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B R Macias

Publications and source records attributed to B R Macias.

Countermeasures for Mitigation of Sensorimotor Decrements Following Head-Down Tilt Bed Rest

BACKGROUND Astronauts experience postflight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although exercise is partially effective for mitigating cardiovascular and muscular deconditioning, additional countermeasures are needed to further preserve sensorimotor function. Proprioception training and electrical muscle stimulation (EMS) are two promising in-flight countermeasures. Since prolonged head down tilt bed rest (HDTBR) is a spaceflight analog for body unloading and causes postural and locomotor control decrements that parallel those observed after spaceflight, it can be used to facilitate the development of these countermeasures. METHODS This study will determine the effects of proprioception training and EMS on functional task performance and sensorimotor function following 60 days of 6° HDTBR. Subjects will be randomly assigned to one of four groups: 1) an EMS arm, 2) a proprioception training arm, 3) an exercise plus proprioceptive training arm, and 4) a control arm. The EMS countermeasure will include daily bilateral stimulation of selected bilateral lower extremity muscles (30 minutes per session). Proprioception training will be performed three days per week (25 minutes per session) consisting of body-loaded postural tasks in the horizontal position on an air bearing sled. Exercise training will mimic current protocols used on the International Space Station, but treadmill aerobic exercise will be replaced with additional cycling aerobic exercise. Primary outcome measures will include pre- and post- HDTBR functional tests that require high demand for dynamic control of postural stability. Secondary measures will be used to explore key physiological changes that underlie countermeasure benefits. All HDTBR and data collection activities will be completed by the German Aerospace Center (DLR) at the :envihab facility. Given the constrained samples size, a Bayesian modelling approach will be used to quantify the probability that there is an effect of a given magnitude. HARDWARE AND PROTOCOL DEVELOPMENT Final hardware modifications and protocol developments were completed in preparation for Campaign 1, which began in September 2024. These included shipment, setup, and operator training for the transportable gravity bed, horizontal squat device, foam obstacle course, EMS devices, leg dexterity system, foot sole skin sensitivity system, and Radiofrequency Echographic Multi Spectrometry (REMS) ultrasound device. In addition, specialized protocols were developed for data collection using DLR’s equipment, including muscle morphology magnetic resonance imaging (MRI), optical coherence tomography, venous blood flow MRI and ultrasound, muscle ultrasound and impedance, and skin blood flow ultrasound. We will present early data from the first campaign, which concluded in November, 2024. These will be compared with previous data from the recent 30-day HDTBR campaigns (Spaceflight associated neuro-ocular syndrome countermeasures (SANS-CM)) conducted at DLR. RELEVANCE The deliverable from this project will be proof-of-concept sensorimotor countermeasure designs for functional task performance with full assessment of efficacy in a spaceflight analog. If one or more countermeasures are effective, they will be translated for validation with the suite of operationally implemented in-flight countermeasures.

T R Macaulay↗

Effect of Strict Head Down Tilt Bedrest on Pituitary Gland Height

BACKGROUND Pituitary gland deformity and loss of pituitary height have been identified in astronauts postflight, hypothesized to be related to increased intracranial pressure or intracranial pressure pulsatility exposure from prolonged weightlessness. Microgravity-induced chronic headward fluid shift has been suggested as a root cause of intracranial compliance changes leading to altered intracranial pressure dynamics. Elevated intracranial pressure or pressure pulsatility is theorized to promote the development of an arachnoid diverticulum, which herniates into the pituitary fossa via a defect in the diaphragma sellae compressing the pituitary gland. We aimed to determine if chronic headward fluid induced by strict head-down tilt bed rest (HDTBR) can cause similar quantitative changes in pituitary gland height. METHODS Control group data from two 6-degree HDTBR studies were analyzed (SANS CM and AGBRESA). The AGBRESA study collected MRI data at Baseline, 14 days into HDTBR (HDTBR-14), 52 days into HDTBR (HDTBR-52), and three days into Recovery (R+ 3) and included eight healthy adults (2 women), age = 33 ± 8 years. The SANS CM collected MRI data at Baseline, 15 days into HDTBR (HDTBR-15), 29 days into HDTBR (HDTBR-29), and 12 days into Recovery (R+12) and included twelve healthy adults (4 women), age = 34 ± 9 years. Pituitary gland height was evaluated using a sagittal, 3D T1-MPRAGE sequence obtained on a dedicated 3T Siemens Biograph MRI scanner using a 32-channel head coil. Following the reconstruction of a true orthogonal sagittal plane of the pituitary gland using a 3D multiplanar reconstruction tool (Horosproject.org), the anterior pituitary mid-gland height at the pituitary stalk level was quantified according to the methodology described by Kramer et al. . A paired t-test was used to evaluate changes from the baseline measurements. FINDINGS The mean height of the pituitary gland at baseline was 6.5 ± 1.7 mm (AGBRESA) and 5.7 ± 1.6 mm (SANS CM). From baseline measurements, the SANS CM STUDY data showed a decrease in mean pituitary height of 0.3 mm (p=.011) at HDTBR-15, 0.5 mm at HDTBR-29 (p<.001) and 0.2 mm at R+12 (p=.02). From baseline measurements, the AGBRESA data showed a decrease in mean pituitary height of 0.3 mm (p=.06) at HDTBR-14, 0.6 mm at HDTBR-52 (p<.002) and 0.2 mm at R+3 (p=.13). CONCLUSION HDTBR results in progressive loss of pituitary height, which is most severe with the longest HDTBR exposure. Early pituitary height loss was the same at HDTBR-14 (AGBRESA) and HDTBR-15 (SANS CM). Residual pituitary height loss was the same at R+12 and R+3 but only significant in the latter (SANS CM). The degree of pituitary height loss at HDTBR-52 replicates the 0.6 mm height loss found in long-duration astronauts after approximately six months of microgravity exposure (p<.01, preflight mean height=5.9 mm). The hormonal effects of pituitary height loss are unknown in astronauts and HDTBR subjects and should be investigated in future studies. Future work will examine the individual variability in the loss of pituitary gland height and whether those changes are associated with other SANS findings, such as optic disc edema.

L A Kramer↗

Mitigating Headward Fluid Shifts with Venoconstrictive Thigh Cuffs during Spaceflight

Venoconstrictive thigh cuffs (VTC) are a mechanical countermeasure capable of attenuating the spaceflight induced headward fluid shift, and thus may be a viable spaceflight associated neuro-ocular syndrome (SANS) countermeasure. Crewmembers can use VTC to mitigate the headward fluid shift to aid in adapting to spaceflight. However, data are needed to determine if VTC affect ocular structures. PURPOSE The purpose of this study is to determine the efficacy of long duration use of VTC application to mitigate the spaceflight-induced headward fluid shift. We hypothesize that a VTC countermeasure will temporarily reverse the headward fluid shift and attenuate spaceflight-induced changes of internal jugular vein (IJV) cross-sectional area, IJV pressure, stroke volume, cardiac output, intraocular pressure (IOP), and optic nerve head and retinal morphology. METHODS This study will evaluate the effectiveness of VTC countermeasure application on the headward fluid shift, as well as cardiovascular and ocular variables. VTC during spaceflight will be worn for an extended duration (up to 6 hours) with data collected at three time points (30 minutes, 3 hours, and 6 hours) to characterize the temporal profile of key fluid shift outcome measures of the vascular fluid shift, IOP, and ocular structure changes. Ten astronauts will be recruited to participate and will be studied before and during approximately 180-day International Space Station (ISS) spaceflight missions. Baseline data collection will occur approximately 90-days before launch (Figure). Preflight, each leg of the crewmember will be measured to determine the VTC cuff size and a cuff fit check session will occur prior to the preflight baseline ground imaging to verify the appropriate fit measured via a surface contact pressure. Prior to donning the VTC, baseline measures without VTC will be collected seated, supine, and supine followed by data collection with the VTC. The baseline data collection will include ultrasound (IJV area and pressure, stroke volume and cardiac output), brachial blood pressure and heart rate, optical coherence tomography (OCT) imaging (total retinal thickness and choroid thickness), and IOP. An inflight cuff fit check session, same as the preflight fit check, will occur prior to VTC use on ISS. The inflight VTC experiment will be conducted early (FD45) and late (R-45) to determine if mission duration affects VTC fit and the efficacy of fluid redistribution. A system usability scale comfort questionnaire will be included in each VTC session to capture feedback from crewmembers regarding the comfort and usability of the VTC. SCIENTIFIC & MISSION IMPACT Results will narrow knowledge gaps described in the Human Research Roadmap to mitigate the headward fluid shift during spaceflight and help NASA to 1) determine the efficacy of extended use VTC application to mitigate the spaceflight-induced headward fluid shift and 2) further the understanding of the use of VTC on vascular fluid shifts, IOP, and ocular structure during spaceflight. Supported by NASA Human Research Program Directed Research. Figure. Detailed Testing Schedule. Baseline data collection at L-90 will be performed in a randomized order of position.

J V Jasien↗

Characterization of Jugular Venous Blood Flow During Acute Fluid Shifts

INTRODUCTION Exposure to weightlessness induces a headward fluid shift and redistribution of fluids, resulting in increased internal jugular vein (IJV) cross-sectional area and altered IJV blood flow dynamics including stasis and retrograde flow. These findings may contribute to various risks of spaceflight, including thrombosis or other risks affected by cerebral venous blood flow. To date, our understanding of the cerebral venous outflow dynamics is limited to the left IJV assessed ~45and ~150days into spaceflight. Therefore, it is unknown how quickly the alterations in venous blood flow dynamics change as a result of weightlessness. The purpose of this study is to determine 1) if venous stasis is an immediate effect of weightlessness, and therefore a risk for short-duration missions, and 2) the effect of weightlessness on brachiocephalic venous flow. METHODS In this study, we will determine the effects of acute weightlessness during parabolic flight on right and left IJV cross-sectional area, as well as blood flow dynamics through the IJV and brachiocephalic veins in 12 healthy subjects. Baseline ultrasound images will be obtained on the ground prior to the parabolic flight in the seated and supine postures to determine normal changes in blood flow with posture-induced fluid shifts in a 1genvironment. Subjects will then undergo parabolic flight withrepeated,~20 second exposure to 0g. Each data collection session will include 2D ultrasonography to quantify IJV cross-sectional area and Doppler ultrasonography to characterize venous blood flow patterns in the IJV and brachiocephalic veins. RESULTS Data collection for this study is planned to take place in October, 2021.CONCLUSIONS This study will characterize the immediate venous response in the left and right IJV and brachiocephalic veins upon entry into weightlessness. The results from this parabolic flight study will be compared with previous data from International Space Station crewmembers collectedafter~45 and ~150 days into spaceflight to provide a more complete understanding of the temporal profile of changes in venous blood flow dynamics during weightlessness and whether these findings develop in veins other than the left IJV. Supported by the NASA Human Research Program.

K Marshall-Bowman↗

Indices of Cardiovascular Disease Risk in Astronauts After Long-Duration Spaceflight in Low Earth Orbit

Current human spaceflight missions consist primarily of 4-6 month stays onboard the International Space Station (ISS), but in the future will include longer missions to the Moon and Mars. These missions will expose astronauts to increased risk of oxidative and inflammatory damage from a variety of sources (e.g., galactic cosmic radiation, psychological stress, reduced physical activity). Earth-based evidence suggests that increased oxidative stress and inflammation accelerates development of cardiovascular disease, but it is unclear if the spaceflight environment increases this risk in astronauts.

S M C Lee↗

Intracranial Effects of Artificial Gravity: A 3T MRI Study

INTRODUCTION Spaceflight associated neuro-ocular syndrome (SANS) is characterized by the development of optic disc edema, posterior globe flattening, choroidal/retinal folds and hyperopic refractive errors1. SANS is hypothesized to be a result of headward fluid shifts that invariably occurs in the microgravity environment. As a countermeasure, artificial gravity (AG) through centrifugation has been proposed to reduce this headward fluid shift, however there is no current proof of benefit. The goal of this study was to determine if the application of AG can prevent or reduce known changes in brain volumetry, internal carotid artery (ICA) stroke volume and cerebral spinal fluid (CSF) flow velocity that occurs during simulated chronic headward fluid shift using head down tilt bed rest (HDTBR) methodology2 as an indicator of countermeasure efficacy. METHODS Healthy volunteers were recruited for an IRB approved HDTBR study performed at the German Aerospace Center in Cologne, Germany. Strict six-degree HDTBR was used as a spaceflight analog to induce a continuous headward fluid shift. HDTBR was carried out for 60 days for all subjects. Short-arm centrifugation was utilized to generate AG equating to ~0.3g of acceleration at the level of the eye. The subjects were divided equally into three groups: NoAG (control; n=8), daily intermittent AG (6 x 5 min iAG; n=8), and daily continuous 30 min (cAG; n=8). All studies were performed on a single dedicated 3T MRI Scanner. Pulse-gated MRI phase-contrast flow imaging was used to quantify ICA stroke volume and peak-to-peak CSF flow velocity in the mid cerebral aqueduct. 3D-SPGR was acquired for volumetric segmentation of the brain and CSF spaces. MRI acquisitions were obtained at baseline (BDC), 14 days into HDTBR (HDTBR14), 52 days into HDTBR (HDTBR52) and 3-5 days after HDTBR (recovery, R+3/5).The data were analyzed by the mixed model, which included intervention and time (BDC, HDTBR 14, HDTBR 52, R+3/5) as the fixed effects and included subject as the random effect.RESULTS24 healthy subject volunteers (16 men, 8 women, mean age = 33 years ± 9 [standard deviation] and mean BMI = 24.3 kg/m2 ± 2.0) successfully completed all phases of the study. Strict six-degree HDTBR was characterized by progressive and statistically significant (p<.01) increases in mean combined brain and CSF volumes and mean aqueductal CSF peak-to-peak flow velocity, as well as statistically significant (p<.01) progressive decrease in mean ICA stroke volume from baseline to 52 days post intervention (Figs. 1-3). Compared to baseline, only combined brain and CSF volumes did not return to baseline values in the recovery period (p=NS). Neither iAG nor cAG exerted any significant effects on the measured MRI brain parameters as compared to HDTBR alone (p=NS). CONCLUSION Our results indicate that HDTBR at 6-degrees was effective in producing alterations in ICA stroke volume, aqueductal CSF flow velocity, and combined brain and CSF volumetric change that is associated with chronic headward fluid shift. Short duration, 30-min daily exposure to either iAG or cAG appears to be insufficient in preventing or reducing the effects of chronic HDTBR and thus may not be a suitable countermeasure as currently deployed. AG protocol modifications, including increased duration and magnitude of exposure, should be considered for future research.

L A Kramer↗

Space-Cent: Studying the Physiological and Anatomical Effects of Centrifugation and Head Down Tilt: 2021 Update

BACKGROUND The objective of this study was to evaluate the cerebral and ocular physiological and anatomical effects of head-down tilt bedrest (HDBR) with and without daily artificial gravity (AG) in healthy subjects to provide novel insights into possible countermeasures for the Spaceflight Associated Neuro-ocular Syndrome (SANS). Previous long-term studies using the spaceflight analog of strict 6° HDBR for 30 days revealed changes in ocular structure, including optic disc edema. The effects of an AG countermeasure using intermittent centrifugation to restore upright hydrostatic gradients and reduce the ocular and brain anatomical effects has not been explored. METHODS The effects of 60-day exposure to simulated microgravity (6° HDBR) on the cerebral, ocular and vestibular systems with and without the intervention of daily 30 minute exposure to AG (short-arm centrifugation) was evaluated in 24 healthy subjects. Non-invasive measurements of cerebral blood flow, intracranial blood volume (near infrared spectroscopy, NIRS), cerebral and ocular structure (MRI and optical coherence tomography), internal jugular vein area (ultrasound), lateral ventricular volumes (MRI), intraocular pressure, and sensorimotor/vestibular (i.e. balance and coordination) systems were made during various time-points during the bedrest study. Additional measures with ultrasound and NIRS were made during centrifugation. RESULTS The study began in Spring 2019 and all 24 subjects completed the testing by end of 2019. Data analysis continues. We report the following updated results for 2021. MRI showed significant decreases in carotid artery flow, increases in brain and CSF volumes, and aqueductal flow velocities in all subjects in HDT compared to baseline supine, but no effects of the short duration AG. All groups showed increased posterior globe flattening during bedrest compared to baseline, without protection from AG. As previously reported we observed chorioretinal folds for the first time in a bedrest analog, as well as optic disc edema, with no protection from the short-term AG. Data from the study is now being transmitted to the NASA LSDA which will allow for future research. CONCLUSIONS The 6 degree HDBR analog produced significant changes in the anatomical and physiological functions of the brain and eye in healthy subjects. Daily 30 minute exposure to AG with short-arm centrifugation had significant transient effects on physiology of the cerebrovascular system, but was not sufficient to prevent the anatomical effects of HDBR on the brain and eye.

E M Bershad↗

Characterization of Jugular Venous Blood Flow During Acute Fluid Shifts

INTRODUCTION Exposure to weightlessness induces a headward fluid shift and redistribution of fluids, resulting in increased internal jugular vein (IJV) cross-sectional area and altered IJV blood flow dynamics, including stasis and retrograde flow. These findings may contribute to various risks of spaceflight, including thrombosis or other risks affected by cerebral venous blood flow. To date, our understanding of the cerebral venous outflow dynamics in weightlessness is limited to the left IJV assessed ~45 and ~150 days into spaceflight. Therefore, it is unknown how quickly the alterations in venous blood flow dynamics change as a result of weightlessness. The purpose of this study is to determine 1) if venous stasis is an immediate effect of weightlessness and therefore a risk for short-duration missions and 2) the effect of weightlessness on brachiocephalic venous flow. METHODS In this study, we investigated the effects of acute weightlessness during parabolic flight on the right and left IJV in 12 healthy subjects. Baseline ultrasound images were obtained on the ground (1g) in the seated and supine postures and during 0g parabolic flight. Each data collection session included 2D ultrasonography to quantify IJV cross-sectional area and Doppler ultrasonography to characterize venous blood flow patterns in the bilateral IJVs. RESULTS There was a similar pattern of response in the left and right IJV area across postures and g-levels. IJV area increased from seated to supine by 0.74 mm2 (95% CI: 0.56 to 0.91 mm2, p<.001) and increased further during weightlessness by 0.29 mm2 (95% CI: 0.11 to 0.47 mm2, p=.0015). IJV Doppler images revealed stagnant flow in the left IJV in one subject during 0g exposure that was not present during any imaging on the ground; the right IJV continued to show pulsatile, nominal flow patterns in both 0g and 1g. CONCLUSIONS This study characterized the immediate effect of the weightlessness-induced headward fluid shift on venous parameters in the left and right IJV. The left IJV appears to be more susceptible to flow alterations, including stagnant flow, during both short and long-duration exposure to weightlessness that may contribute to the risk of thrombosis inflight.

K Marshall-Goebel↗

Standard Measures During Spaceflight

The goal of the Spaceflight Standard Measures project is to ensure that a set of measures, representing the Human Research Program’s key risks and acquired with minimal impact on time and resources, is consistently captured from crewmembers through the end of the International Space Station (ISS) Program. Data collected under the Spaceflight Standard Measures project include assessments of sleep/wake cycles, cognition, immune status and function, general blood and urine chemistry (urine is collected only before flight and after landing), microbiome composition (gastrointestinal tract, saliva, and body surface), cardiovascular structure and function (carotid intima-media thickness, orthostatic responses), sensorimotor function, sleep quality, and team processes. Data is collected once or twice before the flight (180 and 90 days before launch), twice during the 6-month missions (flight day 30 and 30 days before return to Earth) with the exception of actigraphy, which is recorded during two-week periods before, during, and after the mission. In this presentation, we will review the data collected to date on 31 ISS crewmembers. These data are placed in the NASA Life Sciences Portal (NLSP) and are available for occupational surveillance (using non-identifiable data), Institutional Review Board-approved data sharing requests, and retrospective data requests. This data repository enables high-level monitoring of the effectiveness of countermeasures and meaningful interpretation of health and performance outcomes for various mission durations. The knowledge gained from this project informs and supports future hypothesis-driven research that will enable the success of planetary missions.

G R Clement↗