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Introduction: Microgravity (μG) exposure and even early recovery from μG in combination with mild hypoxia may increase the alveolar-arterial oxygen (O2) partial pressure gradient., Methods: Four male astronauts on STS-69 (1995) and four on STS-72 (1996) were exposed on Earth to an acute sequential hypoxic challenge by breathing for 4 min 18.0%, 14.9%, 13.5%, 12.9%, and 12.2% oxygen-balance nitrogen. The 18.0% O2 mixture at sea level resulted in an inspired O2 partial pressure (PIo2) of 127 mmHg. The equivalent PIO2 was also achieved by breathing 26.5% O2 at 527 mmHg that occurred for several days in μG on the Space Shuttle. A Novametrix CO2SMO Model 7100 recorded hemoglobin (Hb) oxygen saturation through finger pulse oximetry (Spo2, %). There were 12 in-flight measurements collected. Measurements were also taken the day of (R+0) and 2 d after (R+2) return to Earth. Linear mixed effects models assessed changes in Spo2 during and after exposure to μG., Results: Astronaut Spo2 levels at baseline, R+0, and R+2 were not significantly different from in flight, about 97% given a PIo2 of 127 mmHg. There was also no difference in astronaut Spo2 levels between baseline and R+0 or R+2 over the hypoxic challenge., Conclusions: The multitude of physiological changes associated with μG and during recovery from μG did not affect astronaut Spo2 under hypoxic challenge.Conkin J, Wessel JH III, Norcross JR, Bekdash OS, Abercromby AFJ, Koslovsky MD, Gernhardt ML. Hemoglobin oxygen saturation with mild hypoxia and microgravity. Aerosp Med Hum Perform. 2017; 88(6):527-534.

Introduction: Ambulation during extravehicular activity on Mars may increase the risk of decompression sickness through enhanced bubble formation in the lower body., Hypotheses: walking effort (ambulation) before an exercise-enhanced denitrogenation (prebreathe) protocol at 14.7 psia does not increase the incidence of venous gas emboli (VGE) at 4.3 psia, but does increase incidence if performed after tissues become supersaturated with nitrogen at 4.3 psia., Methods: VGE results from 45 control subjects who performed exercise prebreathe without ambulation before or during a 4-h exposure to 4.3 psia were compared to 21 subjects who performed the same prebreathe but ambulated before and during the hypobaric exposure (Group I) and to 41 subjects who only ambulated before the hypobaric exposure (Group II). Monitoring for VGE in the pulmonary artery was for 4 min at about 12-min intervals using precordial Doppler ultrasound (2.5 mHz). Detected VGE were assigned a categorical grade from I to IV. The detection of Grade III or IV was classified as "high VGE grade.", Results: The incidence of high VGE grade for Group I (57%) was greater than the control (17%) and Group II (15%). The incidence of pain-only decompression sickness was greater for Group I (20%) than the control (0%) and Group II (5%)., Conclusions: High-grade VGE are increased by mild ambulation conducted under a supersaturated state (Group I vs. II); however, no increase was observed with mild ambulation during the saturated state alone (control vs. Group II).Conkin J, Pollock NW, Natoli MJ, Martina SD, Wessell JH III, Gernhardt ML. Venous gas emboli and ambulation at 4.3 psia. Aerosp Med Hum Perform. 2017; 88(4):370-376.

Introduction: The Hypobaric Decompression Sickness (DCS) Treatment Model links a decrease in computed bubble volume from increased pressure (ΔP), increased oxygen (O2) partial pressure, and passage of time during treatment to the probability of symptom resolution [P(SR)]. The decrease in offending volume is realized in two stages: 1) during compression via Boyles law; and 2) during subsequent dissolution of the gas phase via the oxygen window., Methods: We established an empirical model for the P(SR) while accounting for multiple symptoms within subjects. The data consisted of 154 cases of hypobaric DCS symptoms with ancillary information from tests on 56 men and 18 women., Results: Our best estimated model is P(SR)=1/(1+exp(-(ln(ΔP)-1.510+0.795×AMB-0.00308×Ts)/0.478)), where ΔP is pressure difference (psid); AMB=1 if ambulation took place during part of the altitude exposure, otherwise AMB=0; and Ts is the elapsed time in minutes from the start of altitude exposure to recognition of a DCS symptom., Discussion: Values of ΔP as inputs to the model would be calculated from the Tissue Bubble Dynamics Model based on the effective treatment pressure: ΔP=P2-P1|=P1×V1/V2-P1, where V1 is the computed volume of a bubble at low pressure P1 and V2 is computed volume after a change to a higher pressure P2. If 100% ground-level oxygen was breathed in place of air, then V2 continues to decrease through time at P2 at a faster rate.

Introduction: The fitting of probabilistic decompression sickness (DCS) models is more effective when data encompass a wide range of DCS incidence. We obtained such data from the Air Force Research Laboratory Altitude Decompression Sickness Research Database. The data are results from 29 tests comprising 708 human altitude chamber exposures (536 men and 172 women). There were 340 DCS outcomes with per-test DCS incidence ranging from 0 to 88%. The tests were characterized by direct ascent at a rate of 5000 ft x min(-1) (1524 m x min(-1)) to a range of altitudes (226 to 378 mmHg) for 4 h after prebreathe times of varying length and with varying degrees of physical activity while at altitude., Methods: Logistic regression was used to develop an expression for the probability of DCS [P(DCS)] using the Hill equation with decompression dose as the main predictor. Here, decompression dose is defined in terms of either the tissue ratio (TR) or a bubble growth index (BGI). Other predictors in the model were gender and peak exercise intensity at altitude., Results: All three predictors (decompression dose, gender, and exercise intensity) were important contributions to the model for P(DCS)., Discussion: Higher TR or BGI, male gender, and higher exercise intensity at altitude all increased the modeled decompression dose. Using either TR or BGI to define decompression dose provided comparable results, suggesting that a simple TR is adequate for simple altitude exposures as an abstraction of the true decompression dose. The model is primarily heuristic and limits estimates of P(DCS) to only a 4-h exposure.

Background: To reduce bubble formation and growth during hypobaric exposures, a denitrogenation or nitrogen "washout" procedure is performed. This procedure consists of prebreathing oxygen fractions as close to one as possible (oxygen prebreathe) prior to depressurization before ascending to the working altitude or low spacesuit pressures. During the NASA prebreathe reduction program (PRP), it was determined that the addition of a light arm exercise to short, individually designed, performance-based heavy exercise (dual cycle ergometry) during an abbreviated 2-h prebreathe (F1O2 - 1.0) reduced the occurrence of decompression sickness (DCS). Heavy-exercise-induced DCS reduction is likely to be related to the enhancement of the tissue nitrogen washout during the oxygen prebreathe. In addition to the heavy-exercise-induced microcirculatory adaptation, we hypothesized that the light exercise would not cause sufficient microcirculatory changes in the limbs to explain alone this further DCS protection. We evaluated microcirculatory changes as minimal by replicating the exercise characteristics of the PRP trials in 13 healthy subjects., Methods: Noninvasive near infrared spectroscopy (NIRS) allowed observation of instantaneous variations of total, oxygenated, and deoxygenated hemoglobin/myoglobin concentrations in the microcirculatory networks (probes facing the vastus lateralis and deltoid muscles) of active limbs during dynamic exercise., Results: The high-intensity leg exercise alone produced the changes in NIRS parameters; the light arm exercise induced minimal microcirculatory volume changes. However, this coupling appeared to be critical in previous altitude PRP chamber studies by reducing DCS., Discussion: With only minimal microcirculatory blood volume changes, it is unlikely that light exercise alone causes significant nitrogen tissue washout. Therefore, our results suggest that in addition to nitrogen tissue washout, another unknown exercise-induced effect may have further enhanced the DCS protection, possibly mediated via the anti-inflammatory effect of exercise, gas micronuclei reduction, NO pathways, or other molecular mechanisms.

Introduction: The existence of a general influence of exercise on the incidence of decompression sickness (DCS) has been known for more than a half-century. However, quantification of the effect has not been done for several reasons, including isolation of exercise as the only variable. The DCS database at Brooks City-Base, TX, contains detailed physiologic information on over 3000 altitude exposures. The purpose of this study was to measure Vo2 during the activities performed during those exposures to retrospectively determine if Vo2, a quantifiable index of exercise intensity, was related to the level of reported DCS., Methods: Ground-level activity was designed to duplicate the standardized activity during the altitude exposures. Breath-by-breath Vo2 was determined for each activity using a COSMED metabolic measurement system. Comparison of the Vo2 during four levels of activity performed under otherwise comparable conditions allowed a determination of correlation between Vo2 and DCS risk observed during the altitude exposures., Results and Discussion: Four previous altitude exposure profiles at 8992 m to 9144 m (29,500 to 30,000 ft; 231 to 226 mmHg) for 4 h following a 1-h prebreathe resulted in 38-86% DCS. This study provided the Vo2 of activities during those studies. The correlation between DCS incidence and the highest 1-min Vo2 of activity was 0.89., Conclusion: The highest 1-min Vo2 showed a high correlation with level of DCS risk. Future exposures involving lower levels of activity could provide data that would allow improvement in modeling of DCS risk.

Introduction: Variables that define who we are, such as age, weight and fitness level influence the risk of decompression sickness (DCS) and venous gas emboli (VGE) from diving and aviation decompressions. We focus on age since astronauts that perform space walks are approximately 10 yr older than our test subjects. Our null hypothesis is that age is not statistically associated with the VGE outcomes from decompression to 4.3 psia., Methods: Our data are from 7 different NASA tests where 188 men and 50 women performed light exercise at 4.3 psia for planned exposures no less than 4 h. Prebreathe (PB) time on 100% oxygen ranged from 150-270 min, including ascent time, with exercise of different intensity and length being performed during the PB in four of the seven tests with 150 min of PB. Subjects were monitored for VGE in the pulmonary artery using a Doppler ultrasound bubble detector for a 4-min period every 12 min. There were six design variables; the presence or absence of lower body adynamia and five PB variables; plus five concomitant variables on physical characteristics: age, weight height, body mass index, and gender that were available for logistic regression (LR). We used LR models for the probability of DCS and VGE, and multinomial logit (ML) models for the probability of Spencer VGE Grades 0-IV at exposure times of 61, 95, 131, 183 min, and for the entire exposure., Results: Age was significantly associated with VGE in both the LR and ML models, so we reject the null hypothesis. Lower body adynamia was significant for all responses., Conclusions: Our selection of tests produced a wide range of the explanatory variables, but only age, lower body adynamia, height, and total PB time was helpful in various combinations to model the probability of DCS and VGE.

A patent foramen ovale (PFO) has been reported to be an important risk factor for cardioembolic cerebrovascular accidents through paradoxical systemic embolization, and it provides one potential mechanism for the paradoxical systemic embolization of venous gas bubbles produced after altitude or hyperbaric decompressions. Here, we present in a single document a summary of the original findings and views from authors in this field. It is a comprehensive review of 145 peer-reviewed journal articles related to PFO that is intended to encourage reflection on PFO detection methods and on the possible association between PFO and stroke. There is a heightened debate on whether aviators, astronauts, and scuba divers should go through screening for PFO. Because it is a source of an important controversy, we prefer to present the findings in the format of a neutral bibliographic review independent of our own opinions. Each cited peer-reviewed article includes a short summary in which we attempt to present potential parallels with the pathophysiology of decompression bubbles. Two types of articles are summarized, as follows. First, we report the original clinical and physiological findings which focus on PFO. The consistent reporting sequence begins by describing the method of detection of PFO and goal of the study, followed by bulleted results, and finally the discussion and conclusion. Second, we summarize from review papers the issues related only to PFO. At the end of each section, an abstract with concluding remarks based on the cited articles provides guidelines.