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In the vast program of medical investigations fulfilled by the cosmonaut-physician in the nearly 15-mo orbital flight a large share related to metabolism. These comprehensive studies could not have been made earlier as they required appropriate medical qualification of investigator. The article highlights the scientific-methodical aspects of the program and biochemical, hematological and immunological data obtained by the cosmonaut-physician from the MIR crews. Results of these metabolic studies laid grounds for a system of laboratory diagnostic evaluation of crew health during long-term space flight.

Plans to send humans to Mars dictate revision of the whole crew medical support system. Autonomy of the mission will extend crew responsibilities for all dimensions of medical support. The article compares and contrasts medical support of crews on orbital and interplanetary missions, and considers the place and functionality of medical informational technologies in a mission to Mars.

Strength properties of prostatic calculi (PC) were studied by microhardness HV. Fifteen calculi under study were divided into 3 groups by the size: 2-3 mm (group 1), 4-6 mm (group 2), > 6 mm (group 3). The surface of the thin sections of the calculi appeared as concentric, spherical layers of different size indicating formation of the calculus from the center. In the latter one could see a pigmented nucleus of organic nature. Some calculi had two nuclei under one cover--attached calculi. Correlations between the structure, morphology of prostatic calculi and their strength properties were established. These correlations allowed one to characterize destruction features of the calculi in different destructing impacts. We have designed and introduced into practice a complex of local physiotherapy in prostatolithiasis. This physiotherapy was conducted in combination with medicines for chronic prostatitis and included exposure of the prostate to ultrasound in impulse regime (4 mc, 0.4-1.0 W/cm2). The ultrasound was delivered through the rectum (insertion of the setting IUT 2.264-7-2.09u to the site of the concrements location) and alternated with laser therapy (insertion of the radiator P-2 into the rectum and radiator LO1 to the perineal area (5 W, 80 Hz, 64-128 s) and introduction of sulfide mud heated with the device PPK-01 Pra, electrostimulation for better passage of the prostatic section. The above therapy destructed the concrements which eliminated from the prostatic ducts as a result of which prostatic function recovered. The complex produced a good effect: 65% patients stated enhancement of the erectile function after 3 days of the treatment. After 5-6 procedures pain syndrome relieved in 40% patients, after 11-15 procedures in 87%. Ultrasonic investigation showed that posttreatment size of the prostate diminished from 0.8 to 0.2 cm. The absence of the calcinates's shadows were recorded in 87% patients, the symptoms of chronic prostatitis disappeared. The results of the combined physiotherapy demonstrate efficacy of the above method in true prostatoliths.

Results of experimental evaluation of the performance of pilots bound to stay up to 24 hrs in the working pose as a function of inclination of supporting surfaces (backrest and seat) are presented. Small inclination angles (up to 23 degrees) were found to be more provocative of discomfort, painful sensations and work deterioration characterized by higher intensity. It was shown that periodic change of the seatback inclination is an effective way to prevent fatigue in pilots on long-duration flights and to prolong time of comfortable stay in forced posture up to 12-16 hrs. The data on the time of comfortable stay and dynamics of pilot's performance as a function of angles of supporting surfaces of the seat laid the grounds to determination of the best combination to provide comfort to pilot on flight.

Specificity of the use of ballistocardiography (BCG) in space flight is considered. In particular, the contactless method makes it possible to continue recording during the night hours and study the ultradian rhythms reflective of the state of higher autonomous centers. As was stated, on months 7 to 8 of the mission by cosmonaut-physician Polyakov the BCG amplitude rose in concert with activation of the higher autonomous centers that were apparently involved in maintaining the established cardiovascular homeostasis. By months 11 to 13 on mission, the BCG amplitude decline resulted in an increase in the SCG/BCG index representing the amount of myocardium energy spent on blood transport.

Results of the joint Russian/US studies of the effect of microgravity on bone tissues in 18 cosmonauts on return from 4.5- to 14.5-month long missions are presented. Dual-energy x-ray gamma-absorbtiometry (QDR-1000 W, Hologic, USA) was used to measure bone mineral density (BMD, g/cm2) and mineral content (BMC, g) in the whole body, the scalp including cervical vertebra, arms, ribs, sternal and lumbar regions of the spinal column, pelvis and legs. A clearly defined dependence of topography of changes upon the position of a skeletal segment in the gravity vector was established. The greatest BMD losses have been observed in the skeleton of the lower body, i.e. in pelvic bones (-11.99 +/- 1.22%), lumbar vertebra (-5.63 +/- 0.817%), and in proximal femur, particularly in the femoral neck (-8.17 +/- 1.24%). Bones of the upper skeleton were either unchanged (insignificant) or showed a positive trend. Overall changes in bone mass of the whole skeleton of male cosmonauts during the period of about 6 months on mission made up -1.41 +/- 0.406% and suggest the mean balance of calcium over flight equal to -227 +/- 62.8 mg/day. Reasoning is given to qualify these states of cosmonauts' bone tissues as local osteopenia. On the literature and results of authors' clinical evidence, discussed is availability of the densitometric data for predicting risk of trauma. A biological nature of the changes under observation is hypothesized.

In the nearly 15-month mission aboard MIR the cosmonaut-physician and members of three crews (MIR-15, -16, and -17) carried out a program of hematological investigations. Most of the changes related to the red blood system and included reduction in hemoglobin and hematocrit. Erythrocytes had decreased concentration and took on abnormal forms. There were also signs of altered metabolism of erythrocytes. Of interest are phase-by-phase variations in the levels of erythrocytes in the course of long-term stay in microgravity, and absence of a convincing correlation between hemoglobin, erythrocyte and hematocrit levels. But for lymphocytosis that returned to the norm already on the first day of recovery, no material changes occurred to the leukocyte profile. Investigations at the landing site displayed erythropenia, decreased reticulocytes and ensuing reticulocyte reaction, and gradual regain of the erythrocyte number that can be viewed as a normal physiological reaction of the blood system to the set of factors of spaceflight and early readaptation. Besides, the investigations showed a large individually of blood reactions to prolonged stay in space flight.

Experiment INTERSTITIUM was performed on days 3, 170, 287, and 430 of the long-term MIR mission of the Russian cosmonaut-physician in order to evaluate reactivity of the system of hormonal regulation of homeostasis during LBNP sessions. Data of the experiment displayed different types of reaction of the volume controls to LBNP at the onset (F-3), in the course of and soon after recovery (R-4) from the extended mission which are signs of specific phases of adaptive shifts in the organism of cosmonaut. Exaggerated reactivity of the hormonal systems during LBNP in flight suggests more significant consequences of the test for the cardiovascular system of human in microgravity. The most expressed hormonal reaction to LBNP was documented at the very beginning of the postflight period. Plasma cGMP was materially reduced in the process of the mission and remained quite low on R-4; return of nucleotides to the norm was observed no earlier than on R-90. Complete recovery from the space mission took three months when the hormonal reaction to LBNP was same as prior to launch.

Medical results of inflight cardiovascular measurements made in the 6th prime crew at rest and during provocative graded bicycle exercises and LBNP tests are presented. The methods of electrocardiography, tetrapolar rheography, kinetocardiography, arteriovenous pulsography and tacho-oscillography have been used to examine the cosmonauts. Together with regular cardiovascular changes typical of microgravity effect the individual peculiarities of developing the control mechanisms are noted. Thus in one of the cosmonauts a number of symptoms responsible for a decreased venous return. As a whole the functional state of the cardiovascular system on all flight stages was characterized by a sufficiently high physiological level.

During a 25-day space mission of French cosmonaut on board Mir station, the joint Soviet-French Czecho-Slovak experiment "Minilab" has been conducted in order to evaluate a fluid-electrolyte metabolism status and its hormonal control at different flight stages and early postflight. In cosmonaut venous blood was drawn twice, and 24-hour urine samples were collected on mission Days 5 and 19. With the aid of Plasma-02 equipment the blood plasma and urinary samples were treated, frozen and maintained aboard the station. Postflight, frozen samples were delivered to the laboratory for further analyses. In-flight, urinary excretion of fluid and sodium decreased by 25-35%. On mission Day 9, the blood plasma levels of vasopressin increased by 450% and on Day 20 by 700% as opposed to the baseline levels, blood aldosterone content was also elevated with an increased renal excretion of both hormones. Blood plasma renin activity elevated two-fold, and atrio-natriuretic factor (ANF) content practically did not differ from a baseline value. In-flight circulating plasma volume (CPV) decreased by 20%. Postflight, there occurred the body hypohydration and activation of the hormonal systems providing a retention of body fluids and electrolytes to restore an adequate CPV and fluid-electrolyte homeostatic as a whole.

This paper present hematological data obtained during space flights of the third and the fourth prime crew flights (EO-3 and EO-4). In the EO-3 flight, RBCs, WBCs and blood formed elements were counted by the cosmonaut-researcher. In the EO-4 flight, blood was drawn by the cosmonaut-researcher and analyzed on the ground; also, blood smears treated in the Microview unit and videotaped were used. Blood parameters in EO-3 and EO-4 crewmembers were close or equal to the normal. However there were cases with changes in bends, myelocytes, neutrophils, lymphocytes; also anisocytosis, hypochromia, target-like erythrocytes, and single acanthocytes were seen. Comparison of blood smears on unstained and stained glass slides revealed significant differences in the amount of target-like erythrocytes in the same cosmonaut at the same time (on the prestained glass slide only 4 erythrocytes and no aggregates in single fields of vision were detected while on the unstained glass slide aggregates in single fields of vision were seen). Pre- and postflight examinations of bone marrow revealed polymorphocellular marrow and mature hemopoietic cells.

The authors' opinion that adaptation inhibition of erythron functioning under weightlessness produces an unfavourable effect on the optimal physical state of a cosmonaut and his working capacity in the post-flight period has been confirmed by the analysis of certain hematological parameters studied in cosmonauts. The data obtained have necessitated investigation of threshold values of erythron functioning under weightlessness, and creation of artificial gravitation on board the piloted space ship to normalize erythropoiesis. Investigation of these problems of space hematology would be helpful in validation of the limits of human's long-term stay under weightlessness, and in the pre- and post-flight period management.

The article is based on the materials of special reanimation units of Leningrad Emergency Medical Care Centre. The reanimation measures undertaken in a group of 420 patients with grave trauma and shock of the 1--IV grade are described. An efficacy of respiratory reanimation per se was studied in a separate group of patients (102) after strangulation asphyxia. A scheme of a special medical car intended for reanimation is being suggested.

A strategy of insulin treatment of mothers with diabetes mellitus at abdominal delivery has been developed. For the first 3 days after cesarean section, maternal glycemia was measured every 5 hrs and followed by simple short-acting insulin correction where necessary. On day 4-5 after resuming a normal diet (table No. 9), the puerperants were switched to long-acting insulin preparations. It was only by day 8-9 that the majority of the patients (87%) needed the same insulin dose as they used prior to the conception. This insulin regimen was used in 62 cases of abdominal delivery and prevented a decompensation of diabetes mellitus in all of those.

The amino acid composition of the quadriceps muscle of rats flown onboard the biosatellite Cosmos-936 and exposed to the ground-based synchronous control experiment was studied. The weightless rats showed changes in the amino acid concentration in the quadriceps muscle. The centrifuged flight and synchronous rats displayed an accumulation of free amino acids in the above muscle.

The paper presents data of clinical and laboratory investigations performed in patients with vulvar leukoplakia or kraurosis before and after the helium-neon laser therapy. The impairment of adrenal performance (related to glucocorticoid, androgenic or mineralocorticoid functions) has been identified in the examinees. Employment of the laser therapy has normalized the impaired functions and beneficially affected local dystrophic processes in vulvar tissues. Local application of aerosol corticoid agents prolongs the response to the therapy.

Results of hypnosuggestive treatment employed for women suffering from vomiting of pregnancy are discussed. In case of patient's consent the method works, but if any doubts of prejudices arise it fails. The main advantage of the method is a possibility to exclude or significantly reduce the damage of the fetus due to chemotherapeutic management of the condition.