Despite a significant decline over time, intellectual and academic outcomes remained within the average range at 5 years post diagnosis for the majority of patients. Future studies should determine if scores remain within the average range at time points further out from treatment. Patients at heightened risk should be closely monitored and provided with recommendations for appropriate interventions.

To conduct crewed simulation experiments of bioregenerative life support systems on the ground is a critical step for human life support in deep-space exploration. An artificial closed ecosystem named Lunar Palace 1 was built through integrating efficient higher plant cultivation, animal protein production, urine nitrogen recycling, and bioconversion of solid waste. Subsequently, a 105-day, multicrew, closed integrative bioregenerative life support systems experiment in Lunar Palace 1 was carried out from February through May 2014. The results show that environmental conditions as well as the gas balance between O and CO in the system were well maintained during the 105-day experiment. A total of 21 plant species in this system kept a harmonious coexistent relationship, and 20.5% nitrogen recovery from urine, 41% solid waste degradation, and a small amount of insect in situ production were achieved. During the 105-day experiment, oxygen and water were recycled, and 55% of the food was regenerated. Key Words: Bioregenerative life support systems (BLSS)-Space agriculture-Space life support-Waste recycle-Water recycle. Astrobiology 16, 925-936.

Objective Sleep disorders are associated with psychological and physical health, although reports in long‐term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes. Methods Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes. Results Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04‐1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01‐1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09‐2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40‐2.07]), restricted sleep time (PR = 1.35 [1.12‐1.62]), fatigue (PR = 2.11 [1.92‐2.32]), daytime sleepiness (PR = 2.19 [1.71‐2.82]), snoring (PR = 1.85 [1.08‐3.16]), and more sleep medication (PR = 2.86 [2.00‐4.09]) and supplement use (PR = 1.89[1.33‐2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02‐2.08]), fatigue (PR = 1.31 [1.01‐1.72]), and using sleep medications (PR = 2.16 [1.13‐4.12]) were more likely to develop migraines/headaches. Conclusions Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.

Rationale: The relationship between treatment-related impairment of pulmonary function in adult survivors of childhood cancer and subsequent physical function has not been studied. Objectives:In this prospective evaluation of 606 adult survivors of childhood cancer, we sought to determine the risk factors for, as well as the functional impact of, clinically ascertained pulmonary function impairment.Methods: We measured FEV 1 , FVC, total lung capacity (TLC), and single-breath diffusing capacity of the lung for carbon monoxide corrected for hemoglobin (DL COcorr ), expressing the results as percent predicted and lower limit of normal (LLN) values, and we also assessed functional exercise capacity (6-minute-walk distance). Lung radiation exposure was expressed as the estimated percentage of lung tissue that received at least 10 Gy (V10). Associations of clinical and treatment factors with pulmonary function measures were assessed using log-binomial regression to calculate relative risks and 95% confidence intervals. Measurements and Main Results:The participants' median age at evaluation was 34.2 years, and the median elapsed time from diagnosis was 21.9 years. Among the sample population, 50.7% had an FEV 1 percent predicted less than 80%, 47.2% had an FVC percent predicted less than 80%, 31.2% had a TLC percent predicted less than 75%, and 44.6% had DL COcorr percent predicted less than 75%. Also, 49.0% had FEV 1 less than the LLN on the basis of the Global Lung Function Initiative (GLI) criteria, and 45.4% had FVC less than LLN. Obstructive lung defects (FEV 1 /FVC, ,0.7) were found in 0.8%, but none had obstructive lung defects on the basis of the GLI criterion of FEV 1 /FVC less than the LLN. Restrictive lung defects (TLC, ,75%) were found in 31.2% of participants. V10 and elapsed time since diagnosis were associated with abnormal FEV 1 and FVC based on the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 criteria, and with abnormal FEV 1 using the GLI criterion. Age at diagnosis was an additional risk factor for abnormal FVC based on the GLI criteria. Age at diagnosis and V10 were associated with abnormal TLC. Increased body mass index, V10, and elapsed time since diagnosis were risk factors for abnormal DL COcorr . Abnormal pulmonary function tests were associated with decreased 6-minute walk distance.Conclusions: Impaired pulmonary function in adult survivors of childhood cancer is associated with decreased physical function. These patients may benefit from interventions designed to preserve and/or improve pulmonary function.

Background To the authors' knowledge, few studies to date have examined long‐term neurocognitive outcomes in survivors of childhood soft‐tissue sarcoma. Methods A total of 150 survivors (41% of whom were female with a mean current age of 33 years [SD, 8.9 years] and a time since diagnosis of 24 years [SD, 8.7 years]) and 349 community controls (56% of whom were female with a mean current age of 35 years [SD, 10.2 years]) completed comprehensive neuropsychological testing, echocardiography, electrocardiography, pulmonary function tests, endocrine evaluation, and physical examination. Patient‐reported outcomes of health‐related quality of life (HRQOL) and social attainment were collected. Survivors were compared with norms and controls on neurocognitive outcomes using general linear models, and on HRQOL and social attainment using modified Poisson models. The impacts of treatment and chronic health conditions on outcomes were examined using multivariable general linear models (effect size was expressed as unstandardized β estimates that reflected the unit of change from a mean of 0 and an SD of 1) and modified Poisson models (effect size expressed as relative risks). Results Compared with controls and population norms, survivors demonstrated lower performance on measures of verbal reasoning (mean z score, −0.45 [SD, 1.15]; P < .001) mathematics (mean z score, −0.63 [SD, 1.07]; P < .001), and long‐term memory (mean z score, −0.37 [SD, 1.14]; P < .001). Cumulative anthracycline exposure (per 100 mg/m2) was found to be associated with poorer verbal reasoning (β = −0.14 z scores; P = .04), reading (β = −0.09 z score; P = .04), and patient‐reported vitality (relative risk, 1.32; 95% CI, 1.09‐1.59). Neurologic and neurosensory chronic conditions were associated with poorer mathematics (neurologic conditions: β = −0.63 z score [P = 0.02]; and hearing impairment: β = −0.75 z scores [P < 0.01]). Better cognitive performance was associated with higher social attainment. Conclusions Long‐term survivors of soft‐tissue sarcoma are at risk of neurocognitive problems and poor HRQOL associated with anthracycline treatment and chronic health conditions.

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Background The impact of specific treatment modalities on long‐term renal function and blood pressure among adult survivors of Wilms tumor (WT) has not been well documented. Methods Among 40 WT survivors and 35 noncancer controls, we estimated the glomerular filtration rate (eGFR) using the Chronic Kidney Disease‐Epidemiology (CKD‐EPI) equations with and without cystatin C, obtained 24‐hour ambulatory blood pressure readings, and, among survivors only, measured 99mTc diethylenetriamine pentaacetic acid (DTPA) plasma clearance. Survivors were treated with unilateral nephrectomy and nonnephrotoxic chemotherapy. Twenty received whole abdomen radiation therapy (WART) [median –16.5 Gray (Gy)], and 20 received no radiation therapy. Pairwise comparisons between survivors treated with and without WART, and each group to controls were performed using two‐sample t tests. Results Twenty‐six (65%) WT survivors were female, and 33 (83%) were non‐Hispanic white. GFR estimated with creatinine or creatinine + cystatin C was decreased among irradiated survivors compared with controls. No irradiated or unirradiated participant had an eGFR (creatinine + cystatin C) < 60 mL/min/1.73 m2. The prevalence of hypertension was significantly increased among unirradiated (25%) and irradiated survivors (35%) compared with controls (0%). Of the 24‐hour ambulatory blood pressure monitoring parameters evaluated, only mean sleep period diastolic blood pressure load of those who received WART was significantly different from that of controls. Conclusions Chronic kidney disease was infrequent in long‐term survivors of unilateral nonsyndromic WT, whether treated with WART or no radiation. The prevalence of hypertension was increased in both groups compared with controls, emphasizing the need for ongoing monitoring of renal and cardiovascular health.

BackgroundSurvivors of childhood cancer may be at increased risk for treatment-related kidney dysfunction. Although associations with acute kidney toxicity are well described, evidence informing late kidney sequelae is less robust.MethodsTo define the prevalence of and risk factors for impaired kidney function among adult survivors of childhood cancer who had been diagnosed ≥10 years earlier, we evaluated kidney function (eGFR and proteinuria). We abstracted information from medical records about exposure to chemotherapeutic agents, surgery, and radiation treatment and evaluated the latter as the percentage of the total kidney volume treated with ≥5 Gy (V5), ≥10 Gy (V10), ≥15 Gy (V15), and ≥20 Gy (V20). We also used multivariable logistic regression models to assess demographic and clinical factors associated with impaired kidney function and Elastic Net to perform model selection for outcomes of kidney function.ResultsOf the 2753 survivors, 51.3% were men, and 82.5% were non-Hispanic White. Median age at diagnosis was 7.3 years (interquartile range [IQR], 3.3–13.2), and mean age was 31.4 years (IQR, 25.8–37.8) at evaluation. Time from diagnosis was 23.2 years (IQR, 17.6–29.7). Approximately 2.1% had stages 3–5 CKD. Older age at evaluation; grade ≥2 hypertension; increasing cumulative dose of ifosfamide, cisplatin, or carboplatin; treatment ever with a calcineurin inhibitor; and volume of kidney irradiated to ≥5 or ≥10 Gy increased the odds for stages 3–5 CKD. Nephrectomy was significantly associated with stages 3–5 CKD in models for V15 or V20.ConclusionsWe found that 2.1% of our cohort of childhood cancer survivors had stages 3–5 CKD. These data may inform screening guidelines and new protocol development.