InnovaSpace Journal Club #1 Report: Jugular Venous Blood Flow Stasis & Thrombosis During Spaceflight
Author: Lucas Rehnberg
NHS Doctor - Anaesthetics & Intensive Care | MSc Space Physiology & Health
Extremely pleased to report on the 1st InnovaSpace Journal Club meeting that had the participation of a very international audience, with attendees from Belgium, Brazil, India, Israel, Italy, Romania, and UK! Thank you to all those who attended and look forward to future talks and discussions.
For those who couldn’t attend, or are interested in the Space Journal Club, I have created a ‘one page’ summary of the paper we discussed. I have also added in the discussion points raised after the critical appraisal of the paper, together with links to additional reading material for anyone wishing to learn more.
PAPER PRESENTED & DISCUSSED:
After 50+ years of spaceflight, the first documented venous thrombus in an astronaut identified - highlighting a new pathology, not previously diagnosed in astronauts.
Who are the authors?
Experts in this field from several space agencies => NASA, IBMP (Russia), ESA
Funding => NASA, under the Human research program. Part of the multi-institution international fluid shifts study.
What is interesting about this paper/ Why would the medical space community be interested in this?
New pathology, not diagnosed before. Potentially massive implications for future long duration missions. LBNP could potentially be a countermeasure to enhance venous blood flow or improve cerebral venous outflow.
The research question.
Loss of hydrostatic gradient and variation on Earth, sustained fluid redistribution. Effect on cerebral venous drainage/blood flow. Possible mechanism linked to SANS? Increased risk of clot formation due to static/retrograde flow?
Why is this research question important?
Static/stagnant flow can predispose individuals to thrombus formation. Long lasting effects of thrombi for astronauts, potentially affecting crew performance (i.e. risk of anticoagulation, emboli, then leading to reduced performance affecting the crew and mission).
The study design.
Primary research => prospective cohort study (follow a similar patient group over time, comparing a particular outcome). Subjects were 11 astronauts, on the ISS.
Ultrasonographic assessment of left IJV (IJV are main conduits of cerebral drainage)
- pre flight (3 positions, seated, supine & head down tilt)
- at approximately D50 and D150 of spaceflight
- with and without LBNP (approx the same days, Russian Chibis-M LBNP)
Authors: Space Crew Group Members
Sibsankar Palit, Tomas Ducai, Dhanusshya Raghu, and Raluca Papacocea
“If people sat outside and looked at the stars each night, I’ll bet they’d live a lot differently…….How so?.......... Well, when you look into infinity, you realise that there are more important things than what people do all day.”
Humans are planning to one day build settlements beyond Earth, although it should be noted that, currently, the total number of humans who have ventured beyond Earth (astronauts) is minuscule in comparison to the 8 billion global population. There is still a lot of work to be done. We are still not sure if space travel will be possible for everyone in our respective lifetimes, but in the meantime, there are several cosmic events that we can all witness from this blue dot on which we live. These include eclipses, meteor showers, etc. that occur at specific times, and give us a sense of belonging to the cosmos! So, we should try not to miss these cosmic events if at all possible. There are astronomy clubs and science museums that can be visited, or sometimes we can even view these events online using applications like Stellarium or Youtube, etc.
A few members of the InnovaSpace Space Crew working group have actively engaged in observing two vital cosmic events that took place toward the end of 2022 - the Partial Solar Eclipse (25.10.2022) and Total Lunar Eclipse (08.11.2022). Below are a few snapshots of the recent eclipses.
Author: Swapnil K Singh
Undergraduate: Astronomy Research & Mechanical Engineering - Astrophysicist of the future!
Albert Einstein gave the theory of relativity and because of him we know how gravity works and also the nature of space-time. With the help of the theory of relativity, we can say that gravity warps space-time fabric and that's how we feel the effect of gravity.
Later, in year 1921, German scientist Theodor Kaluza came up with an idea that if the force of gravity warps space-time, then other forces like electromagnetic or nuclear forces also warp space-time. However, we know that's not true, so then Kaluza thought that maybe these forces do not warp the space-time of this dimension but warp the space of other dimensions, and so, the theory of other dimensions (string theory) came into existence. The Kaluza–Klein theory (KK theory) is a classical unified field theory of gravitation and electromagnetism built around the idea of a fifth dimension beyond the common 4D of space and time, and considered an important precursor to string theory.
String theory predicts that all objects in our universe are composed of vibrating filaments (and membranes) of energy. It proposes that subatomic particles are sub-sub-subatomic strings. If we zoom in on the particles closely enough, what we usually think of as little billiard balls reveal themselves to be tiny loops or lengths of a more primitive material. These strings vibrate like miniature guitar strings, and each type of particle corresponds to a string playing a certain pitch. These strings came in two forms — closed strings and open strings. An open string has ends that don’t touch each other, while a closed string is a loop with no open end.
Author: Dr. Paul Zilberman
Medical Doctor, Anaesthetist, Hadassah Medical Center Jerusalem, Israel
Recently, more and more space dreamers and serious scientists foresee a human travelling to Mars.
The closest planet to us in a centre to periphery direction from the Sun, Mars is still at 86,362 million km distance. Hmmmm…
It is said that in similar conditions and with similar materials, the resultant product will usually look the same. Well, Mars is somehow considered a terrestrial planet.
For illustration, I bring two pictures to your attention - similar, but with evident differences. Both show sunrise, but one is from Mitzpe Ramon in Southern Israel, while the other is from Mars. Obviously, the second image was not taken by me!
With a bit of imagination, we can compare both images - would you take your family at the weekend for a grill (BBQ)? In both places?
A grill? Well… let’s see what we need. Here on Earth, we know. But what do we have on Mars?
Minimum temperature of -110 degrees Centigrade - too cold to eat outside.
Maximum temperature is +35 degrees Centigrade. That’s ok, a bit like Mitzpe Ramon. So, let’s do the grill. But something’s missing!
Yes, for fire we need some oxygen. The oxygen level on Mars is 0.2%, roughly 1/100 of what we have on Earth. Hmm… definitely not enough.
And for a good and tasty grill you need to stay next to it and watch the meat, flip it from time to time. This is difficult too as the gravity on Mars is 3.721 m/s2, roughly 1/3 of that on Earth. Kinda floating a bit, isn’t it… ?
So, until we are able to have a grill on Mars, provided we can transport enough meat there and keep it edible, let’s enjoy a traditional and classic one in our own backyard. Enjoy!
But…look to the skies from time to time…You will see Mars with the naked eye.
BTW, we’ve started producing artificial meat over here…
Authors: Pooja S, Rohith V, Pranav PD and Sibsankar Palit
The LIFE- To & Beyond colleagues & team
“He who can listen to music in the midst of noise can achieve great things”.
In this quote, Sarabhai emphasises achieving harmony in the state of disorder to attain greatness.
Perhaps you may have heard about the Indian Space Research Organisation (ISRO), the most cost-effective and efficient space organisation in the whole world, the one that succeeded first-time in its Mars mission and also with a multitude of other ambitious missions. But... do you know the people who were involved in its making?
Let me introduce you to Dr. Vikram Sarabhai - the man involved in the organisation's very foundation and considered to be the Father of ISRO. This remarkable personality also contributed to India and the world in terms of institutional building and serving society through science and technology. He also excelled in helping India to achieve global standing in nuclear power and was Founder of the first Indian Institute of Management (IIM).
A multitalented guy, right?
So, let's get to know more about our hero, Dr. Vikram Sarabhai…..
Early Life & Education
Vikram Ambalal Sarabhai was born to Ambalal Sarabhai and Sarala Devi on the 12th August 1919 in Ahmedabad, Gujarat, India. His father was a textile industrialist and his mother a teacher, who ran the school in which Sarabhai underwent his primary education. Sarabhai had a keen interest in maths and science, and after passing a higher education intermediate science exam at Gujarat College, Ahmedabad, he then studied 'Natural sciences' at St John's College, University of Cambridge in England, graduating in 1940.
Unfortunately, the sudden outbreak of the Second World War forced his return to India, where he joined the Indian Institute of Science (IISC), in Bengaluru (formerly Bangalore). He conducted research on cosmic rays under the guidance of another pioneering Indian scientist and Institution builder Dr. Homi J Bhabha and supervision of Indian Nobel Laureate, Sir Chandrasekhara V. Raman. Within 2 years of his research, he submitted his first scientific paper on the "Time distribution of cosmic rays" in 1942. He finally returned to Cambridge University in 1945 and obtained a PhD in 1947, with his thesis entitled “Cosmic Ray Investigations in Tropical Latitudes”.
Author: Anna Karahan
Science and art have constantly inspired and influenced each other for centuries. Both are based on curiosity, open-mindedness and flexibility – they let humans discover, create, and overcome challenges, encouraging us to look at our world from outside the box, from different angles and perspectives.
What influence does art and design have on today's science, engineering and space exploration?
What is the power of our imagination and creativity?
What meaning does art, design, music and AI have on space stations?
During an interdisciplinary conversation moderated by astronomer Dr. Milena Ratajczak, experts from various fields tried to answer these questions, and more! Taking part in the debate were: Prof. Thais Russomano (InnovaSpace), Dr. Dolly Daou (Food Design Lab, Cumulus org.), Dr. Niamh Shaw (Dream Big - Space Communications), Javier Rodríguez González (CDTI / PERASPERA), Andrea Merlo (Thales Alenia Space), Ben Haldeman (LifeShip), and Mateusz Józefowicz (European Space Foundation).
This conversation took place as part of an Inspiration Zone topic during the European Rover Challenge (ERC2022), which occurred between 9-11 September 2022 in Poland. The focus of the ERC is to promote an international robotics competition. University teams from around the world design, construct and program their own robots, based on artificial intelligence algorithms. The European Rover Challenge is also about the popularization of science and enabling an international networking space. That's why the Inspiration Zone is a crucial element of the ERC. Visitors can expect to see various exhibitors presenting their projects and scientific experiments, as well as meetings with special guests, industry specialists, discussion panels and workshops related to technology, robotics and space.
This blog is promoted and supported by the Space Art Design & Architecture Working Group
Authors: Mario Mollo & Thais Russomano
MM: Physiotherapy student | TR: Director, InnovaSpace | BOTH: Lifelong Space Enthusiasts!
Ever wondered what trees might look like if they grew on other celestial bodies?
Would a tree taken to grow on a planet smaller than ours and with less gravitational force, such as Mars where gravity is one-third that of Earth (hypogravity), have branches and leaves that point upwards, away from the soil?
On the other hand, what if we took a tree to Jupiter, the biggest planet in the Solar System, where the force of gravity is 3.5 times that of Earth (hypergravity)? On this gigantic planet would tree leaves and branches be pulled downwards, unable to defeat gravity, perhaps looking more like the image below?
Or let’s consider a different scenario in which a tree is already native to a planet that has gravity bigger than on Earth – growing from a seed it would adapt straight away to the gravitational force of the planet, and perhaps grow differently. Do you think it might grow with a trunk that is thicker, larger, stronger, like the tree below?
For the moment, however, until we can transport trees and plants to grow on other celestial bodies or perhaps even discover a planet where vegetation grows naturally, we will have to admire the trees that grow and are shaped by the gravitational force of our own planet Earth. These are the trees we have been lucky enough to grow up with, the usual ones that we are so accustomed to, the trees that we must take good care of and protect well, as they are things of beauty and so rare in our Solar System and beyond.
Author: Lucas Rehnberg
NHS Doctor - Anaesthetics & Intensive Care | MSc Space Physiology & Health
My name is Lucas, I am a doctor in the UK working in anaesthetics (or Anaesthesiology for any American readers) and intensive care medicine. I have had an interest in space medicine for over 10 years now, inspired by none other than Prof Thais Russomano who has mentored me over the years and still does. My Master’s dissertation (back in 2009) focused on CPR (cardiopulmonary resuscitation) methods in microgravity, with my continued research interest surrounding critical care in space. I am careful to say that I am a doctor with an interest in space medicine and physiology, as opposed to a ‘Space Doctor’ – as there are many individuals out there who have committed many more years than I have to this field and are vastly more experienced than I am! A club I aspire to join one day.
The idea of this blog, or series of blogs, is to look at some of the latest research in space physiology and space medicine, then consider how this will play out clinically. With a particular focus on critical care and potentially worst-case scenarios when in space (or microgravity environment). Something all doctors will have done in their careers; we are equipped with the skills to critically appraise papers and then ask if they are clinically relevant, or how will it change current practice.
Over the last 60 (ish) years of human space flight, there is lots of evidence to show that there are many risks when the human body has prolonged exposure to microgravity, which can affect most body systems – eyes, brain, neuro-vestibular, psychological, heart, muscle, bone, kidneys, immune system, vasculature, clotting and even some that we haven’t fully figured out yet. But then what needs to be done is to tease out how clinically relevant are these from the research, how could that potentially play out if you were the doctor in space, then how to mitigate that risk and potentially treat it.
Author: Tobias Leach
3rd Year Medical Student | University of Bristol | Passionate about space!
Space provides boundless opportunities for human existence and innumerable threats to human health.
The question is, are we yet prepared to deal with a catastrophic event, such as a cardiac arrest in space?
To gain an understanding of the current state of CPR in microgravity with a focus on chest compressions in the event of a sudden cardiac arrest onboard.
An Ovid Medline search was conducted: 17 articles were found; 12 were excluded; six additional articles were found in the references of the remaining five articles, bringing the total number of articles included to 11. These were then critically analysed.
No CPR method currently reaches the European Resuscitation Council (ERC) guidelines. The Handstand (HS) method appears to be the strongest. Evetts-Russomano (ER) is the second strongest method. Automatic chest compression device (ACCD) performed consistently well.
CPR appears to be far more difficult in microgravity. Inconsistencies in research methodology do not help. The ER method should be used as a first contact method and the HS method should be used once the casualty is restrained. An ACCD should be considered as part of the medical equipment. Further research is needed, directly comparing all positions under the same conditions.
Author: Prof. K. Ganapathy
Hon Distinguished Professor The Tamilnadu Dr MGR Medical University; Emeritus Professor, National Academy of Medical Sciences; Past President, Telemedicine Society of India & Neurological Society of India; Director Apollo Telemedicine Networking Foundation & Apollo Tele Health Services, India
Introduction: Metaverse is the augmented virtual world formed by convergence of virtual and physical space. Users interact within this created world, meeting each other virtually, immersing themselves in performing virtual activities, which subsequently could lead to real experiences. Conventionally, the healthcare “industry” is conservative in deploying future ready technology.
Aims and Objectives: This overview discusses the untapped potential of metaverse applications in healthcare from a clinician’s perspective. Bereft of technical jargon, the article points out the advantages, disadvantages, limitations, and challenges in actual deployment of the metaverse in clinical practice in the real world. The exponential transformation occurring in this area is highlighted. The highly technical literature is simplified for easier comprehension.
Findings: Clinical applications, use of the metaverse in training, education, and augmenting telehealth consultations, in an immersive milieu, is discussed. Direct “in-person” interaction with digital products and solutions will be a new experience for a healthcare provider and the beneficiary. The role of digital twins is illustrated. Consultation process and various clinical applications in the metaverse are outlined. Technology‑enabled futuristic training and education is discussed.
Conclusion: Demonstrating significant improvement in healthcare outcomes using the metaverse will be difficult to prove. This alone will ultimately lead to the development of a business model, insurance reimbursement and behavioral modification necessary for accepting and using, a hitherto unused method in patient care.
Keywords: Augmented reality and healthcare, blockchain and healthcare, metaverse and healthcare, virtual reality and healthcare
The full article can be read and freely downloaded following this LINK
to the InnovaSpace Knowledge Station