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Hung PH, Lin FC, Tsai HC, Chao HS, Chou CW, Chang SC. The usefulness of prophylactic use of acetazolamide in subjects with acute mountain sickness. J Chin Med Assoc 2019; 82:126-132. [PMID: 30839503 DOI: 10.1097/jcma.0000000000000014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The mechanisms of acetazolamide (ACZ) in the prophylaxis of acute mountain sickness (AMS) remain unclear. This study evaluated the changes in physiological variables of sleep and heart rate variability (HRV) in subjects with earlier history of AMS who underwent prophylactic treatment of ACZ. METHODS Nonacclimatized healthy subjects were transported using a bus from 555 m to 3150 m within 3 hours. Polysomnography (PSG) was performed 3 days before ascent (T0), for two consecutive nights at 3150 m (T1 and T2), and 2 days after descent (T3). HRV was measured before sleep and after awakening from T0 to T3. AMS was diagnosed using a self-reported Lake Louise score questionnaire. Subjects found confirmed to have AMS were enrolled in this study. The physiological variables and HRV were compared in AMS subjects without (control group) and with prophylactic ACZ (prophylactic ACZ group). RESULTS Thirteen AMS subjects were enrolled. The PSG results were analyzed in eight and HRV were analyzed in nine of the 13 subjects. The prophylactic use of ACZ in the subjects with a history of AMS significantly improved sleep efficiency (p = 0.012) and awakening percentages (p = 0.017) at T1, significantly higher levels of arterial oxygen saturation (SaO2) and lower values of partial pressure end-tidal carbon dioxide tension (PETCO2) at four time points. Furthermore, they had a higher rapid eye movement sleep percentage (p = 0.05) at T2. Prophylactic ACZ treatment significantly increased the normalized unit of high frequency at T1 after awakening (p = 0.028). CONCLUSION Significantly higher quality of sleep, higher SaO2 during sleep, and lower PETCO2 at high altitude were found in the subjects with a history of AMS using prophylactic ACZ before rapid ascent. ACZ may accelerate the acclimatization process for rapid ascents to high altitudes by increasing parasympathetic tone based on HRV analyses.
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Affiliation(s)
- Pin-Hsi Hung
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Ear-Nose-Throat, Taipei City Hospital, Yangming Branch, Taipei, Taiwan, ROC
| | - Fang-Chi Lin
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Han-Chen Tsai
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chung-Wei Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shi-Chuan Chang
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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202
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Xin Y, Wang Y, Wang H, Tang X, Bai Y, Lu S, Xin Y. The response of nitric oxide system to high Altitude in Phrynocephalus erythrurus on Qinghai-Tibetan plateau. Comp Biochem Physiol B Biochem Mol Biol 2019; 230:29-36. [PMID: 30690199 DOI: 10.1016/j.cbpb.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 11/24/2022]
Abstract
Nitric oxide (NO), produced by nitric oxide synthases (NOS) from L-arginine, plays important roles in a wide range of physiological processes. However, little is known about ectothermic species. To investigate the response of NO/NOS system in adaptation to different altitudes in Phrynocephalus genus, the red tail toad-headed lizard Phrynocephalus erythrurus that live at 4500-5300 m on the Qinghai-Tibet Plateau and another low altitude living lizard Phrynocephalus przewalskii were selected in the present study. The results of mRNA expression and activity of NOSs, as well as NO metabolite levels in different tissues of the two lizards indicate that nNOS mRNA levels in cardiac and skeletal muscle were notably elevated in P. erythrurus, and iNOS expression was also increased markedly (up to 4-fold) in cardiac muscle. There was no significant difference in eNOS mRNA level in tested tissues between two species. However, the total NOS activity in skeletal muscle of P. erythrurus was slightly lower than that of P. przewalskii (p < .05) while no difference in other tissues. Similarly, lower iNOS activity (p < .01) was found in cardiac and skeletal muscle in P. erythrurus compared to P. przewalskii. In addition, the NO metabolite levels were dramatically lower in P. erythrurus in all tested tissues. We propose that higher nNOS and iNOS mRNA expression, lower iNOS activity and NO metabolite levels may represent physiological characteristics in nitric oxide system, which may contribute to high-altitude adaptation in P. erythrurus.
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Affiliation(s)
- Ying Xin
- Medical College of Northwest Minzu University, Lanzhou, China
| | - Yan Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Huihui Wang
- Institute of Biochemistry and Molecular Biology, School of Life Science, Lanzhou University, Lanzhou, China
| | - Xiaolong Tang
- Institute of Biochemistry and Molecular Biology, School of Life Science, Lanzhou University, Lanzhou, China
| | - Yucheng Bai
- The No. 1 Middle School of Gannan State, Hezuo City, China
| | - Songsong Lu
- Faculty of Forestry, Gansu Agricultural University, Lanzhou, China
| | - Ying Xin
- Medical College of Northwest Minzu University, Lanzhou, China.
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203
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Kim CH, Sajgalik P, Van Iterson EH, Jae SY, Johnson BD. The effect of remote ischemic pre-conditioning on pulmonary vascular pressure and gas exchange in healthy humans during hypoxia. Respir Physiol Neurobiol 2019; 261:62-66. [PMID: 30658096 DOI: 10.1016/j.resp.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/26/2018] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
Abstract
This study investigated whether rIPC alters the typical changes in pulmonary arterial pressure, pulmonary gas exchange associated with exercise in hypoxia. METHODS 16 healthy adults were randomized to either rIPC treatment (n = 8) or control (n = 8). Afterward, subjects performed supine ergometry at constant load (30 W, 40˜50 rpm) for 25 min during hypoxia (12.5% O2). Following a 90˜120 min rest, either rIPC or sham treatment was performed, which was then followed by post-assessment exercise. Throughout exercise, pulmonary arterial systolic pressure (PASP) and mean pulmonary arterial pressure (mPAP) were measured via echocardiography, while pulmonary gas exchange was being assessed. RESULTS The rICP group demonstrated improved PASP and mPAP (p < 0.05), whereas the control group did not. Additionally, breathing efficiency (VE/VCO2) and end-tidal CO2 (PETCO2) were improved in rIPC group (p < 0.05), but not in controls. CONCLUSION These data suggest that rIPC contributes to reduced pulmonary arterial pressure, and improved pulmonary gas exchange during hypoxic exercise. However, follow-up studies are needed to apply these findings to patient care settings.
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Affiliation(s)
- Chul-Ho Kim
- Human Integrative Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.
| | - Pavol Sajgalik
- Human Integrative Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Erik H Van Iterson
- Human Integrative Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Sae Young Jae
- Department of Sports Science, University of Seoul, Seoul, Republic of Korea
| | - Bruce D Johnson
- Human Integrative Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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204
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Ramirez-Zuniga I, Rubin JE, Swigon D, Clermont G. Mathematical modeling of energy consumption in the acute inflammatory response. J Theor Biol 2019; 460:101-114. [PMID: 30149010 PMCID: PMC6690200 DOI: 10.1016/j.jtbi.2018.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 01/20/2023]
Abstract
When a pathogen invades the body, an acute inflammatory response is activated to eliminate the intruder. In some patients, runaway activation of the immune system may lead to collateral tissue damage and, in the extreme, organ failure and death. Experimental studies have found an association between severe infections and depletion in levels of adenosine triphosphate (ATP), increase in nitric oxide production, and accumulation of lactate, suggesting that tissue energetics is compromised. In this work we present a differential equations model that incorporates the dynamics of ATP, nitric oxide, and lactate accompanying an acute inflammatory response and employ this model to explore their roles in shaping this response. The bifurcation diagram of the model system with respect to the pathogen growth rate reveals three equilibrium states characterizing the health, aseptic and septic conditions. We explore the domains of attraction of these states to inform the instantiation of heterogeneous virtual patient populations utilized in a survival analysis. We then apply the model to study alterations in the inflammatory response and survival outcomes in metabolically altered conditions such as hypoglycemia, hyperglycemia, and hypoxia.
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Affiliation(s)
- Ivan Ramirez-Zuniga
- Department of Mathematics, 301 Thackeray Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States.
| | - Jonathan E Rubin
- Department of Mathematics, 301 Thackeray Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - David Swigon
- Department of Mathematics, 301 Thackeray Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Gilles Clermont
- Department of Mathematics, 301 Thackeray Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States; Department of Critical Care Medicine, 3550 Terrace St., University of Pittsburgh Medical Center, Pittsburgh, PA 15261, United States; Department of Chemical and Petroleum Engineering, Swanson School of Engineering, University of Pittsburgh, PA 15260, United States
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205
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Inada M, Taguchi M, Harimoto K, Karasawa Y, Takeuchi M, Ito M. Protective effects of dexamethasone on hypoxia-induced retinal edema in a mouse model. Exp Eye Res 2019; 178:82-90. [DOI: 10.1016/j.exer.2018.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/09/2018] [Accepted: 09/25/2018] [Indexed: 01/09/2023]
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206
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Beidleman BA, Fulco CS, Glickman EL, Cymerman A, Kenefick RW, Cadarette BS, Andrew SP, Staab JE, Sils IV, Muza SR. Acute Mountain Sickness is Reduced Following 2 Days of Staging During Subsequent Ascent to 4300 m. High Alt Med Biol 2018; 19:329-338. [PMID: 30517038 DOI: 10.1089/ham.2018.0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether 2 days of staging at 2500-3500 m, combined with either high or low physical activity, reduces acute mountain sickness (AMS) during subsequent ascent to 4300 m. METHODS Three independent groups of unacclimatized men and women were staged for 2 days at either 2500 m (n = 18), 3000 m (n = 16), or 3500 m (n = 15) before ascending and living for 2 days at 4300 m and compared with a control group that directly ascended to 4300 m (n = 12). All individuals departed to the staging altitudes or 4300 m after spending one night at 2000 m during which they breathed supplemental oxygen to simulate sea level conditions. Half in each group participated in ∼3 hours of daily physical activity while half were sedentary. Women accounted for ∼25% of each group. AMS incidence was assessed using the Environmental Symptoms Questionnaire. AMS was classified as mild (≥0.7 and <1.5), moderate (≥1.5 and <2.6), and severe (≥2.6). RESULTS While staging, the incidence of AMS was lower (p < 0.001) in the 2500 m (0%), 3000 m (13%), and 3500 m (40%) staged groups than the direct ascent control group (83%). After ascent to 4300 m, the incidence of AMS was lower in the 3000 m (43%) and 3500 m (40%) groups than the 2500 m group (67%) and direct ascent control (83%). Neither activity level nor sex influenced the incidence of AMS during further ascent to 4300 m. CONCLUSIONS Two days of staging at either 3000 or 3500 m, with or without physical activity, reduced AMS during subsequent ascent to 4300 m but staging at 3000 m may be recommended because of less incidence of AMS.
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Affiliation(s)
- Beth A Beidleman
- 1 Biophysics and Biomedical Modeling Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Charles S Fulco
- 2 Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | | | - Allen Cymerman
- 2 Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Robert W Kenefick
- 2 Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Bruce S Cadarette
- 2 Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Sean P Andrew
- 2 Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Janet E Staab
- 3 Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Ingrid V Sils
- 2 Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Stephen R Muza
- 4 Strategic Scientific Management Office, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
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207
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NR3C2 Gene is Associated with Susceptibility to High-Altitude Pulmonary Edema in Han Chinese. Wilderness Environ Med 2018; 29:488-492. [DOI: 10.1016/j.wem.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 07/07/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022]
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208
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Li Y, Zhang Y, Zhang Y. Research advances in pathogenesis and prophylactic measures of acute high altitude illness. Respir Med 2018; 145:145-152. [DOI: 10.1016/j.rmed.2018.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 09/14/2018] [Accepted: 11/06/2018] [Indexed: 12/30/2022]
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209
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Shannon OM, McGawley K, Nybäck L, Duckworth L, Barlow MJ, Woods D, Siervo M, O'Hara JP. "Beet-ing" the Mountain: A Review of the Physiological and Performance Effects of Dietary Nitrate Supplementation at Simulated and Terrestrial Altitude. Sports Med 2018; 47:2155-2169. [PMID: 28577258 PMCID: PMC5633647 DOI: 10.1007/s40279-017-0744-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Exposure to altitude results in multiple physiological consequences. These include, but are not limited to, a reduced maximal oxygen consumption, drop in arterial oxygen saturation, and increase in muscle metabolic perturbations at a fixed sub-maximal work rate. Exercise capacity during fixed work rate or incremental exercise and time-trial performance are also impaired at altitude relative to sea level. Recently, dietary nitrate (NO3−) supplementation has attracted considerable interest as a nutritional aid during altitude exposure. In this review, we summarise and critically evaluate the physiological and performance effects of dietary NO3− supplementation during exposure to simulated and terrestrial altitude. Previous investigations at simulated altitude indicate that NO3− supplementation may reduce the oxygen cost of exercise, elevate arterial and tissue oxygen saturation, improve muscle metabolic function, and enhance exercise capacity/performance. Conversely, current evidence suggests that NO3− supplementation does not augment the training response at simulated altitude. Few studies have evaluated the effects of NO3− at terrestrial altitude. Current evidence indicates potential improvements in endothelial function at terrestrial altitude following NO3− supplementation. No effects of NO3− supplementation have been observed on oxygen consumption or arterial oxygen saturation at terrestrial altitude, although further research is warranted. Limitations of the present body of literature are discussed, and directions for future research are provided.
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Affiliation(s)
- Oliver Michael Shannon
- Research Institute for Sport, Physical Activity, and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.
| | - Kerry McGawley
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Linn Nybäck
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Lauren Duckworth
- Research Institute for Sport, Physical Activity, and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK
| | - Matthew John Barlow
- Research Institute for Sport, Physical Activity, and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK
| | - David Woods
- Research Institute for Sport, Physical Activity, and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK.,Defence Medical Services, Royal Centre for Defence Medicine, Birmingham, B152TH, UK
| | - Mario Siervo
- Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, NE45PL, UK
| | - John Paul O'Hara
- Research Institute for Sport, Physical Activity, and Leisure, Leeds Beckett University, Leeds, LS6 3QS, UK
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210
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East D, Steele J. Occurrence of Acute Mountain Sickness in Nonclimbing Tourists at Mount Mitchell, North Carolina (2037 m). High Alt Med Biol 2018; 20:99. [PMID: 30376383 DOI: 10.1089/ham.2018.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David East
- 1 Biology Department, Guilford College , Greensboro, North Carolina
| | - Janet Steele
- 2 Department of Biology, University of Nebraska-Kearney , Kearney, Nebraska
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211
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Posch AM, Dandorf S, Hile DC. The Effects of Acetazolamide on Exercise Performance at Sea Level and in Hypoxic Environments: A Review. Wilderness Environ Med 2018; 29:541-545. [PMID: 30314664 DOI: 10.1016/j.wem.2018.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022]
Abstract
Lowlanders rapidly ascending to high altitude (>2500 m) often develop acute mountain sickness (AMS). While acclimatization is the most effective method of reducing symptoms of AMS (ie, headache, fatigue, nausea, gastrointestinal distress, etc.), it may take several days to become fully acclimated. Prophylactic use of acetazolamide (AZ), a carbonic anhydrase inhibitor, has become a popular alternative to staged acclimatization because it can be a less time-consuming method of reducing symptoms of AMS. While numerous studies have shown the effectiveness of AZ in mitigating the symptoms of AMS, a review of the existing literature regarding the effects of AZ on submaximal and maximal exercise performance at sea level and at altitude has not been performed. Literature search identified 17 peer reviewed articles examining the effects of AZ on exercise performance both at sea level and at altitude, as well as the associated side effects of prophylactic AZ use for the attenuation of AMS. This review finds that AZ treated cohorts experience a reduction in time to exhaustion during both submaximal and maximal exercise performance at sea level. At altitude, AZ treated cohorts' recorded widely variable submaximal and maximal exercise performance. At sea level, AZ impairs submaximal and maximal exercise performance. Due to the wide variation of findings of previously published studies, the effects of AZ on submaximal and maximal exercise performance at altitude remain unknown.
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Affiliation(s)
- Alexander M Posch
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL (Mr Posch) and the Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD (Drs Dandorf and Hile).
| | - Stewart Dandorf
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL (Mr Posch) and the Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD (Drs Dandorf and Hile)
| | - David C Hile
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL (Mr Posch) and the Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD (Drs Dandorf and Hile)
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212
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Joyce K, Lucas S, Imray C, Balanos G, Wright AD. Advances in the available non-biological pharmacotherapy prevention and treatment of acute mountain sickness and high altitude cerebral and pulmonary oedema. Expert Opin Pharmacother 2018; 19:1891-1902. [DOI: 10.1080/14656566.2018.1528228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- K.E. Joyce
- School of Sport, Exercise, & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - S.J.E. Lucas
- School of Sport, Exercise, & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - C.H.E. Imray
- Department of Vascular Surgery, University Hospitals of Coventry and Warwickshire; Warwick Medical School, Coventry, UK
| | - G.M Balanos
- School of Sport, Exercise, & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A. D. Wright
- Department of Medicine, University of Birmingham, Edgbaston, UK
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213
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Li Y, Han J, Chen Y, Chen C, Chu B, Zhang Y. p-Coumaric acid as a prophylactic measure against normobaric hypoxia induced pulmonary edema in mice. Life Sci 2018; 211:215-223. [PMID: 30248349 DOI: 10.1016/j.lfs.2018.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/14/2018] [Accepted: 09/21/2018] [Indexed: 01/07/2023]
Abstract
AIMS Previous studies indicate that the anti-hypoxia effects of Tibetan Turnip (Brassica rapa ssp. rapa) were closely related to its characteristic components being p-coumaric acid (CA) and p-coumaric acid‑β‑d‑glucopyranoside (CAG). Since CAG would be converted to CA in vivo, this study aims to further examine the efficacy and mechanism of CA against pulmonary edema induced by normobaric hypoxia. MAIN METHODS Male ICR mice were assigned to the normoxia group and several hypoxia groups, given sterile water, CA or dexamethasone orally, once daily for four consecutive days. One hour after the final gavage, mice in the above hypoxia groups were put into the normobaric hypoxia chamber (9.5% O2) for 24 h while mice in normoxia group remained outside the chamber. After hypoxia exposure, lung water content (LWC), pulmonary vascular permeability, the protein content of bronchoalveolar lavage fluid (BALF), plasma total nitrate/nitrite (NOx) and endothelin-1 (ET-1) content, histological and ultra-microstructure analyses were performed. Expression of occludin was assayed by immunohistochemistry. KEY FINDINGS In a hypoxic environment of 9.5% O2, mice treated with 100 mg/kg body wt CA had significantly lower LWC and BALF protein content than mice in the hypoxia vehicle group. Meanwhile, mice in CA group showed intact lung blood-gas-barrier, increased levels of plasma total NO, decreased levels of plasma ET-1 and upregulation of occludin expression. SIGNIFICANCE CA exerts preventive effects against normobaric hypoxic pulmonary edema in mice, its mechanisms involved improving the integrity of the lung barrier, inhibiting oxidative stress and inflammation.
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Affiliation(s)
- Yunhong Li
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Jianxin Han
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Yufeng Chen
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Chun Chen
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Bingquan Chu
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China; School of Biological and Chemical Engineering, Zhejiang Provincial Key Lab for Chem & Bio Processing Technology of Farm Product, Zhejiang University of Science & Technology, Hangzhou 310023, Zhejiang, China
| | - Ying Zhang
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China.
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214
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Noh SJ, Lee H. Rapidly Progressing Fatal High-Altitude Illness in a Patient with Hyperthyroidism. High Alt Med Biol 2018; 19:288-290. [PMID: 30179522 DOI: 10.1089/ham.2017.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Noh, Sang Jae and Ho Lee. Rapidly progressing fatal high-altitude illness in a patient with hyperthyroidism. High Alt Med Biol. 19:288-290, 2018.-High-altitude illness (HAI) refers to a broad spectrum of diseases ranging from acute mountain sickness to high-altitude cerebral and pulmonary edema that are induced by high-altitude hypoxic stress. In this study, we present a case of a rapidly progressing fatal HAI (high-altitude cerebral edema and pulmonary edema) in a patient with hyperthyroidism. The victim is a 20-year-old female being treated for Graves' disease, who died after visiting a high-altitude region for travel. The autopsy examination showed cerebral and pulmonary edema, and right ventricular enlargement. A postmortem thyroid function test revealed thyrotoxic status; thyrotoxicosis may have contributed to the rapid progression of the HAI.
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Affiliation(s)
- Sang Jae Noh
- Department of Forensic Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital and Research Institute for Endocrine Sciences , Jeonju-si, Korea
| | - Ho Lee
- Department of Forensic Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital and Research Institute for Endocrine Sciences , Jeonju-si, Korea
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215
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Pun M, Guadagni V, Bettauer KM, Drogos LL, Aitken J, Hartmann SE, Furian M, Muralt L, Lichtblau M, Bader PR, Rawling JM, Protzner AB, Ulrich S, Bloch KE, Giesbrecht B, Poulin MJ. Effects on Cognitive Functioning of Acute, Subacute and Repeated Exposures to High Altitude. Front Physiol 2018; 9:1131. [PMID: 30246787 PMCID: PMC6111975 DOI: 10.3389/fphys.2018.01131] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/30/2018] [Indexed: 01/12/2023] Open
Abstract
Objective: Neurocognitive functions are affected by high altitude, however the altitude effects of acclimatization and repeated exposures are unclear. We investigated the effects of acute, subacute and repeated exposure to 5,050 m on cognition among altitude-naïve participants compared to control subjects tested at low altitude. Methods: Twenty-one altitude-naïve individuals (25.3 ± 3.8 years, 13 females) were exposed to 5,050 m for 1 week (Cycle 1) and re-exposed after a week of rest at sea-level (Cycle 2). Baseline (BL, 520 m), acute (Day 1, HA1) and acclimatization (Day 6, HA6, 5,050 m) measurements were taken in both cycles. Seventeen control subjects (24.9 ± 2.6 years, 12 females) were tested over a similar period in Calgary, Canada (1,103 m). The Reaction Time (RTI), Attention Switching Task (AST), Rapid Visual Processing (RVP) and One Touch Stockings of Cambridge (OTS) tasks were administered and outcomes were expressed in milliseconds/frequencies. Lake Louise Score (LLS) and blood oxygen saturation (SpO2) were recorded. Results: In both cycles, no significant changes were found with acute exposure on the AST total score, mean latency and SD. Significant changes were found upon acclimatization solely in the altitude group, with improved AST Mean Latency [HA1 (588 ± 92) vs. HA6 (526 ± 91), p < 0.001] and Latency SD [HA1 (189 ± 86) vs. HA6 (135 ± 65), p < 0.001] compared to acute exposure, in Cycle 1. No significant differences were present in the control group. When entering Acute SpO2 (HA1-BL), Acclimatization SpO2 (HA6-BL) and LLS score as covariates for both cycles, the effects of acclimatization on AST outcomes disappeared indicating that the changes were partially explained by SpO2 and LLS. The changes in AST Mean Latency [ΔBL (−61.2 ± 70.2) vs. ΔHA6 (−28.0 ± 58), p = 0.005] and the changes in Latency SD [ΔBL (−28.4 ± 41.2) vs. ΔHA6 (−0.2235 ± 34.8), p = 0.007] across the two cycles were smaller with acclimatization. However, the percent changes did not differ between cycles. These results indicate independent effects of altitude across repeated exposures. Conclusions: Selective and sustained attention are impaired at altitude and improves with acclimatization.The observed changes are associated, in part, with AMS score and SpO2. The gains in cognition with acclimatization during a first exposure are not carried over to repeated exposures.
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Affiliation(s)
- Matiram Pun
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Veronica Guadagni
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kaitlyn M Bettauer
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Lauren L Drogos
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Julie Aitken
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Sara E Hartmann
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Furian
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zürich, Zurich, Switzerland
| | - Lara Muralt
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zürich, Zurich, Switzerland
| | - Mona Lichtblau
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zürich, Zurich, Switzerland
| | - Patrick R Bader
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zürich, Zurich, Switzerland
| | - Jean M Rawling
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea B Protzner
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Silvia Ulrich
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zürich, Zurich, Switzerland
| | - Konrad E Bloch
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zürich, Zurich, Switzerland
| | - Barry Giesbrecht
- Department of Psychological and Brain Sciences, Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Marc J Poulin
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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216
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Tsai TY, Wang SH, Lee YK, Su YC. Ginkgo biloba extract for prevention of acute mountain sickness: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2018; 8:e022005. [PMID: 30121603 PMCID: PMC6104799 DOI: 10.1136/bmjopen-2018-022005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Trials of ginkgo biloba extract (GBE) for the prevention of acute mountain sickness (AMS) have been published since 1996. Because of their conflicting results, the efficacy of GBE remains unclear. We performed a systematic review and meta-analysis to assess whether GBE prevents AMS. METHODS The Cochrane Library, EMBASE, Google Scholar and PubMed databases were searched for articles published up to 20 May 2017. Only randomised controlled trials were included. AMS was defined as an Environmental Symptom Questionnaire Acute Mountain Sickness-Cerebral score ≥0.7 or Lake Louise Score ≥3 with headache. The main outcome measure was the relative risk (RR) of AMS in participants receiving GBE for prophylaxis. Meta-analyses were conducted using random-effects models. Sensitivity analyses, subgroup analyses and tests for publication bias were conducted. RESULTS Seven study groups in six published articles met all eligibility criteria, including the article published by Leadbetter et al, where two randomised controlled trials were conducted. Overall, 451 participants were enrolled. In the primary meta-analysis of all seven study groups, GBE showed trend of AMS prophylaxis, but it is not statistically significant (RR=0.68; 95% CI 0.45 to 1.04; p=0.08). The I2 statistic was 58.7% (p=0.02), indicating substantial heterogeneity. The pooled risk difference (RD) revealed a significant risk reduction in participants who use GBE (RD=-25%; 95% CI, from a reduction of 45% to 6%; p=0.011) The results of subgroup analyses of studies with low risk of bias, low starting altitude (<2500 m), number of treatment days before ascending and dosage of GBE are not statistically significant. CONCLUSION The currently available data suggest that although GBE may tend towards AMS prophylaxis, there are not enough data to show the statistically significant effect of GBE on preventing AMS. Further large randomised controlled studies are warranted.
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Affiliation(s)
- Tou-Yuan Tsai
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Shih-Hao Wang
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
- Department of Recreation and Leisure Industry Management, College of Management, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yi-Kung Lee
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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217
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Abstract
BACKGROUND Acute mountain sickness (AMS) is common in high-altitude travelers, and may lead to life-threatening high-altitude cerebral edema (HACE) or high-altitude pulmonary edema (HAPE). The inhaled drugs have a much lower peak serum concentrations and a shorter half-life period than oral drugs, which give them a special character, greater local effects in the lung. Meanwhile, short-term administration of inhaled drugs results in almost no adverse reactions. METHODS We chose inhaled ipratropium bromide/salbutamol sulfate (combivent, COM), budesonide (pulmicortrespules, BUD), and salbutamol sulfate (ventolin, VEN) in our study to investigate their prophylactic efficacy against AMS. Since COM is a compound drug of ipratropium bromide and salbutamol sulfate, to verify which part of COM plays a role in the prevention of AMS, we also tested VEN in our experiment. RESULTS In our study, Lake Louise scores (LLS) in the COM (1.14 ± 0.89 vs 1.91 ± 1.23, P < .05) and BUD (1.35 ± 0.94 vs 1.91 ± 1.23, P < .05) groups were both significantly lower than the placebo group at 72 hours. There were no significant differences in LLS scores among the 4 groups at 120 hours. The incidence of AMS in the COM group was significantly reduced at 72 hours (16.7% in COM group vs 43.4% in placebo group, P < .05) after exposure to high-altitude. There were no significant differences in AMS incidences at 120 hours among the 4 groups. CONCLUSION The prophylactic use of COM could prevent AMS in young Chinese male at 72 hours after high-altitude exposure. BUD also could reduce LLS but not prevent AMS at 72 hours. Ipratropium bromide maybe the effective drug in COM work on the prevention of AMS alone.
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Affiliation(s)
- Xiaomei Wang
- Department of Transfusion Medicine
- Department of Geriatrics
| | | | - Rong Li
- Department of Laboratory Medicine, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Weiling Fu
- Department of Laboratory Medicine, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
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218
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Coffman KE, Stewart GM, Carlson AR, Wheatley CM, Johnson BD. Effect of age on the presence of comet tails at high altitude. Respir Physiol Neurobiol 2018; 259:166-169. [PMID: 30056244 DOI: 10.1016/j.resp.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/16/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
Abstract
Extravascular lung water (EVLW) increases in healthy adults upon exposure to high altitude, likely due to increased pulmonary vascular resistance (PVR). Older individuals experience increased PVR during exercise, which may be exacerbated by trekking at high altitude. This study aimed to determine whether EVLW development is greater in older versus younger adults during graded altitude exposure. Fourteen younger (32 ± 6y) and 12 older (58 ± 5y) healthy adults completed an 11-day trek of Mount Kilimanjaro. EVLW was assessed at rest via comet tails prior to the trek in Moshi (950 m), at Shira Camp (3505 m), at Barafu Camp (4837 m), and post-descent. An increase in altitude from Baseline to Barafu tended to increase the proportion of participants with mild EVLW (p = 0.06). A higher proportion of older versus younger individuals tended to show mild EVLW at Barafu (56 vs. 14%, p = 0.06). In conclusion, EVLW formation may be more common in older adults trekking at high altitude. However, the presence of EVLW in older adults was subclinical.
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Affiliation(s)
- Kirsten E Coffman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA.
| | - Glenn M Stewart
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Alex R Carlson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA
| | - Courtney M Wheatley
- Department of Cardiovascular Diseases, Mayo Clinic, E Shea Blvd, Phoenix, AZ, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic, E Shea Blvd, Phoenix, AZ, USA
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219
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Wu G, Xu G, Chen DW, Gao WX, Xiong JQ, Shen HY, Gao YQ. Hypoxia Exacerbates Inflammatory Acute Lung Injury via the Toll-Like Receptor 4 Signaling Pathway. Front Immunol 2018; 9:1667. [PMID: 30083155 PMCID: PMC6064949 DOI: 10.3389/fimmu.2018.01667] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022] Open
Abstract
Acute lung injury (ALI) is characterized by non-cardiogenic diffuse alveolar damage and often leads to a lethal consequence, particularly when hypoxia coexists. The treatment of ALI remains a challenge: pulmonary inflammation and hypoxia both contribute to its onset and progression and no effective prevention approach is available. Here, we aimed to investigate the underlying mechanism of hypoxia interaction with inflammation in ALI and to evaluate hypoxia-inducible factor 1 alpha (HIF-1α)—the crucial modulator in hypoxia—as a potential therapeutic target against ALI. First, we developed a novel ALI rat model induced by a combined low-dose of lipopolysaccharides (LPS) with acute hypoxia. Second, we used gene microarray analysis to evaluate the inflammatory profiles of bronchi alveolar lavage fluid cells of ALI rats. Third, we employed an alveolar macrophage cell line, NR8383 as an in vitro system together with a toll-like receptor 4 (TLR4) antagonist TAK-242, to verify our in vivo findings from ALI animals. Finally, we tested the therapeutic effects of HIF-1α augmentation against inflammation and hypoxia in ALI. We demonstrated that (i) LPS upregulated inflammatory genes, tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6), in the alveolar macrophages of ALI rats, which were further enhanced when ALI combined with hypoxia; (ii) hypoxia exposure could further enhance the upregulation of alveolar macrophageal TLR4 that was noticed in LPS-induced inflammatory ALI, conversely, TLR4 antagonist TAK-242 could suppress the macrophageal expression of TLR4 and inflammatory cytokines, including TNF-α, IL-1β, and IL-6, suggesting that the TLR4 signaling pathway as a central link between inflammation and hypoxia in ALI; (iii) manipulation of HIF-1α in vitro could suppress TLR4 expression induced by combined LPS and hypoxia, via suppressing promoter activity of the TLR4 gene; (iv) preconditioning augmentation of HIF-1α in vivo by HIF hydroxylase inhibitor, DMOG excreted protection against inflammatory, and hypoxic processes in ALI. Together, we see that hypoxia can exacerbate inflammation in ALI via the activation of the TLR4 signaling pathway in alveolar macrophages and predispose impairment of the alveolar-capillary barrier in the development of ALI. Targeting HIF-1α can suppress TLR4 expression and macrophageal inflammation, suggesting the potential therapeutic and preventative value of HIF-1α/TLR4 crosstalk pathway in ALI.
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Affiliation(s)
- Gang Wu
- College of High Altitude Military Medicine, Institute of Medicine and Hygienic Equipment for High Altitude Region, Army Medical University, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Gang Xu
- College of High Altitude Military Medicine, Institute of Medicine and Hygienic Equipment for High Altitude Region, Army Medical University, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - De-Wei Chen
- Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China.,Department of Pathophysiology, College of High Altitude Military Medicine, Army Medical University, Chongqing, China
| | - Wen-Xiang Gao
- College of High Altitude Military Medicine, Institute of Medicine and Hygienic Equipment for High Altitude Region, Army Medical University, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
| | - Jian-Qiong Xiong
- Intensive Care Unit, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hai-Ying Shen
- Robert Stone Dow Laboratories, Legacy Research Institute, Legacy Health, Portland, OR, United States
| | - Yu-Qi Gao
- College of High Altitude Military Medicine, Institute of Medicine and Hygienic Equipment for High Altitude Region, Army Medical University, Chongqing, China.,Key Laboratory of High Altitude Medicine, People's Liberation Army, Chongqing, China
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220
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Park HY, Kim J, Park MY, Chung N, Hwang H, Nam SS, Lim K. Exposure and Exercise Training in Hypoxic Conditions as a New Obesity Therapeutic Modality: A Mini Review. J Obes Metab Syndr 2018; 27:93-101. [PMID: 31089548 PMCID: PMC6489458 DOI: 10.7570/jomes.2018.27.2.93] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 01/15/2023] Open
Abstract
Obesity is an important health problem caused by positive energy balance. Generally, low calorie dietary intake combined with regular exercise is the most common modality to lose bodily fat in obese people. Although this is the first modality of choice for obesity treatment, it needs to be applied to obese patients for at least 12 weeks or more and it does not provide consistent results because it is difficult to suppress increased appetite due to exercise. Recently, many researchers have been applying hypoxic conditions for the treatment of obesity, as many studies show that people residing in high altitudes have a lower percentage of body fat and fewer obesity-related illnesses than people living at sea level. Hypoxic therapy treatment, including hypoxic exposure or hypoxic exercise training, is recommended as a way to treat and prevent obesity by suppression of appetite, increasing basal metabolic rate and fat oxidation, and minimizing side effects. Hypoxic therapy inhibits energy intake and appetite-related hormones, and enhances various cardiovascular and metabolic function parameters. These observations indicate that hypoxic therapy is a new treatment modality for inducing fat reduction and promoting metabolic and cardiovascular health, which may be an important and necessary strategy for the treatment of obesity. As such, hypoxic therapy is now used as a general medical practice for obesity treatment in many developed countries. Therefore, hypoxic therapy could be a new, practical, and useful therapeutic modality for obesity and obesity-related comorbidities.
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Affiliation(s)
- Hun-Young Park
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Korea
| | - Jisu Kim
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Korea
| | - Mi-Young Park
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Korea
| | - Nana Chung
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Korea
| | - Hyejung Hwang
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Korea
| | - Sang-Seok Nam
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Korea
| | - Kiwon Lim
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Korea.,Laboratory of Exercise Nutrition, Department of Physical Education, Konkuk University, Seoul, Korea
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221
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Pun M, Hartmann SE, Furian M, Dyck AM, Muralt L, Lichtblau M, Bader PR, Rawling JM, Ulrich S, Bloch KE, Poulin MJ. Effect of Acute, Subacute, and Repeated Exposure to High Altitude (5050 m) on Psychomotor Vigilance. Front Physiol 2018; 9:677. [PMID: 29915546 PMCID: PMC5994420 DOI: 10.3389/fphys.2018.00677] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022] Open
Abstract
Aim: High altitude (HA) hypoxia may affect cognitive performance and sleep quality. Further, vigilance is reduced following sleep deprivation. We investigated the effect on vigilance, actigraphic sleep indices, and their relationships with acute mountain sickness (AMS) during very HA exposure, acclimatization, and re-exposure. Methods: A total of 21 healthy altitude-naive individuals (25 ± 4 years; 13 females) completed 2 cycles of altitude exposure separated by 7 days at low altitude (LA, 520 m). Participants slept at 2900 m and spent the day at HA, (5050 m). We report acute altitude exposure on Day 1 (LA vs. HA1) and after 6 days of acclimatization (HA1 vs. HA6). Vigilance was quantified by reaction speed in the 10-min psychomotor vigilance test reaction speed (PVT-RS). AMS was evaluated using the Environmental Symptoms Questionnaire Cerebral Score (AMS-C score). Nocturnal rest/activity was recorded to estimate sleep duration using actigraphy. Results: In Cycle 1, PVT-RS was slower at HA1 compared to LA (4.1 ± 0.8 vs. 4.5 ± 0.6 s-1, respectively, p = 0.029), but not at HA6 (4.6 ± 0.7; p > 0.05). In Cycle 2, PVT-RS at HA1 (4.6 ± 0.7) and HA6 (4.8 ± 0.6) were not different from LA (4.8 ± 0.6, p > 0.05) and significantly greater than corresponding values in Cycle 1. In both cycles, AMS scores were higher at HA1 than at LA and HA6 (p < 0.05). Estimated sleep durations (TST) at LA, 1st and 5th nights were 431.3 ± 28.7, 418.1 ± 48.6, and 379.7 ± 51.4 min, respectively, in Cycle 1 and they were significantly reduced during acclimatization exposures (LA vs. 1st night, p > 0.05; LA vs. 5th night, p = 0.012; and 1st vs. 5th night, p = 0.054). LA, 1st and 5th nights TST in Cycle 2 were 477.5 ± 96.9, 430.9 ± 34, and 341.4 ± 32.2, respectively, and we observed similar deteriorations in TST as in Cycle 1 (LA vs. 1st night, p > 0.05; LA vs. 5th night, p = 0.001; and 1st vs. 5th night, p < 0.0001). At HA1, subjects who reported higher AMS-C scores exhibited slower PVT-RS (r = -0.56; p < 0.01). Subjects with higher AMS-C scores took longer time to react to the stimuli during acute exposure (r = 0.62, p < 0.01) during HA1 of Cycle 1. Conclusion: Acute exposure to HA reduces the PVT-RS. Altitude acclimatization over 6 days recovers the reaction speed and prevents impairments during subsequent altitude re-exposure after 1 week spent near sea level. However, acclimatization does not lead to improvement in total sleep time during acute and subacute exposures.
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Affiliation(s)
- Matiram Pun
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sara E Hartmann
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Furian
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Adrienna M Dyck
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Lara Muralt
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Patrick R Bader
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Jean M Rawling
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Silvia Ulrich
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Pulmonary Division, Sleep Disorders Centre and Pulmonary Hypertension Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Marc J Poulin
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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222
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Horiuchi M, Uno T, Endo J, Handa Y, Hasegawa T. Impact of Sleeping Altitude on Symptoms of Acute Mountain Sickness on Mt. Fuji. High Alt Med Biol 2018; 19:193-200. [DOI: 10.1089/ham.2017.0106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Masahiro Horiuchi
- Division of Human Environmental Science, Mt. Fuji Research Institute, Fuji-yoshida, Japan
| | - Tadashi Uno
- Division of Human Environmental Science, Mt. Fuji Research Institute, Fuji-yoshida, Japan
| | - Junko Endo
- Division of Human Environmental Science, Mt. Fuji Research Institute, Fuji-yoshida, Japan
| | - Yoko Handa
- Division of Human Environmental Science, Mt. Fuji Research Institute, Fuji-yoshida, Japan
| | - Tatsuya Hasegawa
- Division of Human Environmental Science, Mt. Fuji Research Institute, Fuji-yoshida, Japan
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223
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Böttcher M, Lentini S, Arens ER, Kaiser A, van der Mey D, Thuss U, Kubitza D, Wensing G. First-in-man-proof of concept study with molidustat: a novel selective oral HIF-prolyl hydroxylase inhibitor for the treatment of renal anaemia. Br J Clin Pharmacol 2018; 84:1557-1565. [PMID: 29575006 DOI: 10.1111/bcp.13584] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 12/17/2022] Open
Abstract
AIMS Insufficient erythropoietin (EPO) synthesis is a relevant cause of renal anaemia in patients with chronic kidney disease. Molidustat, a selective hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor, increases endogenous EPO levels dose dependently in preclinical models. We examined the pharmacokinetics, safety, tolerability and effect on EPO levels of single oral doses of molidustat in healthy male volunteers. METHODS This was a single-centre, randomized, single-blind, placebo-controlled, group-comparison, dose-escalation study. Molidustat was administered at doses of 5, 12.5, 25, 37.5 or 50 mg as a polyethylene glycol-based solution. RESULTS In total, 45 volunteers received molidustat and 14 received placebo. Molidustat was absorbed rapidly, and the mean maximum plasma concentration and area under the concentration-time curve increased dose dependently. The mean terminal half-life was 4.64-10.40 h. A significant increase in endogenous EPO was observed following single oral doses of molidustat of 12.5 mg and above. Geometric mean peak EPO levels were 14.8 IU l-1 (90% confidence interval 13.0, 16.9) for volunteers who received placebo and 39.8 IU l-1 (90% confidence interval: 29.4, 53.8) for those who received molidustat 50 mg. The time course of EPO levels resembled the normal diurnal variation in EPO. Maximum EPO levels were observed approximately 12 h postdose and returned to baseline after approximately 24-48 h. All doses of molidustat were well tolerated and there were no significant changes in vital signs or laboratory safety parameters. CONCLUSIONS Oral administration of molidustat to healthy volunteers elicited a dose-dependent increase in endogenous EPO. These results support the ongoing development of molidustat as a potential new treatment for patients with renal anaemia.
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Affiliation(s)
- M Böttcher
- Clinical Sciences, Clinical Pharmacology Cardiovascular/Hematology, Global Drug Discovery, Bayer AG, Wuppertal, Germany
| | - S Lentini
- Clinical Sciences, Clinical Pharmacology Cardiovascular/Hematology, Global Drug Discovery, Bayer AG, Wuppertal, Germany
| | - E R Arens
- Clinical Sciences, Clinical Pharmacology Cardiovascular/Hematology, Global Drug Discovery, Bayer AG, Wuppertal, Germany
| | - A Kaiser
- Research and Clinical Science Statistics, Clinical Pharmacology Cardiovascular/Hematology, Global Drug Discovery, Bayer AG, Berlin, Germany
| | - D van der Mey
- Clinical Sciences, Clinical Pharmacology Cardiovascular/Hematology, Global Drug Discovery, Bayer AG, Wuppertal, Germany
| | - U Thuss
- Drug Metabolism and Pharmacokinetics, Global Early Development, Global Drug Discovery, Bayer AG, Wuppertal, Germany
| | - D Kubitza
- Clinical Sciences, Clinical Pharmacology Cardiovascular/Hematology, Global Drug Discovery, Bayer AG, Wuppertal, Germany
| | - G Wensing
- Clinical Sciences, Clinical Pharmacology Cardiovascular/Hematology, Global Drug Discovery, Bayer AG, Wuppertal, Germany
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Wu Y, Zhang C, Chen Y, Luo YJ. Association between acute mountain sickness (AMS) and age: a meta-analysis. Mil Med Res 2018; 5:14. [PMID: 29747689 PMCID: PMC5946480 DOI: 10.1186/s40779-018-0161-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute mountain sickness (AMS) is a potentially lethal condition caused by acute hypoxia after ascending to altitudes higher than 2500 m in a short time. The main symptom of AMS is headache. Numerous risk factors of AMS have been examined, including gender, obesity, ascent rate, age and individual susceptibility. In previous studies, age was considered a predisposing factor for AMS. However, different opinions have been raised in recent years. To clarify the association between AMS and age, we conducted this meta-analysis. METHODS We obtained observational studies that explored risk factors for AMS by searching PubMed, Embase, China National Knowledge Internet (CNKI), the Wanfang database and CQVIP for articles published before March 2017. The studies included were required to provide the mean age and its standard deviation for subjects with and without AMS, the maximum altitude attained and the mode of ascent. The Lake Louse Score (LLS) or the Chinese AMS score (CAS) was used to judge the severity of AMS symptoms and incidence. Studies were pooled for the analysis by using a random effects model in RevMan 5.0. Meta-regression and subgroup analyses were conducted to identify sources of heterogeneity using Stata 14.2 and RevMan 5.0. RESULTS In total, 17 studies were included, and the overall number of subjects with and without AMS was 1810 and 3014, respectively. The age ranged from 10 to 76 years. Analysis of the 17 included studies showed that age was not associated with AMS (mean difference (MD) = 0.10; 95% CI: -0.38-0.58; P = 0.69). CONCLUSION This meta-analysis suggests that there is no association between age and the risk of AMS. Race, age, and ascent mode are common sources of heterogeneity, which may provide an analytical orientation for future heterogeneity analyses.
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Affiliation(s)
- Yu Wu
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China.,Battalion 5 of Cadet Brigade, Army Medical University, Chongqing, 400038, China
| | - Chi Zhang
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China.,Key Laboratory of High Altitude Environmental Medicine of PLA, Army Medical University, Chongqing, 400038, China
| | - Yu Chen
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China.,Key Laboratory of High Altitude Environmental Medicine of PLA, Army Medical University, Chongqing, 400038, China
| | - Yong-Jun Luo
- Department of Military Medical Geography, Army Medical Service Training Base, Army Medical University, Chongqing, 400038, China. .,Key Laboratory of High Altitude Environmental Medicine of PLA, Army Medical University, Chongqing, 400038, China.
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225
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Du H, Zhao J, Su Z, Liu Y, Yang Y. Sequencing the exons of human glucocorticoid receptor (NR3C1) gene in Han Chinese with high-altitude pulmonary edema. J Physiol Anthropol 2018; 37:7. [PMID: 29587872 PMCID: PMC5869773 DOI: 10.1186/s40101-018-0168-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/13/2018] [Indexed: 02/01/2023] Open
Abstract
Background High-altitude pulmonary edema (HAPE) is a serious acute mountain sickness that mainly occurs in non-acclimatized individuals after rapid ascent to high altitude. The precise etiology of HAPE remains unclear. This study aimed to investigate whether NR3C1 gene polymorphism is associated with the susceptibility to HAPE. Methods The exons of NR3C1 gene were sequenced by a ABI 3730 DNA analyzer in 133 HAPE patients and matched 135 healthy Han Chinese controls from the Yushu area in Qinghai (the altitude greater than 3500 m). Results DNA sequencing showed the heterozygous substitutions at codon 588 (rs6194) in exon 6 and 766 (rs6196) in exon 9 of NR3C1 gene. The genotypic distributions and allelic frequencies of NR3C1 SNP rs6194 showed significant differences in two groups (P < 0.05). The frequencies of the C allele were significantly higher in the HAPE group than in the control group (P < 0.05) with an odds ratio of 3.009 (95% CI = 1.250-7.244). There were no differences in genotypic and allelic frequencies in rs6196 polymorphism between the two groups. Conclusions NR3C1 gene rs6194 polymorphism is correlated with HAPE susceptibility. CC genotype and C allele of rs6194 polymorphism might increase the risk of HAPE in Han Chinese.
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Affiliation(s)
- Hui Du
- Department of Basic Medical Sciences, Medical College, Qinghai University, Xining, 810001, Qinghai, China.,Research Center for High Altitude Medical Sciences, Medical College, Qinghai University, Xining, 810001, Qinghai, China
| | - Jing Zhao
- Department of Basic Medical Sciences, Medical College, Qinghai University, Xining, 810001, Qinghai, China
| | - Zhanhai Su
- Department of Basic Medical Sciences, Medical College, Qinghai University, Xining, 810001, Qinghai, China
| | - Yongnian Liu
- Department of Basic Medical Sciences, Medical College, Qinghai University, Xining, 810001, Qinghai, China
| | - Yingzhong Yang
- Department of Basic Medical Sciences, Medical College, Qinghai University, Xining, 810001, Qinghai, China. .,Research Center for High Altitude Medical Sciences, Medical College, Qinghai University, Xining, 810001, Qinghai, China.
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Gangwar A, Paul S, Ahmad Y, Bhargava K. Competing trends of ROS and RNS-mediated protein modifications during hypoxia as an alternate mechanism of NO benefits. Biochimie 2018; 148:127-138. [PMID: 29571702 DOI: 10.1016/j.biochi.2018.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/16/2018] [Indexed: 01/01/2023]
Abstract
Hypoxia, especially altitude associated hypoxia is known to cause severe physiological alterations and life-threatening conditions. Impaired redox balance along with oxidative stress, protein carbonylation and instigation of apoptotic events are common sub-cellular events that follow the hypoxic insult. The role of nitric oxide (NO) is very dynamic and versatile in preventing the ill effects of hypoxia vis-a-vis reacting with oxidative species and causing protein nitrosylation. Although several mechanisms of NO-mediated cytoprotection are known during hypoxic insult, limited pieces of evidence are available to support the relationship between two downstream events of oxidative stress, protein carbonylation (caused by carbonyl; CO radical) and protein nitrosylation/nitration (caused by NO/peroxynitrite; ONOO radical). In this study, we investigated an entirely new aspect of NO protection in hypoxia involving crosstalk between carbonylation and nitrosylation. Using standard NO inhibitor l-NAME and simulated hypoxic conditions in hypoxia-sensitive cell line H9c2, we evaluated the levels of radicals, cell death, mitochondrial membrane potential, levels of protein nitrosylation, protein nitration and carbonylation and glutathione content. The results were then carefully analyzed in light of NO bioavailability. Our study shows that reducing NO during hypoxia caused cell death via the increased degree of carbonylation in proteins. This provides a new aspect of NO benefits which furthers opens new possibilities to explore potential mechanisms and effects of cross-talk between nitrosylation, protein nitration and carbonylation, especially through some common antioxidant mediators such as glutathione and thioredoxin.
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Affiliation(s)
- Anamika Gangwar
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, 110054, India
| | - Subhojit Paul
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, 110054, India
| | - Yasmin Ahmad
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, 110054, India
| | - Kalpana Bhargava
- Peptide and Proteomics Division, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, Delhi, 110054, India.
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Berendsen RR, van Vessem ME, Bruins M, Teppema LJSM, Aarts LPHJ, Kayser B. Electronic Nose Technology Fails to Sniff Out Acute Mountain Sickness. High Alt Med Biol 2018; 19:232-236. [PMID: 29641295 DOI: 10.1089/ham.2017.0145] [Citation(s) in RCA: 3] [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
Berendsen, Remco R., Marieke E. van Vessem, Marcel Bruins, Luc J.S.M. Teppema, Leon P.H.J. Aarts, and Bengt Kayser. Electronic nose technology fails to sniff out acute mountain sickness. High Alt Med Biol. 19:232-236, 2018. AIM The aim of the study was to evaluate whether an electronic nose can discriminate between individuals with and without acute mountain sickness (AMS) following rapid ascent to 4554 m. RESULTS We recruited recreational climbers (19 women, 82 men; age 35 ± 10 years, mean ± standard deviation [SD]) upon arrival at 4554 m (Capanna Regina Margherita, Italy) for a proof of concept study. AMS was assessed with the Lake Louise self-report score (LLSRS) and the abbreviated Environmental Symptoms Questionnaire (ESQc); scores ≥3 and ≥0.7 were considered AMS, respectively. Exhaled air was analyzed with an electronic nose (Aeonose; The eNose Company, Netherlands). The collected data were analyzed using an artificial neural network. AMS prevalence was 44% with the LLSRS (mean score of those sick 4.4 ± 1.4 [SD]) and 20% with the ESQc (1.2 ± 0.5). The electronic nose could not discriminate between AMS and no AMS (LLSRS p = 0.291; ESQc p = 0.805). CONCLUSION The electronic nose technology utilized in this study could not discriminate between climbers with and without symptoms of AMS in the setting of an acute exposure to an altitude of 4554 m. At this stage, we cannot fully exclude that this technology per se is not able to discriminate for AMS. The quest for objective means to diagnose AMS thus continues.
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Affiliation(s)
- Remco R Berendsen
- 1 Department of Anesthesiology, Leiden University Medical Center , Leiden, Netherlands
| | - Marieke E van Vessem
- 2 Department of Cardiology, Leiden University Medical Center , Leiden, Netherlands
| | | | - Luc J S M Teppema
- 1 Department of Anesthesiology, Leiden University Medical Center , Leiden, Netherlands
| | - Leon P H J Aarts
- 1 Department of Anesthesiology, Leiden University Medical Center , Leiden, Netherlands
| | - Bengt Kayser
- 4 Institute of Sport Sciences, University of Lausanne , Lausanne, Switzerland
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228
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Sridharan K, Sivaramakrishnan G. Pharmacological interventions for preventing acute mountain sickness: a network meta-analysis and trial sequential analysis of randomized clinical trials. Ann Med 2018; 50:147-155. [PMID: 29166795 DOI: 10.1080/07853890.2017.1407034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Individuals ascending to high altitude are at a risk of getting acute mountain sickness (AMS). The present study is a network meta-analysis comparing all the interventions available to prevent AMS. METHODS Electronic databases were searched for randomized clinical trials evaluating the use of drugs to prevent AMS. Incidence of AMS was the primary outcome and incidence of severe AMS, paraesthesia (as side effect of acetazolamide use), headache and severe headache, and oxygen saturation were the secondary outcomes. Odds ratio [95% confidence interval] was the effect estimate for categorical outcomes and weighted mean difference for oxygen saturation. Random effects model was used to derive the direct and mixed treatment comparison pooled estimates. Trial sequential analysis and grading of the evidence for key comparisons were carried out. RESULTS A total of 24 studies were included. Acetazolamide at 125, 250 and 375 mg twice daily, dexamethasone and ibuprofen had statistically significant lower incidence of AMS compared to placebo. All the above agents except ibuprofen were also observed to significantly reduce the incidence of severe AMS. Acetazolamide alone or in combination with Ginkgo biloba were associated with lower incidence of headache, but higher risk of paraesthesia. Acetazolamide at 125 mg and 375 mg twice daily significantly reduce the incidence of severe headache as like ibuprofen. Trial sequential analysis indicates that the current evidence is adequate for the incidence of AMS only for acetazolamide 125 and 250 mg twice daily. Similarly, the strength of evidence for acetazolamide 125 and 250 mg twice daily was moderate while it was either low or very low for all other comparisons. CONCLUSIONS Acetazolamide at 125, 250 and 375 mg twice daily, ibuprofen and dexamethasone significantly reduce the incidence of AMS of which adequate evidence exists only for acetazolamide 125 and 250 mg twice daily therapy. Acetazolamide 125 mg twice daily could be the best in the pool considering the presence of enough evidence for preventing AMS and associated with lower incidence of paraesthesia. Key messages Acetazolamide 125, 250 and 375 mg twice daily, dexamethasone and ibuprofen reduce the incidence of AMS in high altitudes. Adequate evidence exists supporting the use of acetazolamide 125 mg and 250 mg twice daily for preventing AMS of which acetazolamide 125 mg twice daily could be the best.
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Affiliation(s)
- Kannan Sridharan
- a Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences , Arabian Gulf University , Manama , Bahrain
| | - Gowri Sivaramakrishnan
- b School of Oral Health, College of Medicine, Nursing and Health Sciences , Fiji National University , Suva , Fiji
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229
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Kurtzman RA, Caruso JL. High-Altitude Illness Death Investigation. Acad Forensic Pathol 2018; 8:83-97. [PMID: 31240027 PMCID: PMC6474454 DOI: 10.23907/2018.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/05/2017] [Accepted: 02/06/2018] [Indexed: 11/12/2022]
Abstract
High altitude illness (HAI) is the current accepted clinical term for a group of disorders including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE), which occur in travelers visiting high-altitude locations. High-altitude illness is due to hypobaric hypoxia, is not associated with age or physical conditioning, and mild forms are easily treated. High-altitude cerebral edema and HAPE are medical emergencies that are fatal if not promptly treated and fortunately are uncommon. The cause of most high-altitude fatalities is not related to HAI and can be easily distinguished from HACE and HAPE; however, other causes of death may have symptoms and physical findings that overlap with HAI, making postmortem diagnosis challenging. Fatalities due to HAPE and HACE are diagnoses of exclusion. Medical examiners and coroners who work in jurisdictions with high-altitude locations should be aware of the risk factors, physiology, pathology, differential diagnosis, and classification of HAI to accurately recognize HAI as a cause of death. Medical examiners who do not work in jurisdictions with high-altitude locations may be asked to evaluate deaths that occur overseas associated with high-altitude trekking and mountaineering activities.
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230
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Guo YB, He YX, Cui CY, Ouzhu L, Baima K, Duoji Z, Deji Q, Bian B, Peng Y, Bai CJ, Gongga L, Pan YY, Qu L, Kang M, Ciren Y, Baima Y, Guo W, Yang L, Zhang H, Zhang XM, Zheng WS, Xu SH, Chen H, Zhao SG, Cai Y, Liu SM, Wu TY, Qi XB, Su B. GCH1 plays a role in the high-altitude adaptation of Tibetans. Zool Res 2018; 38:155-162. [PMID: 28585439 PMCID: PMC5460084 DOI: 10.24272/j.issn.2095-8137.2017.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Tibetans are well adapted to high-altitude hypoxia. Previous genome-wide scans have reported many candidate genes for this adaptation, but only a few have been studied. Here we report on a hypoxia gene ( GCH1, GTP-cyclohydrolase I), involved in maintaining nitric oxide synthetase (NOS) function and normal blood pressure, that harbors many potentially adaptive variants in Tibetans. We resequenced an 80.8 kb fragment covering the entire gene region of GCH1 in 50 unrelated Tibetans. Combined with previously published data, we demonstrated many GCH1 variants showing deep divergence between highlander Tibetans and lowlander Han Chinese. Neutrality tests confirmed a signal of positive Darwinian selection on GCH1 in Tibetans. Moreover, association analysis indicated that the Tibetan version of GCH1 was significantly associated with multiple physiological traits in Tibetans, including blood nitric oxide concentration, blood oxygen saturation, and hemoglobin concentration. Taken together, we propose that GCH1 plays a role in the genetic adaptation of Tibetans to high altitude hypoxia.
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Affiliation(s)
- Yong-Bo Guo
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou Gansu 730070, China; State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Yao-Xi He
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China; High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Chao-Ying Cui
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Luobu Ouzhu
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Kangzhuo Baima
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Zhuoma Duoji
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Quzong Deji
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Ba Bian
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Yi Peng
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Cai-Juan Bai
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Lanzi Gongga
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Yong-Yue Pan
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | | | - Min Kang
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Yangji Ciren
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Yangji Baima
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - Wei Guo
- High Altitude Medical Research Center, School of Medicine, Tibetan University, Lhasa Tibet 850000, China
| | - la Yang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Hui Zhang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Xiao-Ming Zhang
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Wang-Shan Zheng
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou Gansu 730070, China; State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Shu-Hua Xu
- Chinese Academy of Sciences Key Laboratory of Computational Biology, Max Planck Independent Research Group on Population Genomics, CAS-MPG Partner Institute for Computational Biology(PICB), Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China; School of Life Science and Technology, Shanghai Tech University, Shanghai 200031, China; Collaborative Innovation Center of Genetics and Development, Shanghai 200438, China
| | - Hua Chen
- Center for Computational Genomics, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China
| | - Sheng-Guo Zhao
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou Gansu 730070, China
| | - Yuan Cai
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou Gansu 730070, China
| | - Shi-Ming Liu
- National Key Laboratory of High Altitude Medicine, High Altitude Medical Research Institute, Xining Qinghai 810012, China
| | - Tian-Yi Wu
- National Key Laboratory of High Altitude Medicine, High Altitude Medical Research Institute, Xining Qinghai 810012, China
| | - Xue-Bin Qi
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China.
| | - Bing Su
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China.
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Lo HY, Chen LLC, Su DH, Chen CH, Hsu TY, Wang SH, Weng YM, Chan CW, Wu SH, Chen HC, Chiu TF. Three-Minute Step Test for Predicting Acute Mountain Sickness: A Post Hoc Analysis of Rhodiola Crenulata Extract for Prevention of Acute Mountain Sickness, a Randomized, Double-Blind, Placebo-Controlled, Crossover Trial. J Acute Med 2018; 8:22-29. [PMID: 32995198 DOI: 10.6705/j.jacme.201803_8(1).0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Acute mountain sickness (AMS) often occurs in individuals who rapidly travel above 2,500 m. As the convenience of traveling and the development of mountain sports increase, AMS will become an increasingly important public health problem. However, no method to effectively predict AMS before it occurs is currently available. Methods This post hoc study investigated whether the 3-Minute Step Test (3MST), which evaluates physical fitness, is predictive of AMS development. The data collected in "Rhodiola crenulata extract for prevention of AMS: a randomized, double-blind, placebo-controlled, crossover trial" was used in the analysis. This study collected 204 observations of 102 participants who made two ascents of Hehuan Mountain (3,100 m) by bus within a 3-month period. Participants completed the 3MST at 250 m (before ascent) and 3,100 m (on Hehuan Mountain). The presence of AMS was accessed using the Lake Louise scoring system. Results AMS was identified in 124 observations (60.78%). In the univariate analysis, the pre-departure 3MST score (at 250 m) was not significantly associated with AMS (p = 0.498), but the 3MST score measured at 3,100 m, ascent number, pulse rate at 3,100 m, and saturation of peripheral oxygen (SpO2) measured at 3,100 m were significantly correlated with the occurrence of AMS (p = 0.002, 0.039, 0.005, < 0.001, respectively). In a further multivariate analysis, only SpO2 measured at 3,100 m had a significant association with AMS (p = 0.016 and 0.006, respectively). The trend analysis showed that for every 1-point increase in the 3MST score at 3,100 m, the AMS decreased by 4% (adjusted odds ratio [AOR] = 0.96, 95% confidence interval [CI] = 0.92-1.01). Conclusion The 3MST score cannot be a predictor of AMS, but it may have a potential role in predicting ascent safety in high-altitude areas.
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Affiliation(s)
- Hsiang Yun Lo
- New Taipei City Hospital Department of Emergency Medicine New Taipei City Taiwan.,Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Lisa Li-Chuan Chen
- Landseed Hospital Research Center, Department of Community Medicine Taoyuan Taiwan
| | - Deng-Huang Su
- National Taiwan University Division of Biostatistics, Institute of Epidemiology and Preventive Medicine, College of Public Health Taipei Taiwan
| | | | - Tai-Yi Hsu
- China Medical University Hospital Department of Emergency Medicine Taichung Taiwan
| | - Shih-Hao Wang
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Department of Emergency Medicine Chiayi Taiwan.,Chiayi Chang Gung Memorial Hospital Department of Physical Medicine and Rehabilitation Chiayi Taiwan
| | - Yi-Ming Weng
- Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan.,Ministry of Health and Welfare Department of Emergency Medicine, Taoyuan General Hospital Taoyuan Taiwan
| | - Cheng-Wei Chan
- Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan.,Ministry of Health and Welfare Department of Emergency Medicine, Chang-Hua Hospital Changhua Taiwan
| | - Shih-Hao Wu
- Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Hang-Cheng Chen
- China Medical University Hospital Department of Emergency Medicine Taichung Taiwan
| | - Te-Fa Chiu
- China Medical University Hospital Department of Emergency Medicine Taichung Taiwan
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232
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Liptzin DR, Abman SH, Giesenhagen A, Ivy DD. An Approach to Children with Pulmonary Edema at High Altitude. High Alt Med Biol 2018; 19:91-98. [PMID: 29470103 DOI: 10.1089/ham.2017.0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Liptzin, Deborah R., Steven H. Abman, Ann Giesenhagen, and D. Dunbar Ivy. An approach to children with pulmonary edema at high altitude. High Alt Med Biol. 19:91-98, 2018. INTRODUCTION Diagnosis of high-altitude illness can be more challenging in children, especially those who are preverbal. Families often travel to high elevations for family vacations, either for skiing, hiking, and/or camping. They may present to their primary care providers looking for anticipatory guidance before travel or may follow-up after developing high-altitude illness. High-altitude pulmonary edema (HAPE) can be fatal. OBSERVATIONS There is no indication for HAPE prophylaxis in altitude naive children. Children may develop HAPE either when traveling from low altitude to high altitude for vacation (classic HAPE), when returning to high-altitude homes after travel to low altitude (reentry HAPE), or even with a respiratory illness at high altitude without any change in elevation (high-altitude resident pulmonary edema or HARPE). Children may be more susceptible to HAPE because of increased vascular reactivity, immature control of breathing, and increased frequency of respiratory illnesses. Children with HAPE warrant evaluation for underlying cardiopulmonary abnormalities, including structural heart disease and pulmonary hypertension. Treatment of HAPE includes supplemental oxygen and descent, but underlying cardiopulmonary disease may also help guide treatment and prevention. CONCLUSIONS AND RELEVANCE Evaluation for structural heart disease and pulmonary hypertension should be considered in children with HAPE. Future studies should be done to elucidate the optimal strategies for prevention and treatment of HAPE and to better understand the development of HAPE in children.
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Affiliation(s)
- Deborah R Liptzin
- 1 Breathing Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
| | - Steven H Abman
- 1 Breathing Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
| | - Ann Giesenhagen
- 2 Heart Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
| | - D Dunbar Ivy
- 2 Heart Institute and Pediatric Heart-Lung Center, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado , Aurora, Colorado
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233
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Lipman GS, Pomeranz D, Burns P, Phillips C, Cheffers M, Evans K, Jurkiewicz C, Juul N, Hackett P. Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness. Am J Med 2018; 131:200.e9-200.e16. [PMID: 28668540 DOI: 10.1016/j.amjmed.2017.05.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide. METHODS This double-blind, randomized, placebo-controlled trial compared inhaled budesonide versus oral acetazolamide versus placebo, starting the morning of ascent from 1240 m (4100 ft) to 3810 m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (headache and Lake Louise Questionnaire ≥3 and another symptom). RESULTS A total of 103 participants were enrolled and completed the study; 33 (32%) received budesonide, 35 (34%) acetazolamide, and 35 (34%) placebo. Demographics were not different between the groups (P > .09). Acute mountain sickness prevalence was 73%, with severe acute mountain sickness of 47%. Fewer participants in the acetazolamide group (n = 15, 43%) developed acute mountain sickness compared with both budesonide (n = 24, 73%) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.3-10.1) and placebo (n = 22, 63%) (OR 0.5, 95% CI 0.2-1.2). Severe acute mountain sickness was reduced with acetazolamide (n = 11, 31%) compared with both budesonide (n = 18, 55%) (OR 2.6, 95% CI 1-7.2) and placebo (n = 19, 54%) (OR 0.4, 95% CI 0.1-1), with a number needed to treat of 4. CONCLUSION Budesonide was ineffective for the prevention of acute mountain sickness, and acetazolamide was preventive of severe acute mountain sickness taken just before rapid ascent.
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Affiliation(s)
- Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, Calif.
| | - David Pomeranz
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Patrick Burns
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Caleb Phillips
- Department of Computational Science, University of Colorado, Boulder
| | - Mary Cheffers
- Emergency Medicine Residency L.A. County, University of Southern California, Los Angeles
| | - Kristina Evans
- Stanford-Kaiser Emergency Medicine Residency, Palo Alto, Calif
| | - Carrie Jurkiewicz
- Emeregency Medicine Residency, University of Chicago School of Medicine, Ill
| | - Nick Juul
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Peter Hackett
- Department of Emergency Medicine, Institute for Altitude Medicine, University of Colorado, Boulder
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Plasma proteomic study of acute mountain sickness susceptible and resistant individuals. Sci Rep 2018; 8:1265. [PMID: 29352170 PMCID: PMC5775437 DOI: 10.1038/s41598-018-19818-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022] Open
Abstract
Although extensive studies have focused on the development of acute mountain sickness (AMS), the exact mechanisms of AMS are still obscure. In this study, we used isobaric tags for relative and absolute quantitation (iTRAQ) proteomic analysis to identify novel AMS−associated biomarkers in human plasma. After 9 hours of hypobaric hypoxia the abundance of proteins related to tricarboxylic acid (TCA) cycle, glycolysis, ribosome, and proteasome were significantly reduced in AMS resistant (AMS−) group, but not in AMS susceptible (AMS+) group. This suggested that AMS− individuals could reduce oxygen consumption via repressing TCA cycle and glycolysis, and reduce energy consumption through decreasing protein degradation and synthesis compared to AMS+ individuals after acute hypoxic exposure. The inflammatory response might be decreased resulting from the repressed TCA cycle. We propose that the ability for oxygen consumption reduction may play an important role in the development of AMS. Our present plasma proteomic study in plateau of the Han Chinese volunteers gives new data to address the development of AMS and potential AMS correlative biomarkers.
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235
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Baniya S, Basnyat B. Mismanagement of Severe Altitude Illness in a Tertiary Hospital in Nepal: A Cautionary Tale. Wilderness Environ Med 2018; 29:140-142. [PMID: 29338986 DOI: 10.1016/j.wem.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Buddha Basnyat
- Oxford University Clinical Research Unit - Nepal Kathmandu, Nepal; Himalayan Rescue Association Kathmandu, Nepal
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Ding XH, Wang Y, Cui B, Qin J, Zhang JH, Rao RS, Yu SY, Zhao XH, Huang L. Acute Mountain Sickness Is Associated With a High Ratio of Endogenous Testosterone to Estradiol After High-Altitude Exposure at 3,700 m in Young Chinese Men. Front Physiol 2018; 9:1949. [PMID: 30740062 PMCID: PMC6355701 DOI: 10.3389/fphys.2018.01949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 12/22/2018] [Indexed: 12/12/2022] Open
Abstract
Background: A large proportion of populations suffer from acute mountain sickness (AMS) after exposure at high altitude. AMS is closely related with age and gender implying that the sex hormones may play critical roles in AMS. Our observational study aimed to identify the association between the endogenous testosterone (T), estradiol (E2) and AMS. Methods: A total of 113 subjects were recruited in 2012. The participants were evaluated at 500 m and after acute (1 day) and short-term (7 days) high-altitude exposure at 3,700 m. The subjects also completed a case report form questionnaire and underwent blood pressure measurements and an echocardiography examination. The red blood cell (RBC) count, Hb concentration ([Hb]), hematocrit (HCT), E2, T, and erythropoietin (EPO) were measured. Results: Upon acute high-altitude exposure, E2 and EPO were significantly lower in AMS+ group, and T/E2 and stroke volume were higher. On the 1st day, AMS score correlated positively with the T/E2 ratio while it negatively correlated with E2. After 7 days at 3,700 m, the AMS+ subjects had higher erythropoietic parameters: EPO, T, and T/E2 were significantly higher in the AMS+ group. [Hb], RBC count, HCT, EPO, T and T/E2 were also correlated with AMS score. EPO, HCT, and the RBC count were also correlated with T/E2. Regression analyses indicated that T/E2 significantly correlated to AMS score and T/E2 on the 1st day was an independent predictor for AMS on the 7th day. Conclusion: AMS was correlated with T/E2 ratio and EPO. After short-term exposure, higher T/E2 may contribute to AMS together with EPO via erythropoiesis. Furthermore, T/E2 level at high altitude in the early stage was an independent predictor for AMS in the latter stage.
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Affiliation(s)
- Xiao-Han Ding
- Department of Health Care and Geriatrics, Lanzhou General Hospital of Lanzhou Military Region, Lanzhou, China
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yanchun Wang
- Department of Health Care and Geriatrics, Lanzhou General Hospital of Lanzhou Military Region, Lanzhou, China
| | - Bin Cui
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jun Qin
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ji-Hang Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Rong-Sheng Rao
- Department of Ultrasonography, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shi-Yong Yu
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiao-Hui Zhao
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lan Huang
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- *Correspondence: Lan Huang,
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Haslam NR, Garth R, Kelly N. Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report. Wilderness Environ Med 2017; 28:318-321. [DOI: 10.1016/j.wem.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 10/18/2022]
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Huppertz T, Freiherr J, Olzowy B, Kisser U, Stephan J, Fesl G, Haegler K, Feddersen B, Fischer R, Mees K, Becker S. Reduction of olfactory sensitivity during normobaric hypoxia. Auris Nasus Larynx 2017; 45:747-752. [PMID: 29153259 DOI: 10.1016/j.anl.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/22/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Acute mountain sickness (AMS) is caused by a low partial pressure of oxygen and may occur above 2500m. The aim of this research was to evaluate olfactory and gustatory abilities of healthy subjects during baseline conditions and after seven hours of normobaric hypoxia. METHODS Sixteen healthy subjects were assessed using the Sniffin' Sticks, as well as intensity and pleasantness ratings. Gustatory function was evaluated utilizing the Taste Strips. Experiments were carried out under baseline conditions (518m altitude) followed by a second testing session after seven hours of normobaric hypoxia exposure (comparable to 4000m altitude). RESULTS During normobaric hypoxia olfactory sensitivity and intensity estimates were significantly reduced. CONCLUSIONS We conclude that normobaric hypoxia leads to a significant decrease of olfactory sensitivity and intensity ratings.
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Affiliation(s)
- Tilman Huppertz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
| | - Jessica Freiherr
- Diagnostic and Interventional Neuroradiology, Uniklinik RWTH Aachen, Germany
| | - Bernhard Olzowy
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, Germany
| | - Ulrich Kisser
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, Germany
| | - Jutta Stephan
- Institute for Altitude Training - Altitude Balance, Munich, Germany
| | - Gunther Fesl
- Department of Neuroradiology, Ludwig Maximilians University Munich, Germany
| | - Kathrin Haegler
- Department of Neuroradiology, Ludwig Maximilians University Munich, Germany
| | - Berend Feddersen
- Department of Neurology, Ludwig Maximilians University Munich, Germany
| | | | - Klaus Mees
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University Munich, Germany
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Meier D, Collet TH, Locatelli I, Cornuz J, Kayser B, Simel DL, Sartori C. Does This Patient Have Acute Mountain Sickness?: The Rational Clinical Examination Systematic Review. JAMA 2017; 318:1810-1819. [PMID: 29136449 DOI: 10.1001/jama.2017.16192] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Acute mountain sickness (AMS) affects more than 25% of individuals ascending to 3500 m (11 500 ft) and more than 50% of those above 6000 m (19 700 ft). AMS may progress from nonspecific symptoms to life-threatening high-altitude cerebral edema in less than 1% of patients. It is not clear how to best diagnose AMS. OBJECTIVE To systematically review studies assessing the accuracy of AMS diagnostic instruments, including the visual analog scale (VAS) score, which quantifies the overall feeling of sickness at altitude (VAS[O]; various thresholds), Acute Mountain Sickness-Cerebral score (AMS-C; ≥0.7 indicates AMS), and the clinical functional score (CFS; ≥2 indicates AMS) compared with the Lake Louise Questionnaire Score (LLQS; score of ≥5). DATA EXTRACTION AND SYNTHESIS Searches of MEDLINE and EMBASE from inception to May 2017 identified 1245 publications of which 91 were suitable for prevalence analysis (66 944 participants) and 14 compared at least 2 instruments (1858 participants) using a score of 5 or greater on the LLQS as a reference standard. To determine the prevalence of AMS for establishing the pretest probability of AMS, a random-effects meta-regression was performed based on the reported prevalence of AMS as a function of altitude. MAIN OUTCOMES AND MEASURES AMS prevalence, likelihood ratios (LRs), sensitivity, and specificity of screening instruments. RESULTS The final analysis included 91 articles (comprising 66 944 study participants). Altitude predicted AMS and accounted for 28% of heterogeneity between studies. For each 1000-m (3300-ft) increase in altitude above 2500 m (8200 ft), AMS prevalence increased 13% (95% CI, 9.5%-17%). Testing characteristics were similar for VAS(O), AMS-C, and CFS vs a score of 5 or greater on the LLQS (positive LRs: range, 3.2-8.2; P = .22 for comparisons; specificity range, 67%-92%; negative LRs: range, 0.30-0.36; P = .50 for comparisons; sensitivity range, 67%-82%). The CFS asks a single question: "overall if you had any symptoms, how did they affect your activity (ordinal scale 0-3)?" For CFS, moderate to severe reduction in daily activities had a positive LR of 3.2 (95% CI, 1.4-7.2) and specificity of 67% (95% CI, 37%-97%); no reduction to mild reduction in activities had a negative LR of 0.30 (95% CI, 0.22-0.39) and sensitivity of 82% (95% CI, 77%-87%). CONCLUSIONS AND RELEVANCE The prevalence of acute mountain sickness increases with higher altitudes. The visual analog scale for the overall feeling of sickness at altitude, Acute Mountain Sickness-Cerebral, and clinical functional score perform similarly to the Lake Louise Questionnaire Score using a score of 5 or greater as a reference standard. In clinical and travel settings, the clinical functional score is the simplest instrument to use. Clinicians evaluating high-altitude travelers who report moderate to severe limitations in activities of daily living (clinical functional score ≥2) should use the Lake Louise Questionnaire Score to assess the severity of acute mountain sickness.
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Affiliation(s)
- David Meier
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Ambulatory Care and Community Medicine, University of Lausanne; Lausanne, Switzerland
| | - Isabella Locatelli
- Ambulatory Care and Community Medicine, University of Lausanne; Lausanne, Switzerland
| | - Jacques Cornuz
- Ambulatory Care and Community Medicine, University of Lausanne; Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
| | - David L Simel
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Health System, Durham, North Carolina
| | - Claudio Sartori
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Wang C, Yan M, Jiang H, Wang Q, He S, Chen J, Wang C. Mechanism of aquaporin 4 (AQP 4) up-regulation in rat cerebral edema under hypobaric hypoxia and the preventative effect of puerarin. Life Sci 2017; 193:270-281. [PMID: 29054452 DOI: 10.1016/j.lfs.2017.10.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/08/2017] [Accepted: 10/17/2017] [Indexed: 01/05/2023]
Abstract
AIM We aim to investigate the mechanism of aquaporin 4 (AQP 4) up-regulation during high-altitude cerebral edema (HACE) in rats under hypobaric hypoxia and preventative effect of puerarin. METHODS Rats were exposed to a hypobaric chamber with or without the preventative treatment of puerarin or dexamethasone. Morriz water maze was used to evaluate the spatial memory injury. HE staining and W/D ratio were used to evaluate edema injury. Rat astrocytes and microglia were co-cultured under the condition of hypoxia with the administration of p38 inhibitor, NF-κB inhibitor or puerarin. Interleukin 6 (IL-6) and tumor necrosis factor α (TNF α) of cortex and culture supernatant were measured with ELISA. AQP4, phosphorylation of MAPKs, NF-κB pathway of cortex and astrocytes were measured by Western blot. KEY FINDINGS Weakened spatial memory and cerebral edema were observed after hypobaric hypoxia exposure. AQP4, phosphorylation of NF-κB and MAPK signal pathway of cortex increased after hypoxia exposure and decreased with preventative treatment of puerarin. Hypoxia increased TNF-α and IL-6 levels in cortex and microglia and puerarin could prevent the increase of them. AQP4 of astrocytes increased after co-cultured with microglia when both were exposed to hypoxia. AQP4 showed a decrease after administered with p38 inhibitor, NF-κB inhibitor or puerarin. SIGNIFICANCE Hypoxia triggers inflammatory response, during which AQP4 of astrocytes can be up regulated through the release of TNF-α and IL-6 from microglia. Puerarin can exert a preventative effect on the increase of AQP4 through inhibiting the release of TNF-α and phosphorylation of NF-κB, MAPK pathway.
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Affiliation(s)
- Chi Wang
- Department of Clinical Laboratory, PLA General Hospital, 100853 Beijing, China
| | - Muyang Yan
- Department of Hyperbaric Chamber, PLA General Hospital, 100853 Beijing, China
| | - Hui Jiang
- Department of Hyperbaric Chamber, PLA General Hospital, 100853 Beijing, China
| | - Qi Wang
- Outpatient Department of Chinese People's Liberation Army Aviation School, 101023 Beijing, China
| | - Shang He
- Department of Clinical Laboratory, PLA General Hospital, 100853 Beijing, China
| | - Jingwen Chen
- Department of Hyperbaric Chamber, PLA General Hospital, 100853 Beijing, China
| | - Chengbin Wang
- Department of Clinical Laboratory, PLA General Hospital, 100853 Beijing, China.
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STAT3-RXR-Nrf2 activates systemic redox and energy homeostasis upon steep decline in pO 2 gradient. Redox Biol 2017; 14:423-438. [PMID: 29078168 PMCID: PMC5680518 DOI: 10.1016/j.redox.2017.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/30/2017] [Accepted: 10/15/2017] [Indexed: 01/04/2023] Open
Abstract
Hypobaric hypoxia elicits several patho-physiological manifestations, some of which are known to be lethal. Among various molecular mechanisms proposed so far, perturbation in redox state due to imbalance between radical generation and antioxidant defence is promising. These molecular events are also related to hypoxic status of cancer cells and therefore its understanding has extended clinical advantage beyond high altitude hypoxia. In present study, however, the focus was to understand and propose a model for rapid acclimatization of high altitude visitors to enhance their performance based on molecular changes. We considered using simulated hypobaric hypoxia at some established thresholds of high altitude stratification based on known physiological effects. Previous studies have focused on the temporal aspect while overlooking the effects of varying pO2 levels during exposure to hypobaric hypoxia. The pO2 levels, indicative of altitude, are crucial to redox homeostasis and can be the limiting factor during acclimatization to hypobaric hypoxia. In this study we present the effects of acute (24h) exposure to high (3049m; pO2: 71kPa), very high (4573m; pO2: 59kPa) and extreme altitude (7620m; pO2: 40kPa) zones on lung and plasma using semi-quantitative redox specific transcripts and quantitative proteo-bioinformatics workflow in conjunction with redox stress assays. It was observed that direct exposure to extreme altitude caused 100% mortality, which turned into high survival rate after pre-exposure to 59kPa, for which molecular explanation were also found. The pO2 of 59kPa (very high altitude zone) elicits systemic energy and redox homeostatic processes by modulating the STAT3-RXR-Nrf2 trio. Finally we posit the various processes downstream of STAT3-RXR-Nrf2 and the plasma proteins that can be used to ascertain the redox status of an individual.
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242
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Moraga FA, Osorio J, Calderón-Jofré R, Pedreros A. Hemoconcentration During Maximum Exercise in Miners with Chronic Intermittent Exposure to Hypobaric Hypoxia (3800 m). High Alt Med Biol 2017; 19:15-20. [PMID: 29035586 DOI: 10.1089/ham.2017.0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Moraga, Fernando A., Jorge Osorio, Rodrigo Calderón-Jofré, and Andrés Pedreros. Hemoconcentration during maximum exercise in miners with chronic intermittent exposure to hypobaric hypoxia (3800 m). High Alt Med Biol. 19:15-20, 2018. OBJECTIVE To evaluate the effect of maximum exercise on hemoconcentration in miners with chronic intermittent hypobaric hypoxia (CIHH) at 3800 m. MATERIALS AND METHODS Sixteen miners with CIHH at high altitude (3800 m) were subjected to maximum exercise levels on a cycle ergometer, increasing exercise load by 50 W every 3 minutes at sea level and high altitude (3800 m). During exercise, arterial oxygen saturation and heart rate were measured. Blood samples were taken at each step to measure hemoglobin concentration and hematocrit. Arterial blood oxygen content was also calculated. RESULTS At sea level, a decrease in arterial oxygen saturation to 92.1% ± 2.5% was observed at 150 W and the hematocrit, hemoglobin concentration and oxygen content were not altered. At high altitude, arterial oxygen saturation decreased, reaching 88.2% ± 4.9% at 50 W and remained constant during the entire exercise protocol. Hemoglobin concentration and hematocrit increased reaching 16.4 ± 0.9 g/dL and 48.8% ± 1.6%, respectively, at 100 W and were maintained until recovery. Arterial oxygen content was constant during exercise and increased in the recovery period. CONCLUSION An increase in hemoglobin concentration during exercise compensates for the decline in arterial oxygen saturation, meanwhile arterial oxygen content remains constant.
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Affiliation(s)
- Fernando A Moraga
- 1 Laboratorio de Fisiología, Hipoxia y Función Vascular, Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica del Norte , Coquimbo, Chile
| | - Jorge Osorio
- 2 Instituto de Estudios de la Salud , Universidad Arturo Prat, Iquique, Chile
| | - Rodrigo Calderón-Jofré
- 1 Laboratorio de Fisiología, Hipoxia y Función Vascular, Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica del Norte , Coquimbo, Chile
| | - Andrés Pedreros
- 1 Laboratorio de Fisiología, Hipoxia y Función Vascular, Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica del Norte , Coquimbo, Chile
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Association between single nucleotide polymorphisms in ADRB2, GNB3 and GSTP1 genes and high-altitude pulmonary edema (HAPE) in the Chinese Han population. Oncotarget 2017; 8:18206-18212. [PMID: 28212552 PMCID: PMC5392320 DOI: 10.18632/oncotarget.15309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
High altitude pulmonary edema (HAPE) occurs mainly under conditions such as high altitude, rapid ascent, or hypoxia. Previous studies suggest that ADRB2, GNB3, TH, and GSTP1 polymorphisms are associated with various lung diseases. We evaluated whether those polymorphisms are associated with the risk of HAPE in a Chinese Han population. ADRB2, GNB3, TH and GSTP1 polymorphisms were genotyped using a Sequenom MassARRAY. Logistic regression, adjusted for age and gender, was used to evaluate the association between the genotypes and the risk of HAPE by computing odds ratios (ORs) and 95% confidence intervals (95% CIs). The results revealed that GNB3 rs4963516 allele ''G'' (G vs T: OR = 0.70, 95% CI = 0.55-0.90, p = 0.006) was associated with HAPE risk. The ADRB2 rs1042718 alleles had a 1.29-fold (95%CI = 1.00-1.66; p = 0.045) increased risk of HAPE, and the GSTP1 rs749174 alleles had a 0.71-fold (95%CI = 0.52-0.99; p = 0.042) decreased risk of HAPE. Co-dominant and dominant models of GNB3 rs4963516 decreased the risk of HAPE (p = 0.023 and p = 0.008, respectively). Our results indicate GNB3 and GSTP1 polymorphisms may protect against HAPE progression, while ADRB2 polymorphisms are associated with an increased risk of HAPE.
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Sánchez-Mascuñano A, Masuet-Aumatell C, Morchón-Ramos S, Ramon JM. Relationship of altitude mountain sickness and smoking: a Catalan traveller's cohort study. BMJ Open 2017; 7:e017058. [PMID: 28947454 PMCID: PMC5623483 DOI: 10.1136/bmjopen-2017-017058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study is to analyse the relationship between smoking and altitude mountain sickness in a cohort of travellers to 2500 metres above sea level (masl) or higher. SETTING Travel Health Clinic at the Hospital Universitari de Bellvitge, in Barcelona, Spain. PARTICIPANTS A total of 302 adults seeking medical advice at the travel clinic, between July 2012 and August 2014, before travelling to 2500 masl or above, who agreed to participate in the study and to be contacted after the trip were included. Individuals who met the following criteria were excluded: younger than 18 years old, taking carbonic anhydrase inhibitors for chronic use, undergoing treatment with systemic corticosteroids and taking any medication that might prevent or treat altitude mountain sickness (AMS) prior to or during the trip. The majority of participants were women (n=156, 51.7%). The mean age was 37.7 years (SD 12.3). The studied cohort included 74 smokers (24.5%), 158 (52.3%) non-smokers and 70 (23.2%) ex-smokers. No statistical differences were observed between different sociodemographic characteristics, constitutional symptoms or drug use and smoking status. OUTCOMES The main outcome was the development of AMS, which was defined according to the Lake Louise AMS criteria. RESULTS AMS, according to the Lake Louise score, was significantly lower in smokers; the value was 14.9%, 95% CI (6.8 to 23.0%) in smokers and 29.4%, 95% CI (23.5 to 35.3%) in non-smokers with an adjusted OR of 0.54, 95% CI (0.31 to 0.97) independent of gender, age and maximum altitude reached. CONCLUSIONS These results suggest that smoking could reduce the risk of AMS in non-acclimated individuals. Further studies should be performed in larger cohorts of travellers to confirm these results. Despite the results, smoking must be strongly discouraged because it greatly increases the risk of cardiorespiratory diseases, cancer and other diseases.
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Affiliation(s)
- Alba Sánchez-Mascuñano
- Department of Preventive Medicine, Bellvitge Biomedical Research Institute (IDIBELL), International Health Center and Travel Medicine Clinic, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Cristina Masuet-Aumatell
- Department of Preventive Medicine, Bellvitge Biomedical Research Institute (IDIBELL), International Health Center and Travel Medicine Clinic, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Sergio Morchón-Ramos
- Department of Preventive Medicine, Bellvitge Biomedical Research Institute (IDIBELL), International Health Center and Travel Medicine Clinic, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Josep M Ramon
- Department of Preventive Medicine, Bellvitge Biomedical Research Institute (IDIBELL), International Health Center and Travel Medicine Clinic, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
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Avellanas Chavala ML. A journey between high altitude hypoxia and critical patient hypoxia: What can it teach us about compression and the management of critical disease? Med Intensiva 2017; 42:380-390. [PMID: 28919307 DOI: 10.1016/j.medin.2017.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/15/2017] [Indexed: 01/02/2023]
Abstract
High altitude sickness (hypobaric hypoxia) is a form of cellular hypoxia similar to that suffered by critically ill patients. The study of mountaineers exposed to extreme hypoxia offers the advantage of involving a relatively homogeneous and healthy population compared to those typically found in Intensive Care Units (ICUs), which are heterogeneous and generally less healthy. Knowledge of altitude physiology and pathology allows us to understanding how hypoxia affects critical patients. Comparable changes in mitochondrial biogenesis between both groups may reflect similar adaptive responses and suggest therapeutic interventions based on the protection or stimulation of such mitochondrial biogenesis. Predominance of the homozygous insertion (II) allele of the angiotensin-converting enzyme gene is present in both individuals who perform successful ascensions without oxygen above 8000 m and in critical patients who overcome certain disease conditions.
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Faulhaber M, Pocecco E, Gatterer H, Niedermeier M, Huth M, Dünnwald T, Menz V, Bernardi L, Burtscher M. Seven Passive 1-h Hypoxia Exposures Do Not Prevent AMS in Susceptible Individuals. Med Sci Sports Exerc 2017; 48:2563-2570. [PMID: 27414687 DOI: 10.1249/mss.0000000000001036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The present study evaluated the effects of a preacclimatization program comprising seven passive 1-h exposures to 4500-m normobaric hypoxia on the prevalence and severity of acute mountain sickness (AMS) during a subsequent exposure to real high altitude in persons susceptible to AMS. METHODS The project was designed as a randomized controlled trial including 32 healthy female and male participants with known susceptibility to AMS symptoms. After baseline measurements, participants were randomly assigned to the hypoxia or the control group to receive the preacclimatization program (seven passive 1-h exposures within 7 d to normobaric hypoxia or sham hypoxia). After completing preacclimatization, participants were transported (bus, cog railway) to real high altitude (3650 m, Mönchsjoch Hut, Switzerland) and stayed there for 45 h (two nights). Symptoms of AMS and physiological responses were determined repeatedly. RESULTS AMS incidence and severity did not significantly differ between groups during the high-altitude exposure. In total, 59% of the hypoxia and 67% of the control group suffered from AMS at one or more time points during the high-altitude exposure. Hypoxic and hypercapnic ventilatory responses were not affected by the preacclimatization program. Resting ventilation at high altitude tended to be higher (P = 0.06) in the hypoxia group compared with the control group. No significant between-group differences were detected for heart rate variability, arterial oxygen saturation, and hematological and ventilatory parameters during the high-altitude exposure. CONCLUSION Preacclimatization using seven passive 1-h exposures to normobaric hypoxia corresponding to 4500 m did not prevent AMS development during a subsequent high-altitude exposure in AMS-susceptible persons.
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Affiliation(s)
- Martin Faulhaber
- 1Department of Sport Science, University of Innsbruck, Innsbruck, AUSTRIA; 2Austrian Society of Alpine and High Altitude Medicine, Innsbruck, AUSTRIA; 3Department for Medical Sciences and Health System Management, Institute for Sports Medicine, Alpine Medicine and Health Tourism, Hall in Tirol, Tyrol, AUSTRIA; 4Department of Internal Medicine, University of Pavia, Pavia, ITALY; and 5Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, FINLAND
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247
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Ebert-Santos C. High-Altitude Pulmonary Edema in Mountain Community Residents. High Alt Med Biol 2017; 18:278-284. [PMID: 28846035 DOI: 10.1089/ham.2016.0100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ebert-Santos, Christine. High-altitude pulmonary edema in mountain community residents. High Alt Med Biol. 18:278-284, 2017.-High-altitude pulmonary edema (HAPE) affects lowlanders ascending quickly to elevations above 2440 m. Mountain resident children with no travel can sometimes develop HAPE as was observed over 30 years ago (Fasules et al., 1985). This is not well known and children instead are diagnosed as having pneumonia or asthma. In our clinic at 2800 m, we see children presenting with severe hypoxemia, clinical, and radiographic findings consistent with HAPE despite no recent travel. We call this mountain resident HAPE. We reviewed records of 48 patients with pulmonary symptoms. Analysis included vital signs, pulse oximetry, laboratories, physical findings, and clinical course. We identified 33 residents with HAPE and no travel, five with reentry HAPE, two visitors with classic HAPE, six residents with pneumonia, and two with asthma. Also, 48 X-rays on hypoxemic children seen between 2006 and 2017 were reviewed. Five showed definite HAPE with follow-up X-rays within 48 hours confirming rapid clearing on oxygen, 27 showed findings consistent with HAPE or viral pneumonia and no repeat study. Children living at elevation presenting with hypoxemia are commonly misdiagnosed. Rapid improvement with oxygen and little to no improvement with bronchodilators are more consistent with HAPE, and thus, antibiotics and other treatments can be avoided.
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Berger MM, Macholz F, Lehmann L, Dankl D, Hochreiter M, Bacher B, Bärtsch P, Mairbäurl H. Remote ischemic preconditioning does not prevent acute mountain sickness after rapid ascent to 3,450 m. J Appl Physiol (1985) 2017; 123:1228-1234. [PMID: 28798201 DOI: 10.1152/japplphysiol.00505.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/13/2017] [Accepted: 08/01/2017] [Indexed: 01/08/2023] Open
Abstract
Remote ischemic preconditioning (RIPC) has been shown to protect remote organs, such as the brain and the lung, from damage induced by subsequent hypoxia or ischemia. Acute mountain sickness (AMS) is a syndrome of nonspecific neurologic symptoms and in high-altitude pulmonary edema excessive hypoxic pulmonary vasoconstriction (HPV) plays a pivotal role. We hypothesized that RIPC protects the brain from AMS and attenuates the magnitude of HPV after rapid ascent to 3,450 m. Forty nonacclimatized volunteers were randomized into two groups. At low altitude (750 m) the RIPC group (n = 20) underwent 4 × 5 min of lower-limb ischemia (induced by inflation of bilateral thigh cuffs to 200 mmHg) followed by 5 min of reperfusion. The control group (n = 20) underwent a sham protocol (4 × 5 min of bilateral thigh cuff inflation to 20 mmHg). Thereafter, participants ascended to 3,450 m by train over 2 h and stayed there for 48 h. AMS was evaluated by the Lake Louise score (LLS) and the AMS-C score. Systolic pulmonary artery pressure (SPAP) was assessed by transthoracic Doppler echocardiography. RIPC had no effect on the overall incidence (RIPC: 35%, control: 35%, P = 1.0) and severity (RIPC vs. CONTROL P = 0.496 for LLS; P = 0.320 for AMS-C score) of AMS. RIPC also had no significant effect on SPAP [maximum after 10 h at high altitude; RIPC: 33 (SD 8) mmHg; controls: 37 (SD 7) mmHg; P = 0.19]. This study indicates that RIPC, performed immediately before passive ascent to 3,450 m, does not attenuate AMS and the magnitude of high-altitude pulmonary hypertension.NEW & NOTEWORTHY Remote ischemic preconditioning (RIPC) has been reported to improve neurologic and pulmonary outcome following an acute ischemic or hypoxic insult, yet the effect of RIPC for protecting from high-altitude diseases remains to be determined. The present study shows that RIPC, performed immediately before passive ascent to 3,450 m, does not attenuate acute mountain sickness and the degree of high-altitude pulmonary hypertension. Therefore, RIPC cannot be recommended for prevention of high-altitude diseases.
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Affiliation(s)
- Marc M Berger
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria; .,Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Franziska Macholz
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Lehmann
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Daniel Dankl
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Marcel Hochreiter
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Bernhard Bacher
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Peter Bärtsch
- Division of Sports Medicine, Department of Internal Medicine VII, University of Heidelberg, Heidelberg, Germany; and
| | - Heimo Mairbäurl
- Division of Sports Medicine, Department of Internal Medicine VII, University of Heidelberg, Heidelberg, Germany; and.,Translational Lung Research Center, Heidelberg, Germany
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Hypoxia augments LPS-induced inflammation and triggers high altitude cerebral edema in mice. Brain Behav Immun 2017; 64:266-275. [PMID: 28433745 DOI: 10.1016/j.bbi.2017.04.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/06/2017] [Accepted: 04/17/2017] [Indexed: 11/20/2022] Open
Abstract
High altitude cerebral edema (HACE) is a life-threatening illness that develops during the rapid ascent to high altitudes, but its underlying mechanisms remain unclear. Growing evidence has implicated inflammation in the susceptibility to and development of brain edema. In the present study, we investigated the inflammatory response and its roles in HACE in mice following high altitude hypoxic injury. We report that acute hypobaric hypoxia induced a slight inflammatory response or brain edema within 24h in mice. However, the lipopolysaccharide (LPS)-induced systemic inflammatory response rapidly aggravated brain edema upon acute hypobaric hypoxia exposure by disrupting blood-brain barrier integrity and activating microglia, increasing water permeability via the accumulation of aquaporin-4 (AQP4), and eventually leading to impaired cognitive and motor function. These findings demonstrate that hypoxia augments LPS-induced inflammation and induces the occurrence and development of cerebral edema in mice at high altitude. Here, we provide new information on the impact of systemic inflammation on the susceptibility to and outcomes of HACE.
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Accinelli RA, López LM. Altitude-Related Illnesses. Arch Bronconeumol 2017; 54:115-116. [PMID: 28720255 DOI: 10.1016/j.arbres.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Roberto Alfonso Accinelli
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Neumología, Hospital Cayetano Heredia, Lima, Perú.
| | - Lidia Marianella López
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Perú
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