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Evaluation of Acute Mountain Sickness by Unsedated Transnasal Esophagogastroduodenoscopy at High Altitude. Clin Gastroenterol Hepatol 2020; 18:2218-2225.e2. [PMID: 31778804 DOI: 10.1016/j.cgh.2019.11.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is not clear how rapid ascent to a high altitude causes the gastrointestinal symptoms of acute mountain sickness (AMS). We assessed the incidence of endoscopic lesions in the upper gastrointestinal tract in healthy mountaineers after a rapid ascent to high altitude, their association with symptoms, and their pathogenic mechanisms. METHODS In a prospective study, 25 mountaineers (10 women; mean age, 43.8 ± 9.5 y) underwent unsedated, transnasal esophagogastroduodenoscopy in Zurich (490 m) and then on 2 test days (days 2 and 4) at a high altitude laboratory in the Alps (Capanna Regina Margherita, 4559 m). Symptoms were assessed using validated instruments for AMS (the acute mountain sickness score and the Lake Louise scoring system) and visual analogue scales (scale, 0-100). Levels of messenger RNAs (mRNAs) in duodenal biopsy specimens were measured by quantitative polymerase chain rection. RESULTS The follow-up endoscopy at high altitude was performed in 19 of 25 patients on day 2 and in 23 of 25 patients on day 4. The frequency of endoscopic lesions increased from 12% at baseline to 26.3% on day 2 and to 60.9% on day 4 (P < .001). The incidence of ulcer disease increased from 0 at baseline to 10.5% on day 2 and to 21.7% on day 4 (P = .014). Mucosal lesions were associated with lower hunger scores (37.3 vs 67.4 in patients without lesions; P = .012). Subjects with peptic lesions had higher levels of HIF2A mRNA, which encodes a hypoxia-induced transcription factor, and ICAM1 mRNA, which encodes an adhesion molecule, compared with subjects without lesions (fold changes, 1.38 vs 0.63; P = .001; and 1.37 vs 0.66; P = .011, respectively). CONCLUSIONS In a prospective study of 25 mountaineers, fast ascent to a high altitude resulted in rapid onset of clinically meaningful mucosal lesions and ulcer disease. Duodenal biopsy specimens from these subjects had increased levels of HIF2A mRNA and ICAM1 mRNA, which might contribute to the formation of hypoxia-induced peptic lesions. Further studies are needed of the mechanisms of this process.
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152
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Nimmatoori DP, Singhania N, Bansal S, Singh A, Samal S. If You Go Up, You May Fall: A Rare Case of Rapidly Progressing Multifocal High-Altitude Vascular Thrombosis. Cureus 2020; 12:e9860. [PMID: 32963901 PMCID: PMC7500711 DOI: 10.7759/cureus.9860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A high-altitude (HA) exposure can lead to hypercoagulability, increasing the risk for major thromboembolic events. The spontaneous vascular thrombosis can be arterial or venous, and may occur after a short or extended stay at higher elevations. Diagnosis is often challenging, and delays in treatment can lead to inevitable and disabling sequelae. With a limited scope of experimental studies and trials to prove HA thrombogenicity, a greater awareness of the diversity of presentations and management is imperative to those engaged in treating such patients. We report a case of rapidly progressing HA vascular thrombosis.
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Affiliation(s)
| | | | | | - Anil Singh
- Hospital Medicine, Geisinger Medical Center, Scranton, USA
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153
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Wang Y, Duo D, Yan Y, He R, Wu X. Magnesium lithospermate B ameliorates hypobaric hypoxia-induced pulmonary arterial hypertension by inhibiting endothelial-to-mesenchymal transition and its potential targets. Biomed Pharmacother 2020; 130:110560. [PMID: 34321157 DOI: 10.1016/j.biopha.2020.110560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/25/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by vascular remodeling leading to elevation of pulmonary artery pressure, right ventricular hypertrophy, and death. Currently, there are no cure exists for PAH. Magnesium lithospermate B (MLB) is the major component of Salvia przewalskii water extracts with treating angina and cardiovascular damage, anti-inflammation, anti-oxidation and anti-apoptosis. However, the effects of MLB on PAH still unclear. This study we investigated the efficacy of MLB in the hypobaric hypoxia-induced rat model of PAH. The results showed that MLB relieved mean pulmonary arterial pressure (mPAP) and right ventricular hypertrophy index (RVHI). Meanwhile, MLB significantly reduced pulmonary vascular remodeling. Additionally, MLB inhibited hypobaric hypoxia-induced α-smooth muscle actin (α-SMA) expression, cell apoptosis, and α-SMA and von Willebrand factor (vWF) co-expression in lung, suggesting that MLB could inhibit hypobaric hypoxia-induced endothelial-to-mesenchymal transition (EndMT). Furthermore, after treatment with MLB, the expression of hypoxia inducible factor-1α (HIF-1α), nuclear factor-kappa B (NF-κB), monocyte chemoattractant protein-1 (MCP-1), proliferating cell nuclear antigen (PCNA), cyclin-dependent kinase 4 (CDK4), CyclinD1, RhoA, rho-associated protein kinase 1 (ROCK1) and ROCK2 was decreased. Further, CHK1, PIM1, STK6, LKHA4, PDE5A, BRAF1, PLK1, AKT1, PAK6, PAK7 and ELNE may be the potential targets of MLB. Taken together, our findings suggest that MLB ameliorates hypobaric hypoxia-induced PAH by inhibiting EndMT in rats, and has potential value in the preventment and treatment of PAH.
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Affiliation(s)
- Yafeng Wang
- The First Hospital of Lanzhou University, Lanzhou 730000, China; Qinghai Provincial People's Hospital,Xining 810007,China.
| | - Delong Duo
- Qinghai Provincial People's Hospital,Xining 810007,China
| | - Yingjun Yan
- Qinghai Provincial People's Hospital,Xining 810007,China
| | - Rongyue He
- Qinghai Provincial People's Hospital,Xining 810007,China
| | - Xinan Wu
- The First Hospital of Lanzhou University, Lanzhou 730000, China.
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154
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Manferdelli G, Marzorati M, Easton C, Porcelli S. Changes in prefrontal cerebral oxygenation and microvascular blood volume in hypoxia and possible association with acute mountain sickness. Exp Physiol 2020; 106:76-85. [DOI: 10.1113/ep088515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/24/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Giorgio Manferdelli
- Institute of Biomedical Technologies National Research Council Segrate Italy
- School of Health and Exercise Sciences University of the West of Scotland Paisley UK
| | - Mauro Marzorati
- Institute of Biomedical Technologies National Research Council Segrate Italy
| | - Chris Easton
- School of Health and Exercise Sciences University of the West of Scotland Paisley UK
| | - Simone Porcelli
- Institute of Biomedical Technologies National Research Council Segrate Italy
- Department of Molecular Physiology University of Pavia Pavia Italy
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155
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Li J, Li Y, Atakan MM, Kuang J, Hu Y, Bishop DJ, Yan X. The Molecular Adaptive Responses of Skeletal Muscle to High-Intensity Exercise/Training and Hypoxia. Antioxidants (Basel) 2020; 9:E656. [PMID: 32722013 PMCID: PMC7464156 DOI: 10.3390/antiox9080656] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022] Open
Abstract
High-intensity exercise/training, especially interval exercise/training, has gained popularity in recent years. Hypoxic training was introduced to elite athletes half a century ago and has recently been adopted by the general public. In the current review, we have summarised the molecular adaptive responses of skeletal muscle to high-intensity exercise/training, focusing on mitochondrial biogenesis, angiogenesis, and muscle fibre composition. The literature suggests that (peroxisome proliferator-activated receptor gamma coactivator 1-alpha) PGC-1α, vascular endothelial growth factor (VEGF), and hypoxia-inducible factor 1-alpha (HIF1-α) might be the main mediators of skeletal muscle adaptations to high-intensity exercises in hypoxia. Exercise is known to be anti-inflammatory, while the effects of hypoxia on inflammatory signalling are more complex. The anti-inflammatory effects of a single session of exercise might result from the release of anti-inflammatory myokines and other cytokines, as well as the downregulation of Toll-like receptor signalling, while training-induced anti-inflammatory effects may be due to reductions in abdominal and visceral fat (which are main sources of pro-inflammatory cytokines). Hypoxia can lead to inflammation, and inflammation can result in tissue hypoxia. However, the hypoxic factor HIF1-α is essential for preventing excessive inflammation. Disease-induced hypoxia is related to an upregulation of inflammatory signalling, but the effects of exercise-induced hypoxia on inflammation are less conclusive. The effects of high-intensity exercise under hypoxia on skeletal muscle molecular adaptations and inflammatory signalling have not been fully explored and are worth investigating in future studies. Understanding these effects will lead to a more comprehensive scientific basis for maximising the benefits of high-intensity exercise.
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Affiliation(s)
- Jia Li
- College of Physical Education, Southwest University, Chongqing 400715, China;
- Institute for Health and Sport (iHeS), Victoria University, P.O. Box 14428, Melbourne 8001, Australia; (M.M.A.); (J.K.); (D.J.B.)
| | - Yanchun Li
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100192, China; (Y.L.); (Y.H.)
| | - Muhammed M. Atakan
- Institute for Health and Sport (iHeS), Victoria University, P.O. Box 14428, Melbourne 8001, Australia; (M.M.A.); (J.K.); (D.J.B.)
- Division of Nutrition and Metabolism in Exercise, Faculty of Sport Sciences, Hacettepe University, 06800 Ankara, Turkey
| | - Jujiao Kuang
- Institute for Health and Sport (iHeS), Victoria University, P.O. Box 14428, Melbourne 8001, Australia; (M.M.A.); (J.K.); (D.J.B.)
| | - Yang Hu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100192, China; (Y.L.); (Y.H.)
| | - David J. Bishop
- Institute for Health and Sport (iHeS), Victoria University, P.O. Box 14428, Melbourne 8001, Australia; (M.M.A.); (J.K.); (D.J.B.)
| | - Xu Yan
- Institute for Health and Sport (iHeS), Victoria University, P.O. Box 14428, Melbourne 8001, Australia; (M.M.A.); (J.K.); (D.J.B.)
- Sarcopenia Research Program, Australia Institute for Musculoskeletal Sciences (AIMSS), Melbourne 3021, Australia
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156
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Salgado RM, Coffman KE, Bradbury KE, Mitchell KM, Yurkevicius BR, Luippold AJ, Mayer TA, Charkoudian N, Alba BK, Fulco CS, Kenefick RW. Effect of 8 days of exercise-heat acclimation on aerobic exercise performance of men in hypobaric hypoxia. Am J Physiol Regul Integr Comp Physiol 2020; 319:R114-R122. [PMID: 32432914 DOI: 10.1152/ajpregu.00048.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exercise-heat acclimation (EHA) induces adaptations that improve tolerance to heat exposure. Whether adaptations from EHA can also alter responses to hypobaric hypoxia (HH) conditions remains unclear. This study assessed whether EHA can alter time-trial performance and/or incidence of acute mountain sickness (AMS) during HH exposure. Thirteen sea-level (SL) resident men [SL peak oxygen consumption (V̇o2peak) 3.19 ± 0.43 L/min] completed steady-state exercise, followed by a 15-min cycle time trial and assessment of AMS before (HH1; 3,500 m) and after (HH2) an 8-day EHA protocol [120 min; 5 km/h; 2% incline; 40°C and 40% relative humidity (RH)]. EHA induced lower heart rate (HR) and core temperature and plasma volume expansion. Time-trial performance was not different between HH1 and HH2 after 2 h (106.3 ± 23.8 vs. 101.4 ± 23.0 kJ, P = 0.71) or 24 h (107.3 ± 23.4 vs. 106.3 ± 20.8 kJ, P > 0.9). From HH1 to HH2, HR and oxygen saturation, at the end of steady-state exercise and time-trial tests at 2 h and 24 h, were not different (P > 0.05). Three of 13 volunteers developed AMS during HH1 but not during HH2, whereas a fourth volunteer only developed AMS during HH2. Heat shock protein 70 was not different from HH1 to HH2 at SL [1.9 ± 0.7 vs. 1.8 ± 0.6 normalized integrated intensities (NII), P = 0.97] or after 23 h (1.8 ± 0.4 vs. 1.7 ± 0.5 NII, P = 0.78) at HH. Our results indicate that this EHA protocol had little to no effect-neither beneficial nor detrimental-on exercise performance in HH. EHA may reduce AMS in those who initially developed AMS; however, studies at higher elevations, having higher incidence rates, are needed to confirm our findings.
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Affiliation(s)
- Roy M Salgado
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Kirsten E Coffman
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Karleigh E Bradbury
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Katherine M Mitchell
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Beau R Yurkevicius
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Adam J Luippold
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Thomas A Mayer
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Billie K Alba
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Charles S Fulco
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Robert W Kenefick
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
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157
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Jha V, Jha A. Swine-influenza (H1N1 influenza) mimicking a case of high altitude pulmonary oedema (HAPO). BMJ Case Rep 2020; 13:13/6/e232564. [DOI: 10.1136/bcr-2019-232564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Here we present a case of a 37-year-old soldier of Indian Army, posted in high altitude area of Ladakh region (>4200 m), who after rejoining after a month leave, presented with dry cough, low-grade fever and dyspnoea on exertion while undergoing acclimatisation, and on examination, was detected to have hypoxaemia, fever and bilateral fine crepitations on chest auscultation. He was started on treatment for high altitude pulmonary oedema at a medical aid post, and later referred to General Hospital at Leh. The course of the illness was complicated by worsening hypoxaemia, continuous high-grade fever, leucopenia and hypotension. Focused medical history revealed that he had travelled to the state of Gujarat during his leave, where high incidence of H1N1 influenza was being reported during the ongoing pandemic. Oseltamivir was empirically started, in addition to parenteral antibiotics and he was started on inotropic support. In view of severe hypoxaemia, not responding to non-invasive ventilation, he was intubated and placed on mechanical ventilation. The patient turned out to be H1N1 positive and succumbed to his illness 3 days later.
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158
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He X, Zheng J, He Y, Wang Y, Wang L, Bai M, Jin T, Yuan D. Long Non-coding RNA LINC-PINT and LINC00599 Polymorphisms are Associated With High-altitude Pulmonary Edema in Chinese. Arch Bronconeumol 2020; 56:360-364. [DOI: 10.1016/j.arbres.2019.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/03/2019] [Accepted: 09/29/2019] [Indexed: 01/05/2023]
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159
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Lang M, Som A, Carey D, Reid N, Mendoza DP, Flores EJ, Li MD, Shepard JAO, Little BP. Pulmonary Vascular Manifestations of COVID-19 Pneumonia. Radiol Cardiothorac Imaging 2020; 2:e200277. [PMID: 34036264 PMCID: PMC7307217 DOI: 10.1148/ryct.2020200277] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate pulmonary vascular abnormalities at CT pulmonary angiography (CT-PE) in patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS In this retrospective study, 48 patients with reverse-transcription polymerase chain reaction-confirmed COVID-19 infection who had undergone CT-PE between March 23 and April 6, 2020, in a large urban health care system were included. Patient demographics and clinical data were collected through the electronic medical record system. Twenty-five patients underwent dual-energy CT (DECT) as part of the standard CT-PE protocol at a subset of the hospitals. Two thoracic radiologists independently assessed all studies. Disagreement in assessment was resolved by consensus discussion with a third thoracic radiologist. RESULTS Of the 48 patients, 45 patients required admission, with 18 admitted to the intensive care unit, and 13 requiring intubation. Seven patients (15%) were found to have pulmonary emboli. Dilated vessels were seen in 41 cases (85%), with 38 (78%) and 27 (55%) cases demonstrating vessel enlargement within and outside of lung opacities, respectively. Dilated distal vessels extending to the pleura and fissures were seen in 40 cases (82%) and 30 cases (61%), respectively. At DECT, mosaic perfusion pattern was observed in 24 cases (96%), regional hyperemia overlapping with areas of pulmonary opacities or immediately surrounding the opacities were seen in 13 cases (52%), opacities associated with corresponding oligemia were seen in 24 cases (96%), and hyperemic halo was seen in 9 cases (36%). CONCLUSION Pulmonary vascular abnormalities such as vessel enlargement and regional mosaic perfusion patterns are common in COVID-19 pneumonia. Perfusion abnormalities are also frequently observed at DECT in COVID-19 pneumonia and may suggest an underlying vascular process.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
| | | | - Denston Carey
- From the Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114 (M.L., A.S., D.P.M., E.J.F., M.D.L., J.O.S., B.P.L.);
and Harvard Medical School, Boston, Mass (D.C., N.R.)
| | - Nicholas Reid
- From the Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114 (M.L., A.S., D.P.M., E.J.F., M.D.L., J.O.S., B.P.L.);
and Harvard Medical School, Boston, Mass (D.C., N.R.)
| | - Dexter P. Mendoza
- From the Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114 (M.L., A.S., D.P.M., E.J.F., M.D.L., J.O.S., B.P.L.);
and Harvard Medical School, Boston, Mass (D.C., N.R.)
| | - Efrén J. Flores
- From the Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114 (M.L., A.S., D.P.M., E.J.F., M.D.L., J.O.S., B.P.L.);
and Harvard Medical School, Boston, Mass (D.C., N.R.)
| | - Matthew D. Li
- From the Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114 (M.L., A.S., D.P.M., E.J.F., M.D.L., J.O.S., B.P.L.);
and Harvard Medical School, Boston, Mass (D.C., N.R.)
| | - Jo-Anne O. Shepard
- From the Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114 (M.L., A.S., D.P.M., E.J.F., M.D.L., J.O.S., B.P.L.);
and Harvard Medical School, Boston, Mass (D.C., N.R.)
| | - Brent P. Little
- From the Department of Radiology, Massachusetts General Hospital, 55
Fruit St, Boston, MA 02114 (M.L., A.S., D.P.M., E.J.F., M.D.L., J.O.S., B.P.L.);
and Harvard Medical School, Boston, Mass (D.C., N.R.)
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160
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Li Z, Guo J, Liu C, Shi Y, Li Y, Wang J, Li D, Wang J, Chen Y. Compound Danshen Dripping Pill Promotes Adaptation to Acute High-Altitude Exposure. High Alt Med Biol 2020; 21:258-264. [PMID: 32466660 DOI: 10.1089/ham.2019.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Li, Zongbin, Jun Guo, Chunwei Liu, Yajun Shi, Yang Li, Jinli Wang, Dandan Li, Jing Wang, and Yundai Chen. Compound Danshen Dripping Pill promotes adaptation to acute high-altitude exposure. High Alt Med Biol. 21:258-264, 2020. Background: In this study, we aimed to investigate whether the traditional Chinese medicine, Compound Danshen Dripping Pill (CDDP), can prevent acute mountain sickness (AMS). We allocated CDDP and matching placebos to 160 volunteers before they ascended to a high altitude. Treadmill exercise tests, echocardiography, blood routine examinations, biochemical analysis, and blood gas analysis were performed upon arrival at high altitude. The primary outcome included incidence of AMS, exercise times, and metabolic equivalents (METs) of treadmill exercise tests. Second endpoints included the heart rates and rate-pressure product (RPP) before and after treadmill exercise tests. Results: After high-altitude exposure, the incidence of AMS in the CDDP group was lower than that in the placebo group (48.6% vs. 67.6%, p = 0.022). The exercise time of the treadmill exercise test was significantly longer (507 ± 77.9 seconds vs. 457 ± 90.8 seconds, p = 0.004), the heart rate was lower (pre-exercise: 91.8 ± 11.7 beats/min vs. 97.2 ± 12.7 beats/min, p = 0.016; postexercise: 114 ± 22.2 beats/min vs. 121 ± 22.6 beats/min, p = 0.019), the pre-exercise and postexercise RPP were lower (pre-exercise: 1.13 × 104 ± 1.68 × 103 mmHg·beats/min vs. 1.23 × 104 ± 1.84 × 103 mmHg·beats/min, p = 0.027; postexercise: 1.19 × 104 ± 1.75 × 103 mmHg·beats/min vs. 1.31 × 104 ± 2.00 × 103 mmHg·beats/min, p = 0.002), and the MET value of the treadmill exercise test was significantly higher (9.93 ± 1.18 METs vs. 9.31 ± 1.52 METs, p = 0.037) in the CDDP group. Discussion: CDDP decreases the incidence of AMS and enhances exercise tolerance greater than placebo after high-altitude exposure. CDDP decreases the heart rate and myocardial oxygen consumption, increases the levels of hemoglobin, hematocrit, and antioxidant factors, and decreases the levels of inflammatory factors, which may explain the roles of CDDP in improving the adaptation to high-altitude exposure.
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Affiliation(s)
- Zongbin Li
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun Guo
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chunwei Liu
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yajun Shi
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yang Li
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jinli Wang
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dandan Li
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Wang
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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161
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Treml B, Kleinsasser A, Hell T, Knotzer H, Wille M, Burtscher M. Carry-Over Quality of Pre-acclimatization to Altitude Elicited by Intermittent Hypoxia: A Participant-Blinded, Randomized Controlled Trial on Antedated Acclimatization to Altitude. Front Physiol 2020; 11:531. [PMID: 32547414 PMCID: PMC7272681 DOI: 10.3389/fphys.2020.00531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Intermittent normobaric hypoxia (IH) is increasingly used to pre-acclimatize for a sojourn to high altitude. There is a number of hypoxia - protocols observing the hypoxic ventilatory response (HVR), but little is known about the carry - over quality of the Lake Louise Score (LLS). We thus studied a week - long, 1 h per day poikilocapnic hypoxia protocol on whether acclimatization could be carried over for one week. Rationale for this was that it usually takes one week to get from Europe, Britain or the United States to the base camp of a major mountain. Forty-nine healthy volunteers of both sexes were exposed to daily bouts of 1 h at an inspiratory fraction of oxygen (FiO2) of 0.11 or 0.21 (control) for 7 consecutive days. Seven days after cessation of IH or sham exposures participants were again subjected to hypoxia (FiO2 = 0.11) for 6 h and measurements of isocapnic HVR and blood gases out of the arterialized earlobe were taken and LLS was assessed. In those with IH exposures LLS was reduced which was not the case in those with sham exposure (87 vs. 50%). Changes in HVR or the arterial hemoglobin saturation were not observed. Gender neither affected LLS nor HVR nor blood gases or carry -over quality. We found that our week - long, hypoxia protocol grants a reduction in LLS that can be carried over the time span of one week. In this way, antedated acclimatization may improve safety and comfort on the mountain.
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Affiliation(s)
- Benedikt Treml
- Department of General and Surgical Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Axel Kleinsasser
- Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Tobias Hell
- Department of Mathematics, Leopold – Franzens University Innsbruck, Innsbruck, Austria
| | - Hans Knotzer
- Department of Anesthesiology and Critical Care Medicine, Klinikum Wels – Grieskirchen, Wels, Austria
| | - Maria Wille
- Department of Sport Science, Medical Section, University Innsbruck, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, Medical Section, University Innsbruck, Innsbruck, Austria
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162
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Subudhi AW, Evero O, Reitinger J, Davis C, Gronewold J, Nichols AJ, Van‐Houten SJ, Roach RC. Combined methazolamide and theophylline improves oxygen saturation but not exercise performance or altitude illness in acute hypobaric hypoxia. Exp Physiol 2020; 106:117-125. [DOI: 10.1113/ep088461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/29/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Andrew W. Subudhi
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
- Department of Human Physiology and Nutrition University of Colorado Colorado Springs Colorado Springs CO USA
| | - Oghenero Evero
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Jeremy Reitinger
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Christopher Davis
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Jeffrey Gronewold
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Andrew J. Nichols
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - Robert C. Roach
- Altitude Research Center University of Colorado Anschutz Medical Campus Aurora CO USA
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163
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Fornasiero A, Savoldelli A, Stella F, Callovini A, Bortolan L, Zignoli A, Low DA, Mourot L, Schena F, Pellegrini B. Shortening Work-Rest Durations Reduces Physiological and Perceptual Load During Uphill Walking in Simulated Cold High-Altitude Conditions. High Alt Med Biol 2020; 21:249-257. [PMID: 32412801 DOI: 10.1089/ham.2019.0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Fornasiero, Alessandro, Aldo Savoldelli, Federico Stella, Alexa Callovini, Lorenzo Bortolan, Andrea Zignoli, David A. Low, Laurent Mourot, Federico Schena, and Barbara Pellegrini. Shortening work-rest durations reduces physiological and perceptual load during uphill walking in simulated cold high-altitude conditions. High Alt Med Biol. 21:249-257, 2020. Background: We investigated the effects of two different work-rest durations on the physiological and perceptual responses to a simulated mountain hike in a cold hypoxic environment. Materials and Methods: Twelve healthy nonacclimatized active men (age 31.3 ± 5.3 years, body mass index 22.4 ± 1.5 kg/m2) completed a 80-minute work-matched intermittent exercise on a motorized treadmill (25% incline, fixed self-selected speed), in a simulated mountain environment (-25°C, FiO2 = 11%, ≈5000 m a.s.l.), wearing extreme cold weather gear, once with short (20 × 3 minutes walking with 1 minute rest; SHORT) and once with long (10 × 6 minutes walking with 2 minutes rest; LONG) work-rest durations. Heart rate (HR), pulse oxygen saturation (SpO2), rate of perceived exertion (RPE), and thermal sensation (TS) were assessed throughout the exercise protocols. Cardiac autonomic modulation was assessed before (PRE) and after exercise (POST) in supine position, as well as during standing resting periods by means of HR recovery (HRR) assessment. Results: SpO2 and TS were similar (p > 0.05) in SHORT and LONG protocols. HR and RPE were increased, and HRR reduced during LONG compared to SHORT (p < 0.05). Parasympathetic activity indices were reduced at POST after both protocols (p < 0.05), but to a lesser extent after SHORT (p < 0.05). Conclusions: Reduced work-rest durations are associated with improved perceptual responses and less perturbation of cardiac autonomic balance, compared to longer work-rest durations. Shorter exercise periods from more frequent breaks during hikes at high altitude may represent a valid strategy to limit the impact of exercise under extreme environmental conditions.
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Affiliation(s)
- Alessandro Fornasiero
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Aldo Savoldelli
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Stella
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
| | - Alexa Callovini
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
| | - Lorenzo Bortolan
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Zignoli
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy.,Department of Industrial Engineering, University of Trento, Trento, Italy
| | - David A Low
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool, United Kingdom
| | - Laurent Mourot
- Laboratory of Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance, Health, Innovation Platform (EA 3920), University of Bourgogne Franche-Comté, Besançon, France.,Tomsk Polytechnic University, Tomsk, Russia
| | - Federico Schena
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Barbara Pellegrini
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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164
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Nepal G, Yadav JK, Rehrig JH, Bhandari N, Baniya S, Ghimire R, Mahotra N. Efficacy and safety of inhaled budesonide on prevention of acute mountain sickness during emergent ascent: a meta-analysis of randomized controlled trials. BMC Emerg Med 2020; 20:38. [PMID: 32404064 PMCID: PMC7222565 DOI: 10.1186/s12873-020-00329-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Acute Mountain Sickness (AMS) is a pathophysiologic process that occurs in non-acclimated susceptible individuals rapidly ascending to high-altitude. Barometric pressure falls at high altitude and it translates to a decreased partial pressure of alveolar oxygen (PAO2) and arterial oxygen (PaO2). A gradual staged ascent with sufficient acclimatization can prevent AMS but emergent circumstances requiring exposure to rapid atmospheric pressure changes – such as for climbers, disaster or rescue team procedures, and military operations – establishes a need for effective prophylactic medications. This systematic review and meta-analysis aim to analyze the incidence of AMS during emergent ascent of non-acclimatized individuals receiving inhaled budesonide compared to placebo. Methods This current meta-analysis was conducted according to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched PubMed, Google Scholar and Embase for relevant studies. The efficacy of budesonide in reducing incidence of AMS was evaluated by calculating the pooled ORs and 95% CIs. The efficacy of budesonide in maintaining hemoglobin-oxygen saturation was evaluated by calculating standard mean difference (SMD) and 95% confidence intervals. Results We found that at high altitude, inhaled budesonide was effective in reducing the incidence of mild AMS [OR: 0.37; 95% CI, 0.14 to 0.9, p = 0.042] but was ineffective in reducing the incidence of severe AMS [OR: 0.46; 95% CI, 0.14 to 1.41, p = 0.17]. Inhaled budesonide was also effective in maintaining SpO2 (SMD: 0.47; 95% CI, 0.09 to 0.84, p = 0.014) at high altitude. However, it was not effective in maintaining or improving pulmonary function at high altitude. Systematic-review found no adverse effects of budesoide in the dose used for prophylaxis of AMS. Conclusions Our systematic review showed that prophylactic inhaled budesonide is effective in preventing mild AMS during emergency ascent but not effective in preventing severe AMS. Though statistically significant, authors recommend caution in interpretation of data and questions for further well designed randomized studies to evaluate the role of budesonide in prophylaxis of AMS during an emergent ascent.
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Affiliation(s)
- Gaurav Nepal
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal. .,Mountain Medicine Society of Nepal, Kathmandu, Nepal.
| | - Jayant Kumar Yadav
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.,Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | | | - Niroj Bhandari
- Kathmandu University School of Medical Sciences, Panauti, Nepal
| | - Santosh Baniya
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.,Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - Rakesh Ghimire
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Narayan Mahotra
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
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165
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Stewart GM, Chase S, Cross TJ, Wheatley-Guy CM, Joyner MJ, Curry T, Lehrer-Graiwer J, Dufu K, Vlahakis NE, Johnson BD. Effects of an allosteric hemoglobin affinity modulator on arterial blood gases and cardiopulmonary responses during normoxic and hypoxic low-intensity exercise. J Appl Physiol (1985) 2020; 128:1467-1476. [PMID: 32324473 DOI: 10.1152/japplphysiol.00185.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Numerous pathophysiological conditions induce hypoxemia-related cardiopulmonary perturbations, decrements in exercise capacity, and debilitating symptoms. Accordingly, this study investigated the efficacy of an allosteric hemoglobin modulator (voxelotor) to enhance arterial oxygen saturation during low-intensity exercise in hypoxia. Eight normal healthy subjects (36 ± 7 yr; 73.8 ± 9.5 kg; 3 women) completed a submaximal cycling test (60 W) under normoxic ([Formula: see text]: 0.21; O2 partial pressure: 144 mmHg) and hypoxic ([Formula: see text]: 0.125; O2 partial pressure: 82 mmHg) conditions before (day 1) and after (day 15) 14 days of oral drug administration. While stationary on a cycle ergometer and during exercise, ratings of perceived exertion (RPE) and dyspnea, oxygen consumption (V̇o2), and cardiac output (Q) were measured noninvasively, while arterial blood pressure (MAP) and blood gases ([Formula: see text], [Formula: see text], and [Formula: see text]) were measured invasively. The 14-day drug administration left shifted the oxygen-hemoglobin dissociation curve (ODC; p50 measured at standard pH and Pco2; day 1: 28.0 ± 2.1 mmHg vs. day 15: 26.1 ± 1.8 mmHg, P < 0.05). RPE, dyspnea, V̇o2, Q, and MAP were not different between day 1 and day 15. [Formula: see text] was similar during normoxia on day 1 and day 15 while stationary but higher during exercise (day 1: 95.2 ± 0.4% vs. day 15: 96.6 ± 0.3%, P < 0.05). [Formula: see text] was higher during hypoxia on day 15 while stationary (day 1: 82.9 ± 3.4% vs. day 15: 90.9 ± 1.8%, P < 0.05) and during exercise (day 1: 73.6 ± 2.5% vs. day 15: 84.8 ± 2.7%, P < 0.01). [Formula: see text] and [Formula: see text]were systematically higher and lower, respectively, after drug (P < 0.01), while the alveolar-arterial oxygen difference was unchanged suggesting hyperventilation contributed to the rise in [Formula: see text]. Oral administration of voxelotor left shifted the ODC and stimulated a mild hyperventilation, leading to improved arterial oxygen saturation without altering V̇o2 and central hemodynamics during rest and low-intensity exercise. This effect was more pronounced during submaximal hypoxic exercise, when arterial desaturation was more evident. Additional studies are needed to determine the effects of voxelotor during maximal exercise and under chronic forms of hypoxia.NEW & NOTEWORTHY In humans, a novel allosteric hemoglobin-oxygen affinity modulator was administered to comprehensively examine the cardiopulmonary consequences of stabilizing a portion of the available hemoglobin in a high-oxygen affinity state during submaximal exercise in normoxia and hypoxia. Oral administration of voxelotor enhanced arterial oxygen saturation during submaximal exercise without altering oxygen consumption and central hemodynamics; however, the partial pressure of arterial carbon dioxide was reduced and the partial pressure of arterial oxygen was increased implying that hyperventilation also contributed to the increase in oxygen saturation. The preservation of arterial oxygen saturation and content was particularly evident during hypoxic submaximal exercise, when arterial desaturation typically occurs, but this did not influence arterial-venous oxygen difference.
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Affiliation(s)
- Glenn M Stewart
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Steven Chase
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Troy J Cross
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Courtney M Wheatley-Guy
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Michael J Joyner
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy Curry
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Kobina Dufu
- Global Blood Therapeutics, South San Francisco, California
| | | | - Bruce D Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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166
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Algaze I, Phillips L, Inglis P, Lathrop G, Gadbois J, Rizzolo K, Harris NS. Incidence of Mild Cognitive Impairment with Ascending Altitude. High Alt Med Biol 2020; 21:184-191. [PMID: 32282276 DOI: 10.1089/ham.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to longitudinally quantify the prevalence of mild cognitive impairment (MCI) in individual trekkers at three different ascending altitudes (Site 1: ∼3500 m, Site 2: ∼4400 m, and Site 3: ∼5100 m). We correlated these findings with the presence of acute mountain sickness (AMS). Materials and Methods: We performed serial assays using the environmental quick mild cognitive impairment (eQMCI) score on 103 English-speaking 18- to 65-year-old volunteers trekking to Everest Base Camp in Nepal during spring 2016. We defined MCI as a score less than 67 (lower scores indicating more cognitive impairment). Additional data collected included the Lake Louise Score, demographics, and other possible confounders. Results: eQMCI scores significantly decreased with ascent from Site 1 to 2 (a score of 78.95 [SD = 7.96] to 74.67 [SD = 8.8] [Site 1-2 p = 0.04]), but then increased on ascent to Site 3 to 83.68 (SD = 8.67) (Site 1-3 p = <0.0001, Site 2-3 p = <0.0001). However, subjects who fulfilled eQMCI criteria for MCI increased despite the overall improvement in score: 6.8% (N = 7) at Site 1, 18.7% (N = 14) at Site 2, and 3.3% (N = 2) at Site 3. Incidence of AMS at Sites 1, 2, and 3 was 22.3% (N = 23), 21.3% (N = 16), and 48.3% (N = 29), respectively. Of those with MCI, 1.94% met criteria for AMS at Site 1 (p = 0.0017), 2.67% at Site 2 (p = 0.6949), and 3.33% at Site 3 (p = <0.0001). Conclusions: There is a significant incidence of MCI at high altitude, even in those without subjective findings of AMS. Interestingly, subjects with a decline in cognitive function show an increasing trend for developing AMS at higher altitude. Future research on the clinical impact of MCI on a subject's health, judgment, and performance remains to be elucidated.
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Affiliation(s)
- Isabel Algaze
- Department of Emergency Medicine, University of California Irvine Medical Center, Orange, California, USA
| | - Lara Phillips
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Gabriel Lathrop
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon, USA
| | - Jaclyn Gadbois
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Katherine Rizzolo
- Department of Internal Medicine, Maine Medical Center, Portland, Maine, USA
| | - N Stuart Harris
- Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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167
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Yuan X, Lu H, Zhao A, Ding Y, Min Q, Wang R. Transcriptional regulation of CYP3A4 by nuclear receptors in human hepatocytes under hypoxia. Drug Metab Rev 2020; 52:225-234. [PMID: 32270716 DOI: 10.1080/03602532.2020.1733004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The human hepatic cytochrome P-450 3A4 (CYP3A4), recognized as a multifunctional enzyme, has a wide range of substrates including commonly used drugs. Previous investigations demonstrated that the expression of CYP3A4 in human hepatocytes could be regulated by some nuclear receptors (NRs) at transcriptional level under diverse situations. The significance of oxygen on CYP3A4-mediated metabolism seems notable while the regulatory mode of CYP3A4 in the particular case still remains elusive. Recently, striking evidence has emerged that both CYP3A4 and its regulator NR could be inhibited by exposure to hypoxia. Therefore, it is of great importance to elucidate whether and how these NRs act in the transcriptional regulation of CYP3A4 in human hepatocytes under hypoxic conditions. In this review, we mainly summarized transcriptional regulation of the pivotal enzyme CYP3A4 by NRs and explored the possible regulatory pathways of CYP3A4 via these major NRs under hypoxia, expecting to provide favorable evidence for further clinical guidance under such pathological situations.
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Affiliation(s)
- Xuechun Yuan
- Key Laboratory of the Plateau Environmental Damage Control, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China.,College of Pharmacy, Lanzhou University, Lanzhou, China
| | - Hui Lu
- Key Laboratory of the Plateau Environmental Damage Control, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Anpeng Zhao
- Key Laboratory of the Plateau Environmental Damage Control, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Yidan Ding
- Key Laboratory of the Plateau Environmental Damage Control, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China.,College of Pharmacy, Lanzhou University, Lanzhou, China
| | - Qiong Min
- Pharmacy department, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Rong Wang
- Key Laboratory of the Plateau Environmental Damage Control, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China.,College of Pharmacy, Lanzhou University, Lanzhou, China
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168
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Duke CB, Sallade TD, Starling J, Pant S, Sheets A, McElwee MK, Young DS, Taylor RA, Keyes LE. Hypertension and Acute Mountain Sickness in Himalayan Trekkers in Nepal: An Observational Cohort Study. Wilderness Environ Med 2020; 31:157-164. [PMID: 32205041 DOI: 10.1016/j.wem.2020.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 01/03/2020] [Accepted: 01/15/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION A history of preexisting hypertension is common in people participating in mountain activities; however, the relationship between blood pressure (BP), preexisting hypertension, and acute mountain sickness (AMS) is not well studied. We sought to determine these relationships among trekkers in the Everest region of Nepal. METHODS This was a prospective observational cohort study of a convenience sample of adult, nonpregnant volunteers trekking in the Everest Base Camp region in Nepal. We recorded Lake Louise Scores for AMS and measured BP at 2860 m, 3400 m, and 4300 m. The primary outcome was AMS. RESULTS A total of 672 trekkers (including 60 with history of preexisting hypertension) were enrolled at 2860 m. We retained 529 at 3400 m and 363 at 4300 m. At 3400 m, 11% of participants had AMS, and 13% had AMS at 4300 m. We found no relationship between AMS and measured BP values (P>0.05), nor was there any relation of BP to AMS severity as measured by higher Lake Louise Scores (P>0.05). Preexisting hypertension (odds ratio [OR] 0.16; 95% CI 0.025-0.57), male sex (OR 0.59; 95% CI 0.37-0.96), and increased SpO2 (OR 0.93; 95% CI 0.87-0.98) were associated with reduced rates of AMS in multivariate analyses adjusting for known risk factors for AMS. CONCLUSIONS AMS is common in trekkers in Nepal, even at 3400 m. There is no relationship between measured BP and AMS. However, a medical history of hypertension may be associated with a lower risk of AMS. More work is needed to confirm this novel finding.
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Affiliation(s)
- Charles B Duke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - T Douglas Sallade
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA
| | - Jennifer Starling
- Department of Emergency Medicine, University of Colorado and Colorado Permanente Medical Group, Saint Joseph Hospital, Denver, CO
| | - Sushil Pant
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | | | - Matthew K McElwee
- Department of Medicine, Division of Rheumatic and Autoimmune Diseases, University of Minnesota, Minneapolis, MN
| | - David S Young
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Linda E Keyes
- University of Colorado Emergency Medicine and Boulder Emergency Physicians, Boulder, CO.
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169
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Garrido E, Botella de Maglia J, Castillo O. Acute, subacute and chronic mountain sickness. Rev Clin Esp 2020; 221:S0014-2565(20)30064-3. [PMID: 32197780 DOI: 10.1016/j.rce.2019.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022]
Abstract
More than 100 million people ascend to high mountainous areas worldwide every year. At nonextreme altitudes (<5500 m), 10-85% of these individuals are affected by acute mountain sickness, the most common disease induced by mild-moderate hypobaric hypoxia. Approximately 140 million individuals live permanently at heights of 2500-5500 m, and up to 10% of them are affected by the subacute form of mountain sickness (high-altitude pulmonary hypertension) or the chronic form (Monge's disease), the latter of which is especially common in Andean ethnicities. This review presents the most relevant general concepts of these 3 clinical variants, which can be incapacitating and can result in complications and become life-threatening. Proper prevention, diagnosis, treatment and management of these conditions in a hostile environment such as high mountains are therefore essential.
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Affiliation(s)
- E Garrido
- Servicio de Hipobaria y Fisiología Biomédica, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Estudios de Medicina de Montaña (IEMM), Barcelona, España.
| | - J Botella de Maglia
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Estudios de Medicina de Montaña (IEMM), Barcelona, España
| | - O Castillo
- Instituto Nacional de Biología Andina, Universidad Nacional Mayor de San Marcos, Lima, Perú
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170
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Xiao J, Li X, Fan X, Fan F, Lei H, Li C. Gene Expression Profile Reveals Hematopoietic-Related Molecule Changes in Response to Hypoxic Exposure. DNA Cell Biol 2020; 39:548-554. [PMID: 32155344 DOI: 10.1089/dna.2019.5004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Qing-Tibet Plateau is characterized by low oxygen pressure, which is an important biomedical and ecological stressor. However, the variation in gene expression during periods of stay on the plateau has not been well studied. We recruited eight volunteers to stay on the plateau for 3, 7, and 30 days. Human Clariom D arrays were used to measure transcriptome changes in the mRNA expression profiles in these volunteers' blood. Analysis of variance (ANOVA) indicated that 699 genes were significantly differentially expressed in response to entering the plateau during hypoxic exposure. The genes with changes in transcript abundance were involved in the terms phosphoprotein, acetylation, protein binding, and protein transport. Furthermore, numerous genes involved in hematopoietic functions, including erythropoiesis and immunoregulation, were differentially expressed in response to hypoxia. This phenomenon may be one of reasons why the majority of people entering the plateau do not have excessive erythrocyte proliferation and are susceptible to infection.
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Affiliation(s)
- Jun Xiao
- Department of Blood Transfusion, Air Force Medical Center, PLA, Beijing, P.R. China
| | - Xiaowei Li
- Department of Blood Transfusion, Air Force Medical Center, PLA, Beijing, P.R. China
| | - Xiu Fan
- Department of Blood Transfusion, Air Force Medical Center, PLA, Beijing, P.R. China
| | - Fengyan Fan
- Department of Blood Transfusion, Air Force Medical Center, PLA, Beijing, P.R. China
| | - Huifen Lei
- Department of Blood Transfusion, Air Force Medical Center, PLA, Beijing, P.R. China
| | - Cuiying Li
- Department of Blood Transfusion, Air Force Medical Center, PLA, Beijing, P.R. China
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171
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Newman JH. Pulmonary Hypertension by the Method of Paul Wood. Chest 2020; 158:1164-1171. [PMID: 32147248 DOI: 10.1016/j.chest.2020.02.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/10/2020] [Accepted: 02/15/2020] [Indexed: 11/25/2022] Open
Abstract
A physiological approach to the analysis of hemodynamic data in pulmonary hypertension (PH) has the advantage of reducing the large number (well over 100) of potential causal illnesses into four simple mechanisms. A fifth condition is composed of mixtures of the four basic mechanisms. This approach was beautifully described by Paul Wood, the great cardiologist whose name is given to the units of pulmonary vascular resistance (PVR), Wood units. This approach uses well understood physiological contributions to pulmonary vascular pressure. It is powerful, the major uncertainty being in determination of the magnitude of each mechanism in patients that have mixed PH of several causes. It also makes sense of the occasionally awkward clustering of conditions in the clinical classification of the World Symposium, which omits pulmonary vasoconstriction, hyperkinetic states, and the highly prevalent condition of "mixed" PH. This method of analysis is described and demonstrated, much as Wood did in his writings. The method is useful in the office, the ICU, and in consultation. A basic message from this approach is that correct assessment requires measurement of each of the three major inputs, pulmonary arterial pressure (Ppa), pulmonary artery wedge pressure (Pwedge) and cardiac output (CO). Some cases also need left ventricular end diastolic pressure (LVEDP). Other data contributing to analysis will be discussed in each condition. A key to avoiding mistakes is to always remember that PH is simply an elevation in pressure and is not inherently diagnostic of cause.
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Affiliation(s)
- John H Newman
- Pulmonary Circulation Center, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
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172
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Krusche T, Limmer M, Jendrusch G, Platen P. Influence of Natural Hypobaric Hypoxic Conditions on Dynamic Visual Performance. High Alt Med Biol 2020; 21:1-11. [PMID: 31746645 DOI: 10.1089/ham.2019.0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: Both dynamic and static visual performances are essential for safety and motoric performance at altitude. There is a lack of information regarding alterations in dynamic visual performance (DVP) in oxygen-reduced environments. The purpose of this study was to analyze DVP in natural hypoxic conditions in a group of young, healthy hikers. Methods: DVP in four parafoveal subfields was analyzed using the computer-assisted Düsseldorf Test for Dynamic Vision. Measurements were performed twice at altitudes above 3500 m during an 8-day alpine hike. Results: On day 5 (3647 m), no changes in DVP were detected. On day 6 (4554 m), however, we found a significant reduction in DVP in the superior parafoveal retinal subfield, partly representing the lower visual field. The observed changes did not correlate with oxygen saturation, hematocrit, or cardiovascular parameters. We found no interrelation between symptoms of acute mountain sickness and DVP at altitude. Conclusions: Our data suggest that hiking at altitudes above 4500 m results in lower DVP in the visual field of healthy young people. The alteration might affect motor performance and coordination, increasing the risk of accidents.
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Affiliation(s)
- Till Krusche
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-Universität Bochum, Bochum, Germany
| | - Mirjam Limmer
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-Universität Bochum, Bochum, Germany.,Institute of Outdoor Sports and Environmental Science, German Sport University Cologne, Cologne, Germany
| | - Gernot Jendrusch
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-Universität Bochum, Bochum, Germany
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-Universität Bochum, Bochum, Germany
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173
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Watanabe S, Usui-Kawanishi F, Karasawa T, Kimura H, Kamata R, Komada T, Inoue Y, Mise N, Kasahara T, Takahashi M. Glucose regulates hypoxia-induced NLRP3 inflammasome activation in macrophages. J Cell Physiol 2020; 235:7554-7566. [PMID: 32115713 DOI: 10.1002/jcp.29659] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
Although the intimate linkage between hypoxia and inflammation is well known, the mechanism underlying this linkage has not been fully understood. Nucleotide-binding oligomerization domain-like receptor (NLR) family pyrin domain containing 3 (NLRP3) inflammasome is an intracellular multiprotein complex that regulates interleukin-1β (IL-1β) secretion and pyroptosis, and is implicated in the pathogenesis of sterile inflammatory diseases. Here, we investigated the regulatory mechanism of NLRP3 inflammasome activation in response to hypoxia in macrophages. Severe hypoxia (0.1% O2 ) induced the processing of pro-IL-1β, pro-caspase-1, and gasdermin D, as well as the release of IL-1β and lactate dehydrogenase in lipopolysaccharide (LPS)-primed murine macrophages, indicating that hypoxia induces NLRP3 inflammasome-driven inflammation and pyroptosis. NLRP3 deficiency and a specific caspase-1 blockade inhibited hypoxia-induced IL-1β release. Hypoxia-induced IL-1β release and cell death were augmented under glucose deprivation, and an addition of glucose in the media negatively regulated hypoxia-induced IL-1β release. Under hypoxia and glucose deprivation, hypoxia-induced glycolysis was not driven and subsequently, the intracellular adenosine triphosphates (ATPs) were depleted. Atomic absorption spectrometry analysis showed a reduction of intracellular K+ concentrations, indicating the K+ efflux occurring under hypoxia and glucose deprivation. Furthermore, hypoxia and glucose deprivation-induced IL-1β release was significantly prevented by inhibition of K+ efflux and KATP channel blockers. In vivo experiments further revealed that IL-1β production was increased in LPS-primed mice exposed to hypoxia (9.5% O2 ), which was prevented by a deficiency of NLRP3, an apoptosis-associated speck-like protein containing a caspase recruitment domain, and caspase-1. Our results demonstrate that NLRP3 inflammasome can sense intracellular energy crisis as a danger signal induced by hypoxia and glucose deprivation, and provide new insights into the mechanism underlying hypoxia-induced inflammation.
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Affiliation(s)
- Sachiko Watanabe
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Fumitake Usui-Kawanishi
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.,Department of Pharmaceutical Engineering, Toyama Prefectural University, Imizu, Toyama, Japan
| | - Tadayoshi Karasawa
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroaki Kimura
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryo Kamata
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takanori Komada
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yoshiyuki Inoue
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Nathan Mise
- Department of Environmental and Preventive Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tadashi Kasahara
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masafumi Takahashi
- Division of Inflammation Research, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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174
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Abstract
BACKGROUND The aim of the study was to provide a theoretical basis for the early diagnosis and prediction of acute altitude sickness, to provide a better entry mode for healthy people from plain areas to plateau areas, and to preliminarily clarify the possible mechanism of this approach. METHODS We measured endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), nitric oxide (NO), and hypoxia-inducible factor 1 (HIF-1) levels in each sample and determined flow-mediated dilation (FMD) values using a portable OMRON color Doppler with a 7.0- to 12.0-MHz linear array probe. We used the Lewis Lake score to diagnose acute mountain sickness (AMS) and to stratify the disease severity. RESULTS We found no cases of AMS at any of the studied elevation gradients. We found significant differences in FMD values between individuals when at 400 m above sea level and when at 2200, 3200, and 4200 m above sea level (P < .05) but found no significant differences among those at 2200, 3200, and 4200 m. Our variance analysis showed that serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in individuals at ≥3000 m and those at subplateau and plain areas (<3000 m) significantly differed (P < .05). The level of these factors also significantly differed between individuals at elevation gradients of plateau areas (3260 m vs 4270 m) (P < .05). We found no significant differences in serum ET-1, VEGF, and ADMA levels between individuals at the plateau (2260 m) and plain (400 m) areas (P > .05). NO and HIF-1 levels were significantly different in serum samples from individuals between the plateau (2260 m) and plain (400 m) areas (P < .05). However, with increasing altitude, the NO level gradually increased, whereas ET-1, ADMA, VEGF, and HIF-1 levels showed a decreasing trend. With the increase of altitude, there is no correlation between the trend of FMD and hematologic-related factors such as VEGF, NO, and HIF-1. CONCLUSION A healthy young male population ascending to a high-altitude area experiences a low incidence of AMS. Entering an acute plateau exposure environment from different altitude gradients may weaken the effect of acute highland exposure on vascular endothelial dysfunction in healthy individuals. Changes in serum ET-1, VEGF, ADMA, NO, and HIF-1 levels in healthy young men may be related to the body's self-regulation and protect healthy individuals from AMS. A short stay in a subplateau region may initiate an oxygen-free preconditioning process in healthy individuals, thereby protecting them from AMS. Noninvasive brachial artery endothelial function test instead of the detection of invasive hematologic-related factors for early diagnosis and prediction of the occurrence and severity of acute high-altitude disease is still lack of sufficient theoretical basis.
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Affiliation(s)
- Ning Fan
- Graduate School of Qinghai University
| | - Cun Liu
- Qinghai Cardiovascular Hospital
| | - Ming Ren
- The Affiliated Hospital of Qing Hai University, Xi Ning, Qing Hai, China
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175
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Vanderhaeghen T, Vandewalle J, Libert C. Hypoxia-inducible factors in metabolic reprogramming during sepsis. FEBS J 2020; 287:1478-1495. [PMID: 31970890 DOI: 10.1111/febs.15222] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/20/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022]
Abstract
Sepsis is a highly heterogeneous syndrome that is caused by an imbalanced host response to infection. Despite huge investments, sepsis remains a contemporary threat with significant burden on health systems. Vascular dysfunction and elevated oxygen consumption by highly metabolically active immune cells result in tissue hypoxia during inflammation. The transcription factor hypoxia-inducible factor-1a (HIF1α), and its family members, plays an important role in cellular metabolism and adaptation to cellular stress caused by hypoxia. In this review, we discuss the role of HIF in sepsis. We show possible mechanisms by which the inflammatory response activated during sepsis affects the HIF pathway. The activated HIF pathway in turn changes the metabolism of both innate and adaptive immune cells. As HIF expression in leukocytes of septic patients can be directly linked with mortality, we discuss multiple ways of interfering with the HIF signaling pathway.
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Affiliation(s)
- Tineke Vanderhaeghen
- Center for Inflammation Research, VIB, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Belgium
| | - Jolien Vandewalle
- Center for Inflammation Research, VIB, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Belgium
| | - Claude Libert
- Center for Inflammation Research, VIB, Ghent, Belgium.,Department of Biomedical Molecular Biology, Ghent University, Belgium
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176
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Behera J, Nagarajan S, Saran U, Kumar R, Keshri GK, Suryakumar G, Chatterjee S. Nitric oxide restores peripheral blood mononuclear cell adhesion against hypoxia via NO-cGMP signalling. Cell Biochem Funct 2020; 38:319-329. [PMID: 31989682 DOI: 10.1002/cbf.3502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/01/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022]
Abstract
Hypoxia is the most detrimental threat to humans residing at high altitudes, affecting multifaceted cellular responses that are crucial for normal homeostasis. Inhalation of nitric oxide has been successfully implemented to combat the hypoxia effect in the high altitude patients. We hypothesize that nitric oxide (NO) restores the peripheral blood mononuclear cell-matrix deadhesion during hypoxia. In the present study, we investigate the cellular action of exogenous NO in the hypoxia-mediated diminution of cell-matrix adhesion of PBMNC and NO bioavailability in vitro. The result showed that NO level and cell-matrix adhesion of PBMNC were significantly reduced in hypoxia as compared with normoxia, as assessed by the DAF-FM and cell adhesion assay, respectively. In contrast, cellular oxidative damage response was indeed upregulated in hypoxic PBMNC. Further, gene expression analysis revealed that mRNA transcripts of cell adhesion molecules (Integrin α5 and β1) and eNOS expressions were significantly downregulated. The mechanistic study revealed that administration of NO and 8-Br-cGMP and overexpression of eNOS-GFP restored the basal NO level and recovers cell-matrix adhesion in PBMNC via cGMP-dependent protein kinase I (PKG I) signalling. In conclusion, NO-cGMP/PKG signalling may constitute a novel target to recover high altitude-afflicted cellular deadhesion. SIGNIFICANCE OF THIS STUDY: Cellular adhesion is a complex multistep process. The ability of cells to adhere to extracellular matrix is an essential physiological process for normal homeostasis and function. Hypoxia exposure in the PBMNC culture has been proposed to induce oxidative damage and cellular deadhesion and is generally believed to be the key factor in the reduction of NO bioavailability. In the present study, we demonstrated that NO donor or overexpression of eNOS-GFP has a protective effect against hypoxia-induced cellular deadhesion and greatly improves the redox balance by inhibiting the oxidative stress. Furthermore, this protective effect of NO is mediated by the NO-cGMP/PKG signal pathway, which may provide a potential strategy against hypoxia.
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Affiliation(s)
- Jyotirmaya Behera
- Vascular Biology Lab, AU-KBC Research Centre, MIT Campus of Anna University, Chennai, India
| | - Shunmugam Nagarajan
- Vascular Biology Lab, AU-KBC Research Centre, MIT Campus of Anna University, Chennai, India
| | - Uttara Saran
- Department of Biotechnology, Anna University, Chennai, India
| | - Ravi Kumar
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Gaurav K Keshri
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | | | - Suvro Chatterjee
- Vascular Biology Lab, AU-KBC Research Centre, MIT Campus of Anna University, Chennai, India.,Department of Biotechnology, Anna University, Chennai, India
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177
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Kanipakam H, Sharma K, Thinlas T, Mohammad G, Pasha MAQ. Structural and functional alterations of nitric oxide synthase 3 due to missense variants associate with high-altitude pulmonary edema through dynamic study. J Biomol Struct Dyn 2020; 39:294-309. [PMID: 31902292 DOI: 10.1080/07391102.2019.1711190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The human endothelial nitric oxide synthase (NOS3) is 28 Kbp at 7q36.1 and encodes protein comprising of 1280 amino acids. Being a major source of nitric oxide, the enzyme is crucial to the vascular homeostasis and thereby to be an important pharmaceutical target. We hence have been investigating this molecule in a high-altitude disorder namely, high-altitude pulmonary edema (HAPE). We performed a genome-wide association study (GWAS) in a case-control design of sojourners that included healthy controls and HAPE patients (n = 200) each. Four NOS3 missense SNPs i.e. rs1799983 (E298D), rs3918232 (V827M), rs3918201 (R885M) and rs3918234 (Q982L), were associated significantly with HAPE (P-value < 0.05). Furthermore, extensive in silico analyses were performed to predict the detrimental effect of the four variant types and their three most relevant co-factors namely, heme, flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN) that are accountable for amendment of protein stability leading to structural de-construction. Subsequently, we validated the findings in a larger sample size of the two study groups. HAPE patients had a higher frequency of the four variants and significantly decreased levels of circulating nitric oxide (NO) (P-value < 0.001). The in silico and human subjects findings complement each other. This study explored the impact of HAPE-associated NOS3 variants with its protein structure stability and holds promise to be current and future drug targets.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Hema Kanipakam
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Kavita Sharma
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Tashi Thinlas
- Department of Medicine, SNM Hospital, Leh, Ladakh, India
| | | | - M A Qadar Pasha
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
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178
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Iron and Sphingolipids as Common Players of (Mal)Adaptation to Hypoxia in Pulmonary Diseases. Int J Mol Sci 2020; 21:ijms21010307. [PMID: 31906427 PMCID: PMC6981703 DOI: 10.3390/ijms21010307] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Hypoxia, or lack of oxygen, can occur in both physiological (high altitude) and pathological conditions (respiratory diseases). In this narrative review, we introduce high altitude pulmonary edema (HAPE), acute respiratory distress syndrome (ARDS), Chronic Obstructive Pulmonary Disease (COPD), and Cystic Fibrosis (CF) as examples of maladaptation to hypoxia, and highlight some of the potential mechanisms influencing the prognosis of the affected patients. Among the specific pathways modulated in response to hypoxia, iron metabolism has been widely explored in recent years. Recent evidence emphasizes hepcidin as highly involved in the compensatory response to hypoxia in healthy subjects. A less investigated field in the adaptation to hypoxia is the sphingolipid (SPL) metabolism, especially through Ceramide and sphingosine 1 phosphate. Both individually and in concert, iron and SPL are active players of the (mal)adaptation to physiological hypoxia, which can result in the pathological HAPE. Our aim is to identify some pathways and/or markers involved in the physiological adaptation to low atmospheric pressures (high altitudes) that could be involved in pathological adaptation to hypoxia as it occurs in pulmonary inflammatory diseases. Hepcidin, Cer, S1P, and their interplay in hypoxia are raising growing interest both as prognostic factors and therapeutical targets.
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179
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Wang Y, Duo D, Yan Y, He R, Wang S, Wang A, Wu X. Extract of Salvia przewalskii Repair Tissue Damage in Chronic Hypoxia Maybe through the RhoA-ROCK Signalling Pathway. Biol Pharm Bull 2019; 43:432-439. [PMID: 31875579 DOI: 10.1248/bpb.b19-00775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Salvia przewalskii Maxim is a traditional Chinese herbal medicine and is known to have antibacterial, antiviral, anti-oxidant, anti-thrombotic and anti-depressant properties. However, the major active components of S. przewalskii and its anti-hypoxic effects are still unclear. This study probed the major active component and anti-hypoxic activity of S. przewalskii. The major active components of S. przewalskii were detected by HPLC. The anti-hypoxic effects of S. przewalskii were detected in mice and a rat model of hypoxic preconditioning. The results showed that there are eight active components, including sodium danshensu, rosmarinic acid, lithospermic acid, salvianolic acid B, dihydrotanshinone I, cryptotanshinone, tanshinone I and tanshinone IIA, and each component showed a certain anti-hypoxic effect. Moreover, S. przewalskii enhanced anti-hypoxia in mice, which was manifested as prolonged survival time in acute hypoxic preconditioning and the amelioration of acute hypoxia-induced changes in the activity of superoxide dismutase (SOD) and lactate dehydrogenase (LDH). In addition, S. przewalskii also repaired tissue damage in chronic hypoxia by downregulating hypoxia inducible factor-1α (HIF-1α), proliferating cell nuclear antigen (PCNA), Bcl-2, CDK4, CyclinD1 and P27Kip1 and inhibiting pro-inflammatory cytokines and the RhoA-Rho-associated protein kinase (ROCK) signalling pathway. Our findings provide new insight into the anti-hypoxic effect of S. przewalskii as a promising agent for high-altitude pulmonary hypertension treatment.
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Affiliation(s)
- Yafeng Wang
- Department of pharmacy, Qinghai Provincial People's Hospital
| | - Delong Duo
- Department of pharmacy, Qinghai Provincial People's Hospital
| | - Yingjun Yan
- Department of pharmacy, Qinghai Provincial People's Hospital
| | - Rongyue He
- Department of pharmacy, Qinghai Provincial People's Hospital
| | - Shengbiao Wang
- Department of pharmacy, Qinghai Provincial People's Hospital
| | - Aixia Wang
- Department of pharmacy, Qinghai Provincial People's Hospital
| | - Xinan Wu
- Department of pharmacy, The First Hospital of Lanzhou University
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180
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Carballo-Fazanes A, Barcala-Furelos R, Eiroa-Bermúdez J, Fernández-Méndez M, Abelairas-Gómez C, Martínez-Isasi S, Murciano M, Fernández-Méndez F, Rodríguez-Núñez A. Physiological demands of quality cardiopulmonary resuscitation performed at simulated 3250 meters high. Am J Emerg Med 2019; 38:2580-2585. [PMID: 31911060 DOI: 10.1016/j.ajem.2019.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 01/03/2023] Open
Abstract
AIM To analyse the effect of oxygen fraction reduction (O2 14%, equivalent to 3250 m) on Q-CPR and rescuers' physiological demands. METHODOLOGY A quasi-experimental study was carried out in a sample of 9 Q-CPR proficient health care professionals. Participants, in teams of 2 people, performed 10 min CPR on a Laerdal ResusciAnne mannequin (30:2 compression/ventilation ratio and alternating roles between rescuers every 2 min) in two simulated settings: T21-CPR at sea level (FiO2 of 21%) and T14 - CPR at 3250 m altitude (FiO2 of 14%). Effort self-perception was rated from 0 (no effort) to 10 (maximum demand) points. RESULTS Quality of chest compressions was good and similar in both conditions (T21 vs T14). However, the percentage of ventilations with adequate tidal volume was lower in altitude than at sea level conditions (35.9 ± 25.2% vs. 54.7 ± 23.2%, p = 0.035). The subjective perception of effort was significantly higher at simulated altitude (5 ± 2) than at sea level (3 ± 2) (p = 0.038). Maximum heart rate during the tests was similar in both conditions; however, mean oxygen saturation was significantly lower in altitude conditions (90.5 ± 2.5% vs. 99.3 ± 0.5%, p < 0.001). CONCLUSION Although performing CPR under simulated hypoxic altitude conditions significantly increases the physiological demands and subjective feeling of tiredness compared to sea level CPR, trained rescuers are able to deliver good Q-CPR in such conditions, at least in the first 10 min of resuscitation.
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Affiliation(s)
- Aida Carballo-Fazanes
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Santiago de Compostela's Health Research Institute (IDIS), Santiago de Compostela, Spain
| | - Roberto Barcala-Furelos
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Santiago de Compostela's Health Research Institute (IDIS), Santiago de Compostela, Spain; Faculty of Education and Sport Sciences, REMOSS Network Research, Universidade de Vigo, Pontevedra, Spain
| | | | - María Fernández-Méndez
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; School of Nursing, REMOSS Network Research, Universidade de Vigo, Pontevedra, Spain
| | - Cristian Abelairas-Gómez
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Santiago de Compostela's Health Research Institute (IDIS), Santiago de Compostela, Spain; Faculty of Education and Sport Sciences, REMOSS Network Research, Universidade de Vigo, Pontevedra, Spain; Faculty of Education Sciences, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - Santiago Martínez-Isasi
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Faculty of Nursing, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Murciano
- Pediatric Department, Hospital Universitario Policlinico Humberto I, Universidad de Roma "Sapienza", Roma, Italy
| | - Felipe Fernández-Méndez
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; School of Nursing, REMOSS Network Research, Universidade de Vigo, Pontevedra, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Santiago de Compostela's Health Research Institute (IDIS), Santiago de Compostela, Spain; Faculty of Nursing, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Pediatric Intensive Care Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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181
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Bao H, Li R, He M, Kang D, Zhao L. DTI Study on Brain Structure and Cognitive Function in Patients with Chronic Mountain Sickness. Sci Rep 2019; 9:19334. [PMID: 31852992 PMCID: PMC6920146 DOI: 10.1038/s41598-019-55498-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 11/27/2019] [Indexed: 11/19/2022] Open
Abstract
In chronic mountain sickness (CMS) patients, the structure of the brain, memory and cognition are often irreversibly damaged by chronic hypoxia due to red blood cell overcompensation, elevated haemoglobin and blood stasis. In this study, we aimed to evaluate this damage using diffusion tensor imaging (DTI) and to study the correlations among the fractional anisotropy (FA),the apparent diffusion coefficient (ADC) value, the severity index of CMS and the simple Mental State Examination (MMSE) score in CMS patients. A total of 17 patients with CMS and 15 healthy controls were recruited for conventional brain magnetic resonance imaging (MRI) and DTI scans, and ADC images were reconstructed along with FA and FA colour maps. The FA and ADC values of the selected regions of interest (ROIs) were measured and compared. The FA and ADC values were also compared with the haemoglobin (Hb) and MMSE scores. CMS patients are prone to intracranial ischaemia, infarction and haemorrhage. Multiple structural changes occur in the brain of CMS patients, and these changes are related to the severity of the disease and cognitive function variation. The white matter fibre bundles of CMS patients showed no obvious damage, except in the ischaemic site.
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Affiliation(s)
- Haihua Bao
- Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
| | - Ruiyang Li
- Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Mingli He
- Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Dongjie Kang
- Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Lili Zhao
- Department of Medical Imaging Center, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
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182
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Sex-based differences in the prevalence of acute mountain sickness: a meta-analysis. Mil Med Res 2019; 6:38. [PMID: 31813379 PMCID: PMC6900850 DOI: 10.1186/s40779-019-0228-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/13/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND When lowlanders rapidly ascend to altitudes > 2500 m, they may develop acute mountain sickness (AMS). The individual susceptibility, ascending velocity, time spent at altitude, activity levels and altitude reached are considered risk factors for AMS. However, it is not clear whether sex is a risk factor. The results have been inconclusive. We conducted a meta-analysis to test whether there were sex-based differences in the prevalence of AMS using Lake Louise Scoring System. METHODS Systematic searches were performed in August 2019 in EMBASE, PubMed, and Web of Science for prospective studies with AMS data for men and women. The titles and abstracts were independently checked in the primary screening step, and the selected full-text articles were independently assessed in the secondary screening step by the two authors (YPH and JLW) based on pre-defined inclusion criteria. The meta-analysis was performed using by the STATA 14.1 software program. A random-effects model was employed. RESULTS Eighteen eligible prospective studies were included. A total of 7669 participants (2639 [34.4%] women) were tested. The results showed that there was a statistically significant higher prevalence rate of AMS in women than in men (RR = 1.24, 95%CI 1.09-1.41), regardless of age or race. Howerver, the heterogeneity was significant in the analysis (Tau2 = 0.0403, Chi2 = 50.15, df = 17; I2 = 66.1%, P = 0.000), it was main caused by different numbers of subjects among the studies (coefficient = - 2.17, P = 0.049). Besides, the results showed that there was no evidence of significant publication bias in the combined studies on the basis of Egger's test (bias coefficient = 1.48, P = 0.052) and Begg's test (P = 0.130). CONCLUSIONS According to this study, the statistically significant finding emerging from this study was that women have a higher prevalence of AMS. However, the authors could not exclude studies where patients were on acetazolamide. Our analysis provided a direction for future studies of the relationship of sex and the risk of AMS, such as the pathological mechanism and prevention research.
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183
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Xie Y, Yang Y, Han Y, Yang D, Sun Y, Wang X, Nguyen AH, Chen Y, Tian J, Zhang Q, Xin C, Cao K, Wang H, Liu X, Wang G, Wang N. Association Between Arterial Blood Gas Variation and Intraocular Pressure in Healthy Subjects Exposed to Acute Short-Term Hypobaric Hypoxia. Transl Vis Sci Technol 2019; 8:22. [PMID: 31788351 PMCID: PMC6871546 DOI: 10.1167/tvst.8.6.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association between changes in arterial blood gases and intraocular pressure (IOP) after acute, short-term exposure to simulated elevation of 4000 m above sea level. Methods Twenty-five healthy young lowlanders participated in this prospective study. IOP was measured in both eyes with an Accupen tonometer. Arterial blood gas parameters (partial oxygen pressure [PaO2], partial carbon dioxide pressure [PaCO2], pH, and bicarbonate ion [HCO3 -]) were checked using a blood gas analyzer. Measurements were taken at sea level (T1), at 15-minute (T2) and at 2-hour (T3) exposure times to simulated 4000 m above sea level in a hypobaric chamber, and upon return to sea level (T4). Associations between arterial blood gas parameters and IOP were evaluated using multivariate linear regression. Results PaO2 significantly decreased at T2 and T3, resolving at T4 (P < 0.001). pH significantly increased at T2 and returned to baseline at T3 (P = 0.004). Actual and standard bicarbonate ion both dropped with IOP at T3 and T4. IOP significantly decreased from 16.4 ± 3.4 mm Hg at T1 to 15.1 ± 2.1 mm Hg (P = 0.041) at T3 and remained lower (14.9 ± 2.4 mm Hg; P = 0.029) at T4. IOP was not correlated with pH. Multivariate linear regression showed that lower IOP was associated with lower standard bicarbonate ion (beta = -1.061; 95% confidence interval, -0.049 to -2.074; P = 0.04) when adjusted for actual bicarbonate and diastolic blood pressure. Conclusions Hypobaric hypoxia triggers plasma bicarbonate ion reduction which, rather than pH, may decrease aqueous humor formation and subsequently cause IOP reduction. These findings may shed light on the mechanism of IOP regulation at high altitude. Translational Relevance Hypoxia-triggered reduction in plasma bicarbonate ion may decrease aqueous humor production, leading to IOP reduction at high altitude. These findings may provide new insight into a potential mechanism of IOP regulation. Hypobaric hypoxia at high altitude is an environmental factor that can reduce IOP and, therefore, deserves further study.
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Affiliation(s)
- Yuan Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yiquan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Diya Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yunxiao Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinmao Wang
- Department of Pneumology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Anh Hong Nguyen
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Yihan Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiaxin Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qing Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Xin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huaizhou Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaofang Liu
- Department of Pneumology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guozhong Wang
- Department of Hyperbaric and Hypobaric Chamber, Civil Aviation General Hospital, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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184
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Estoppey J, Léger B, Vuistiner P, Sartori C, Kayser B. Low- and High-Altitude Cortisol Awakening Responses Differ Between AMS-Prone and AMS-Resistant Mountaineers. High Alt Med Biol 2019; 20:344-351. [DOI: 10.1089/ham.2019.0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jan Estoppey
- Institute of Sport Sciences, Synathlon, Uni-Centre, Lausanne, Switzerland
| | - Bertrand Léger
- Department of Medical Research, Romandie Clinic for Rehabilitation, Sion, Switzerland
| | - Philippe Vuistiner
- Department of Medical Research, Romandie Clinic for Rehabilitation, Sion, Switzerland
| | - Claudio Sartori
- Department of Internal Medicine, University Hospital, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, Synathlon, Uni-Centre, Lausanne, Switzerland
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185
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Gatterer H, Bernatzky G, Burtscher J, Rainer M, Kayser B, Burtscher M. Are Pre-Ascent Low-Altitude Saliva Cortisol Levels Related to the Subsequent Acute Mountain Sickness Score? Observations from a Field Study. High Alt Med Biol 2019; 20:337-343. [DOI: 10.1089/ham.2019.0034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Günther Bernatzky
- Department of Ecology and Evolution, University of Salzburg, Salzburg, Austria
| | - Johannes Burtscher
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine and Mountain Medicine, Austria
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186
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Rupp T, Saugy JJ, Bourdillon N, Verges S, Millet GP. Positive expiratory pressure improves arterial and cerebral oxygenation in acute normobaric and hypobaric hypoxia. Am J Physiol Regul Integr Comp Physiol 2019; 317:R754-R762. [PMID: 31530174 DOI: 10.1152/ajpregu.00025.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Positive expiratory pressure (PEP) has been shown to limit hypoxia-induced reduction in arterial oxygen saturation, but its effectiveness on systemic and cerebral adaptations, depending on the type of hypoxic exposure [normobaric (NH) versus hypobaric (HH)], remains unknown. Thirteen healthy volunteers completed three randomized sessions consisting of 24-h exposure to either normobaric normoxia (NN), NH (inspiratory oxygen fraction, FiO2 = 13.6%; barometric pressure, BP = 716 mmHg; inspired oxygen partial pressure, PiO2 = 90.9 ± 1.0 mmHg), or HH (3,450 m, FiO2 = 20.9%, BP = 482 mmHg, PiO2 = 91.0 ± 0.6 mmHg). After the 6th and the 22nd hours, participants breathed quietly through a facemask with a 10-cmH2O PEP for 2 × 5 min interspaced with 5 min of free breathing. Arterial (SpO2, pulse oximetry), quadriceps, and cerebral (near-infrared spectroscopy) oxygenation, middle cerebral artery blood velocity (MCAv; transcranial Doppler), ventilation, and cardiovascular responses were recorded continuously. SpO2without PEP was significantly lower in HH (87 ± 4% on average for both time points, P < 0.001) compared with NH (91 ± 3%) and NN (97 ± 1%). PEP breathing did not change SpO2 in NN but increased it similarly in NH and HH (+4.3 ± 2.5 and +4.7 ± 4.1% after 6h; +3.5 ± 2.2 and +4.1 ± 2.9% after 22h, both P < 0.001). Although MCAv was reduced by PEP (in all sessions and at all time points, -6.0 ± 4.2 cm/s on average, P < 0.001), the cerebral oxygenation was significantly improved (P < 0.05) with PEP in both NH and HH, with no difference between conditions. These data indicate that PEP could be an attractive nonpharmacological means to improve arterial and cerebral oxygenation under both normobaric and hypobaric mild hypoxic conditions in healthy participants.
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Affiliation(s)
- Thomas Rupp
- Laboratoire Interuniversitaire de Biologie de la Motricité, Inter-University Laboratory of Human Movement Science, University Savoie Mont Blanc, Chambery, France
| | - Jonas J Saugy
- Institute of Sport Sciences of the University of Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bourdillon
- Institute of Sport Sciences of the University of Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Samuel Verges
- Hypoxia-pathophysiology 2 Laboratory, Grenoble Alpes University, France.,Unité 1042, INSERM, Grenoble, Grenoble, France
| | - Grégoire P Millet
- Institute of Sport Sciences of the University of Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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187
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Ströhle M, Vögele A, Neuhauser P, Rauch S, Brugger H, Paal P. Sudden Cardiac Arrest and Cardiopulmonary Resuscitation with Automated External Defibrillator in the Austrian Mountains: A Retrospective Study. High Alt Med Biol 2019; 20:392-398. [PMID: 31618064 DOI: 10.1089/ham.2018.0134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Few data exist on the likelihood of surviving sudden cardiac arrest in the mountains. The aim of this study was to analyze the epidemiology and outcomes of patients suffering sudden cardiac arrest and undergoing cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) in the Austrian mountains. Materials and Methods: We analyzed all cardiac arrest cases in the Austrian mountains reported in the nationwide Austrian Alpine Police database from October 26, 2005, to December 31, 2015. To obtain information on outcomes, these patient data were manually merged with patient data from the main Austrian referral center for mountain emergencies, Innsbruck Medical University Hospital. Results: Overall, 781 cases of sudden cardiac arrest in the Austrian mountains were recorded. In 136 cases (17%), CPR with AED was attempted. The most frequent activities at the time of sudden cardiac arrest were hiking (n = 63, 46%) and skiing or snowboarding (n = 44, 32%). In the nationwide Austrian Alpine Police database, only 4 (3%) patients survived, whereas in the Innsbruck Medical University Hospital database, there were seven survivors who received CPR and AED. All survivors had received immediate CPR with an AED. Five patients had good neurological outcome (cerebral performance category 1-2). Conclusions: In the Austrian mountains, CPR was attempted in less than 20% of sudden cardiac arrest cases. The few that survived had received immediate CPR with an AED. To better understand the circumstances and outcome of sudden cardiac arrest in the mountains, out-of hospital and in-hospital data should be linked.
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Affiliation(s)
- Mathias Ströhle
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Vögele
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Paul Neuhauser
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Paracelsus Medical University Salzburg, Hospitallers Brothers Hospital, Salzburg, Austria
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188
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Beidleman BA, Fulco CS, Cymerman A, Staab JE, Buller MJ, Muza SR. New metric of hypoxic dose predicts altitude acclimatization status following various ascent profiles. Physiol Rep 2019; 7:e14263. [PMID: 31660703 PMCID: PMC6817994 DOI: 10.14814/phy2.14263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/14/2019] [Indexed: 11/24/2022] Open
Abstract
Medical personnel need practical guidelines on how to construct high altitude ascents to induce altitude acclimatization and avoid acute mountain sickness (AMS) following the first night of sleep at high altitude. Using multiple logistic regression and a comprehensive database, we developed a quantitative prediction model using ascent profile as the independent variable and altitude acclimatization status as the dependent variable from 188 volunteers (147 men, 41 women) who underwent various ascent profiles to 4 km. The accumulated altitude exposure (AAE), a new metric of hypoxic dose, was defined as the ascent profile and was calculated by multiplying the altitude elevation (km) by the number of days (d) at that altitude prior to ascent to 4 km. Altitude acclimatization status was defined as the likely presence or absence of AMS after ~24 h of exposure at 4 km. AMS was assessed using the Cerebral Factor Score (AMS-C) from the Environmental Symptoms Questionnaire and deemed present if AMS-C was ≥0.7. Other predictor variables included in the model were age and body mass index (BMI). Sex, race, and smoking status were considered in model development but eliminated due to inadequate numbers in each of the ascent profiles. The AAE (km·d) significantly (P < 0.0001) predicted AMS in the model. For every 1 km·d increase in AAE, the odds of getting sick decreased by 41.3%. Equivalently, for every 1 km·d decrease in AAE, the odds of getting sick increased by 70.4%. Age and BMI were not significant predictors. The model demonstrated excellent discrimination (AUC = 0.83 (95% CI = 0.79-0.91) and calibration (Hosmer-Lemeshow = 0.11). The model provides a priori estimates of altitude acclimatization status resulting from the use of various rapid, staged, and graded ascent profiles.
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Affiliation(s)
- Beth A. Beidleman
- U.S. Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Charles S. Fulco
- U.S. Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Allen Cymerman
- U.S. Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Janet E. Staab
- U.S. Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Mark J. Buller
- U.S. Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Stephen R. Muza
- U.S. Army Research Institute of Environmental MedicineNatickMassachusetts
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189
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Aksel G, Çorbacıoğlu ŞK, Özen C. High-altitude illness: Management approach. Turk J Emerg Med 2019; 19:121-126. [PMID: 31687609 PMCID: PMC6819752 DOI: 10.1016/j.tjem.2019.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 09/15/2019] [Accepted: 09/15/2019] [Indexed: 11/30/2022] Open
Abstract
In high altitudes, usually above 2500 m, travelers are faced with decreased partial pressure of oxygen along with decreased barometric pressure. High-altitude illness, a syndrome of acute mountain sickness, high-altitude cerebral edema and high-altitude pulmonary edema, occurs due to the hypobaric hypoxia when there is inadequate acclimatization. This review provides detailed information about pathophysiology, clinical features, prevention and treatment strategies for high-altitude illness according to the current literature.
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Affiliation(s)
- Gökhan Aksel
- University of Health Sciences, Ümraniye Training and Research Hospital, Emergency Medicine Clinic, İstanbul, Turkey
| | - Şeref Kerem Çorbacıoğlu
- University of Health Sciences, Keçiören Training and Research Hospital, Emergency Medicine Clinic, Ankara, Turkey
| | - Can Özen
- Emergency Department, King's College Hospital, London, UK
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190
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Trunk AD, Rondina MT, Kaplan DA. Venous Thromboembolism at High Altitude: Our Approach to Patients at Risk. High Alt Med Biol 2019; 20:331-336. [PMID: 31479310 DOI: 10.1089/ham.2019.0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a prevalent disorder that confers substantial cardiovascular morbidity and, in serious cases, death. VTE has a complex and incompletely understood etiopathogenesis with genetic, acquired, and environmental risk factors. As the focus of this review, one environmental risk factor, which may interact with other risk factors such as hereditary and/or acquired thrombophilias, is travel to high altitude (HA), although current evidence is limited. As guidelines do not directly address this topic, we will discuss the epidemiology of HA-VTE, review the putative mechanisms for thrombosis at HA, and discuss our clinical approach to both risk stratification and counseling, including specific pharmacologic and nonpharmacologic recommendations for patients with elevated VTE risk before they travel to HA.
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Affiliation(s)
- Andrew D Trunk
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Matthew T Rondina
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.,Department of Internal Medicine and GRECC, George E. Wahlen VAMC, Salt Lake City, Utah.,Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah.,Molecular Medicine Program, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, Utah
| | - David A Kaplan
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
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191
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Abstract
PURPOSE OF REVIEW To understand the global distribution of different forms of pulmonary hypertension. RECENT FINDINGS Different registries have explored the epidemiological characteristics of pulmonary hypertension. Interestingly, there is a clear difference in the prevalence of different forms of pulmonary hypertension in developed regions in comparison with less developed countries. This finding suggests not only that extrapolation of data should be avoided but also that the known prevalence of pulmonary hypertension might be underestimated. SUMMARY Pulmonary hypertension might be more prevalent than what is currently believed. Specific forms of pulmonary hypertension distributed worldwide might characterize an unrecognized burden that still have to be properly approached. This highlights the heterogeneity of pulmonary hypertension around the world. It is clear that more epidemiological data are still needed as well as studies addressing management alternatives in these specific regions.
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192
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Romero F, Palacios J, Jofré I, Paz C, Nwokocha CR, Paredes A, Cifuentes F. Aristoteline, an Indole-Alkaloid, Induces Relaxation by Activating Potassium Channels and Blocking Calcium Channels in Isolated Rat Aorta. Molecules 2019; 24:molecules24152748. [PMID: 31362388 PMCID: PMC6695676 DOI: 10.3390/molecules24152748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 11/16/2022] Open
Abstract
Alkaloids derived from plants have shown great medicinal benefits, and are often reported for their use in cardiovascular disease management. Aristotelia chilensis (Molina) Stuntz (Maqui) has shown important medicinal properties in traditional useage. In this study, we evaluated the effect of the indole-alkaloid aristoteline (ARI), isolated from leaves of Maqui, on vascular reactivity of isolated aortic rings from normotensive rats. ARI induced relaxation (100%) in a concentration-dependent manner in intact or denuded-endothelium aortic rings pre-contracted with phenylephrine (PE; 1 μM). However, a specific soluble guanylyl cyclase inhibitor (ODQ; 1 μM) significantly reduced the relaxation to ARI in aortic rings pre-contracted with PE. In the presence of ARI, the contraction induced by KCl or PE was significantly (p < 0.05) decreased. Interestingly, the potassium channel blockade with 10 μM BaCl2 (Kir), 10 μM glibenclamide (KATP), 1 mM tetraethylammonium (TEA; KCa1.1), or 1 mM 4-aminopyridine (4-AP; Kv) significantly (p < 0.05) reduced the ARI-induced relaxation. ARI significantly (p < 0.05) reduced the contractile response to agonist of CaV1.2 channels (Bay K8644; 10 nM), likely reducing the influx of extracellular calcium through plasma membrane. The mechanisms associated with this process suggest an activation of the potassium channels, a calcium-induced antagonism and endothelium independent vasodilation that possibly involves the nitric oxide-independent soluble guanylate cyclase pathway.
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Affiliation(s)
- Fernando Romero
- Vicerrectoría de Investigación y Postgrado, Programa de Doctorado en Ciencias Médicas, Universidad de la Frontera, Temuco 4780000, Chile.
| | - Javier Palacios
- Laboratorio de Bioquímica Aplicada, Departamento de Química y Farmacia, Facultad Ciencias de la Salud, Universidad Arturo Prat, Iquique 1110939, Chile.
| | - Ignacio Jofré
- Laboratorio de Neurociencias y Biología de Péptidos, Centro de Excelencia en Biotecnología de La Reproducción, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile
| | - Cristian Paz
- Laboratorio de Productos Naturales y Descubrimiento de Fármacos, Departamento de Ciencias básicas, Universidad de La Frontera, Temuco 4811230, Chile
| | - Chukwuemeka R Nwokocha
- Department of Basic Medical Sciences Physiology Section, Faculty of Medical Sciences, The University of the West Indies, Mona, Kingston 7, KGN, Jamaica (W.I.)
| | - Adrián Paredes
- Laboratorio de Química Biológica, Instituto Antofagasta, Universidad de Antofagasta, Antofagasta 1270300, Chile
| | - Fredi Cifuentes
- Laboratorio de Fisiología Experimental, Instituto Antofagasta, Universidad de Antofagasta, Antofagasta 1270300, Chile
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193
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Friend AT, Balanos GM, Lucas SJ. Isolating the independent effects of hypoxia and hyperventilation‐induced hypocapnia on cerebral haemodynamics and cognitive function. Exp Physiol 2019; 104:1482-1493. [DOI: 10.1113/ep087602] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/25/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Alexander T. Friend
- School of SportExercise and Rehabilitation SciencesUniversity of Birmingham Edgbaston UK
| | - George M. Balanos
- School of SportExercise and Rehabilitation SciencesUniversity of Birmingham Edgbaston UK
| | - Samuel J.E. Lucas
- School of SportExercise and Rehabilitation SciencesUniversity of Birmingham Edgbaston UK
- Centre for Human Brain HealthUniversity of Birmingham Edgbaston UK
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194
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Paul S, Gangwar A, Patir H, Bhargava K, Ahmad Y. Reverse translating SULT1A1, a potential biomarker in roentgenographically tested rat model of rapid HAPE induction. Life Sci 2019; 229:132-138. [DOI: 10.1016/j.lfs.2019.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/22/2023]
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195
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Luks AM, Auerbach PS, Freer L, Grissom CK, Keyes LE, McIntosh SE, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update. Wilderness Environ Med 2019; 30:S3-S18. [PMID: 31248818 DOI: 10.1016/j.wem.2019.04.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 12/16/2022]
Abstract
To provide guidance to clinicians about best preventive and therapeutic practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each form of acute altitude illness that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2010 and subsequently updated as the WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness in 2014.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Luanne Freer
- Yellowstone National Park, WY; Midway Atoll National Wildlife Refuge, Honolulu, HI; Everest ER, Himalayan Rescue Association, Kathmandu, Nepal
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Denver, CO; Boulder Community Health, Boulder, CO
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - George W Rodway
- University of California, Davis School of Nursing, Sacramento, CA
| | - Robert B Schoene
- Division of Pulmonary and Critical Care Medicine, Sound Physicians, St. Mary's Medical Center, San Francisco, CA
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA; Himalayan Rescue Association, Kathmandu, Nepal
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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196
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Zhang Y, Gou W, Zhang Y, Zhang H, Wu C. Insights into hypoxic adaptation in Tibetan chicken embryos from comparative proteomics. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY D-GENOMICS & PROTEOMICS 2019; 31:100602. [PMID: 31212116 DOI: 10.1016/j.cbd.2019.100602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 01/23/2023]
Abstract
Tibetan chicken, an indigenous breed, is highly adapted to the extreme environment of the Qinghai-Tibet Plateau. It serves as a model organism to identify genetic differences between hypoxia-adapted and lowland breeds. However, the mechanisms underlying hypoxia adaptation are yet unclear. This study aimed to identify differently abundant proteins (DAPs) and elucidate the mechanisms involved in hypoxic adaptation in the Tibetan chicken. In this study, we obtained proteome data for the embryonic heart tissues of Tibetan and Chahua chickens incubated under hypoxia (TCH and CHH) and normoxia (TCN and CHN) using isobaric tags for relative and absolute quantitation (iTRAQ) technology. We identified 4210 proteins from 53,352 unique peptides in the heart tissue of chicken embryos. Pairwise TCH vs. CHH, TCH vs. TCN, CHH vs. CHN, and TCN vs. CHN comparisons revealed 118, 176, 103, and 162 differently abundant proteins, respectively. Several key proteins (EGLN1, MAP2K2, MYLK, QARS, NOTCH2, and MYH7) and pathways (glutathione metabolism, PPAR signaling pathway, and vascular smooth muscle contraction) were identified and considered important candidates for high-altitude adaptation in Tibetan chicken. This study provides novel insights into the chicken embryonic heart tissue and furthers the current understanding of the mechanisms of survival among animals in high-altitude environments.
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Affiliation(s)
- Yawen Zhang
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Wenyu Gou
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Ying Zhang
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Hao Zhang
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China.
| | - Changxin Wu
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, College of Animal Science and Technology, China Agricultural University, Beijing, China
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197
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Alsup C, Lipman GS, Pomeranz D, Huang RW, Burns P, Juul N, Phillips C, Jurkiewicz C, Cheffers M, Evans K, Saraswathula A, Baumeister P, Lai L, Rainey J, Lobo V. Interstitial Pulmonary Edema Assessed by Lung Ultrasound on Ascent to High Altitude and Slight Association with Acute Mountain Sickness: A Prospective Observational Study. High Alt Med Biol 2019; 20:150-156. [DOI: 10.1089/ham.2018.0123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carl Alsup
- Sierra Nevada Memorial Hospital, Emergency Medicine, Grass Valley, California
| | - Grant S. Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Rwo-Wen Huang
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Patrick Burns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nicholas Juul
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Caleb Phillips
- Department of Computational Science, University of Colorado, Boulder, Colorado
| | - Carrie Jurkiewicz
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Mary Cheffers
- Department of Emergency Medicine, University of Southern California, Los Angeles, California
| | - Kristina Evans
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Anirudh Saraswathula
- Department of Emergency Medicine, University of Chicago School of Medicine, Chicago, Illinois
| | - Peter Baumeister
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Lucinda Lai
- Stanford University School of Medicine, Stanford, California
| | - Jessica Rainey
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Viveta Lobo
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
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198
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Krusche T, Jendrusch G, Platen P. Short- and middle-term high-altitude exposure does not affect visual acuity and contrast sensitivity of healthy young people. J Sci Med Sport 2019; 22 Suppl 1:S12-S16. [PMID: 31151876 DOI: 10.1016/j.jsams.2019.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Visual acuity and contrast sensitivity are crucial for optimal performance and safe sport activity. From a practical sport-specific perspective, visual performance is obligatory for orientation and movement control in mountainous areas. The purpose of this study was to analyze the effect of hypobaric hypoxic conditions on visual acuity and contrast sensitivity of short-term and middle-term acclimatized healthy young people. DESIGN This study used a repeated-measure design with ten eye-healthy and physically active students representing different types of sports. METHODS With the help of a computer-based Landolt C and a Sine Wave Contrast test, visual performance was investigated similar before (156 m), during a nine-day high-altitude sojourn (sleeping level: 890-4640 m), and three months later (156 m). All tests were performed under standardized illumination conditions. Additionally, morning blood oxygen saturation, hematocrits, hemoglobin, body mass, and self-reported symptoms of acute mountain sickness criteria were determined. RESULTS Whole blood oxygen saturation declined during altitude exposure. The analysis of central visual performance at altitude showed no effect of hypobaric hypoxia. CONCLUSION Our data suggest that activity in a hypobaric hypoxia condition at moderate to high altitude levels of up to 4600 m does not affect visual acuity and contrast sensitivity of acclimatized healthy young people. However, in contrast to previous studies that outlined acutely impaired central visual performance with respect to hypoxia, we suggest that acclimatization might induce adaptation of visual perception performance and therefore reduce the risk of accidents resulting from partial loss of visual performance at altitude.
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Affiliation(s)
- Till Krusche
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-Universität Bochum, Germany.
| | - Gernot Jendrusch
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-Universität Bochum, Germany
| | - Petra Platen
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-Universität Bochum, Germany
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199
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Yang Y, Du H, Li Y, Guan W, Tang F, Ga Q, Ge RL. NR3C1 gene polymorphisms are associated with high-altitude pulmonary edema in Han Chinese. J Physiol Anthropol 2019; 38:4. [PMID: 30999951 PMCID: PMC6472084 DOI: 10.1186/s40101-019-0194-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/28/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND High-altitude pulmonary edema (HAPE) is a life-threatening form of non-cardiogenic edema which occurs in unacclimatized individuals after rapid ascent to high altitude. NR3C1 gene encodes for glucocorticoid receptor (GR) which plays an important role in stress and inflammation. This study aimed to investigate the association of NR3C1 polymorphisms with the susceptibility to HAPE in Han Chinese. METHODS The 30 SNPs in the NR3C1 gene were genotyped by the Sequenom MassARRAY SNP assay in 133 HAPE patients (HAPE-p) and 135 matched Han Chinese resistant to HAPE (HAPE-r). The genotypic and allele frequencies, odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated, respectively. RESULTS The 12 SNPs showed a significant difference between the HAPE-p and HAPE-r groups. In allelic model analysis, we found that the allele "A" of rs17287745, rs17209237, rs17209251, rs6877893, and rs1866388; the allele "C" of rs6191, rs6188, and rs2918417; the allele "T" of rs33388 and rs4634384; and the allele "G" of rs41423247 and rs10052957 were associated with increased the risk of HAPE. In the genetic model analysis, we found that rs17287745, rs6191, rs6188, rs33388, rs2918417, rs6877893, rs1866388, rs41423247, rs4634384, and rs10052957 were relevant to the increased HAPE risk under the dominant model. In addition, the haplotype AACACTCAAGTG of the 12 SNPs was detected to be significantly associated with HAPE risk (OR = 2.044, 95%CI = 1.339~3.120, P = 0.0008), while the haplotype GGAGCACGACCG was associated with the decreased risk of HAPE (OR = 0.573, 95% CI = 0.333~0.985, P = 0.0422). CONCLUSIONS Our findings provide new evidence for the association between SNPs in NR3C1 and an increased risk of HAPE in the Chinese population. NR3C1 polymorphisms are associated with the susceptibility to HAPE in Han Chinese.
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Affiliation(s)
- Yingzhong Yang
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, 16 Kunlun Rd, Xining, 810001 Qinghai People’s Republic of China
- Basic and Applied Key Laboratory for High Altitude Medical Science and Technology of Qinghai, Xining, 810001 Qinghai China
- Qinghai-Utah United Key Laboratory for High Altitude Medical Science, Xining, 810001 Qinghai China
| | - Hui Du
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, 16 Kunlun Rd, Xining, 810001 Qinghai People’s Republic of China
| | - Yuhong Li
- Department of Respiration, Affiliated Hospital, Qinghai University, Xining, 810001 Qinghai China
| | - Wei Guan
- Department of Respiration, Affiliated Hospital, Qinghai University, Xining, 810001 Qinghai China
| | - Feng Tang
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, 16 Kunlun Rd, Xining, 810001 Qinghai People’s Republic of China
- Basic and Applied Key Laboratory for High Altitude Medical Science and Technology of Qinghai, Xining, 810001 Qinghai China
- Qinghai-Utah United Key Laboratory for High Altitude Medical Science, Xining, 810001 Qinghai China
| | - Qin Ga
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, 16 Kunlun Rd, Xining, 810001 Qinghai People’s Republic of China
- Basic and Applied Key Laboratory for High Altitude Medical Science and Technology of Qinghai, Xining, 810001 Qinghai China
- Qinghai-Utah United Key Laboratory for High Altitude Medical Science, Xining, 810001 Qinghai China
| | - Ri-Li Ge
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, 16 Kunlun Rd, Xining, 810001 Qinghai People’s Republic of China
- Basic and Applied Key Laboratory for High Altitude Medical Science and Technology of Qinghai, Xining, 810001 Qinghai China
- Qinghai-Utah United Key Laboratory for High Altitude Medical Science, Xining, 810001 Qinghai China
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200
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Buchan CA, Kotton CN. Travel medicine, transplant tourism, and the solid organ transplant recipient-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13529. [PMID: 30859623 DOI: 10.1111/ctr.13529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel-related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation, and all SOT recipients should be seen by a travel medicine specialist prior to traveling to destinations with higher rates of infection. Patients should be advised on vaccine-preventable illnesses as well as any need for prophylaxis (ie, malaria) based on their individual travel itineraries. Information with regards to specific recommendations for vaccines and prophylactic medications, along with drug-drug interactions, is summarized. Counseling should be provided for modifiable risks and exposures (ie, food and water safety, and insect bite prevention) as well as non-infectious travel topics. These guidelines also briefly address risks associated with transplant tourism and specific infections to consider if patients seek care for transplants done in foreign countries.
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Affiliation(s)
- C Arianne Buchan
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Camille Nelson Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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