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Bokov P, Dudoignon B, Fikiri Bavurhe R, Couque N, Matrot B, Delclaux C. Dyspnea in young subjects with congenital central hypoventilation syndrome. Pediatr Res 2024:10.1038/s41390-024-03305-1. [PMID: 38851851 DOI: 10.1038/s41390-024-03305-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND It has been stated that patients with congenital central hypoventilation syndrome (CCHS) do not perceive dyspnea, which could be related to defective CO2 chemosensitivity. METHODS We retrospectively selected the data of six-minute walk tests (6-MWT, n = 30), cardiopulmonary exercise test (CPET, n = 5) of 30 subjects with CCHS (median age, 9.3 years, 17 females) who had both peripheral (controller loop gain, CG0) and central CO2 chemosensitivity (hyperoxic, hypercapnic response test [HHRT]) measurement. MAIN RESULTS Ten subjects had no symptom during the HHRT, as compared to the 20 subjects exhibiting symptoms, their median ages were 14.7 versus 8.8 years (p = 0.006), their maximal PETCO2 were 71.6 versus 66.7 mmHg (p = 0.007), their median CO2 response slopes were 0.28 versus 0.30 L/min/mmHg (p = 0.533) and their CG0 values were 0.75 versus 0.50 L/min/mmHg (p = 0.567). Median dyspnea Borg score at the end of the 6-MWT was 1/10 (17/30 subjects >0), while at the end of the CPET it was 3/10 (sensation: effort). This Borg score positively correlated with arterial desaturation at walk (R = 0.43; p = 0.016) and did not independently correlate with CO2 chemosensitivities. CONCLUSION About half of young subjects with CCHS do exhibit mild dyspnea at walk, which is not related to hypercapnia or residual CO2 chemosensitivity. IMPACT Young subjects with CCHS exhibit some degree of dyspnea under CO2 exposure and on exercise that is not related to residual CO2 chemosensitivity. It has been stated that patients with CCHS do not perceive sensations of dyspnea, which must be tempered. The mild degree of exertional dyspnea can serve as an indicator for the necessity of breaks.
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Affiliation(s)
- Plamen Bokov
- Université de Paris, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, F-75019, Paris, France
| | - Benjamin Dudoignon
- Université de Paris, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, F-75019, Paris, France
| | | | - Nathalie Couque
- AP-HP, Hôpital Robert Debré, Département de génétique, F-75019, Paris, France
| | - Boris Matrot
- Université de Paris, INSERM NeuroDiderot, F-75019, Paris, France
| | - Christophe Delclaux
- Université de Paris, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil - CRMR Hypoventilations alvéolaires rares, INSERM NeuroDiderot, F-75019, Paris, France.
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Han Y, Li S, Zhang Z, Ning X, Wu J, Zhang X. Bawei Chenxiang Wan ameliorates right ventricular hypertrophy in rats with high altitude heart disease by SIRT3-HIF1α-PDK/PDH signaling pathway improving fatty acid and glucose metabolism. BMC Complement Med Ther 2024; 24:190. [PMID: 38750550 PMCID: PMC11094862 DOI: 10.1186/s12906-024-04490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Bawei Chenxiang Wan (BCW) is among the most effective and widely used therapies for coronary heart disease and angina pectoris in Tibet. However, whether it confers protection through a right-ventricle (RV) myocardial metabolic mechanism is unknown. METHODS Male Sprague-Dawley rats were orally administrated with BCW, which was injected concurrently with a bolus of Sugen5416, and subjected to hypoxia exposure (SuHx; 5000 m altitude) for 4 weeks. Right ventricular hypertrophy (RVH) in high-altitude heart disease (HAHD) was assessed using Fulton's index (FI; ratio of RV to left ventricle + septum weights) and heart-weight-to-body-weight ratio (HW/BW). The effect of therapeutic administration of BCW on the RVH hemodynamics was assessed through catheterization (mean right ventricular pressure and mean pulmonary artery pressure (mRVP and mPAP, respectively)). Tissue samples were used to perform histological staining, and confirmatory analyses of mRNA and protein levels were conducted to detect alterations in the mechanisms of RVH in HAHD. The protective mechanism of BCW was further verified via cell culture. RESULTS BCW considerably reduced SuHx-associated RVH, as indicated by macro morphology, HW/BW ratio, FI, mPAP, mRVP, hypertrophy markers, heart function, pathological structure, and myocardial enzymes. Moreover, BCW can alleviate the disorder of glucose and fatty acid metabolism through upregulation of carnitine palmitoyltransferase1ɑ, citrate synthase, and acetyl-CoA and downregulation of glucose transport-4, phosphofructokinase, and pyruvate, which resulted in the reduced levels of free fatty acid and lactic acid and increased aerobic oxidation. This process may be mediated via the regulation of sirtuin 3 (SIRT3)-hypoxia-inducible factor 1α (HIF1α)-pyruvate dehydrogenase kinase (PDK)/pyruvate dehydrogenase (PDH) signaling pathway. Subsequently, the inhibition of SIRT3 expression by 3-TYP (a selective inhibitor of SIRT3) can reverse substantially the anti-RVH effect of BCW in HAHD, as indicated by hypertrophy marker and serum myocardial enzyme levels. CONCLUSIONS BCW prevented SuHx-induced RVH in HAHD via the SIRT3-HIF1ɑ-PDK/PDH signaling pathway to alleviate the disturbance in fatty acid and glucose metabolism. Therefore, BCW can be used as an alternative drug for the treatment of RVH in HAHD.
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Affiliation(s)
- Yiwei Han
- School of Medicine, Xizang Minzu University, Wenhui Road East, Weicheng District, Xianyang, Shaanxi, 712082, P.R. China
- Engineering Research Center of Tibetan Medicine Detection Technology, Ministry of Education, Xianyang, Shaanxi, 712082, P.R. China
- Joint Laboratory for Research On Active Components and Pharmacological Mechanism of Tibetan Materia Medica of Tibetan Medical Research Center of Tibet, Xianyang, Shaanxi, 712082, P.R. China
| | - Shadi Li
- School of Medicine, Xizang Minzu University, Wenhui Road East, Weicheng District, Xianyang, Shaanxi, 712082, P.R. China
- Engineering Research Center of Tibetan Medicine Detection Technology, Ministry of Education, Xianyang, Shaanxi, 712082, P.R. China
- Joint Laboratory for Research On Active Components and Pharmacological Mechanism of Tibetan Materia Medica of Tibetan Medical Research Center of Tibet, Xianyang, Shaanxi, 712082, P.R. China
| | - Zhiying Zhang
- School of Medicine, Xizang Minzu University, Wenhui Road East, Weicheng District, Xianyang, Shaanxi, 712082, P.R. China
- Engineering Research Center of Tibetan Medicine Detection Technology, Ministry of Education, Xianyang, Shaanxi, 712082, P.R. China
- Joint Laboratory for Research On Active Components and Pharmacological Mechanism of Tibetan Materia Medica of Tibetan Medical Research Center of Tibet, Xianyang, Shaanxi, 712082, P.R. China
| | - Xin Ning
- School of Medicine, Xizang Minzu University, Wenhui Road East, Weicheng District, Xianyang, Shaanxi, 712082, P.R. China
- Engineering Research Center of Tibetan Medicine Detection Technology, Ministry of Education, Xianyang, Shaanxi, 712082, P.R. China
- Joint Laboratory for Research On Active Components and Pharmacological Mechanism of Tibetan Materia Medica of Tibetan Medical Research Center of Tibet, Xianyang, Shaanxi, 712082, P.R. China
| | - Jiajia Wu
- School of Medicine, Xizang Minzu University, Wenhui Road East, Weicheng District, Xianyang, Shaanxi, 712082, P.R. China
- Engineering Research Center of Tibetan Medicine Detection Technology, Ministry of Education, Xianyang, Shaanxi, 712082, P.R. China
- Joint Laboratory for Research On Active Components and Pharmacological Mechanism of Tibetan Materia Medica of Tibetan Medical Research Center of Tibet, Xianyang, Shaanxi, 712082, P.R. China
| | - Xiaoying Zhang
- School of Medicine, Xizang Minzu University, Wenhui Road East, Weicheng District, Xianyang, Shaanxi, 712082, P.R. China.
- Engineering Research Center of Tibetan Medicine Detection Technology, Ministry of Education, Xianyang, Shaanxi, 712082, P.R. China.
- Joint Laboratory for Research On Active Components and Pharmacological Mechanism of Tibetan Materia Medica of Tibetan Medical Research Center of Tibet, Xianyang, Shaanxi, 712082, P.R. China.
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Su R, Peng P, Zhang W, Huang J, Fan J, Zhang D, He J, Ma H, Li H. Dose-effect of exercise intervention on heart rate variability of acclimatized young male lowlanders at 3,680 m. Front Physiol 2024; 15:1331693. [PMID: 38606008 PMCID: PMC11007668 DOI: 10.3389/fphys.2024.1331693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
This study investigated whether exercise could improve the reduced HRV in an environment of high altitude. A total of 97 young, healthy male lowlanders living at 3,680 m for >1 year were recruited. They were randomized into four groups, of which three performed-low-, moderate-, and high-intensity (LI, MI, HI) aerobic exercise for 4 weeks, respectively. The remaining was the control group (CG) receiving no intervention. For HI, compared to other groups, heart rate (p = 0.002) was significantly decreased, while standard deviation of RR intervals (p < 0.001), SD2 of Poincaré plot (p = 0.046) and the number of successive RR interval pairs that differ by > 50 ms divided by total number of RR (p = 0.032), were significantly increased after intervention. For MI, significantly increase of trigonometric interpolation in NN interval (p = 0.016) was observed after exercise. Further, a decrease in systolic blood pressure (SBP) after high-intensity exercise was found significantly associated with an increase in SD2 (r = - 0.428, p = 0.042). These results indicated that there was a dose effect of different intensities of aerobic exercise on the HRV of acclimatized lowlanders. Moderate and high-intensity aerobic exercise would change the status of the autonomic nervous system (ANS) and decrease the blood pressure of acclimatized lowlanders exposed to high altitude.
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Affiliation(s)
- Rui Su
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Ping Peng
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Wenrui Zhang
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Jie Huang
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Jing Fan
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Delong Zhang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Jiayuan He
- National Clinical Research Center for Geriatric, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Manufacturing, Sichuan University, Chengdu, Sichuan, China
| | - Hailin Ma
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
| | - Hao Li
- Key Laboratory of High Altitudes Brain Science and Environmental Acclimation, Tibet University, Lhasa, China
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Lili L, Meydan C, Rickard N, Zhang B. The importance of personalization in high altitude protocols for hematologic and metabolic benefits in sports: A multi-dimensional N-of-1 case study. Heliyon 2024; 10:e23159. [PMID: 38170057 PMCID: PMC10758776 DOI: 10.1016/j.heliyon.2023.e23159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
The hematologic and metabolic benefits of high altitude exposure have been extensively studied in athletes due to their promising performance enhancing effects. However, despite the increased research and development of various high altitude protocols for achieving peak performance, the reproducibility of the results at the individual level remains sparse. To systematically address this limitation and establish a more effective method to achieve consistent results at the individual level, we conducted a multi-dimensional study of one elite endurance athlete in two Phases. In Phase 1, we applied the standard protocol of LHTH (Live-High-Train-High) using a commercially available, at-home, normobaric, high altitude simulation tent under the SHTL (Sleep-High-Train-Low) model. Then, we developed the athlete's personalized protocol for peak hematologic parameters during their off-season. This protocol determined the exact total high altitude exposure time required to achieve peak hematologic parameters, which in the case of this athlete, amounted to 45 nights with approximately 8hrs per night. In Phase 2, we replicated the Phase 1 protocol during the athlete's in-season and observed the same or even higher hematologic and metabolic benefits compared to Phase 1. During both phases, we collected thousands of multi-dimensional data points to ensure that the athlete's lifestyle and environmental factors remained stable, and to increase the likelihood that physiological changes resulted primarily from the high altitude exposure. The data trends in both Phases validated that, for this athlete, hematologic measures such as red blood cell count, hematocrit, and hemoglobin, as well as electrolyte content, body weight and gut microbiome composition improved to their personal best values after a total of approximately 15 days of high altitude exposure (45 nights with roughly 8hrs per night totaling 360hrs or 15days). These improvements did not occur after the 21 days recommended by the LHTH protocol highlighting the significance of personalization in high altitude protocols that are designed for peak performance parameters. Therefore, to maximize the benefits in hematologic and other metabolic values and thus increase muscle oxygen supply and peak aerobic capacity through high altitude exposure, each athlete may require a unique total duration of high altitude exposure tailored to their individual physiology. This duration must be determined by their specific response in hematologic peaking. Therefore, initially establishing a personalized protocol for an athlete by determining their required total duration of high altitude exposure for peak hematologic values during their off-season and applying this protocol during their in-season phase may lead to more successful and reproducible benefits compared to following a generalized protocol alone.
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Affiliation(s)
- Loukia Lili
- Thorne HealthTech, Inc., 152W 57th st, New York, NY 10019, USA
| | - Cem Meydan
- Thorne HealthTech, Inc., 152W 57th st, New York, NY 10019, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10021, USA
| | - Nate Rickard
- Thorne HealthTech, Inc., 152W 57th st, New York, NY 10019, USA
| | - Bodi Zhang
- Thorne HealthTech, Inc., 152W 57th st, New York, NY 10019, USA
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