Total Body Water Dynamics Estimated with Bioelectrical Impedance Vector Analysis and B-Type Natriuretic Peptide After Exposure to Hypobaric Hypoxia: A Field Study

Strapazzon, Giacomo, Matiram Pun, Tomas Dal Cappello, Emily Procter, Piergiorgio Lochner, Hermann Brugger, and Antonio Piccoli. Total body water dynamics estimated with bioelectrical impedance vector analysis and B-type natriuretic peptide after exposure to hypobaric hypoxia: A field study. High Alt Med Biol. 18:384-391, 2017.-The relationship between total body water (TBW) dynamics and N-terminal pro-B-type natriuretic peptide (NT-proBNP), a stable metabolite of B-type natriuretic peptide, during acute high altitude exposure is not known. To investigate this, we transported 19 healthy lowland subjects to 3830 m with a helicopter after baseline measurements (262 m). The physiological measurements and clinical assessments were taken at 9, 24, 48, and 72 hours and on the eighth day of altitude exposure. A bioelectrical impedance vector analysis (BIVA) from height corrected Resistance-Reactance (R-Xc graph) was used to estimate TBW status. NT-proBNP was measured from venous blood samples. The changes in impedance vector were lengthened at 9 (p = 0.011), 48 (p = 0.033), and 72 hours (p = 0.015) indicating dehydration compared to baseline. However, there was no dehydration at 24 hours (p > 0.05) from the baseline and the subjects trended to get euhydrated from 9 to 24 hours (p = 0.097). The maximum percent changes in vector length from the baseline were within 10%-15%. There was a significant increase of natural logarithm (ln)(NT-proBNP) after ascent with a peak at 24 hours, although similarly to BIVA values, ln(NT-proBNP) returned to baseline after 8 days of altitude exposure. The changes in impedance vector length were not correlated with the changes in ln(NT-proBNP) (r = -0.101, p = 0.656). In conclusion, the dehydration at high altitude as reflected by 10%-15% vector lengthening falls within "appropriate dehydration" in healthy lowland subjects. NT-proBNP does not simply reflect the TBW status during acute high altitude exposure and needs further investigation.

Oxygen saturation increases over the course of the night in mountaineers at high altitude (3050-6354 m)

BACKGROUND

Blood oxygen saturation (SpO 2 ) is frequently measured to determine acclimatization status in high-altitude travellers. However, little is known about nocturnal time course of SpO 2 (SpO 2N ), but alterations in SpO 2N might be practically relevant as well. To this end, we describe the time-course of SpO 2N in mountaineers at high altitude.

METHODS

SpO 2N was continuously measured in ten male mountaineers during a three-week expedition in Peru (3,050-6,354m). Average SpO 2N of the first (SpO 2N1 ) and second half (SpO 2N2 ) of an individual's sleep duration was calculated from 2h intervals of uninterrupted sleep. Heart rate oscillations and sleep dairies were used to exclude periods of wakefulness. SpO 2 was also measured at rest in the morning.

RESULTS

SpO 2N significantly increased from SpO 2N1 to SpO 2N2 . The magnitude of this increase (ΔSpO 2 ) was reduced with time spent at altitude. On night 1 (3,050m) SpO 2 increased from 83.4% (N1) to 86.3% (N2). At the same location on night 21, SpO 2 increased from 88.3% to 90.1%, which is a relative change of 4.7% and 2.0%, respectively. This pattern of increase in SpO 2N was perturbed when individual acclimatization was poor or altitude was extreme (5630m). SpO 2N was significantly lower than SpO 2 at rest in the morning.

CONCLUSIONS

This study is the first to demonstrate an increase of SpO 2 during the night in mountaineers at high altitude (3,050-6,354m) with high consistency between and within subjects. The magnitude of ΔSpO 2N decreased as acclimatization improved, suggesting that these changes in ΔSpO 2 between nights might be a valuable indicator of individual acclimatization. In addition, the failure of any increase in SpO 2N during the night might indicate insufficient acclimatization. Even though underlying mechanisms for the nocturnal increase remain unclear, the timing of SpO 2N measurement is obviously of utmost importance for its interpretation. Finally our study illustrates the detailed effects of ventilatory acclimatization over several weeks.

Biometeorological Assessment of Mortality Related to Extreme Temperatures in Helsinki Region, Finland, 1972-2014

Climate change is expected to increase heat-related and decrease cold-related mortality. The extent of acclimatization of the population to gradually-changing thermal conditions is not well understood. We aimed to define the relationship between mortality and temperature extremes in different age groups in the Helsinki-Uusimaa hospital district in Southern Finland, and changes in sensitivity of the population to temperature extremes over the period of 1972-2014. Time series of mortality were made stationary with a method that utilizes 365-day Gaussian smoothing, removes trends and seasonality, and gives relative mortality as the result. We used generalized additive models to examine the association of relative mortality to physiologically equivalent temperature (PET) and to air temperature in the 43-year study period and in two 21-year long sub-periods (1972-1992 and 1994-2014). We calculated the mean values of relative mortality in percentile-based categories of thermal indices. Relative mortality increases more in the hot than in the cold tail of the thermal distribution. The increase is strongest among those aged 75 years and older, but is somewhat elevated even among those younger than 65 years. Above the 99th percentile of the PET distribution, the all-aged relative mortality decreased in time from 18.3 to 8.6%. Among those ≥75 years old, the decrease in relative mortality between the sub-periods were found to be above the 90th percentile. The dependence of relative mortality on cold extremes was negligible, except among those ≥75 years old, in the latter period. Thus, heat-related mortality is also remarkable in Finland, but the sensitivity to heat stress has decreased over the decades.

Short-term arrival strategies for endurance exercise performance at moderate altitude

For sea level-based endurance athletes who compete at moderate and high altitudes, many are not logistically able to arrive at altitude weeks before the event to fully acclimatize. For those who can only arrive at altitude the night before competition, we asked if there is a physiological and performance advantage in reducing altitude exposure time to 2 h before competition. On three separate visits, 10 cyclists completed overnight laboratory exposures of: 1) a 14-h exposure to normobaric hypoxia (16.2% O₂, simulating 2,500 m; 14H), 2) a 12-h exposure to normoxia, then a 2-h hypoxic exposure (2H), and 3) a 14-h exposure to normoxia (CON). Immediately following each exposure, subjects completed a 20-km cycle ergometry time trial in normoxia (CON) or 16.2% O₂ (14H and 2H). Measures of plasma volume changes, sleep quality, ventilatory acclimatization, perceived exertion, oxygen uptake, and 20-km time were collected. No significant differences were observed in performance measures or perceived exertion between hypoxic trials. Plasma volume loss was significantly greater during 14H than 2H and CON. No differences in ventilatory acclimatization or sleep quality were observed between trials. Although some divergent 20-km performance responses were observed between 14H and 2H, they were not explained by the physiological measures completed. The data suggest that endurance athletes who are logistically restricted from arriving at altitude more than the evening before competition would not gain an advantage by delaying their arrival until a few hours before the competition, although unique individual responses may ultimately influence optimal arrival strategy.NEW & NOTEWORTHY For athletes who cannot arrive at altitude multiple days before an endurance competition to properly acclimatize, this study asked if shortening hypoxic exposure time to 2 h before a competition was more advantageous than arrival at altitude the evening before competition. Our data suggest that athletes who cannot arrive at altitude with adequate time for complete acclimatization can choose the short-term arrival strategy that best fits with the logistics of their travel.

A Comparative Study on Hearing Aid Benefits of Digital Hearing Aid Use (BTE) from Six Months to Two Years

Introduction  For many reasons, it is important for audiologists and consumers to document improvement and benefit from amplification device at various stages of uses of amplification device. Professional are also interested to see the impact of amplification device on the consumer's auditory performance at different stages i.e. immediately after fitting and over several months of use.

Objective  The objective of the study was to measure the hearing aid benefit following 6 months – 1-year usage, 1 year – 1.5 yeaŕs usage, and 1.5 yeaŕs – 2 years' usage.

Methods  A total of 45 subjects participated in the study and were divided equally in three groups: hearing aid users from 6 months to 1 year, 1 year to 1.5 year, and 1.5 year to two years. All subjects responded to the Hearing Aid Benefit Questionnaire (63 questions), which assesses six domains of listening skills.

Result  Results showed the mean scores obtained were higher for all domains in the aided condition, as compared with unaided condition for all groups. Results also showed a significant improvement in the overall score between first-time users with hearing aid experience of six months to one year and hearing aid users using hearing aids for a period between 1.5 and 2 years.

Conclusion  It is possible to conclude that measuring the hearing aid benefit with the self-assessment questionnaires will assist the clinicians in making judgments about the areas in which a patient is experiencing more difficulty in everyday listening environment and in revising the possible technologies.

Heat acclimation has a protective effect on the central but not peripheral nervous system

This study aimed to clarify the pathway mediating hyperthermia-induced alterations in neural drive transmission and determine if heat acclimation protects voluntary muscle activation and cognitive function in hyperthermic humans. Electrically evoked potentials (H reflex and M wave), executive function (special planning and working memory), and maximal voluntary isometric contractions (120 s) were assessed in 14 participants in control conditions [CON, 24°C, 40% relative humidity (RH)] and in a hyperthermic state (HYP, 44-50°C, 50% RH) on consecutive days in a counterbalanced order. Thereafter, participants were passively heat acclimated for 11 days (1 h per day, 48-50°C, 50% RH) before repeating the initial assessments. Heat acclimation decreased rectal temperature in CON (-0.2°C, P < 0.05), but participants were maintained at ~39°C in HYP. Heat acclimation increased the time required to reach 39°C (+9 min), along with sweat rate (+0.7 l/h), and serum extracellular expression of heat shock protein 72 (eHSP72; +20%) in HYP (P < 0.05). M-wave and H-reflex amplitudes were lower in HYP than CON (P < 0.05) and were not protected by heat acclimation. Nerve conduction velocity was faster in HYP than CON (P < 0.05) without being influenced by heat acclimation. These results suggest that peripheral neural drive transmission in the hyperthermic state is primarily affected by axonal conduction velocity rather than synaptic failure. Executive function, voluntary activation, and the ability to sustain torque were impaired in HYP (P < 0.05). However, despite no perceptual changes (P > 0.05), heat acclimation restored executive function, while protecting the ability to sustain voluntary activation and torque production during a prolonged contraction in hyperthermia (P < 0.05). Ultimately, heat acclimation induces beneficial central but not peripheral neural adaptations.NEW & NOTEWORTHY Heat acclimation restores planning accuracy and working memory in hyperthermic humans, together with the supraspinal capacity to sustain motor drive during a sustained maximal voluntary contraction. Electrically evoked potential data (M wave, H reflex) indicate that heat acclimation does not protect against hyperthermia-induced impairments in peripheral neural drive transmission. Heat acclimation induces beneficial central but not peripheral neural adaptations.

Long-Term Intermittent Exposure to High Altitude Elevates Asymmetric Dimethylarginine in First Exposed Young Adults

Lüneburg, Nicole, Patricia Siques, Julio Brito, Juan José De La Cruz, Fabiola León-Velarde, Juliane Hannemann, Cristian Ibanez, and Rainer Böger. Long-term intermittent exposure to high altitude elevates asymmetric dimethylarginine in first exposed young adults. High Alt Med Biol. 18:226–233, 2017.—Hypoxia-induced dysregulation of pulmonary and cerebral circulation may be related to an impaired nitric oxide (NO) pathway. We investigated the effect of chronic intermittent hypobaric hypoxia (CIH) on metabolites of the NO pathway. We measured asymmetric and symmetric dimethylarginine (ADMA and SDMA) and monomethyl-L-arginine (L-NMMA) and assessed their associations with acclimatization in male draftees (n = 72) undergoing CIH shifts at altitude (3550 m) during 3 months. Sixteen Andean natives living at altitude (3675 m) (chronic hypobaric hypoxia [CH]) were included for comparison. In CIH, ADMA and L-NMMA plasma concentrations increased from 1.14 ± 0.04 to 1.95 ± 0.09 μmol/L (mean ± SE) and from 0.22 ± 0.07 to 0.39 ± 0.03 μmol/L, respectively, (p < 0.001 for both) after 3 months, whereas SDMA did not change. The concentrations of ADMA and L-NMMA were higher in CH (3.48 ± 0.07, 0.53 ± 0.08 μmol/L; p < 0.001) as compared with CIH. In both CIH and CH, ADMA correlated with hematocrit (r² = 0.07, p < 0.05; r² = 0.26; p < 0.01). In CIH, an association of ADMA levels with poor acclimatization status was observed. We conclude that the endogenous NO synthase inhibitors, ADMA and L-NMMA, are elevated in hypoxia. This may contribute to impaired NO production at altitude and may also be predictive of altitude-associated health impairment.

Acclimatization of the systemic microcirculation to alveolar hypoxia is mediated by an iNOS-dependent increase in nitric oxide availability

Rats breathing 10% O₂ show a rapid and widespread systemic microvascular inflammation that results from nitric oxide (NO) depletion secondary to increased reactive O₂ species (ROS) generation. The inflammation eventually resolves, and the microcirculation becomes resistant to more severe hypoxia. These experiments were directed to determine the mechanisms underlying this microvascular acclimatization process. Intravital microscopy of the mesentery showed that after 3 wk of hypoxia (barometric pressure ~380 Torr; partial pressure of inspired O₂ ~68-70 Torr), rats showed no evidence of inflammation; however, treatment with the inducible NO synthase (iNOS) inhibitor L-N⁶-(1-iminoethyl) lysine dihydrochloride led to ROS generation, leukocyte-endothelial adherence and emigration, and increased vascular permeability. Mast cells harvested from normoxic rats underwent degranulation when exposed in vitro to monocyte chemoattractant protein-1 (MCP-1), the proximate mediator of mast cell degranulation in acute hypoxia. Mast cell degranulation by MCP-1 was prevented by the NO donor spermine-NONOate. MCP-1 did not induce degranulation of mast cells harvested from 6-day hypoxic rats; however, pretreatment with either the general NOS inhibitor L-NG-monomethyl arginine citrate or the selective iNOS inhibitor N-[3-(aminomethyl) benzyl] acetamidine restored the effect of MCP-1. iNOS was demonstrated in mast cells and alveolar macrophages of acclimatized rats. Nitrate + nitrite plasma levels decreased significantly in acute hypoxia and were restored after 6 days of acclimatization. The results support the hypothesis that the microvascular acclimatization to hypoxia results from the restoration of the ROS/NO balance mediated by iNOS expression at key sites in the inflammatory cascade.NEW & NOTEWORTHY The study shows that the systemic inflammation of acute hypoxia resolves via an inducible nitric oxide (NO) synthase-induced restoration of the reactive O₂ species/NO balance in the systemic microcirculation. It is proposed that the acute systemic inflammation may represent the first step of the microvascular acclimatization process.

VESTPD as a measure of ventilatory acclimatization to hypobaric hypoxia

This study compared the ventilation response to an incremental ergometer exercise at two altitudes: 633 mmHg (resident altitude = 1,600 m) and following acute decompression to 455 mmHg (≈4,350 m altitude) in eight male cyclists and runners. At 455 mmHg, the V_ESTPD at RER <1.0 was significantly lower and the V_EBTPS was higher because of higher breathing frequency; at VO₂max, both V_ESTPD and V_EBTPS were not significantly different. As percent of VO₂max, the V_EBTPS was nearly identical and V_ESTPD was 30% lower throughout the exercise at 455 mmHg. The lower V_ESTPD at lower pressure differs from two classical studies of acclimatized subjects (Silver Hut and OEII), where V_ESTPD at submaximal workloads was maintained or increased above that at sea level. The lower V_ESTPD at 455 mmHg in unacclimatized subjects at submaximal workloads results from acute respiratory alkalosis due to the initial fall in HbO₂ (≈0.17 pHa units), reduction in PACO₂ (≈5 mmHg) and higher PAO₂ throughout the exercise, which are partially pre-established during acclimatization. Regression equations from these studies predict V_ESTPD from VO₂ and P_B in unacclimatized and acclimatized subjects. The attainment of ventilatory acclimatization to altitude can be estimated from the measured vs. predicted difference in V_ESTPD at low workloads after arrival at altitude.

Physiological Adjustments and Circulating MicroRNA Reprogramming Are Involved in Early Acclimatization to High Altitude in Chinese Han Males

Background: Altitude acclimatization is a physiological process that restores oxygen delivery to the tissues and promotes oxygen use under high altitude hypoxia. High altitude sickness occurs in individuals without acclimatization. Unraveling the molecular underpinnings of altitude acclimatization could help understand the beneficial body responses to high altitude hypoxia as well as the altered biological events in un-acclimatized individuals. This study assessed physiological adjustments and circulating microRNA (cmiRNA) profiles in individuals exposed to high altitude, aiming to explore altitude acclimatization in humans. Methods: Ninety volunteers were enrolled in this study. Among them, 22 individuals provided samples for microRNA arrays; 68 additional individuals constituted the validation set. Un-acclimatized individuals were identified by the Lake Louise Scoring System. Thirty-three phenotypes were recorded pre- and post-exposure to high altitude, including stress hormones, lipid profiles, hematological indices, myocardial enzyme spectrum, and liver and kidney function related enzymes. CmiRNA expression profiles were assessed using miRCURYTM LNA Array (v.18.0) screening, with data validated by quantitative reverse-transcription polymerase chain reaction (qRT-PCR). Then, associations of plasma microRNA expression with physiological adjustments were evaluated. The biological relevance of the main differentially expressed cmiRNAs was explored by bioinformatics prediction. Results: Nineteen of the 33 phenotypes were significantly altered during early altitude acclimatization, including hematological indices, lipid profiles, and stress hormones; meanwhile, 86 cmiRNAs (79 up-regulated and 7 down-regulated) showed differential expression with statistical significance. Among them, 32 and 25 microRNAs were strongly correlated with low-density lipoprotein-cholesterol and total cholesterol elevations, respectively. In addition, 22 microRNAs were closely correlated with cortisol increase. In un-acclimatized individuals, 55 cmiRNAs were up-regulated and 36 down-regulated, compared with acclimatized individuals. The HIF signaling pathway was suppressed in un-acclimatized individuals. Conclusion: Physiological adjustments, including the hematological system, stress hormones, and lipid molecules contributed to early altitude acclimatization, and showed strong correlations with cmiRNA reprogramming. Moreover, acclimatized and un-acclimatized individuals showed different cmiRNA profile. Suppression of the HIF-1 signaling pathway by microRNA regulation may play a key role in the pathogenesis of un-acclimatization with high altitude hypoxia.

Individual Differences in the Phenotypic Flexibility of Basal Metabolic Rate in Siberian Hamsters Are Consistent on Short- and Long-Term Timescales

Basal metabolic rate (BMR) correlates with the cost of life in endothermic animals. It usually differs consistently among individuals in a population, but it may be adjusted in response to predictable or unpredictable changes in the environment. The phenotypic flexibility of BMR is considered an adaptation to living in a stochastic environment; however, whether it is also repeatable it is still unexplored. Assuming that variations in phenotypic flexibility are evolutionarily important, we hypothesized that they are consistently different among individuals. We predicted that not only BMR but also its flexibility in response to changes in ambient temperature (T_a) are repeatable on short- and long-term timescales. To examine this, we acclimated Siberian hamsters (Phodopus sungorus) for 100 d to winterlike and then to summerlike conditions, and after each acclimation we exposed them interchangeably to 10° and 28°C for 14 d. The difference in BMR measured after each exposure defined an individual's phenotypic flexibility (ΔBMR). BMR was repeatable within and among seasons. It was also flexible in both seasons, but in winter this flexibility was lower in individuals responding to seasonal changes than in nonresponding ones. When we accounted for individual responsiveness, the repeatability of ΔBMR was significant in winter (τ = 0.48, P = 0.01) and in summer (τ = 0.55, P = 0.005). Finally, the flexibility of BMR in response to changes in T_a was also repeatable on a long-term timescale, that is, among seasons (τ = 0.31, P = 0.008). Our results indicate the evolutionary importance of the phenotypic flexibility of energy metabolism and suggest that it may be subject to selection.

Effect of Permissive Dehydration on Induction and Decay of Heat Acclimation, and Temperate Exercise Performance

Purpose: It has been suggested that dehydration is an independent stimulus for heat acclimation (HA), possibly through influencing fluid-regulation mechanisms and increasing plasma volume (PV) expansion. There is also some evidence that HA may be ergogenic in temperate conditions and that this may be linked to PV expansion. We investigated: (i) the influence of dehydration on the time-course of acquisition and decay of HA; (ii) whether dehydration augmented any ergogenic benefits in temperate conditions, particularly those related to PV expansion.

Methods: Eight males [VO_2max: 56.9(7.2) mL·kg⁻¹·min⁻¹] undertook two HA programmes (balanced cross-over design), once drinking to maintain euhydration (HA_Eu) and once with restricted fluid-intake (HA_De). Days 1, 6, 11, and 18 were 60 min exercise-heat stress tests [HST (40°C; 50% RH)], days 2–5 and 7–10 were 90 min, isothermal-strain (T_re ~ 38.5°C), exercise-heat sessions. Performance parameters [VO_2max, lactate threshold, efficiency, peak power output (PPO)] were determined pre and post HA by graded exercise test (22°C; 55%RH).

Results: During isothermal-strain sessions hypohydration was achieved in HA_De and euhydration maintained in HA_Eu [average body mass loss −2.71(0.82)% vs. −0.56(0.73)%, P < 0.001], but aldosterone concentration, power output, and cardiovascular strain were unaffected by dehydration. HA was evident on day 6 {reduced end-exercise T_re [−0.30(0.27)°C] and exercise heart rate [−12(15) beats.min⁻¹], increased PV [+7.2(6.4)%] and sweat-loss [+0.25(0.22) L.h⁻¹], P < 0.05} with some further adaptations on day 11 {further reduced end-exercise T_re [−0.25(0.19)°C] and exercise heart rate [−3(9) beats.min⁻¹], P < 0.05}. These adaptations were not notably affected by dehydration and were generally maintained 7-days post HA. Performance parameters were unchanged, apart from increased PPO (+16(20) W, irrespective of condition).

Conclusions: When thermal-strain is matched, permissive dehydration which induces a mild, transient, hypohydration does not affect the acquisition and decay of HA, or endurance performance parameters. Irrespective of hydration, trained individuals require >5 days to optimize HA.

Ocean acidification influences host DNA methylation and phenotypic plasticity in environmentally susceptible corals

As climate change challenges organismal fitness by creating a phenotype-environment mismatch, phenotypic plasticity generated by epigenetic mechanisms (e.g., DNA methylation) can provide a temporal buffer for genetic adaptation. Epigenetic mechanisms may be crucial for sessile benthic marine organisms, such as reef-building corals, where ocean acidification (OA) and warming reflect in strong negative responses. We tested the potential for scleractinian corals to exhibit phenotypic plasticity associated with a change in DNA methylation in response to OA. Clonal coral fragments of the environmentally sensitive Pocillopora damicornis and more environmentally robust Montipora capitata were exposed to fluctuating ambient pH (7.9-7.65) and low pH (7.6-7.35) conditions in common garden tanks for ~6 weeks. M. capitata responded weakly, or acclimated more quickly, to OA, with no difference in calcification, minimal separation of metabolomic profiles, and no change in DNA methylation between treatments. Conversely, P. damicornis exhibited diminished calcification at low pH, stronger separation in metabolomic profiles, and responsiveness of DNA methylation to treatment. Our data suggest corals differ in their temporal dynamics and sensitivity for environmentally triggered real-time epigenetic reprogramming. The generation of potentially heritable plasticity via environmental induction of DNA methylation provides an avenue for assisted evolution applications in corals under rapid climate change.

Are Experienced Hearing Aid Users Faster at Grasping the Meaning of a Sentence Than Inexperienced Users? An Eye-Tracking Study

This study assessed the effects of hearing aid (HA) experience on how quickly a participant can grasp the meaning of an acoustic sentence-in-noise stimulus presented together with two similar pictures that either correctly (target) or incorrectly (competitor) depict the meaning conveyed by the sentence. Using an eye tracker, the time taken by the participant to start fixating the target (the processing time) was measured for two levels of linguistic complexity (low vs. high) and three HA conditions: clinical linear amplification (National Acoustic Laboratories-Revised), single-microphone noise reduction with National Acoustic Laboratories-Revised, and linear amplification ensuring a sensation level of ≥ 15 dB up to at least 4 kHz for the speech material used here. Timed button presses to the target stimuli after the end of the sentences (offline reaction times) were also collected. Groups of experienced (eHA) and inexperienced (iHA) HA users matched in terms of age, hearing loss, and working memory capacity took part (N = 15 each). For the offline reaction times, no effects were found. In contrast, processing times increased with linguistic complexity. Furthermore, for all HA conditions, processing times were longer (poorer) for the iHA group than for the eHA group, despite comparable speech recognition performance. Taken together, these results indicate that processing times are more sensitive to speech processing-related factors than offline reaction times. Furthermore, they support the idea that HA experience positively impacts the ability to process noisy speech quickly, irrespective of the precise gain characteristics.

Drug Use and Misuse in the Mountains: A UIAA MedCom Consensus Guide for Medical Professionals

Donegani, Enrico, Peter Paal, Thomas Küpper, Urs Hefti, Buddha Basnyat, Anna Carceller, Pierre Bouzat, Rianne van der Spek, and David Hillebrandt. Drug use and misuse in the mountains: a UIAA MedCom consensus guide for medical professionals. High Alt Med Biol. 17:157-184, 2016.-Aims: The aim of this review is to inform mountaineers about drugs commonly used in mountains. For many years, drugs have been used to enhance performance in mountaineering. It is the UIAA (International Climbing and Mountaineering Federation-Union International des Associations d'Alpinisme) Medcom's duty to protect mountaineers from possible harm caused by uninformed drug use. The UIAA Medcom assessed relevant articles in scientific literature and peer-reviewed studies, trials, observational studies, and case series to provide information for physicians on drugs commonly used in the mountain environment. Recommendations were graded according to criteria set by the American College of Chest Physicians.

RESULTS

Prophylactic, therapeutic, and recreational uses of drugs relevant to mountaineering are presented with an assessment of their risks and benefits.

CONCLUSIONS

If using drugs not regulated by the World Anti-Doping Agency (WADA), individuals have to determine their own personal standards for enjoyment, challenge, acceptable risk, and ethics. No system of drug testing could ever, or should ever, be policed for recreational climbers. Sponsored climbers or those who climb for status need to carefully consider both the medical and ethical implications if using drugs to aid performance. In some countries (e.g., Switzerland and Germany), administrative systems for mountaineering or medication control dictate a specific stance, but for most recreational mountaineers, any rules would be unenforceable and have to be a personal decision, but should take into account the current best evidence for risk, benefit, and sporting ethics.

Evidence for and Against Genetic Predispositions to Acute and Chronic Altitude Illnesses

MacInnis, Martin J., and Michael S. Koehle. Evidence for and against genetic predispositions to acute and chronic altitude illnesses. High Alt Med Biol. 17:281-293, 2016.-Humans exhibit marked variation in their responses to hypoxia, with susceptibility to acute and chronic altitude illnesses being a prominent and medically important example. Many have hypothesized that genetic differences are the cause of these variable responses to hypoxia; however, until recently, these hypotheses were based primarily on small (and sometimes anecdotal) reports pertaining to apparent differences in altitude illness susceptibility between populations, the notion that a history of altitude illness is indicative of subsequent risk, the heritability of hypoxia-related traits, and candidate gene association studies. In the past 5 years, the use of genomic techniques has helped bolster the claim that susceptibility to some altitude illnesses is likely the result of genetic variation. For each of the major altitude illnesses, we summarize and evaluate the evidence stemming from three important characteristics of a genetic trait: (1) individual susceptibility and repeatability across assessments, (2) biogeographical differences and familial aggregation, and (3) association(s) with genetic variants. Evidence to support a genetic basis for susceptibilities to acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) is limited, owing partially to the subjective and unclear phenotype of AMS and the rarity and severity of HACE. In contrast, recent genomic studies have identified genes that influence susceptibility to high-altitude pulmonary edema, chronic mountain sickness, and high-altitude pulmonary hypertension. The collection of more individual, familial, and biogeographical susceptibility data should improve our understanding of the extent to which genetic variation contributes to altitude illness susceptibility, and genomic and molecular investigations have the potential to elucidate the mechanisms that underpin altitude illness susceptibility.

Differential enrichment of TTF-I and Tip5 in the T-like promoter structures of the rDNA contribute to the epigenetic response of Cyprinus carpio during environmental adaptation

To ensure homeostasis, ectothermic organisms adapt to environmental variations through molecular mechanisms. We previously reported that during the seasonal acclimatization of the common carp Cyprinus carpio, molecular and cellular functions are reprogrammed, resulting in distinctive traits. Importantly, the carp undergoes a drastic rearrangement of nucleolar components during adaptation. This ultrastructural feature reflects a fine modulation of rRNA gene transcription. Specifically, we identified the involvement of the transcription termination factor I (TTF-I) and Tip-5 (member of nucleolar remodeling complex, NoRC) in the control of rRNA transcription. Our results suggest that differential Tip5 enrichment is essential for silencing carp ribosomal genes and that the T0 element is key for regulating the ribosomal gene during the acclimatization process. Interestingly, the expression and content of Tip5 were significantly higher in winter than in summer. Since carp ribosomal gene expression is lower in the winter than in summer, and considering that expression concomitantly occurs with nucleolar ultrastructural changes of the acclimatization process, these results indicate that Tip5 importantly contributes to silencing the ribosomal genes. In conclusion, the current study provides novel evidence on the contributions of TTF-I and NoRC in the environmental reprogramming of ribosomal genes during the seasonal adaptation process in carp.

Heat stress and dehydration in adapting for performance: Good, bad, both, or neither?

Physiological systems respond acutely to stress to minimize homeostatic disturbance, and typically adapt to chronic stress to enhance tolerance to that or a related stressor. It is legitimate to ask whether dehydration is a valuable stressor in stimulating adaptation per se. While hypoxia has had long-standing interest by athletes and researchers as an ergogenic aid, heat and nutritional stressors have had little interest until the past decade. Heat and dehydration are highly interlinked in their causation and the physiological strain they induce, so their individual roles in adaptation are difficult to delineate. The effectiveness of heat acclimation as an ergogenic aid remains unclear for team sport and endurance athletes despite several recent studies on this topic. Very few studies have examined the potential ergogenic (or ergolytic) adaptations to ecologically-valid dehydration as a stressor in its own right, despite longstanding evidence of relevant fluid-regulatory adaptations from short-term hypohydration. Transient and self-limiting dehydration (e.g., as constrained by thirst), as with most forms of stress, might have a time and a place in physiological or behavioral adaptations independently or by exacerbating other stressors (esp. heat); it cannot be dismissed without the appropriate evidence. The present review did not identify such evidence. Future research should identify how the magnitude and timing of dehydration might augment or interfere with the adaptive processes in behaviorally constrained versus unconstrained humans.

The Influence of High-Altitude Acclimatization on Ventilatory and Blood Oxygen Saturation Responses During Normoxic and Hypoxic Testing

We investigated how acclimatization effects achieved during a high-altitude alpinist expedition influence endurance performance, ventilation (V˙E) and blood oxygen saturation (SaO₂) in normoxic (NOR) and hypoxic conditions (HYP). An incremental testing protocol on a cycle ergometer was used to determine the power output corresponding to the Lactate (P_LT) and Ventilatory Threshold (P_VT) in NOR and HYP (FiO₂=0.13) as indirect characteristics of endurance performance in both conditions. Furthermore, changes in V˙E, SaO₂, blood pH and P_co2 were measured at a similar absolute exercise intensity of 180 W in NOR and HYP conditions. Seven experienced alpinists (mean ± SD: age: 50 ± 6 yrs; body mass: 76 ± 5 kg; body height: 175 ± 8 cm) volunteered to participate in this study after they had reached the summit of Gasherbrum II and Ama Dablam. They had therefore experienced the limitations of their acclimatization. Individual differences of P_LT between values reached after and before the expedition (∆P_LT) correlated (r = 0.98, p = 0.01) with differences of SaO₂ (∆SaO₂) in HYP, and differences of P_VT (∆P_VT) correlated (r = -0.83, p = 0.02) with differences of V˙E(ΔV˙E) in HYP. The results suggest that the acclimatization may not have an equivocal and simple influence on the performance in hypoxia: enhanced blood oxygen saturation may be accompanied by increased endurance only, when the increase exceeded 2-3%, but enhanced ventilation, when increased more than 10 l/min in HYP, could detrimentally influence endurance.

Investigating the causes and consequences of symbiont shuffling in a multi-partner reef coral symbiosis under environmental change

Dynamic symbioses may critically mediate impacts of climate change on diverse organisms, with repercussions for ecosystem persistence in some cases. On coral reefs, increases in heat-tolerant symbionts after thermal bleaching can reduce coral susceptibility to future stress. However, the relevance of this adaptive response is equivocal owing to conflicting reports of symbiont stability and change. We help reconcile this conflict by showing that change in symbiont community composition (symbiont shuffling) in Orbicella faveolata depends on the disturbance severity and recovery environment. The proportion of heat-tolerant symbionts dramatically increased following severe experimental bleaching, especially in a warmer recovery environment, but tended to decrease if bleaching was less severe. These patterns can be explained by variation in symbiont performance in the changing microenvironments created by differentially bleached host tissues. Furthermore, higher proportions of heat-tolerant symbionts linearly increased bleaching resistance but reduced photochemical efficiency, suggesting that any change in community structure oppositely impacts performance and stress tolerance. Therefore, even minor symbiont shuffling can adaptively benefit corals, although fitness effects of resulting trade-offs are difficult to predict. This work helps elucidate causes and consequences of dynamism in symbiosis, which is critical to predicting responses of multi-partner symbioses such as O. faveolata to environmental change.

Role of Acclimatization in Weather-Related Human Mortality During the Transition Seasons of Autumn and Spring in a Thermally Extreme Mid-Latitude Continental Climate

Human mortality is closely related to natural climate-determined levels of thermal environmental stress and the resulting thermophysiological strain. Most climate-mortality research has focused on seasonal extremes during winter and summer when mortality is the highest, while relatively little attention has been paid to mortality during the transitional seasons of autumn and spring. The body acclimatizes to heat in the summer and cold in winter and readjusts through acclimatization during the transitions between the two during which time the body experiences the thermophysiological strain of readjustment. To better understand the influences of weather on mortality through the acclimatization process, the aim here is to examine the periods that link very cold and very warms seasons. The study uses the Acclimatization Thermal Strain Index (ATSI), which is a comparative measure of short-term thermophysiological impact on the body. ATSI centers on heat exchange with the body’s core via the respiratory system, which cannot be protected. The analysis is based on data for a major city in the climatic region of the Russian Far East characterized by very hot summers and extremely cold winters. The results show that although mortality peaks in winter (January) and is at its lowest in summer (August), there is not a smooth rise through autumn nor a smooth decline through spring. A secondary peak occurs in autumn (October) with a smaller jump in May. This suggests the acclimatization from warm-to-cold produces more thermophysiological strain than the transition from cold-to-warm. The study shows that ATSI is a useful metric for quantifying the extent to which biophysical adaptation plays a role in increased strain on the body during re-acclimatization and for this reason is a more appropriate climatic indictor than air temperature alone. The work gives useful bioclimatic information on risks involved in transitional seasons in regions characterized by climatic extremes. This could be handy in planning and managing health services to the public and measures that might be used to help mitigate impacts.

Assessment of Muscle Contractile Properties at Acute Moderate Altitude Through Tensiomyography

Under hypoxia, alterations in muscle contractile properties and faster fatigue development have been reported. This study investigated the efficacy of tensiomyography (TMG) in assessing muscle contractile function at acute moderate altitude. Biceps femoris (BF) and vastus lateralis (VL) muscles of 18 athletes (age 20.1 ± 6.1 years; body mass 65.4 ± 13.9 kg; height 174.6 ± 9.5 cm) were assessed at sea level and moderate altitude using electrically evoked contractions on two consecutive days. Maximum radial displacement (Dm), time of contraction (Tc), reaction time (Td), sustained contraction time (Ts), and relaxation time (Tr) were recorded at 40, 60, 80, and 100 mA. At altitude, VL showed lower Dm values at 40 mA (p = 0.008; ES = -0.237). Biceps femoris showed Dm decrements in all electrical stimulations (p < 0.001, ES > 0.61). In VL, Tc was longer at altitude at 40 (p = 0.031, ES = 0.56), and 100 mA (p = 0.03, ES = 0.51). Regarding Td, VL showed significant increases in all electrical intensities under hypoxia (p ≤ 0.03, ES ≥ 0.33). TMG appears effective at detecting slight changes in the muscle contractile properties at moderate altitude. Further research involving TMG along with other muscle function assessment methods is needed to provide additional insight into peripheral neuromuscular alterations at moderate altitude.

Wilderness medicine at high altitude: recent developments in the field

Travel to high altitude is increasingly popular. With this comes an increased incidence of high-altitude illness and therefore an increased need to improve our strategies to prevent and accurately diagnose these. In this review, we provide a summary of recent advances of relevance to practitioners who may be advising travelers to altitude. Although the Lake Louise Score is now widely used as a diagnostic tool for acute mountain sickness (AMS), increasing evidence questions the validity of doing so, and of considering AMS as a single condition. Biomarkers, such as brain natriuretic peptide, are likely correlating with pulmonary artery systolic pressure, thus potential markers of the development of altitude illness. Established drug treatments include acetazolamide, nifedipine, and dexamethasone. Drugs with a potential to reduce the risk of developing AMS include nitrate supplements, propagators of nitric oxide, and supplemental iron. The role of exercise in the development of altitude illness remains hotly debated, and it appears that the intensity of exercise is more important than the exercise itself. Finally, despite copious studies demonstrating the value of preacclimatization in reducing the risk of altitude illness and improving performance, an optimal protocol to preacclimatize an individual remains elusive.