Aerospace medicine and human performance最新文献

Introduction: With future manned missions that extend beyond low Earth orbit, it would be wise to anticipate all risks to astronaut health, including those relevant to ophthalmology and the ocular surface. Corneal edema has been documented among mice experiments conducted onboard the Space Transportation System mission, STS-133, owing to increased stress response gene expression.

Methods: A targeted, relevant search of the literature on topics relating to ocular surface and spaceflight was conducted with scholarly databases PubMed, Web of Science, and Embase from inception to July 2024.

Results: From our search results we identified 12,742 articles, 485 of which met the scope of our initial literature search criteria. Following refinement, 99 articles were included in our review paper. The most frequently mentioned mechanisms of corneal edema related to spaceflight included contact lens related hypoxia (24%). Regarding treatments for corneal edema, surgical grafts (16.9%) were most common. From our data, central corneal thickness measurements in astronauts with prior refractive surgery showed no significant differences pre- and postflight: right eye mean preflight, 492 µm vs. postflight, 493.3 µm; left eye, 499 µm pre- and postflight.

Discussion: This knowledge may contribute to our understanding of the increased risk of ocular surface symptoms reported among astronauts. This review discusses the current literature on corneal endothelial transport physiology and the detriments of corneal edema to astronaut visual function. We also describe the diagnostic modalities we can apply to spaceflight, such as anterior segment optical coherence tomography, and offer convenient countermeasures to spaceflight-related ocular surface anomalies. In doing so, we aim to make future missions safer for human exploration. Lee R, Ong J, Sampige R, Panzo N, Memon H, Suh A, Waisberg E, Mader T, Berdahl J, Chévez-Barrios P, Lee AG. Corneal edema and the endothelium in spaceflight. Aerosp Med Hum Perform. 2025; 96(7):569-577.

Background: Sinus barotrauma, or aerosinusitis, occurs during rapid atmospheric changes in aviation, primarily affecting the frontal sinus. Mucosal swelling from a cold or allergic rhinitis (AR) can obstruct pressure equalization, leading to mucosal tears, cranial pain, and nasal bleeding. Despite its significance in aerospace medicine, high-quality imaging, nasal endoscopy, long-term outcomes, and the impact of AR management on sinus barotrauma remain inadequately documented in the literature.

Case report: A 29-yr-old healthy male healthcare provider experienced severe frontal sinus barotrauma during aircraft descent, presenting with intense frontal headache, ocular pain, and left epistaxis, with head computed tomography revealing a fully opacified left frontal sinus. Despite experiencing persistent severe AR symptoms daily, he had never been diagnosed or treated for AR, and his symptoms worsened during the flight. The clinical presentations and image findings suggested a diagnosis of frontal sinus barotrauma. His initial treatment included oral decongestants, antihistamines, and acetaminophen. Remarkably, follow-up computed tomography/magnetic resonance images over 2 wk, 1 mo, and 1 yr demonstrated the spontaneous resorption of the submucosal hemorrhage in the frontal sinus. Furthermore, though concurrently diagnosed with perennial AR due to house dust mite and cat fur sensitization, the patient's effective pharmacological management of AR symptoms led to an uneventful flight 1 yr later.

Discussion: This case demonstrates that submucosal hemorrhages in the affected sinus generally resolve spontaneously within a year. Also, it highlights the critical need for diagnosing and managing sinonasal disorders in symptomatic individuals before flights to prevent sinus barotrauma. Park MJ, Kang SJ, Kim GT, Kim S. Frontal sinus barotrauma in an airliner passenger with undiagnosed allergic rhinitis. Aerosp Med Hum Perform. 2025; 96(7):581-585.

Introduction: Long-duration spaceflight and isolated, confined, and extreme environments present various challenges to crewmembers. One less-frequently discussed challenge is altered sensory inputs and how they can adversely affect cognition and performance. Maintaining psychological and performance outcomes is crucial for mission success, and simple sensory-based countermeasures (CMs) can be surprisingly effective. This scoping review examines the impact of altered sensory inputs in these extreme environments, assesses current sensory-based CMs, and compares their effectiveness across sensory modalities to guide future strategies.

Methods: Relevant studies were identified through comprehensive searches of PubMed, PsycINFO, Google Scholar, Science Direct, ProQuest, and the NASA Technical Reports Server. Searches included keywords related to the sensory modalities under investigation and potential outcomes. This review focused on English-language publications, with no date restrictions for sensory alterations and a focus on studies published after 2019 for countermeasure research.

Results: Spaceflight leads to sensory changes that affect health and performance. These alterations are highlighted, finding particularly prominent changes in lighting and auditory modalities. These changes result from altered sensory inputs and environmentally driven physiological alterations. Sensory input modulation can influence cognitive and psychological states, affecting performance. Sensory-based CMs were examined for their impact on psychological and performance domains. A total of 285 articles on sensory alterations and 180 on CMs were reviewed, with 52 and 59 articles included, respectively.

Discussion: Sensory-based CMs offer promising approaches to maintain or improve performance. Modulating sensory inputs can mitigate spaceflight-related challenges. Personalized, multisensory approaches appear particularly promising. The review highlights research gaps and suggests avenues for enhancing sensory CMs. White BM, Stankovic A, Thoolen S, Kosmyna N, Ivkovic V, Strangman G. Sensory-based alterations and countermeasures in spaceflight and spaceflight analogs. Aerosp Med Hum Perform. 2025; 96(7):556-568.

Introduction: Most U.S. Navy, but few U.S. Air Force, tactical jets use safety pressure (SP) regulators. SP effects have been studied only with confounding differences in regulator design. We compared a CRU-103 SP regulator to a CRU-103 with SP removed. The hypothesis was that SP does not alter breathing, only shifts pressure more positive.

Methods: Inspiratory flows and mask and hose pressures were measured in 24 subjects (29 for speech at rest, 31 for lung volumes) who breathed in counterbalanced order from both regulators while blind to SP condition.

Results: Both were easy to breathe. Neither was preferred overall. Between regulators, end-expiratory lung volume did not differ. SP stabilized hose pressure and favored inspiration: without speech, hose pressure swings were significantly lower (rest: 25%, exercise: 33%), as were inspiratory work of breathing at rest (33%) and peak inspiratory flow magnitude (rest: 14%; exercise: 11%). Waveforms showed interactions of mask valves and SP at the start and end of expiration. Mask leaks with SP activated the regulator during speech.

Discussion: SP as implemented in the CRU-103 causes mostly subtle differences in pressures and flows. The sensed difference during expiration may result from the initial large pressure gradient for expiratory flow. Shykoff BE, French DC, Warkander DE, Robinson FE. Safety pressure effects in a mechanical demand regulator. Aerosp Med Hum Perform. 2025; 96(7):547-555.

Background: Exposure to pressure changes can result in barotrauma in gas-filled cavities when volume expansion exceeds tissue strength, leading to local disruption. While few cases have been reported, we present a case of pulmonary barotrauma developed postflight in a pilot without underlying disease, and the most likely reason is improper pressure-breathing in flight.

Case report: A 25-yr-old healthy male fighter pilot experienced slight chest pain 3 h after a 1-h flight training mission, during which the peak G was 6 G. The symptoms worsened during eating and were accompanied by chest tightness and shortness of breath. Chest CT scans showed pneumothorax and mediastinal emphysema. Symptoms improved after oxygen inhalation and the pilot resumed flying duties (no high-G dynamic flight maneuvers) after 1 mo of observation on the ground.

Discussion: The case revealed pulmonary barotrauma in an experienced pilot with no disease history due to inappropriate positive pressure-breathing, suggesting the importance of fully training in positive pressure-breathing for G. We recommend pilots who experience unusual respiratory symptoms after landing report to medical for urgent review and the flight surgeon should, at that time, consider flight-related factors leading to barotrauma. Meng W, Zhou Q, Qing L. Postflight pulmonary barotrauma in a pilot without underlying disease. Aerosp Med Hum Perform. 2025; 96(7):578-580.

The aviation industry is exploring possibilities to operate extended long-haul flights with two pilots in the cockpit during critical flight phases and a single pilot flying during cruise flight while the other pilot is sleeping. This Extended Minimum Crew Operations (eMCO) concept raises important aeromedical concerns: 1) a two-pilot cockpit is considered a main safety risk-mitigating factor and eMCO would therefore necessitate a new aeromedical risk assessment concept; 2) sensors and algorithms for monitoring physical and/or cognitive incapacitation are not available or insufficiently reliable; 3) scientific data of augmented long-haul flights is not valid for predicting effects of monotony and boredom or in-flight sleep and sleep inertia on alertness during eMCO cruise-flight; and 4) medical conditions regarding urination, defecation, or menstruation may cause an unscheduled visit to the toilet of the single pilot flying during cruise flight, who then has to request the resting pilot to take over the controls. Simons R, Maher D, Vermeiren R, Wagstaff AS. Aeromedical concerns about extended minimum crew operations. Aerosp Med Hum Perform. 2025; 96(7):590-592.

Background: Deep vein thrombosis (DVT) is a morbid disease that potentially has lethal results, with even further professional ramifications in the aviation community. There are only a few reported cases on outcomes of fliers who developed DVT. As such, more research is needed to assist the aeromedical community in identifying high-risk individuals so that counseling and preventative measures are administered to avoid harmful outcomes.

Case report: We present a 34-yr-old woman with several pre-existing comorbidities who developed ipsilateral DVTs in her lower extremity while in Oman that required medical evacuation back stateside. Days prior to her long-haul flight overseas, she presented to the local emergency department with right lower extremity DVT similar to a prior one she experienced. A week later, while departing the continental United States, she was evaluated by Emergency Medical Technicians for painful ambulation. After being symptomatic for over a week in country, she was admitted to a local hospital where formal diagnosis was made.

Discussion: Aviators are not as familiar with the risks and consequences of thrombus formation. This case highlights several key points, such as a thorough medical clearance process in conjunction with closed loop communication. A history of DVT with additional susceptibilities requires in-depth education prior to long distance travel. A thorough record review should be conducted on a high-risk servicemember to ensure medical optimization. When making the decision to use medical evacuation, risk stratification must be implemented early to ensure safe return. Cheng MT, Middel BL, Anderson KD. Recurrent deep vein thromboses in an active-duty aviator. Aerosp Med Hum Perform. 2025; 96(7):586-589.

Background: General Valérie André flew away one last time. She died at the age of 102 on January 21, 2025. A flight surgeon, paratrooper, helicopter pilot, and pioneer of medical evacuations, she was the first woman in France to attain the rank of general. Decorated with the Grand Cross of the Legion of Honor, the highest French civilian and military decoration, and the United States Legion of Merit, Valérie André remains an icon of resilience and service, an inspiration to all who strive to make a difference. She was a pioneer among pioneers, always the first. She was the first woman to pilot a helicopter in a combat zone, performing over 500 medical evacuations during her career, sometimes under enemy fire during the Indochina War. Her courage shattered barriers, and her legacy as one of the most decorated women in the world speaks to her extraordinary dedication. Her second battle was fought in the civilian world, far from the battlefields. Her personal campaign: the integration of women into the armed forces, where she was also a pioneer. Sauvet F. General Valérie André, the first woman to fly helicopter rescue in a combat zone. Aerosp Med Hum Perform. 2025; 96(7):593-595.

Introduction: Military aviators have long undergone enhanced medical screening to minimize accidents and deaths. U.S. Army aviators undergo a rigorous initial screening process followed by annual medical evaluations governed by published standards of medical fitness which are updated periodically. An aeromedical summary is submitted for disqualifying conditions, resulting in either a waiver of the standard or suspension of flight status. This study aimed to identify the most common disqualifying medical conditions in U.S. Army aviators in recent years and analyze trends over time.

Methods: A retrospective observational study was performed using 5 yr of data from the U.S. Army's Aeromedical Epidemiological Data Repository. Incidence rates for the 10 most common disqualifying conditions, and the waiver approval rate for those conditions, were calculated. Annual incidence was calculated for hypertension aeromedical summary submissions.

Results: Lumbar and cervical spinal disorders (101.55 and 39.26 per 10,000 aviator-years, 81.6% and 79.1% waived, respectively), obstructive sleep apnea (62.00 per 10,000 aviator-years, 93.4% waived), hearing loss (27.96 per 10,000 aviator-years, 98.0% waived), and hypertension (26.13 per 10,000 aviator-years, 97.3% waived) were the most common conditions submitted. Psychological diagnoses were also common, with post-traumatic stress disorder, anxiety and phobias, adjustment disorder, and mood disorders having a cumulative incidence of 44.20 per 10,000 aviator-years and a waiver rate of 45.4%. Submissions for hypertension substantially decreased starting in 2019.

Discussion: Spine disorders are among the leading disqualifying conditions in U.S. Army aviators and metabolic conditions were submitted less often than previously reported, likely due to changes in aeromedical policy with respect to hypertension. Simmons EA, Lee A, Kelley A. The most common disqualifying medical conditions in Army aviators, 2016-2020. Aerosp Med Hum Perform. 2025; 96(6):490-495.

Background: Fabry disease (FD) is a rare, X-linked lysosomal storage disorder caused by deficient alpha-galactosidase A (alpha-Gal A) activity, leading to the accumulation of glycosphingolipids and resulting in a wide spectrum of systemic symptoms, including neurological, renal, cardiovascular, and cerebrovascular manifestations. While the disease affects approximately 1 in 100,000 individuals, its incidence may be underreported, and no cases in aviators have previously been documented.

Case report: A 30-yr-old U.S. Air Force C-5 pilot with a family history of FD was diagnosed with a pathogenic galactosidase alpha gene variant after genetic testing. Initial evaluations revealed proteinuric kidney disease and an otherwise normal neurological workup indicating early FD, prompting initiation of lisinopril, clopidogrel for stroke prevention, and the newly Food and Drug Administration-approved chaperone therapy migalastat. The patient tolerated treatment well with appropriate response to therapy as demonstrated by improved biochemical parameters (alpha-Gal A activity and plasma globotriaosylsphingosine levels) and clinical stability. After 8 mo of multidisciplinary monitoring and comprehensive evaluation, he was granted a time-limited aeromedical waiver and successfully returned to flying duties.

Discussion: FD is a rare, progressive genetic disorder caused by galactosidase alpha gene variants, resulting in alpha-Gal A deficiency and glycosphingolipid accumulation, leading to neurological, renal, cardiac, and cerebrovascular complications. Despite higher aeromedical risks, especially due to stroke and cerebrovascular issues, FD patients may qualify for restricted flight duties under close monitoring and multidisciplinary care. Continued evaluation of novel therapies and individualized aeromedical waivers can support aviators with FD while balancing safety and operational requirements. Carlock T, Kincaid-Sharp E, Orsello C, Ford AW, El-Khoury BB. Navigating Fabry disease in a military aviator. Aerosp Med Hum Perform. 2025; 96(6):525-529.