Wilderness & Environmental Medicine最新文献

{"title":"High Altitude Headache in Highlanders: A Hallmark Symptom of Chronic Mountain Sickness Related to Excessive Erythrocytosis? A Preliminary Report from the World's Highest City.","authors":"Ivan Hancco Zirena, Alberto Florez Prada, Daniel Enrique Rojas Bolivar, Andrea Marengo, Yanis Micha, Stéphane Doutreleau, Julien V Brugniaux, Samuel Verges, Benoit Champigneulle","doi":"10.1177/10806032251376313","DOIUrl":"https://doi.org/10.1177/10806032251376313","url":null,"abstract":"<p><p>IntroductionHeadache is a hallmark symptom of chronic mountain sickness (CMS), a high altitude disease thought to be induced by excessive erythrocytosis (EE) in highlanders. Nevertheless, headache characteristics related to permanent high altitude residence remain understudied, as does the association between headache occurrence and hemoglobin concentration ([Hb]) in highlanders.MethodsA pilot cross-sectional study was conducted in La Rinconada, Peru (altitude 5100 m), over a 2-y period. During all comers' medical consultations, highlanders with no known history of chronic medical conditions (except EE/CMS) were questioned regarding headache symptoms. Headache characteristics were collected as well as clinical data and [Hb].ResultsHeadache prevalence was 61% (200 of 330 highlanders). Clinical characteristics of headache attacks (ie, location, onset, intensity, quality, and duration) were similar between highlanders with and without EE. In multivariate analysis, headache occurrence was associated with lower oxygen saturation (<i>P</i><0.001), higher body mass index (<i>P</i><0.001), and lower self-reported sleep duration (<i>P</i><0.001) but not with [Hb] or sex.ConclusionsThe absence of a statistically significant association between headache occurrence and [Hb] questions the use of headache as a symptom reflecting EE in CMS highlanders.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251376313"},"PeriodicalIF":1.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to \"Wilderness\".","authors":"","doi":"10.1177/10806032251377974","DOIUrl":"10.1177/10806032251377974","url":null,"abstract":"","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"10806032251377974"},"PeriodicalIF":1.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SPOCUS©: Spaceflight Point-of-Care Ultrasound Training Curricula for Crew Medical Officers.","authors":"Chanel Fischetti, Alaina Brinley Rajagopal, Emily H Frisch, Jon Steller, Adam Pissaris, Katharine Clark, Ariana Nelson, Michael Pohlen","doi":"10.1177/10806032251330504","DOIUrl":"10.1177/10806032251330504","url":null,"abstract":"","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"3S-6S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Space Oncology: A Comprehensive Scoping Review.","authors":"Nafise Niknam, Hossein Akbarialiabad, Mohsen Farjoud Kouhanjani, Lydia Johnson Kolaparambil Varghese, Amy Berrington de González, Matthew Mark Melin, Mohammad Shafie'ei, Seyedeh Maryam Mousavi, Seyed Ali Hosseini, Seyed Reza Taha, Thais Russomano, Dedee F Murrell, Ayman Grada, Sancy A Leachman, Zahra Akbari, Armita Jokar Derisi, Marta Jurga, Ajay Kumar, Saswati Das, Jessica D'Urbano, Gabriella Hakim, Najmeh Sadeghian, Shahram Paydar, Michelle Tarbox, Cameron West, Seyyed Mojtaba Ghorashi, Seyed Hossein Hosseini, Timothy Squire, Christopher G Bunick, Rowena Christiansen","doi":"10.1177/10806032251349442","DOIUrl":"10.1177/10806032251349442","url":null,"abstract":"<p><p>Space exploration exposes astronauts to unique conditions such as microgravity and space radiation, potentially influencing gene expression and triggering carcinogenesis. Paradoxically, these extreme environments could uncover other pro-treatment aspects of cancer biology. Despite numerous reviews addressing these aspects in isolation, a comprehensive synthesis of the effects of space stressors on cancer development is incomplete. This scoping review aims to provide a holistic perspective on the influence of spaceflight and associated stressors-including gravitation (hyper- and microgravity), radiation, and vibration-on the potential for cancer development and altered cellular mechanisms. We adhered to the PRISMA-ScR checklist for our review. A multitiered search strategy was employed in English, starting with a preliminary keyword identification in Google Scholar and PubMed. Subsequently, the main search was conducted across five databases-Cochrane, Embase, PubMed, Scopus, and Web of Science-until 22 February 2024. All included studies were thoroughly assessed by two independent reviewers. Of the 15,553 identified articles, 158 were deemed eligible. The majority (92%) were experimental studies, predominantly cell-based (74.17%). Breast (15.19%), thyroid (13.92%), and hematopoietic (11.40%) cancers were the most frequently examined. Spaceflight stressors could affect different biological systems variably, with microgravity impacting spatial growth and metastasis, and cosmic radiation exerting both tumor-suppressive and mutagenic effects. Our findings highlight the need for large-scale, prolonged analog studies mimicking space conditions to enhance mission safety and shed light on the nuanced effects of space stressors on cancer. Additionally, further extensive studies need to be performed in the true weightlessness of spaceflight, both animal-based and on human tissue (cell cultures and potentially whole perfusion organ models), in addition to crew pre/intra/post-flight long-duration evaluations. Furthermore, this unique research avenue may reveal cancer cell sensitivities to these stressors, opening new pathways for innovative therapeutic strategies in cancer treatment.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"148S-171S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Validation of a Spatial Tracking Configuration for Augmented and Co-Localized Medical Assistance Under Gravity Variations in Parabolic Flights.","authors":"Séamus Thierry, Ronan Querrec, Cécile Isabelle Bernard, Sébastien Kubicki, Elisabetta Bevacqua","doi":"10.1177/10806032241308457","DOIUrl":"10.1177/10806032241308457","url":null,"abstract":"<p><p>IntroductionAugmented reality is a promising technology for enhancing remote medical assistance. It assists users by directly projecting the relevant virtual assistance in the real world at the right moment and at the right location. This modality is called colocalization but has not been validated in parabolic flights. Our hypothesis was that this modality is technically feasible in weightlessness and is superior to a paper checklist in assisting a caregiver during a simulated medical emergency.MethodsDuring parabolic flight campaigns, we conducted an abdominal pain simulation scenario and sought to compare procedural assistances. Participants performed a basic medical examination using either classic cognitive aids (such as a paper checklist) or an augmented-reality device projecting visual co-localized (situated or embedded) assistance.ResultsGravity variations induced technical difficulties in the nominal functioning of augmented-reality headsets due to the native accelerometers in these devices. Clinical data were not interpretable due to small sample size secondary to the technical difficulties encountered. Finally, an efficient and stable spatial tracking configuration was found during the last flight, offering future research perspectives.ConclusionsOur study validated the first achievement of a stable co-localized assistance under gravity variation. The augmented-reality headset required an external tracking system based on surrounding infrared cameras and an in-flight calibration to recreate the virtual environment (spatial mapping) independently of gravity conditions. Further studies are needed to clinically validate the potential benefits of co-localized augmented reality for space medicine.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"89S-94S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Large Language Models on Aerospace Medicine Principles.","authors":"Kyle D Anderson, Cole A Davis, Shawn M Pickett, Michael S Pohlen","doi":"10.1177/10806032251330628","DOIUrl":"10.1177/10806032251330628","url":null,"abstract":"<p><p>IntroductionLarge language models (LLMs) hold immense potential to serve as clinical decision-support tools for Earth-independent medical operations. However, the generation of incorrect information may be misleading or even harmful when applied to care in this setting.MethodTo better understand this risk, this work tested two publicly available LLMs, ChatGPT-4 and Google Gemini Advanced (1.0 Ultra), as well as a custom Retrieval-Augmented Generation (RAG) LLM on factual knowledge and clinical reasoning in accordance with published material in aerospace medicine. We also evaluated the consistency of the two public LLMs when answering self-generated board-style questions.ResultsWhen queried with 857 free-response questions from <i>Aerospace Medicine Boards Questions and Answers</i>, ChatGPT-4 had a mean reader score from 4.23 to 5.00 (Likert scale of 1-5) across chapters, whereas Gemini Advanced and the RAG LLM scored 3.30 to 4.91 and 4.69 to 5.00, respectively. When queried with 20 multiple-choice aerospace medicine board questions provided by the American College of Preventive Medicine, ChatGPT-4 and Gemini Advanced responded correctly 70% and 55% of the time, respectively, while the RAG LLM answered 85% correctly. Despite this quantitative measure of high performance, the LLMs tested still exhibited gaps in factual knowledge that potentially could be harmful, a degree of clinical reasoning that may not pass the aerospace medicine board exam, and some inconsistency when answering self-generated questions.ConclusionThere is considerable promise for LLM use in autonomous medical operations in spaceflight given the anticipated continued rapid pace of development, including advancements in model training, data quality, and fine-tuning methods.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"44S-52S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Forest to Intensive Care Unit: Managing Severe Complications of <i>Bothrops bilineatus</i> Envenomation.","authors":"Percy Josué Vásquez Paredes","doi":"10.1177/10806032251337667","DOIUrl":"10.1177/10806032251337667","url":null,"abstract":"<p><p>Snakebites are a critical health issue in remote regions of the Amazon basin. I report a case of <i>Bothrops bilineatus</i> envenomation in a 29-y-old biologist conducting fieldwork in Parque Nacional del Manu, Peru. Following significant logistic delays-including an initial suboptimal antivenom dose and limited access to additional vials-the patient developed progressive edema, necrosis, coagulopathy, and signs of compartment syndrome. Management involved 2 partial doses of antivenom (1 at 1600 and the other at 2100), a subsequent transfer to a tertiary care center, antibiotics, analgesia, and eventually surgical intervention, including debridement and partial amputation. Although the patient received some treatment on the day of the bite, fragmented antivenom dosing and delayed transport likely contributed to worse local injury. This case highlights the importance of prompt, complete antivenom therapy, effective logistics, advanced diagnostic resources, and comprehensive rehabilitation in resource-limited settings.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"384-388"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Treatment of Misdiagnosed Mushroom Poisoning: Do Organic Anion Transporting Polypeptide Substrates Matter?","authors":"Zanina Pereska, Dushan Petkovski, Valentina Arsova","doi":"10.1177/10806032251338278","DOIUrl":"10.1177/10806032251338278","url":null,"abstract":"<p><p>A middle-aged male was admitted to the clinic 4 d after ingestion of wild mushrooms. His medical history included type 2 diabetes, hypertension, and coronary bypass. Initially misdiagnosed with infectious enterocolitis, the patient was treated as an outpatient with intravenous fluids while continuing his chronic medications (i.e., statins, beta-blockers, and aspirin). On Day 3, blood tests confirmed hepatorenal syndrome, and the patient was transferred to the clinic. On admission, he was alert with a blood pressure of 100/60 mmHg, heart rate of 100 beats/min, sinus rhythm, right upper quadrant pain, and jaundice. Lab results showed thrombocytopenia, severe hepatorenal dysfunction, prolonged prothrombin time (29.3 s), and a Model for End-Stage Liver Disease score of 30. For 3 d, the patient was simultaneously exposed to amatoxin and chronic cardiovascular medications, both substrates for the same transporters. Treatment was adjusted to intravenous acetylcysteine (double regimen), oral silymarin (600 mg/d), and supportive therapy. The patient recovered within 10 d, with transaminases normalizing after 3 mo. Understanding transporter-related drug interactions and patient-specific metabolic differences may improve future management strategies and patient survival. Further research is needed on alternative inhibitors of amatoxin uptake and competitive organic anion-transporting polypeptide substrates to expand treatment options.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"389-396"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Assistance in Point-of-Care Ultrasound Skill Retention for Novice Users in Space Medicine Scenarios.","authors":"Victoria S Hurd, Michael Del Valle, Victoria G Kravets, Arian L Anderson, Nhu-Nguyen Le, John L Kendall, Allison P Hayman, Matthew Riscinti","doi":"10.1177/10806032241304441","DOIUrl":"10.1177/10806032241304441","url":null,"abstract":"<p><p>IntroductionAs humanity progresses further into space, astronauts must be increasingly independent from mission control, especially in high-consequence medical scenarios. The high-utility and low-mass nature of point-of-care ultrasound (POCUS) makes this imaging modality ideal for spaceflight mission deployment. However, POCUS operator skill degrades over time, presenting an operational barrier to continuous, effective use. Further, formal medical education and POCUS-specific training are not requirements for astronaut candidates, potentially exacerbating skill degradation. Artificial intelligence (AI) assistance may mitigate skill decay, enabling long-term POCUS skill retention. To characterize the utility of this paradigm in space, we evaluated AI assistance effects on POCUS skill retention in subject pools with astronaut-mimicking educational demographics.MethodsThis prospective cohort study included 30 participants, evenly split into unassisted and AI-assisted cohorts. After undergoing 1 training session, participants collected 5 renal images, bladder images, and bladder volume estimations and completed usability and self-confidence surveys immediately, 2 wk, and 8 wk after initial training. Primary outcomes included target organ capture rates, image quality, bladder volume variability, perceived self-confidence, and perceived system usability.ResultsAI assistance minimized bladder volume variability aggregated over time (<i>P</i>=0.004) and 2 wk after training (<i>P</i>=0.009) and mitigated perceived system usability degradation with time (<i>P</i>=0.04). No trends were found in organ-capture abilities, image quality, or self-confidence.ConclusionPOCUS AI decreased bladder volume variability and mitigated system usability decrement. We recommend increasing study duration or reducing the number of data collections in future study designs and the fieldwide adoption of objective ultrasound image-quality metrics.</p>","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"24S-33S"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10, 14, 19 Essentials?","authors":"Thomas G DeLoughery, Emma P DeLoughery","doi":"10.1177/10806032251342116","DOIUrl":"10.1177/10806032251342116","url":null,"abstract":"","PeriodicalId":49360,"journal":{"name":"Wilderness & Environmental Medicine","volume":" ","pages":"445-446"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}