A Systematic Review and Meta-Analysis of Decompression Sickness in Altitude Physiological Training

High altitude is associated with pTau deposition, neuroinflammation, and myelin loss

Mammals are able to adapt to high altitude (HA) if appropriate acclimation occurs. However, specific occupations (professional climbers, pilots, astronauts and other) can be exposed to HA without acclimation and be at a higher risk of brain consequences. In particular, US Air Force U2-pilots have been shown to develop white matter hyperintensities (WMH) on MRI. Whether WMH are due to hypoxia or hypobaria effects is not understood. We compared swine brains exposed to 5000 feet (1524 m) above sea level (SL) with 21% fraction inspired O₂ (FiO₂) (Control group [C]; n = 5) vs. 30,000 feet (9144 m) above SL with 100% FiO₂ group (hypobaric group [HYPOBAR]; n = 6). We performed neuropathologic assessments, molecular analyses, immunohistochemistry (IHC), Western Blotting (WB), and stereology analyses to detect differences between HYPOBAR vs. Controls. Increased neuronal insoluble hyperphosphorylated-Tau (pTau) accumulation was observed across different brain regions, at histological level, in the HYPOBAR vs. Controls. Stereology-based cell counting demonstrated a significant difference (p < 0.01) in pTau positive neurons between HYPOBAR and C in the Hippocampus. Higher levels of soluble pTau in the Hippocampus of HYPOBAR vs. Controls were also detected by WB analyses. Additionally, WB demonstrated an increase of IBA-1 in the Cerebellum and a decrease of myelin basic protein (MBP) in the Hippocampus and Cerebellum of HYPOBAR vs. Controls. These findings illustrate, for the first time, changes occurring in large mammalian brains after exposure to nonhypoxic-hypobaria and open new pathophysiological views on the interaction among hypobaria, pTau accumulation, neuroinflammation, and myelination in large mammals exposed to HA.

Revisiting decompression sickness risk and mobility in the context of the SmartSuit, a hybrid planetary spacesuit

Gas pressurized spacesuits are cumbersome, cause injuries, and are metabolically expensive. Decreasing the gas pressure of the spacesuit is an effective method for improving mobility, but reduction in the total spacesuit pressure also results in a higher risk for decompression sickness (DCS). The risk of DCS is currently mitigated by breathing pure oxygen before the extravehicular activity (EVA) for up to 4 h to remove inert gases from body tissues, but this has a negative operational impact due to the time needed to perform the prebreathe. In this paper, we review and quantify these important trade-offs between spacesuit pressure, mobility, prebreathe time (or risk of DCS), and space habitat/station atmospheric conditions in the context of future planetary EVAs. In addition, we explore these trade-offs in the context of the SmartSuit architecture, a hybrid spacesuit with a soft-robotic layer that, not only increases mobility with assistive actuators in the lower body, but it also applies some level of mechanical counterpressure (MCP). The additional MCP in hybrid spacesuits can be used to supplement the gas pressure (i.e., increasing the total spacesuit pressure), therefore reducing the risk of DCS (or reduce prebreathe time). Alternatively, the MCP can be used to reduce the gas pressure (i.e., maintaining the same total spacesuit pressure), therefore increasing mobility. Finally, we propose a variable pressure concept of operations for the SmartSuit spacesuit. Our framework quantifies critical spacesuit and habitat trade-offs for future planetary exploration and contributes to the assessment of human health and performance during future planetary EVAs.

Planetary extravehicular activity (EVA) risk mitigation strategies for long-duration space missions

Extravehicular activity (EVA) is one of the most dangerous activities of human space exploration. To ensure astronaut safety and mission success, it is imperative to identify and mitigate the inherent risks and challenges associated with EVAs. As we continue to explore beyond low earth orbit and embark on missions back to the Moon and onward to Mars, it becomes critical to reassess EVA risks in the context of a planetary surface, rather than in microgravity. This review addresses the primary risks associated with EVAs and identifies strategies that could be implemented to mitigate those risks during planetary surface exploration. Recent findings within the context of spacesuit design, Concept of Operations (CONOPS), and lessons learned from analog research sites are summarized, and how their application could pave the way for future long-duration space missions is discussed. In this context, we divided EVA risk mitigation strategies into two main categories: (1) spacesuit design and (2) CONOPS. Spacesuit design considerations include hypercapnia prevention, thermal regulation and humidity control, nutrition, hydration, waste management, health and fitness, decompression sickness, radiation shielding, and dust mitigation. Operational strategies discussed include astronaut fatigue and psychological stressors, communication delays, and the use of augmented reality/virtual reality technologies. Although there have been significant advances in EVA performance, further research and development are still warranted to enable safer and more efficient surface exploration activities in the upcoming future.

Hypobaric Decompression and White Matter Hyperintensities: An Evaluation of the NATO Standard

INTRODUCTION: In their seminal work, McGuire and colleagues reported an increased incidence of white matter hyperintensities (WMH) in a cohort of U2 pilots and hypobaric chamber personnel. WMH burden was higher in U2 pilots with previous reports of decompression sickness (DCS), and McGuire's reports have raised concerns regarding adverse outcomes in the aftermath of hypobaric exposures. Accordingly, a NATO working group has recently revised its standard recommendations regarding hypobaric exposures, including measures to mitigate the risk of WMH. Mandatory recovery time for up to 72 h between repeated exposures has been suggested on the basis of experimental evidence. However, we argue that the evidence is scarce which supports restricting repeated exposures to mitigate WMH. It is plausible that WMH is correlated with DCS and emphasis should be made on limiting the duration of exposures rather than restricting short and repeated exposures. The profiles in the NATO recommendations are meant to mitigate the risk of DCS. Still, they will potentially expose NATO Air Force and Special Operations personnel to flight profiles that can give rise to DCS incidence above 35%. Awaiting reliable data, we recommend limiting the duration of exposures and allowing for short repeated exposures.Ottestad W, Hansen TA, Ksin JI. Hypobaric decompression and white matter hyperintensities: an evaluation of the NATO standard. Aerosp Med Hum Perform. 2021; 92(1):3942.

Diving physiopathology: the end of certainties? Food for thought

Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy and functional aspects of patent foramen ovale (PFO) have slowly resulted in a more liberal approach toward the medical fitness to dive for those bearing a PFO. Circulating vascular gas emboli (VGE) are considered the key actors in development of decompression sickness and can be considered as markers of decompression stress indicating induction of pathophysiological processes not necessarily leading to occurrence of disease symptoms. During the last decade, it has appeared possible to influence post-dive VGE by a so-called "preconditioning" as a pre-dive denitrogenation, exercise or some pharmacological agents. In the text we have deeply examined all the scientific evidence about this complicated but challenging theme. Finally, the role of the "normobaric oxygen paradox" has been clarified and it is not surprising that it could be involved in neuroprotection and cardioprotection. However, the best level of inspired oxygen and the exact time frame to achieve optimal effect is still not known. The aim of this paper was to reflect upon the most actual uncertainties and distil out of them a coherent, balanced advice towards the researchers involved in gas-bubbles-related pathologies.