Aerospace medicine and human performance最新文献

Introduction: Space exploration presents unique challenges to human health due to space radiation, reduced gravity, and prolonged isolation. Astronauts should be prepared to manage medical and dental emergencies. This scoping review maps the evidence on oral health alterations and dental emergencies faced by astronauts during short- and long-term space missions.

Methods: A "Topical Team" assembled by the European Space Agency performed the review described herein. An electronic search was conducted on scientific databases, reference lists of relevant papers, specific textbooks, and space agencies' databases. Inclusion criteria encompassed studies related to dental medicine in microgravity or outer orbital space conditions. Results are presented through narrative format.

Results: Out of 23,686 studies identified, 467 were considered eligible and 80 (54 reviews and 26 human-based studies) were included. The latter were classified into three broad topics: microbiology, space physiology and medicine, and space dentistry. Among the studies involving human subjects, 17 involved individuals who had spent time in space. There are only a few studies about oral health modifications and issues during spaceflight and those have limited evidence. Dental emergencies in space are relatively rare events that tend to increase with mission duration.

Discussion: The impact of microgravity on oral health requires further investigation. Preflight and in-flight measures should focus on prevention and treatment protocols for various dental issues to ensure crew safety and mission success. Understanding and addressing factors affecting oral health in microgravity will enhance the well-being of astronauts and the success of human exploration missions in space. Del Fabbro M, Khijmatgar S, Vandenberghe B, Kijak E, Kulesa-Mrowiecka M, Singhal I, Lorusso F, Xavier BB, Sampson V, Marfia G, Neefs D, Tartaglia GM. Oral health of astronauts in short- and long-term missions in space. Aerosp Med Hum Perform. 2025; 96(2):168-179.

Introduction: The space sector is growing remarkably fast. Its value is expected to increase from $447 billion in 2022 to $2.7 trillion by 2040. The demand for astronauts and astro-civilians is growing, and there will be an increased need for experts who understand the effects of spaceflight on the neuromusculoskeletal (NMSK) system. Orthopedic specialists in space medicine are sparsely reported in the literature, and standards of care for astro-civilians are not well established. This review discusses the current prevalence of peri-flight NMSK injuries in astronauts, the role of orthopedic specialists, and considerations for standards of care for astro-civilians.

Methods: A systematic review using PubMed, MEDLINE, and NASA Technical Report Server was performed to identify original research containing NMSK injuries in astronauts.

Results: There were 29 studies included in the review. In 2388 documented injuries, the prevalence of injuries during preflight is 46.5%, in flight is 37.0%, and postflight is 16.5%. In 2081 documented injury locations, the prevalence of injuries in the upper extremity is 32.4%, in the shoulder is 31.4%, in the back is 26.4%, in the lower extremity is 5.5%, and in the neck is 2.3%.

Discussion: Common peri-flight injuries involve the shoulder, back, and hand, such as shoulder tendonitis, space adaptation back pain, and herniated nucleus pulposus. It is critical to consider NMSK injuries for the growing space sector. As public interest grows, costs related to space are expected to decrease. Decreased costs increase accessibility to space and, consequently, the risk of NMSK injuries, increasing the demand for medical standards and experts in orthopedics and space medicine. Ward GH, Anderson DN, Scheuring RA. Peri-flight neuromusculoskeletal injuries in astronauts. Aerosp Med Hum Perform. 2025; 96(2):155-167.

Introduction: Aviation is a high-risk activity, particularly in pilots with cardiovascular (CV) disease. The occurrence of acute clinical events during flight may have catastrophic implications, justifying the relevance of cardiological evaluation in aviation medicine. However, evidence of the impact of CV diseases in this population is scarce. The aim of this study was to analyze the cardiac causes of disqualification among pilot candidates and pilots of the Portuguese Air Force (PoAF) over a period of 20 yr.

Methods: Retrospective analysis of cardiac causes of disqualification between 1999-2018, both in PoAF candidates and pilots.

Results: In this period, the overall number of candidates was 2529 and the number of PoAF pilots was 760. Among the candidates, 41% (N = 1047) were considered unfit, of which 4% (N = 39) were due to cardiac causes (all men aged 17-25), namely valvular diseases (N = 27) and conduction/heart rhythm disturbances (N = 12). Among the pilots, 2% (N = 18) were considered unfit, mainly due to cardiac disease (50%; N = 9)-all men with mean age of 47 ± 9 (30-60) yr old, all unfit due to acute myocardial infarction, none occurring during flight.

Discussion: Cardiac diseases were an uncommon cause of disqualification among the pilot aviator candidates, but it was the main cause among the pilots of the PoAF over two decades, all due to acute myocardial infarction. Cardiac evaluation in aviation medicine is essential, focusing on CV risk stratification and preclinical detection of coronary artery disease. Certo Pereira J, Monge J, Baptista A, Reis P, Dores H. Cardiac causes of disqualification in Portuguese Air Force pilots. Aerosp Med Hum Perform. 2025; 96(2):128-134.

Introduction: This study aimed to update and reinforce previous research on helicopter emergency medical service accidents in the United States. By investigating predictors of fatalities after helicopter emergency medical service crashes through the application of machine learning techniques, we updated existing data sets and sought to uncover patterns that traditional analysis might not reveal.

Methods: Using the National Transportation Safety Board database, the authors analyzed a dataset of 267 helicopter emergency medical service accidents between 1991-2022. We first calculated fatalities odds ratios for each condition. We then plotted geospatial locations of all reported accidents. Finally, we used XGBoost regression to understand the most important features contributing to fatality after an accident.

Results: The findings reaffirm previous research and identify significant predictors of fatalities in helicopter emergency medical service accidents. Key factors such as adverse flight conditions (weather), the absence of a copilot, and postcrash fires are highlighted as critical to understanding and mitigating risks of fatality.

Discussion: These findings emphasize the utility of machine learning in extracting meaningful insights from accident data, suggesting that such techniques offer a more nuanced understanding of the conditions leading to fatalities. It points out the potential of these methods to not only enhance aviation safety but also to be applied across other sectors. We conclude by underlining the significant potential of techniques like XGBoost in advancing safety measures within helicopter emergency medical service and possibly other aviation sectors. Korentsides J, Keebler JR, Berezovski M, Chaparro A. Factors contributing to fatalities in helicopter emergency medical service accidents. Aerosp Med Hum Perform. 2025; 96(2):111-115.

Introduction: There is increasing interest in the screening and evaluation of individuals with underlying medical conditions for participation in commercial spaceflight, including those with diabetes mellitus. Diabetes risks incapacitation through hypoglycemic or hyperglycemic events. Limited analog data exist regarding tolerance of spaceflight in diabetics; here we evaluated diabetic tolerance of centrifuge-simulated spaceflight.

Methods: Aggregated data from diabetic volunteers in prior studies of centrifuge-simulated spaceflight were compared to nondiabetic subjects. There were 20 (3 women) diabetic volunteers, with glycemic control methods including diet, oral medications, and insulin, who met screening criteria for inclusion and participated in up to 7 centrifuge profiles. Heart rate data collected prior to and during centrifuge spins and subjective postspin symptom questionnaires were analyzed.

Results: Diabetic layperson subjects demonstrated similar hypergravity tolerance compared to nondiabetic laypersons. Two diabetic subjects did not complete all available profiles: one for nausea and one for scheduling constraints. Glycemic control methods (insulin vs. noninsulin) were not associated with differences in tolerance. There were no statistical differences in vital signs or symptoms. One subject had transient symptoms possibly related to hypoglycemia in the setting of decreased oral intake.

Discussion: Diabetes poses a risk of incapacitation in high performance environments. Even so, these data suggest that, with appropriate screening and stratification, diabetic individuals can successfully tolerate spaceflight hypergravity exposures. Further research may allow for inclusion of diabetic individuals in future spaceflight. King SA, Blue RS. Tolerance of centrifuge-simulated spaceflight in individuals with diabetes mellitus. Aerosp Med Hum Perform. 2025; 96(2):101-110.

Introduction: Spaceflight impairs muscle size, strength, recruitment, and aerobic capacity. Flywheel-based inertial training (FIT) has been used as a countermeasure to preserve muscle strength and size. The objective of this study was to determine how submaximal FIT squats with varying moments of inertia (MOI) affects lower extremity muscle recruitment.

Methods: Subjects (7 men, 7 women) completed FIT squats with various MOI: 0.000, 0.005, 0.010, 0.015, and 0.020 kg · m-2 (stages 1-5, respectively) at a pace of 50 squats/min for 3 min each. Electromyography (EMG) of the vastus lateralis, gluteus maximus (GM), biceps femoris, and soleus (SOL) were measured and normalized to maximal effort. Data were analyzed by repeated measures analysis of variance.

Results: Peak EMG amplitude [effect size (ES): 0.75-1.43] and integrated EMG activity (ES: 0.73-1.24) for all muscles increased linearly across MOI. Mean eccentric EMG amplitude was greater than concentric for the vastus lateralis (19-63% greater; ES: 1.58). A significant phase × MOI interaction was noted for the GM and SOL (ES: 1.27 and 2.08, respectively) where greater MOI preferentially increased eccentric EMG amplitude.

Discussion: Increasing MOI increases EMG amplitude of hip extensors, knee extensors, and plantarflexors during submaximal FIT squats in the concentric and eccentric phases. At higher MOI, EMG amplitude is preferentially increased in GM and SOL, especially in the eccentric phase. Submaximal FIT squats can be performed for up to 3 min continuously with active concentric and eccentric phases. This training modality may concomitantly preserve muscle and cardiorespiratory fitness during unloading but this remains to be tested. Mitchinson CJ, Caruso J, Best S, Bollinger L. Lower extremity electromyography during submaximal squats with varying moments of inertia. Aerosp Med Hum Perform. 2025; 96(2):93-100.

Introduction: The resting 12-lead electrocardiogram (ECG) is one of the basic screening tests used in assessing fitness for military service and in periodic examinations of professional soldiers. Its purpose is to reduce the risk of death from cardiovascular disease by early detection of cardiac pathologies predisposing to sudden cardiac arrest. Commonly used electrocardiographic standards do not perform well in screening, accounting for the recognition of a large number of abnormalities unrelated to structural heart disease.

Methods: A comprehensive literature review was performed using electronic databases such as PubMed®, Google Scholar, and relevant aerospace medical journals. The search focused on keywords, including "screening ECG," "electrocardiographic criteria," "military aircrew," and "aviation medicine." Articles that discussed ECG interpretation rules and the implementation of screening protocols in military aircrew were included. The review also involved an examination of guidelines and policies from major aviation regulatory bodies.

Results: This review includes information on topics relevant to the application of 12-lead ECG in screening diagnostics, such as general ECG interpretation criteria, limitations of ECG as a screening tool, objectives of ECG-based screening, and past experiences with the use of screening ECG in athletes within the context of military medicine.

Discussion: We discuss various criteria for the interpretation of screening ECG in athletes and soldiers to increase the specificity of this test. We also present a proposal for a system of criteria for interpreting ECGs in aircrew of the Polish Air Force, which may help improve the detection of cardiac pathologies in this professional group. Kurek MA, Rola M. Screening and interpretation rules for resting electrocardiograms in Polish Air Force aircrew. Aerosp Med Hum Perform. 2025; 96(2):135-142.

Introduction: Women continue to remain a minority among Canadian Armed Forces (CAF) operational pilots, equaling <2% in 2000 and <6% in 2022. Limited sex- and gender-specific research on aeromedical support needs has been completed on this population. This initial manuscript examines aircrew life support equipment (ALSE) and musculoskeletal issues within a larger data set.

Methods: This hypothesis-generating, mixed-methods, epidemiological study used a community-based participatory research approach, involving semi-structured interviews with women who were current CAF members and had ever served as operational pilots. Interviews included aviation occupational interest and medical questionnaires, as well as medical record reviews, which were analyzed descriptively and thematically.

Results: Demographics included 51 of 88 (58%) of CAF operational women pilots from 15 different platforms, with a mean service time of 20 yr (range from 8-41 yr) and mean total flying hour estimation of 2400 h (range of 500-8500 h). At least one piece of ALSE did not fit properly in 82% of subjects, and 52% of this group reported prolonged health impacts. Almost all subjects had musculoskeletal issues, with 35% resulting in a flying impairment.

Discussion: This snapshot looks at sex- and gender-specific aeromedical experiences of operationally trained CAF women pilots, which can be used to guide research, policy, training, and education to improve their aeromedical experiences specifically with ALSE. Sex- and gender-based analysis and optimization could help improve equipment procurement and prevent unnecessary injury and illness in female pilots due to their ALSE. Thorgrimson J, Breeck K. Aircrew life support equipment experiences in Canadian military operational women pilots. Aerosp Med Hum Perform. 2025; 96(2):116-120.

Introduction: The Republic of Singapore Air Force started its corneal refractive surgery (CRS) Program in 2005 through the introduction of photorefractive keratectomy (PRK) to expand its recruitment pool of aviators. This study evaluates short- and long-term occupational outcomes of PRK on young Asian eyes with low-moderate myopia.

Methods: This is a retrospective cohort study of aircrew who underwent PRK under the CRS program over 12 yr. Data collected included demographic characteristics, preoperative spherical equivalent (SE) refraction, pachymetry, keratometry, pre- and postoperative uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity, and SE refraction. Outcome measures included long-term survival rates (i.e., achieving UDVA of 20/20 and flying without optical aids), short-term SE refractive accuracy/UDVA, and postoperative complications.

Results: Included for analysis were 274 eyes of 141 patients. Of these, 82.1% of eyes had UDVA of 20/20 at last follow-up. Cumulative survival rates were 99.8%, 96.5%, 92.9%, 84.7%, and 62.2% at 1, 2, 3, 5, and 10 yr of follow-up, respectively. At the 3-mo mark, 98.2% and 70.4% of eyes had SE refraction within ±0.50 D and ±0.13 D of intended correction, respectively, and 95.2% of eyes met standards for returning to flying duties. Postoperative complications included corneal haze (1.5%), steroid-induced intraocular pressure elevation (0.7%), and PRK-enhancement (0.7%). Higher preoperative myopia was the only risk factor for failure from multivariate analysis.

Discussion: PRK as a structured CRS program is effective both short- and long-term to enable flying without optical aids among young Asian aviators with low-moderate myopia. Ong SC, Chay I, Low J, Tan D, See B. Occupational outcomes of photorefractive keratectomy in young Asian military aviators. Aerosp Med Hum Perform. 2025; 96(2):121-127.

Introduction: Future high-altitude military operations and spaceflight will require new procedures to protect crews from decompression sickness while limiting the operational impact. It is hypothesized that the current prediction models do not accurately reflect actual inert gas dynamics, making them unsuitable for the risk estimation of new hypobaric exposure profiles.

Methods: A biophysical gas exchange model was created, allowing modification of various physiological parameters. Predicted nitrogen (N2) volume flows were compared with an experimental study by the Swedish Aerospace Physiology Centre. Bubble growth predictions, made using the Tissue Bubble Dynamics Model, were compared with measured venous gas emboli (VGE).

Results: While the simulated washout curves captured the general trends, some important discrepancies were observed when using the nominal model parameters. The new biophysical gas exchange model, incorporating changes in cardiac output and individual anthropometric variations, improved the predictions and approximated the experimentally observed N2 washout. The standard bubble growth predictions did not match measured VGE. Using weighing factors based on the N2 gas flow components predicted by the new biophysical model, the bubble growth pattern agrees much better with the measured VGE scores.

Discussion: Traditional decompression models do not account for variations in physiological and environmental factors, leading to incorrect estimates of N2 washout and bubble growth predictions. Using an adaptive biophysical gas exchange model significantly improves the predictions for various altitude exposure profiles. We therefore strongly recommend incorporating adaptive physiological parameters in any model to be used for estimating decompression sickness risk and designing mitigation procedures. De Ridder S, Neyt X, Germonpré P. Adaptive inert gas exchange model for improved hypobaric decompression sickness risk estimation. Aerosp Med Hum Perform. 2025; 96(2):85-92.