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A clinical case of late neurosyphilis with prominent cognitive function failure developed in a young male patient is presented. Atypical disease development and negative laboratory tests required to perform the differential diagnosis with inflammatory and degenerative brain diseases, extended blood and CSF tests for syphilis. During the diagnostic procedures the patient received complex therapy with neurotropic, antioxidant, and anti-dementia drugs. The treatment improved cognitive function and increased the efficacy of further treatment.

Purpose of the work was to study pharmacokinetics of beta adrenoblocker propranolol, and hemodynamic indices in volunteers for simulation of some effects of microgravity The study involved 8 essentially healthy subjects and the head-down tilt (-80) bedrest model reproducing the effects of microgravity (BD). This was designed as three series of investigations, i.e. before BD, on BD day-2 and on the first day of BD completion. Propranolol concentration in blood plasma was determined using high performance liquid chromatography with fluorescence detection. Hemodynamic indices including heart rate (HR), stroke volume, cardiac output, cardiac index and total peripheric resistance were measured using integral rheography; average blood pressure (BPav) Was assessed by Korotkovs method. Statistical deviations in propranolol pharmacokinetics were found in none of the three series. The most characteristic reactions to propranolol were BPav reductions in all series and HR decreases 2 hours after intake in the first and second series. These deviations were not pathologic but physiological variations typical of healthy people. Therefore, propranolol can be advised for rational pharmacotherapy of acute cardiovascular diseases in piloted space missions.

It was shown that multiple spaceflight factors (i.e., acceleration, overvibration, microgravity etc.) do not impact stability of acetaminophen and furosemide tablets stored onboard the International space station over 6 months. Acetaminophen dose in a tablet was 496.44 ± 6.88 mg (99.29 ± 1.38%) before spaceflight (SF) and 481.77 ± 1 2.40 mg (96.35 ± 0.48%) after 6 mos. of storage; furosemide dose in a tablet was 40.19 ± 0.28 mg (100.47 ± 0.71%) before and 39.24 ± 0.72 mg (98.105 ± 1.80%) after SF remaining within the established limits.

An overview of structural, operational and research aspects of the Russian system of medical support to health and performance of cosmonauts on the International space station (ISS) is presented. The backbone of the current tactics of cosmonauts' health maintenance is the original Russian medical care system developed for long-term piloted space fights. Over 12 years of its existence, the ISS has been operated by 33 main crews. The ISS program entrusted the established multilateral medical boards and panels with laying down the health standards as well as the generic and specific medical and engineering requirements mandatory to all international partners. Due to the program international nature, MedOps planning and implementation are coordinated within the network of working level groups with members designated by each IP. The article sums up the experiences and outlines future trends of the Russian medical care system for ISS cosmonauts. The authors pay tribute to academician Anatoli I. Grigoriev for his contribution to creation of the national system of medical safety in long-term piloted space missions, setting the ISS health and environmental standards and uniform principles of integrated crew health management, and gaining consensus on medical policy and operational issues equally during the ISS construction and utilization.

The article describes the telemedicine complex (TM) for real-time medical informatics communication and interaction between medical personnel at the spacecrew landing site and in the mission control center. Scenarios of TM complex employment for crew examination after Standard landing, in bad weather or for providing care to cosmonauts with unsteady or unsatisfactory health state after ballistic landing are outlined. Basic requirements to the TM-assisted express diagnostics of returned spacecrew are defined.

Background: The transition to microgravity eliminates the hydrostatic gradients in the vascular system. The resulting fluid redistribution commonly manifests as facial edema, engorgement of the external neck veins, nasal congestion, and headache. This experiment examined the responses to modified Valsalva and Mueller maneuvers measured by cardiac and vascular ultrasound (ECHO) in a baseline steady state and under the influence of thigh occlusion cuffs available as a countermeasure device (Braslet cuffs)., Methods: Nine International Space Station crewmember subjects (expeditions 16-20) were examined in 15 experiment sessions 101 ± 46 days after launch (mean ± SD; 33-185). Twenty-seven cardiac and vascular parameters were obtained with/without respiratory maneuvers before and after tightening of the Braslet cuffs (162 parameter states/session). Quality of cardiac and vascular ultrasound examinations was assured through remote monitoring and guidance by investigators from the NASA Telescience Center in Houston, TX, and the Mission Control Center in Korolyov, Moscow region, Russia., Results: 14 of 81 conditions (27 parameters measured at baseline, Valsalva, and Mueller maneuver) were significantly different when the Braslet was applied. Seven of 27 parameters were found to respond differently to respiratory maneuvers depending on the presence or absence of thigh compression., Conclusions: Acute application of Braslet occlusion cuffs causes lower extremity fluid sequestration and exerts commensurate measurable effects on cardiac performance in microgravity. Ultrasound techniques to measure the hemodynamic effects of thigh cuffs in combination with respiratory maneuvers may serve as an effective tool in determining the volume status of a cardiac or hemodynamically compromised patient at the "microgravity bedside."

A summary of investigations results of human bone tissue changes in space flight on the orbital station (OS) Mir and international space station (ISS) using dual energy X-ray absorptiometry (DXA) is given. Results comparative analysis revealed an absence of significant differences in bone mass (BM) changes on the both OS. Theoretically expected BM loss was observed in bone trabecular structure of skeleton low part after space flight lasting 5-7 month. The BM losses are qualified in some cases as quicly developed but reversible osteopenia and generally interpreted as evidence of bone functional adaptation to the alterating mechanical loading. It was demonstrated the high individual variability BM loss amplitudes. Simultaneously was observed the individual pattern of BM loss distribution across different segments of skeleton after repetitive flights independently upon type of OS. In according with the above mentioned individual peculiarities it was impossible to establish the dependence of BM changes upon duration of space missions. Therefore we have not sufficiently data for calculation of probability to achive the critical demineralization level by the augmentation the space mission duration till 1.5-2 years. It is more less possibility of the bone quality changes prognosis, which in the aggregate with BM losses determines the bone fracture risk. It become clearly that DXA technology is unsuffitiently for this purpose. It is considered the main direction which may optimized the elaboration of the interplanetary project meaning the perfectly safe of skeleton mechanical function.

Commercial spaceflight participants are typically older than traditional astronauts and often have medical conditions that make medical certification for flight difficult. This case report considers a 43-yr-old spaceflight participant who planned a short-duration Soyuz flight to the International Space Station (ISS). While he participated in many hazardous activities such as parachuting, hang gliding, scuba diving, Antarctic and jungle exploration, and deep sea submersible operations, he knew that several of his medical conditions precluded serving as a career astronaut. At the time of his initial spaceflight prescreen examination, he was known to have previous bilateral photorefractive keratectomy (PRK) for myopia and a cross-fused left ectopic kidney that would be disqualifying for a career astronaut. During the evaluation for the left single cross-fused ectopic kidney, a giant hepatic hemangioma was also discovered. In order to medically qualify for flight, the giant hepatic hemangioma was surgically removed. This case summary investigat*es the implications of a single cross-fused left ectopic kidney and the decision process and treatment implications for spaceflight medical certification in an individual with an asymptomatic giant hepatic hemangioma.

Background: A total of eight commercial spaceflight participants have launched to the International Space Station (ISS) on Soyuz vehicles. Based on an older mean age compared to career astronauts and an increased prevalence of medical conditions, spaceflight participants have provided the opportunity to learn about the effect of space travel on crewmembers with medical problems. The 12-d Soyuz TMA-13/12 ISS flight of spaceflight participant Richard Garriott included medical factors that required preflight intervention, risk mitigation strategies, and provided the opportunity for medical study on-orbit. Equally important, Mr. Garriott conducted extensive medical, scientific, and educational payload operations during the flight. These included 7 medical experiments and a total of 15 scientific projects such as protein crystal growth, Earth observations/photography, educational projects with schools, and amateur radio. The medical studies included the effect of microgravity on immune function, sleep, bone loss, corneal refractive surgery, low back pain, motion perception, and intraocular pressure., Conclusion: The overall mission success resulted from non-bureaucratic agility in mission planning, cooperation with investigators from NASA, ISS, International Partners, and the Korean Aerospace Research Institute, in-flight support and leadership from a team with spaceflight and Capcom experience, and overall mission support from the ISS program. This article focuses on science opportunities that suborbital and orbital spaceflight participant flights offer and suggests that the science program on Richard Garriott's flight be considered a model for future orbital and suborbital missions. The medical challenges are presented in a companion article.

Methods of investigating the physiological functions in space crews on extended missions during night sleep are of much fundamental and practical substance. The design of experiment "Sonocard" utilizes the method of seismocardiography. Purpose of the experiment is to validate the procedures of noncontact in-sleep physiological data recoding which are potent to enhance the space crew medical operations system. The experiment was performed systematically by ISS Russian crew members starting from mission-16. The experimental procedure is easy and does not cause discomfort to human subjects. Results of the initial experimental sessions demonstrated that, as on Earth, sleep in microgravity is crucial for the recovery of body functional reserves and that the innovative technology is instrumental in studying the recovery processes as well as person unique patterns of adaptation to extended space mission. It also allows conclusions about sleep quality, mechanisms of recreation, and body functionality. These data may enrich substantially the information used by medical operators of the space missions control centers.

Acoustics measurements in the Service module of the International space station were performed at the workplaces with the vehicle and life support systems and equipment in operational status, and at the crew sleeping sites. Analysis of the measuring results revealed violation of the noise limits across the whole module. Measures were taken to abate noise at the place of origin and along the propagation path in order to prevent its negative effects on crew health.

Trends in the chemical composition of air revealed by the sanitary-chemical and toxicological investigations in multifactorial ground-based tests and long-term space flights aboard the Salyut- 6, 7, Mir and the International space station have been used to deduce the chemical characteristic and to substantiate methods to and criteria for evaluation of toxic risks to space crews from air chemical pollution. Of particular concern were the toxic risks and crew protection during the first ingress to modules on the stage of station assembly in orbit, in the course of long-term missions, and in the event of acute exposure in off-nominal and emergency conditions.

The results of long-standing investigations of the human bone system in the piloted Mir and International space station missions were reviewed. The noninvasive DXA technology was used to determine bone mass (BM) and body composition. Predictable BM losses in the lower body tubular bones during 5 to 7-mo. space missions are characteristic of rapid but recoverable osteopenia and viewed as functional adaptation to altering mechanic loading of the skeleton. These changes feature high individual variability. Interestingly, the extent of BM changes in different segments of the skeleton displays stability in individual crew members irrespective of space station design. No strong dependence of BM changes on flight duration has been established and, therefore, calculation of the probability of critical bone demineralization after 1.5 to 2 years in space flight is impractical. Still less is the possibility to predict impairment of the bone structure which, together with BM losses, preconditions the risk of fracture. The data presented witness DXA inadequacy for such prediction. Main areas of researches toward optimization of the exploration mission design and planning in the context of the skeleton mechanic function maintenance are considered.

Established with the personal participation of O.G. Gazenko, the Russian system of medical care for cosmonauts' health has been largely preserved till this day. The system was fully functional on board the orbital complex MIR and, with appropriate modifications, has been adopted as a core of the medical care for Russian members of the ISS crews. In the period of 2000-2008, 22 cosmonauts were members of 17 ISS increments from 140 to 216 days in duration. The main functions of the medical care system were to control health, physical and mental performance, and to support implementation of space researches. The flow of readaptation to the normal gravity was, in most cases similar to what has been typical on return from the Russian orbital stations; some deviations are accounted for by application of the in-flight countermeasures. The paper familiarizes reader with some aspects of the theoretical work of academician O.G. Gazenko in the field of medical care in space flight. It outlines the principles of ISS medical management. The integrated medical support system combines medical equipment and items available on the Russian and US segments; the integrated medical group consists of flight surgeons, medical experts and biomedical engineers of the international partners and coordinates planning and implementation of medical operations. Also, challenges of health care on the phase of ISS utilization are defined.

The paper presents the factual data about 6 participants in short-duration space flights of three age groups (according to the WHO classification). The scope of medical care for three young SFPs whose health status was qualified as good replicated the program adopted in Russia for crewmembers trained for short-duration orbital flights. To safeguard three SFPs of middle and elderly age among whom two had deviations in body functions, the standard medical care program was reinforced by prescription of corrective pharmaceuticals to be taken during space flight, supply of personal kits with preventive medicine, inclusion of additional examinations into the standard medical monitoring and modification of the in-flight countermeasure program, if necessary. As a result, all the SFPs missions were accomplished safely and successfully.

Introduction: The medical community of the International Space Station (ISS) has developed joint medical standards and evaluation requirements for Space Flight Participants ("space tourists") which are used by the ISS medical certification board to determine medical eligibility of individuals other than professional astronauts (cosmonauts) for short-duration space flight to the ISS. These individuals are generally fare-paying passengers without operational responsibilities., Material and Context: By means of this publication, the medical standards and evaluation requirements for the ISS Space Flight Participants are offered to the aerospace medicine and commercial spaceflight communities for reference purposes. It is emphasized that the criteria applied to the ISS spaceflight participant candidates are substantially less stringent than those for professional astronauts and/or crewmembers of visiting and long-duration missions to the ISS., Conclusions: These medical standards are released by the government space agencies to facilitate the development of robust medical screening and medical risk assessment approaches in the context of the evolving commercial human spaceflight industry.

Twenty-five patients with type 2 diabetes (DM-2) and its moderate initial decompensation (8.83±1.85%) were examined. The mean age of the examinees was 53.16±8.92 years; the duration of the disease was 2.50±3.06 years. There were 18 females (mean age 54.11 ±9.67 years) whose disease duration was 2.71±3.08 years and 7 males (mean age 50.7 1±6.63 years) with a disease duration of 1.95±3.17 years. Before prescribing metformin, all the patients received diet therapy, but without making a special monitoring of the calorie content of a diet. All the patients were given metformin in an initial daily dose of 500 mg. Later on the daily dose of metformin was increased up to 1000-1500 mg. Metformin treatment was performed during low-calorie diet (as high as 1200 kcal daily); compliance was monitored by an individual dietary diary. In patients with DM-2, metformin exerted a positive effect on fasting glycemia (p = 0.001) and postprandial hyperglycemia (absolute and relative areas under the curve in the oral glucose tolerance test (OGTT)). At the same time there were no perceptible changes in the level of glycated hemoglobin (p = 0.533). Although metformin caused a noticeable decrease from 5.75±4.72 to 3.97±2.71, it was yet statistically insignificant (p = 0.181). In patients with DM-2, metformin therapy enhanced a low-calorie diet-induced body weight loss, most markedly within the first three months of therapy. At the same time, a meta-analysis has shown that this effect of metformin is rather moderate (p = 0.02). Metformin treatment for MD-2 during low-calorie diet improves lipid metabolism, by significantly decreasing the levels of total cholesterol and low-density lipoproteins, and lowers systolic blood pressure.

Genetic demographic characteristics and immunogenetic markers (blood groups ABO, Rhesus, MNSs, P, Duffy, Kidd, and Kell) have been studied in a group of 132 Russian cosmonauts and test subjects (CTSG). Analysis of pedigrees has shown a high exogamy in the preceding generations: almost half of the subjects have mixed ethnic background. According to the results of genetic demographic analysis, a sample from the Moscow population was used as control group (CG). Comparison between the CTSG and CG has demonstrated significant differences in genotype frequencies for several blood group systems. The CTSG is characterized by a decreased proportion of rare interlocus genotypic combinations and an increased man heterozygosity. Analysis of the distributions of individual heterozygosity for loci with codominant expression of alleles has shown that highly heterozygous loci are more frequent in the CTSG. Taking into account that the CTSG has been thoroughly selected from the general population, it is concluded that heterozygosity is related to successful adaptation to a space flight.

The scientific concept of health assessment and prediction in a piloted mission to Mars has been built on the principles of pre-nosologic diagnostics, i.e., identification of the norm-pathology borderline states. The article deals with the medical care policy for the mission, and specific techniques and technologies. A three-level system of health assessment and prediction is proposed. Innovative approaches to evaluation of the body control systems during long exposure in microgravity have a footing of ground-based and space experimental investigations. Namely, these include evaluation of the cardiorespiration autonomous regulation and body functional reserve assessment by noninvasive recording of physiological signals in sleeping crewmembers before and after mission.

Already during the early ISS increments malfunctioning of NASA TVIS (treadmill with vibration isolation system) posed major problems for regular crew training and particularly scamper, one of the key exercises on the Russian physical training program. During ISS increment-3, TVIS unscheduled repairs took virtually all the training time. In search for TVIS backup, Russian and NASA engineers considered jointly Russian treadmill BD-1, originally designed for Russian "shuttle" Buran and accepted it as a suitable backup in case of complete TVIS failure. To enter into the "dialogue" with BD-1, i.e., to record and downlink training data, the treadmill speed indicator, a part of the treadmill stand, was replaced by PC.

Background: Candidates for commercial spaceflight may be older than the typical astronaut and more likely to have medical problems that place them at risk during flight. Since the effects of microgravity on many medical conditions are unknown, physicians have little guidance when evaluating and certifying commercial spaceflight participants. This dynamic new era in space exploration may provide important data for evaluating medical conditions, creating appropriate medical standards, and optimizing treatment alternatives for long-duration spaceflight., Case: A 57-yr-old spaceflight participant for an ISS mission presented with medical conditions that included moderately severe bullous emphysema, previous spontaneous pneumothorax with talc pleurodesis, a lung parenchymal mass, and ventricular and atrial ectopy. The medical evaluation required for certification was extensive and included medical studies and monitoring conducted in analogue spaceflight environments including altitude chambers, high altitude mixed-gas simulation, zero-G aircraft, and high-G centrifuge. To prevent recurrence of pneumothorax, we performed video-assisted thoracoscopic pleurodesis, and to assess lung masses, several percutaneous or direct biopsies. The candidate's 10-d mission was without incident., Conclusion: Non-career astronauts applying for commercial suborbital and orbital spaceflight will, at least in the near future, challenge aerospace physicians with unknowns regarding safety during training and flight, and highlight important ethical and risk-assessment problems. The information obtained from this new group of space travelers will provide important data for the evaluation and in-flight treatment of medical problems that space programs have not yet addressed systematically, and may improve the medical preparedness of exploration-class missions.

The factors of space flight provoke some negative shifts in crew health. Improvement of the methods of diagnostics, evaluation of predisposition to diseases and correction of functional deviations is within the scope of the crew medical operations personnel. It is also a new focus of biomedical research referred to as "personalized medicine" the corner stone of which is genetic analysis. Investigations in this area are prediscovery by character; population genetics seems to be the most adequate approach. The authors give examples of candidate genes the genotypes of which could be of significance to medical operations and discuss the genetic safety of space flight. Aside from the applied aspects, the genetic investigations of space crews are of their own concernment in understanding the genetic basis of differences in biological resistance to unhealthy environment.

This paper summarizes medical experience during the six NASA-Mir flights from March 14, 1995, to June 4, 1998. There were 7 U.S. astronauts who were part of 6 Mir space crews and worked jointly with 12 Russian cosmonauts. Advances in space medicine have created a safer environment; however, experience shows that crewmembers experience traumatic injuries and illnesses of diverse etiologies during spaceflight. During these joint flights both Russian and U.S. medical kits were available to crewmembers who could access either medical kit as appropriate. The Russian medical team had primary responsibility for monitoring and care of all crewmembers and analyzing medical results. When medical incidents occurred, the appropriate Russian or U.S. medical team determined the plan for diagnosis and treatment. Each team kept the other informed regarding medical situations during the flights and strictly observed the principles of medical confidentiality. A summary of medical incidents by programmatic element is described as experienced by the crewmembers and the ground support medical teams. The most frequent medical cases were small traumatic injuries to the skin and mucous membranes and fluctuations in the cardiovascular system, manifesting primarily in the form of cardiac dysrhythmias. The ability to use both the Russian medical aids and the U.S. medical kit significantly increased the effectiveness and reliability of therapeutic and prophylactic care. The degree of medical care and cooperation established precedents for integrating these systems for the medical support of expeditions on the International Space Station.

The authors consider factors and risk sources in long and superlong (interplanetary) missions, conceivable effects of extended exposures in microgravity, and probability of diseases in the crew. They also lay down the basic principles of medical care, including surgery, to be applied in the interplanetary mission, and propose a nomenclature of key means and equipment for the therapeutic and emergency medical care, and a configuration of a medical compartment.

The study of radiation background components in the near-Earth space is very important for different branches of space research, in particular for space dosimetry and for the planning of gamma-astronomy experiments. Detailed information on the neutral components (gamma-quanta, neutrons) of background radiation was obtained during the Grif-1 experiment onboard Mir orbital station (OS). The measurements of fluxes of 0.05-50 MeV gamma-quanta and >30 MeV neutrons with a large area instrument (approximately 250 cm2 for gamma-quanta, approximately 30 cm2 for neutrons) as well as corresponding charged particle measurements (0.4-1.5 MeV electrons, 1-200 MeV protons) were made during this experiment. The background components induced by the station's own radiation as well as the albedo gamma-rays from the Earth's atmosphere were revealed as the result of data analysis for about 600 h of observation. A mathematical model describing the latitude and energy dependences of atmospheric albedo gamma-rays as well as of those of gamma-quanta produced in the material of the station due to cosmic ray interactions was developed. An analytical approximation of the spectrum of induced gamma-rays from radioactive isotopes stored in the station and instrument's materials is presented. The dynamics of gamma-quantum background fluxes during the geomagnetic disturbances of January 10-11, 1997 are discussed. An analytical representation of the latitude dependence of the integral flux of neutrons with >30 MeV is given., (c2002 Elsevier Science Ltd. All rights reserved.)

Presented are results of studying 24-hr variability of the cardiac rhythm which characterizes individual difference in reactions of two crew members to the same set of stresses during a 115-day MIR mission. Spacelab (USA) cardiorecorders were used. Data of monitoring revealed significantly different baseline health statuses of the cosmonauts. These functional differences were also observed in the mission. In one of the cosmonauts, the cardiac regulation changed over to a more economic functioning with the autonomous balance shifted towards enhanced sympathetic activity. After 2-3 months on mission he had almost recovered pre-launch level of regulation. In the other, the regulatory system was appreciably strained at the beginning of the mission as compared with preflight baseline. Later on, on flight months 2-3, this strain kept growing till a drastic depletion of the functional reserve. On return to Earth, this was manifested by a strong stress reaction with a sharp decline in power of high-frequency and grow in power of very low frequency components of the heart rhythm. The data suggest that adaptation to space flight and reactions in the readaptation period are dependent on initial health status of crew members, and functional reserve.

The measurements of high-energy neutron (with energies approximately 30-300 MeV) and proton (with energies approximately 1-200 MeV) fluxes are being conducted on-board "Mir-Spectr" orbital complex. Neutrons are detected by the undirected (FOV approximately 4 pi sr) scintillator spectrometer, consisting of 4 identical CsI(T1) detector units (the effective area for neutrons approximately 30 cm2). The gamma-quanta, which can be also detected by this instrument, are separated from neutrons by the analysis of the scintillator output pulse shape. To exclude registration of charged particles an anticoincidence plastic scintillator shield is realized in each detector unit. The proton fluxes are measured by the telescope based on 3 semiconductor detectors with small geometry factor (approximately 1 cm2 x sr). As the first result of the experiment the upper limit of the integral flux of local and albedo neutrons in the equatorial region (L<1. 1) was estimated. The results of this measurements can be useful for the radiation security. Also, the neutrons of solar flares can be detected in this experiment.

The goal was to lay basis for a change to modern, adequate to international standards technology of the biomedical data transfer to and from the orbital complex, and setting-up a computer network to link all partners in the medical care systems for space missions. Main sources of the board biomedical information were identified as well as associated restrictions on communication capabilities and upgrading the in-flight procedures. Advantages of INTERNET were analyzed and the need for high-speed digital downlink of the biomedical data was substantiated.

During 1986-1990 seven prime spacecrews (16 cosmonauts) have flown on-board the Mir orbital complex. The longest space mission duration was 366 days The principal objectives of the medical tasks were the maintenance of good health and performance of the spacecrews and conducting medical research programs which included study of the cardiovascular, motor, endocrine, blood, immune, and metabolic systems. Results obtained point to the ability of humans to readily adapt to a year-long stay in space and maintain good health and performance. Readaptation had a similar course as after other previous long-term space flights of up to 8 months in duration. Primary body system changes were not qualitatively different from findings after flights aboard the Salyut 6 and 7 space stations. In this case, during and after an 11-12 month flight, body system alterations were even less severe which was a result of adequate countermeasure use, their systematic and creative employment and maintenance of required environments to support life and work in space.

This paper presents observations over 18 cosmonauts who participated in space flights of 75 days to 12 months and stayed in a sanatorium in the city of Kislovodsk thereafter. The rehabilitation stage continued for 30-40 days. The early stage of rehabilitation lasted 2-3 weeks at the cosmodrome or Gagarin Cosmonaut Training Center. They were taken to a sanatorium for further medical rehabilitation when they showed residual phenomena of postflight fatigue, incomplete recovery of the cardiovascular and musculoskeletal systems, hematological, biochemical and immunological changes. Rehabilitation measures included physical training, terrain cure, balneological procedures. Medical monitoring was performed using physical examinations, arterial pressure and heart rate measurement, ECG, Holter monitoring during terrain cure, and blood and urine clinical analysis. The results showed a beneficial development of readaptation, increase of functional capabilities and physical work capacity of crewmembers. Final physical examinations gave evidence that most physiological parameters returned to the preflight level. Increase of flight duration to 11-12 months did not cause increase of post-recovery duration.

The basic goal of medical investigations during and after the 366-day mission was to accumulate data about physiological responses to such a long exposure to microgravity. In flight, cardiovascular and other systems were examined in detail and the efficacy of countermeasures used was assessed. After flight, physiological systems were also followed very carefully. According to the preliminary data, the medical results obtained during and after flight give evidence that man can well adapt to a year-long space flight, maintaining good health and adequate work capacity. The readaptation process was very similar to that observed after shorter flights (6-11 months). As compared to former flights, no new or qualitatively different changes in the vital systems of the body were seen. The observations indicate that the duration of manned space missions can be further increased.

The paper presents the theoretical prerequisites and validation of medical rehabilitation of the cosmonauts following space missions developed on the basis of complex experimental studies and space medicine experience. The main phenomenological manifestations of redaptation and the tasks of stepwise recovery are described. Readaptation changes in the body state are considered, on the one hand, as a consequence of the microgravity effect and, on the other hand, as the adaptation manifestations to 1 g and occurring on the Earth. The principles and approaches to performing the rehabilitative measures, methods, means, dosage and sequence of their applications at early and subsequent stages of readaptation including a sanatorium treatment are presented. An individualization of specific programs of rehabilitative-and-therapeutic measure is of great importance. An effectiveness of medical rehabilitation system now in use and its significance for maintaining the professional longevity of cosmonauts are discussed.

The objective of medical investigations during and after the 366-day manned mission was to accumulate information about human responses to long-term effects of microgravity. To do this, cardiovascular and other systems were examined in detail during and after exposure. The results gave evidence that the crewmembers well adapted to the long-term flight effects. Their good health condition and high work capacity were supported by adequate medical procedures. Postflight readaptation developed similarly to what was seen after previous flights of shorter duration (6-11 months). No qualitatively new changes in the physiological systems were detected during or after this mission.

In 1987, the USSR cosmonauts Y. V. Romanenko (326 days), A. I. Laveikin (approximately 176 days), and A. P. Alexandrov (approximately 160 days) made a space mission on Mir. (A. I. Laveikin showed specific cardiovascular responses to exercise tests and was therefore replaced with A. P. Alexandrov). The most important medical result of this mission was that Yu. V. Romanenko, who remained in orbit for 3 months longer than anyone before, working intensively, did not exhibit any changes that were qualitatively different from those observed in previous long-duration space flights. The health status and work performance of other crewmembers were also good, although each of them showed individual responses. The postflight recovery period went smooth.

At the final stage of long-term space flights first aid should be rendered in a specific way in cases of critical situations. Resuscitation and anesthesiology measures should be applied, if necessary, after study of flight-induced changes in the vital organs and systems. The paper describes the most important factors that should determine the tactics of resuscitation-anesthesiology support of the immediate postflight stage, if theoretically feasible acute life-endangering states develop. It also presents substantiated correction of routine clinical protocols of resuscitation aid.

The cardiovascular effect of head-down tilt (at an angle of -90 degrees) was investigated in 25 mongrel dogs exposed to general anesthesia, myorelaxation or pulmonary ventilation. Changes in the circulation and contractility parameters can be subdivided into three periods. At early stages of the exposure an increase in contractile function and hemodynamic changes typical of preload were seen. At later stages progressive disorders of systemic and regional hemodynamics, inhibition of contractile function, and increasing metabolic changes were observed. All this resulted in the death of the animals after 12-20 hours of head-down tilt. Gross structural changes that occasionally were irreversible were detected in organs of the dead animals.

The study of external respiration and acid-base equilibrium of blood of 35 test subjects exposed to 49-day head-down (-4 degrees) tilting and of 6 test subjects exposed to 182-day head-down (-4 degrees) tilting demonstrated a trend for a decrease in the respiration rate, lung ventilation, oxygen consumption, and a relative increase in the exhalation time. With respect to the arterialized blood gases, a significant decrease in PaO2, an increase in PaCO2 and in the O2 alveolar-arterial difference were seen during the 49-day head-down tilting. During the 182-day head-down tilting a further increase in the CO2 arterio-alveolar difference was noted. These changes suggest shifts of the ventilation-perfusion ration in the lungs and, probably, disturbances of central regulation of respiration induced by head-down tilting. During the recovery period the above changes diminished gradually and disappeared by the 14th and 30th day after the 49- and 182-day head-down tilting, respectively.

When exploring the problems of medical aid to be rendered in manned space flights, it is necessary to take into consideration the specific features of the environment as well as the changes in the human body induced by space flight effects. In space flight anesthesia can be applied using such advanced methods as multi-component balanced anesthesia and peridural anesthesia. Surgery and resuscitation can be performed, employing the procedures and methods that allow operations in an abacterial environment, correction of vital dysfunctions with the aid of artificial pulmonary ventilation, cardiac electrotherapy, and sorptive purification of body fluids. Various aspects of infusion treatment and first medical aid are discussed.

When discussing problems related to medical service in space flight, particular attention should be given to the specific living conditions and changes associated with space flight. In disease and injury, surgery can be provided only after conservative therapy has failed. In this context gnotobiological chambers allowing surgery in aseptic conditions seem promising. A portable set of interchangeable surgical tools should be made of light-weight alloys that can be readily sterilized. Electroanalgesia in combination with auriculoacupuncture as well as peridureal anesthesia may be used as they allow normal operations in autonomous space flight conditions. Changes in the sympatho-adrenal and kallikrein-kinin systems, as well as water-electrolyte balance, should be taken into account in developing methods and means of medical service in critical situations. Special attention should be given to the prevention and treatment of brain edema in view of weightlessness-induced cephalad fluid shifts.