curve analysis established a cut-off value for BH and HDS1 of impossible sacrum of 20.6mm and 18.6mm, respectively. ConclusionBH and HDS1 could be used to predict the possibility of TIS screw fixation. If the BH exceeds 20.6mm or HDS1 is less than 18.6mm, TIS screw fixation for S1 should not be undertaken because of narrowed SZ.

Towards human exploration of space: The THESEUS review series on immunology research priorities.

Dysregulation of the immune system occurs during spaceflight and may represent a crew health risk during exploration missions because astronauts are challenged by many stressors. Therefore, it is crucial to understand the biology of immune modulation under spaceflight conditions in order to be able to maintain immune homeostasis under such challenges. In the framework of the THESEUS project whose aim was to develop an integrated life sciences research roadmap regarding human space exploration, experts working in the field of space immunology, and related disciplines, established a questionnaire sent to scientists around the world. From the review of collected answers, they deduced a list of key issues and provided several recommendations such as a maximal exploitation of currently available resources on Earth and in space, and to increase increments duration for some ISS crew members to 12 months or longer. These recommendations should contribute to improve our knowledge about spaceflight effects on the immune system and the development of countermeasures that, beyond astronauts, could have a societal impact.

Onboard cross-calibration of the Pille-ISS Detector System and measurement of radiation shielding effect of the water filled protective curtain in the ISS crew cabin

As a preparation for long duration space missions it is important to determine and minimize the impact of space radiation on human health. One of the methods to diminish the radiation burden is using an additional local shielding in the places where the crewmembers can stay for longer time. To increase the crew cabin shielding a special protective curtain was designed and delivered to ISS in 2010 containing four layers of hygienic wipes and towels providing an additional shielding thickness of about 8 g/cm2 water-equivalent matter. The radiation shielding effect of the protective curtain, in terms of absorbed dose, was measured with the thermoluminescent Pille-ISS Detector System. In order to verify the reliability of the Pille system an onboard cross-calibration was also performed. The measurement proved that potentially 25% reduction of the absorbed dose rate in the crew cabin can be achieved, that results in 8% (∼16 μGy/day) decrease of the total absorbed dose to the crew, assuming that they spend 8 h in the crew cabin a day.

The effects of long-term microgravity on autonomic regulation of blood circulation in crewmembers of the international space station

The article presents the results of space experiment “Pneumocard”. The investigation involved all 25 Russian members of the ISS crew. The total of 226 sessions were made including 130 aboard the ISS, 50 prior to launch and 46 on return from mission. The objective was to study effects of the spaceflight factors on autonomic regulation of blood circulation, respiration and cardiac contractility during long-duration mission. The purpose was to secure new research data that would clarify our present view of adaptation mechanisms. Registered were the following signals: electrocardiogram, impedance cardiogram, seismic cardiogram, pneumotachogram, finger photoplethysmogram. A set of hardand software was used. Autonomic regulation of blood circulation by HRV analysis was investigated. It was shown that at the onset of a space mission parasympathetic involvement in regulation increases typically with subsequent mobilization of additional functional reserve. It guided the development of a functional states mathematical model incorporating the established types of autonomic regulation. Our data evidence that the combination of HRV analysis, pre-nosology diagnosis and probabilistic estimate of the pathology risk can reinforce the medical care program in space missions.

Treatment of posterior pelvic ring disruptions using a minimally invasive adjustable plate

ObjectiveIliosacral (IS) screw fixation and posterior tension band plate (TBP) technique are two treatment alternatives for posterior pelvic ring injuries. However, IS screw fixation requires continuous fluoroscopic guidance for appropriate screw insertion and carries a risk of neurovascular injuries. TBP technique also has some disadvantages, including limited reduction potential, difficulty in precontouring the plate and a higher rate of symptomatic implants. To address these limitations, we introduced a minimally invasive adjustable plate (MIAP). This study aims to present the preliminary radiological and clinical results of posterior pelvic ring disruptions treated with MIAP. MethodsThe MIAP conforms to the irregular shape of posterior pelvic ring and can be used without prebending. This plate has a role in reducing compressed or separated fractures/dislocations. Sixteen patients, including seven males and nine females, were treated with MIAP through a minimally invasive approach. The fracture patterns consisted of six Type B and ten Type C fractures according to OTA classification of fracture. Preoperative and postoperative radiography was taken to assess the fracture displacement and reduction quality. Postoperative rehabilitation programme was individualised and early exercise was encouraged. Patients were followed up and the functional outcome was evaluated based upon the scoring system proposed by Lindahl and associates. ResultsAll posterior pelvic ring disruptions were reduced and fixed with MIAP. The average duration of surgery was 49min, the average radiation exposure was 6s, and the average blood loss was 80mL for the treatment of posterior pelvic ring injuries. Overall radiological results of the reduction were excellent in eleven patients and good in five. The patients were followed up for 30 months on average. All fractures healed. The functional outcome was excellent in ten patients, good in four and fair in two. There were no iatrogenic neurovascular injuries, implant failures, irritative symptoms or pressure sores due to subcutaneous implantation. ConclusionFavourable clinical and radiological outcomes can be achieved in treating posterior pelvic disruptions with MIAP. This plate is effective in view of its simplicity, less radiation exposure, safety, minimal invasion and stable fixation.

The application of a computer-assisted thermoplastic membrane navigation system in screw fixation of the sacroiliac joint – A clinical study

BackgroundWe inserted iliosacral screws with the aid of a computer-assisted thermoplastic membrane navigation (CATMN) system which is widely used for the accurate and repeatable location tumour in radiation therapy. We hypothesised that application of the CATMN system on IS screws’ insertion will provide a superior result to conventional fluoroscopic imaging with less operative time, more accuracy and lower complication rates. MethodsWe prospectively evaluated 26 consecutive patients who suffered from sacroiliac joint fractures and dislocations (type C, Tile classification) from April 2007 to June 2010 in our hospital. Patients were randomised into two groups: 13 patients in control group and 13 patients in CATMN groups. After operation, inlet and outlet X-ray views and computed tomography (CT) scanning were performed to confirm and compare the screw positions. The operative time, blood loss and accuracy (measured with postoperative CT) were analysed between groups. ResultsIn the control group, 18 screws were placed in 13 patients with conventional fluoroscopic technique; two of 18 (11.1%) screws were misplaced. The average intra-operative blood loss was 145.4±112.0ml, and operation time was 619.2±199.5s. In the CATMN group, 21 screws were placed in 13 patients with the application of the CATMN system. All 21 screws were in safe zones. The average intra-operative blood loss was 46.2±24.3ml and the operation time was 353.8±111.2s. Operative time and blood loss were reduced significantly with the CATMN system (p<0.05). ConclusionApplication of CATMN system has high accuracy in treating sacroiliac joint dislocations and provides a new alternative method for guidance of the IS screw placement.

5‐Lipoxygenase‐dependent apoptosis of human lymphocytes in the International Space Station: data from the ROALD experiment

The functional adaptation of the immune system to the surrounding environment is also a fundamental issue in space. It has been suggested that a decreased number of lymphocytes might be a cause of immunosuppression, possibly due to the induction of apoptosis. Early activation of 5-lipoxygenase (5-LOX) might play a central role in the initiation of the apoptotic program. The goal of the role of apoptosis in lymphocyte depression (ROALD) experiment, flown on the International Space Station as part of the BIO-4 mission of the European Space Agency, was to ascertain the induction of apoptosis in human lymphocytes under authentic microgravity, and to elucidate the possible involvement of 5-LOX. Our results demonstrate that exposure of human lymphocytes to microgravity for 48 h onboard the ISS remarkably increased apoptotic hallmarks such as DNA fragmentation (∼3-fold compared to ground-based controls) and cleaved-poly (ADP-ribose) polymerase (PARP) protein expression (∼3-fold), as well as mRNA levels of apoptosis-related markers such as p53 (∼3-fold) and calpain (∼4-fold); these changes were paralleled by an early increase of 5-LOX activity (∼2-fold). Our findings provide a molecular background for the immune dysfunction observed in astronauts during space missions, and reveal potential new markers to monitor health status of ISS crew members.