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Fayazi B, Tadibi V, Ranjbar K. The role of hypoxia related hormones responses in acute mountain sickness susceptibility individuals unaccustomed to high altitude. PLoS One 2023; 18:e0292173. [PMID: 37796960 PMCID: PMC10553285 DOI: 10.1371/journal.pone.0292173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
Acute mountain sickness (AMS) is caused by rapid ascent to altitude (>2500 m) and remains a poorly understood pathophysiological condition. Accordingly, we investigated the relationship between acute exposure to high altitude and hypoxia related biochemical proteins. 21 healthy subjects (Female (8) and male (13), Age: 36.7±8.5, BMI: 23.2±3.1) volunteers participated in this project and fasting blood samples were taken before (sea level) and after 1 and 24-h exposure to high altitude (3,550 m). Blood oxygen saturation (SpO2), AMS status (Lake Louise Score) and serum HIF-1, Endothelin-1, VEGF and Orexin-A were measured (via ELISA) at 1, 6 and 24 h after exposure to high altitude. Pre-ascent measurement of hypoxia related proteins (Orexin-A, HIF-1, VEGF and Endothelin-1) where all significantly (<0.05) higher in the AMS-resistant individuals (No-AMS) when compared to AMS susceptible individuals (AMS+). Upon ascent to high altitude, 11 out of 21 volunteers had AMS (10.1±0.6 in AMS+ vs. 0.9±0.6 in No-AMS, P<0.05) and presented with lower resting SpO2 levels (77.7±0.4 vs. 83.5±0.3 respectively, p<0.05). Orexin-A, HIF-1, VEGF and Endothelin-1, significantly increased 24 hrs after exposure to high altitude in both AMS+ and No-AMS. The response of Orexin-A was similar between two groups, also, HIF-1 elevation 24 hrs after exposure to altitude was more in AMS+ (13% vs. 19%), but the increase of VEGF and Endothelin-1, 1 and 24 hrs after exposure to altitude in No-AMS was double that of AMS+. Hypoxia related proteins include Orexin-A, HIF-1, VEGF and Endothelin-1 may play a pathophysiological role in those who are susceptible to AMS.
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Affiliation(s)
- Bayan Fayazi
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Vahid Tadibi
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Kamal Ranjbar
- Department of Exercise Physiology, Faculty of Sport Sciences, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
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Nourkami-Tutdibi N, Küllmer J, Dietrich S, Monz D, Zemlin M, Tutdibi E. Serum vascular endothelial growth factor is a potential biomarker for acute mountain sickness. Front Physiol 2023; 14:1083808. [PMID: 37064896 PMCID: PMC10098311 DOI: 10.3389/fphys.2023.1083808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Acute mountain sickness (AMS) is the most common disease caused by hypobaric hypoxia (HH) in high-altitude (HA) associated with high mortality when progressing to high-altitude pulmonary edema (HAPE) and/or high-altitude cerebral edema (HACE). There is evidence for a role of pro- and anti-inflammatory cytokines in development of AMS, but biological pathways and molecular mechanisms underlying AMS remain elusive. We aimed to measure changes in blood cytokine levels and their possible association with the development of AMS.Method: 15 healthy mountaineers were included into this prospective clinical trial. All participants underwent baseline normoxic testing with venous EDTA blood sampling at the Bangor University in United Kingdom (69 m). The participants started from Beni at an altitude of 869 m and trekked same routes in four groups the Dhaulagiri circuit in the Nepali Himalaya. Trekking a 14-day route, the mountaineers reached the final HA of 5,050 m at the Hidden Valley Base Camp (HVBC). Venous EDTA blood sampling was performed after active ascent to HA the following morning after arrival at 5,050 m (HVBC). A panel of 21 cytokines, chemokines and growth factors were assessed using Luminex system (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p40, IL-1ra, sIL-2Rα, IFN-γ, TNF-α, MCP-1, MIP-1α, MIP-1β, IP-10, G-CSF, GM-CSF, EGF, FGF-2, VEGF, and TGF-β1).Results: There was a significant main effect for the gradual ascent from sea-level (SL) to HA on nearly all cytokines. Serum levels for TNF-α, sIL-2Rα, G-CSF, VEGF, EGF, TGF-β1, IL-8, MCP-1, MIP-1β, and IP-10 were significantly increased at HA compared to SL, whereas levels for IFN-γ and MIP-1α were significantly decreased. Serum VEGF was higher in AMS susceptible versus AMS resistant subjects (p < 0.027, main effect of AMS) and increased after ascent to HA in both AMS groups (p < 0.011, main effect of HA). Serum VEGF increased more from SL values in the AMS susceptible group than in the AMS resistant group (p < 0.049, interaction effect).Conclusion: Cytokine concentrations are significantly altered in HA. Within short interval after ascent, cytokine concentrations in HH normalize to values at SL. VEGF is significantly increased in mountaineers suffering from AMS, indicating its potential role as a biomarker for AMS.
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Yang M, Wu Y, Yang XB, Liu T, Zhang Y, Zhuo Y, Luo Y, Zhang N. Establishing a prediction model of severe acute mountain sickness using machine learning of support vector machine recursive feature elimination. Sci Rep 2023; 13:4633. [PMID: 36944699 PMCID: PMC10030784 DOI: 10.1038/s41598-023-31797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/17/2023] [Indexed: 03/23/2023] Open
Abstract
Severe acute mountain sickness (sAMS) can be life-threatening, but little is known about its genetic basis. The study was aimed to explore the genetic susceptibility of sAMS for the purpose of prediction, using microarray data from 112 peripheral blood mononuclear cell (PBMC) samples of 21 subjects, who were exposed to very high altitude (5260 m), low barometric pressure (406 mmHg), and hypobaric hypoxia (VLH) at various timepoints. We found that exposure to VLH activated gene expression in leukocytes, resulting in an inverted CD4/CD8 ratio that interacted with other phenotypic risk factors at the genetic level. A total of 2286 underlying risk genes were input into the support vector machine recursive feature elimination (SVM-RFE) system for machine learning, and a model with satisfactory predictive accuracy and clinical applicability was established for sAMS screening using ten featured genes with significant predictive power. Five featured genes (EPHB3, DIP2B, RHEBL1, GALNT13, and SLC8A2) were identified upstream of hypoxia- and/or inflammation-related pathways mediated by microRNAs as potential biomarkers for sAMS. The established prediction model of sAMS holds promise for clinical application as a genetic screening tool for sAMS.
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Affiliation(s)
- Min Yang
- Department of Traditional Chinese Medicine, Rheumatology Center of Integrated Medicine, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China.
| | - Yang Wu
- Department of Traditional Chinese Medicine, Rheumatology Center of Integrated Medicine, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China
| | - Xing-Biao Yang
- Department of Traditional Chinese Medicine, Rheumatology Center of Integrated Medicine, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China
| | - Tao Liu
- Department of Traditional Chinese Medicine, Rheumatology Center of Integrated Medicine, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China
| | - Ya Zhang
- Department of Traditional Chinese Medicine, Rheumatology Center of Integrated Medicine, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China
| | - Yue Zhuo
- Department of Traditional Chinese Medicine, Rheumatology Center of Integrated Medicine, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China
| | - Yong Luo
- Department of Traditional Chinese Medicine, Rheumatology Center of Integrated Medicine, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China
| | - Nan Zhang
- Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, 610083, China
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Winter C, Bjorkman T, Miller S, Nichols P, Cardinal J, O'Rourke P, Ballard E, Nasrallah F, Vegh V. Acute Mountain Sickness Following Incremental Trekking to High Altitude: Correlation With Plasma Vascular Endothelial Growth Factor Levels and the Possible Effects of Dexamethasone and Acclimatization Following Re-exposure. Front Physiol 2021; 12:746044. [PMID: 34744786 PMCID: PMC8567072 DOI: 10.3389/fphys.2021.746044] [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: 07/23/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The recognition and treatment of high-altitude illness (HAI) is increasingly important in global emergency medicine. High altitude related hypobaric hypoxia can lead to acute mountain sickness (AMS), which may relate to increased expression of vascular endothelial growth factor (VEGF), and subsequent blood-brain barrier (BBB) compromise. This study aimed to establish the relationship between AMS and changes in plasma VEGF levels during a high-altitude ascent. VEGF level changes with dexamethasone, a commonly used AMS medication, may provide additional insight into AMS. Methods: Twelve healthy volunteers ascended Mt Fuji (3,700 m) and blood samples were obtained at distinct altitudes for VEGF analysis. Oxygen saturation (SPO2) measurements were also documented at the same time-point. Six out of the 12 study participants were prescribed dexamethasone for a second ascent performed 48 h later, and blood was again collected to establish VEGF levels. Results: Four key VEGF observations could be made based on the data collected: (i) the baseline VEGF levels between the two ascents trended upwards; (ii) those deemed to have AMS in the first ascent had increased VEGF levels (23.8–30.3 pg/ml), which decreased otherwise (23.8–30.3 pg/ml); (iii) first ascent AMS participants had higher VEGF level variability for the second ascent, and similar to those not treated with dexamethasone; and (iv) for the second ascent dexamethasone participants had similar VEGF levels to non-AMS first ascent participants, and the variability was lower than for first ascent AMS and non-dexamethasone participants. SPO2 changes were unremarkable, other than reducing by around 5% irrespective of whether measurement was taken for the first or second ascent. Conclusion: First ascent findings suggest a hallmark of AMS could be elevated VEGF levels. The lack of an exercise-induced VEGF level change strengthened the notion that elevated plasma VEGF was brain-derived, and related to AMS.
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Affiliation(s)
- Craig Winter
- Kenneth Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,UQ Center for Clinical Research, University of Queensland, Brisbane, QLD, Australia.,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tracy Bjorkman
- UQ Center for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Stephanie Miller
- UQ Center for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Paul Nichols
- Kenneth Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,UQ Center for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - John Cardinal
- School of Human Movement Studies, University of Queensland, Brisbane, QLD, Australia
| | - Peter O'Rourke
- Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - Emma Ballard
- Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - Fatima Nasrallah
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Viktor Vegh
- Centre for Advanced Imaging, University of Queensland, Brisbane, QLD, Australia.,ARC Training Centre for Innovation in Biomedical Imaging Technology, Brisbane, QLD, Australia
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Liu Z, Chen H, Xu T, Wang X, Yao C. HSPA1A gene polymorphism rs1008438 is associated with susceptibility to acute mountain sickness in Han Chinese individuals. Mol Genet Genomic Med 2020; 8:e1322. [PMID: 32478477 PMCID: PMC7434611 DOI: 10.1002/mgg3.1322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background Acute mountain sickness (AMS) usually occurs among non‐acclimated individuals after rapid ascending to high‐altitude environments (generally ≥2,500 m). However, the precise molecular mechanism of AMS remains unclear. Our study aimed to investigate the relationship between several single nucleotide polymorphisms (SNPs) and AMS susceptibility. Methods In this work, sequencing data were obtained from 69 AMS patients and 95 matched acclimated Han Chinese individuals from southwest China. Five SNPs (rs1008438, rs150877473, rs1799983, rs2153364, and rs3025039) were systematically investigated in all the participants. Results In our study, we found that allele frequencies of “A” (AMS 69.57% vs. non‐AMS 54.74%) and “C” (AMS 30.43% vs. non‐AMS 45.26%) in the HSPA1A gene rs1008438 were significantly different between the AMS and non‐AMS groups (p = .01). Genotypes “CC” and “CA” of the HSPA1A gene (rs1008438) were associated with lower risk of developing AMS than the genotype “AA.” Comparing the genotypes “CC + CA” and “AA,” we also observed that the “CC + CA” genotype of rs1008438 was associated with lower AMS risk. Conclusions In our case‐control study, there was a significant association between the rs1008348 polymorphism and AMS susceptibility, suggesting that this particular SNP might be a Han‐specific risk factor for AMS. We believe that this study establishes a foundation for further elucidation of the genetic mechanisms underlying AMS.
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Affiliation(s)
- Zhicheng Liu
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hong Chen
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ting Xu
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaomei Wang
- Department of Geriatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunyan Yao
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Yu J, Liu C, Zhang C, Bian S, Yang J, Zhang J, Gao X, Qiu Y, Huang L. EDN1 gene potentially involved in the development of acute mountain sickness. Sci Rep 2020; 10:5414. [PMID: 32214168 PMCID: PMC7096518 DOI: 10.1038/s41598-020-62379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/09/2020] [Indexed: 11/09/2022] Open
Abstract
Previous investigations have indicated that environmental and genetic factors collectively contribute to the development of acute mountain sickness (AMS), but whether the EDN1 gene is involved in AMS remains to be elucidated. A total of 356 healthy male soldiers who had not traveled to high altitudes in the previous 12 months were enrolled in our study. All participants were taken by plane from 500 m (Chengdu in Sichuan Province) to a 3700 m highland (Lhasa) within 2 hours. Clinical data were collected within 24 hours, and pulmonary function parameters were completed simultaneously. Genotypes were obtained by using iMLDR genotyping assays. A total of 237 soldiers (66.57%) presented AMS symptoms, including headache, dizziness, gastrointestinal upset and fatigue. Soldiers with AMS showed an increase in heart rate (HR), plasma tryptophan and serotonin, and a decrease in SaO2, FEV1, PEF, FVC, V75, V50, V25 and MMF (all P < 0.01). Notably, allele T in single nucleotide polymorphism (SNP) rs2070699 showed a positive correlation with the occurrence of AMS. A general linear regression analysis showed that rs2060799, Mean Arterial Pressure (MAP), SaO2, FVC, tryptophan and serotonin were independent predictors for the occurrence of AMS. Importantly, the area under the curve (AUC) values for tryptophan (0.998), serotonin (0.912) and FVC (0.86) had diagnostic specificity and sensitivity. Our results demonstrated that AMS is accompanied by changes in lung function parameters, increased plasma tryptophan and serotonin levels, and that the EDN1 polymorphism is a potential risk factor for AMS.
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Affiliation(s)
- Jie Yu
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Chen Zhang
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - ShiZhu Bian
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Jie Yang
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - JiHang Zhang
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - XuBin Gao
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - YouZhu Qiu
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Lan Huang
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China. .,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.
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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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Rong H, He X, Zhu L, Zhu X, Kang L, Wang L, He Y, Yuan D, Jin T. Association between regulator of telomere elongation helicase1 (RTEL1) gene and HAPE risk: A case-control study. Medicine (Baltimore) 2017; 96:e8222. [PMID: 28953687 PMCID: PMC5626330 DOI: 10.1097/md.0000000000008222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
High altitude pulmonary edema (HAPE) is a paradigm of pulmonary edema. Mutations in regulator of telomere elongation helicase1 (RTEL1) represent an important contributor to risk for pulmonary fibrosis. However, little information is found about the association between RTEL1 and HAPE risk. The present study was undertaken to tentatively explore the potential relation between single-nucleotide polymorphisms (SNPs) in RTEL1 and HAPE risk in Chinese Han population. A total of 265 HAPE patients and 303 healthy controls were included in our case-control study. Four SNPs in RTEL1 were selected and genotyped using the Sequenom MassARRAY method. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by unconditional logistic regression with adjustment for gender and age. All P values were Bonferroni corrected, and statistical significance was set at P < .0025 (.05/20). In allelic model analysis, we found that the allele "G" of rs6089953 and rs6010621 and the allele "A" of rs2297441 were associated with decreased risk of HAPE. In the genetic model analysis, we found that rs6010621, rs6089953, and rs2297441 were relevant to decreased HAPE risk under dominant model (rs6010621: OR = 0.55; 95% CI = 0.39-0.78; P = .001; rs6089953: OR = 0.68; 95% CI = 0.48-0.96; P = .027; rs2297441: OR = 0.63; 95% CI = 0.45-0.89; P = .008, respectively) and additive model (rs6010621: OR = 0.51; 95% CI = 0.46-0.81; P < .001; rs6089953: OR = 0.72; 95% CI = 0.55-0.95; P = .022; rs2297441: OR = 0.73; 95% CI = 0.57-0.95; P = .019, respectively). SNPs rs6010621 remained significant after Bonferroni correction (P < .0025). In addition, haplotype "GG, GT, AT" of rs6089953-rs6010621 were detected significantly associated with HAPE risk (P < .05), haplotype "GG" remained significant after Bonferroni correction (P < .0025). Our findings provide new evidence for the association between SNPs in RTEL1 and a decreased risk HAPE in the Chinese population. The results need further confirmation.
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Affiliation(s)
- Hao Rong
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Xue He
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Linhao Zhu
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Xikai Zhu
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Longli Kang
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Li Wang
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Yongjun He
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Dongya Yuan
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
| | - Tianbo Jin
- Key Laboratory of Molecular Mechanism and Intervention Research for Plateau Diseases of Tibet Autonomous Region
- Key Laboratory of High Altitude Environment and Genes Related to Diseases of Tibet Autonomous Region
- Key Laboratory for Basic Life Science Research of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang, Shaanxi
- School of Life Science, Northwest University, Xi’an, China
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Bian SZ, Jin J, Dong JQ, Li QN, Yu J, Tang CF, Yu SY, Zhao XH, Qin J, Huang L. A higher baseline somatization score at sea level as an independent predictor of acute mountain sickness. Physiol Behav 2016; 167:202-208. [PMID: 27640135 DOI: 10.1016/j.physbeh.2016.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/28/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The current study aimed to identify the predictive values of psychological factors that are evaluated by the Symptoms Checklist-90 (SCL-90) for acute mountain sickness (AMS). METHODS The subjects (n=285, non-acclimatized young Chinese men), who were recruited in July 2013, completed a case report questionnaire. In addition, their vital signs (heart rate [HR], blood pressure and pulse oxygen saturation) were measured, and their psychological factors were examined using the SCL-90 at sea level. AMS was diagnosed using the Lake Louise self-assessment scoring system in the morning of the second day after their arrival at 3450m. RESULTS Of the nine factors of the SCL-90, the AMS patients (AMS score≥3) were characterized by significantly higher scores for baseline somatization [14.0 (5.0) vs. 13.0 (3.0), p<0.001], obsession-compulsion, depression, anxiety and hostility compared with the non-AMS group (all p values<0.05). Spearman's correlation analyses revealed associations between AMS scores and somatization (r=0.316, p<0.001), depression, anxiety, obsession-compulsion, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation and psychoticism scores (all p values<0.001). Although all nine factors were associated with AMS in a univariate regression (all p<0.05), a further adjusted logistic regression analysis indicated that only baseline somatization score (odds ratio=1.129, p=0.001) was an independent predictor of AMS. Furthermore, some non-AMS often-occurred symptoms (paresthesia, shortness of breath, reduced activity and tinnitus) were also found to be associated with the baseline SCL-90 scores. CONCLUSION AMS is correlated with the baseline somatization score at sea level, which was measured using the SCL-90. A higher baseline somatization score is also an independent predictor of AMS.
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Affiliation(s)
- Shi-Zhu Bian
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
| | - Jun Jin
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
| | - Jun-Qing Dong
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
| | - Qian-Ning Li
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, China.
| | - Jie Yu
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
| | - Cai-Fa Tang
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, China.
| | - Shi-Yong Yu
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
| | - Xiao-Hui Zhao
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
| | - Jun Qin
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, Xinqiao Hospital, Third Military Medical University, China; Department of Cardiology, Xinqiao Hospital, Third Military Medical University, China.
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MacInnis MJ, Koehle MS. Evidence for and Against Genetic Predispositions to Acute and Chronic Altitude Illnesses. High Alt Med Biol 2016; 17:281-293. [PMID: 27500591 DOI: 10.1089/ham.2016.0024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
MacInnis, Martin J., and Michael S. Koehle. Evidence for and against genetic predispositions to acute and chronic altitude illnesses. High Alt Med Biol. 17:281-293, 2016.-Humans exhibit marked variation in their responses to hypoxia, with susceptibility to acute and chronic altitude illnesses being a prominent and medically important example. Many have hypothesized that genetic differences are the cause of these variable responses to hypoxia; however, until recently, these hypotheses were based primarily on small (and sometimes anecdotal) reports pertaining to apparent differences in altitude illness susceptibility between populations, the notion that a history of altitude illness is indicative of subsequent risk, the heritability of hypoxia-related traits, and candidate gene association studies. In the past 5 years, the use of genomic techniques has helped bolster the claim that susceptibility to some altitude illnesses is likely the result of genetic variation. For each of the major altitude illnesses, we summarize and evaluate the evidence stemming from three important characteristics of a genetic trait: (1) individual susceptibility and repeatability across assessments, (2) biogeographical differences and familial aggregation, and (3) association(s) with genetic variants. Evidence to support a genetic basis for susceptibilities to acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) is limited, owing partially to the subjective and unclear phenotype of AMS and the rarity and severity of HACE. In contrast, recent genomic studies have identified genes that influence susceptibility to high-altitude pulmonary edema, chronic mountain sickness, and high-altitude pulmonary hypertension. The collection of more individual, familial, and biogeographical susceptibility data should improve our understanding of the extent to which genetic variation contributes to altitude illness susceptibility, and genomic and molecular investigations have the potential to elucidate the mechanisms that underpin altitude illness susceptibility.
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Affiliation(s)
| | - Michael S Koehle
- 2 School of Kinesiology, University of British Columbia , Vancouver, Canada .,3 Allan McGavin Sport Medicine Clinic, Department of Family Practice, University of British Columbia , Vancouver, Canada
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Special Considerations in Medical Screening for Participants in Remote Endurance Events. Sports Med 2016; 45:1121-31. [PMID: 26002285 DOI: 10.1007/s40279-015-0342-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As participation at remote endurance events increases, so does the need to screen participants for potentially problematic medical conditions, but this process has been ill-defined to date. This article aims to outline a general approach to screening and discusses common or important medical conditions that may need consideration in the screening process. Medical conditions that are considered low risk may translate to high-risk conditions in the setting of a remote and austere location. Medical directors of remote endurance events should have a familiarity with assessing risks and applying informed consent principles to participation. While there are no specific standards on medical disqualification from an event based on medical history alone, several systematic considerations should be made that allow for an assessment of risk to an individual for a specific event. The medical director and event director, in discussion with the athlete and treating clinician when appropriate, should come to a consensus on participation when high-risk medical conditions become apparent during the screening process. Both modifications and accommodations to participation may be used to mitigate both clinical and medicolegal risk and allow for participation.
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MacInnis MJ, Widmer N, Timulsina U, Subedi A, Siwakoti A, Pandit BP, Freeman MG, Carter EA, Manokhina I, Thapa GB, Koehle MS. A Preliminary Genome-Wide Association Study of Acute Mountain Sickness Susceptibility in a Group of Nepalese Pilgrims Ascending to 4380 m. High Alt Med Biol 2015; 16:290-7. [DOI: 10.1089/ham.2015.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Martin J. MacInnis
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Widmer
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Utsav Timulsina
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ankita Subedi
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ashmita Siwakoti
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Bidur Prasad Pandit
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Michael G. Freeman
- Accident and Emergency Department, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Eric A. Carter
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Irina Manokhina
- Child and Family Research Institute, Vancouver, British Columbia, Canada
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ghan Bahadur Thapa
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Michael S. Koehle
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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GUO LI, ZHANG JIHANG, JIN JUN, GAO XUBIN, YU JIE, GENG QIANWEN, LI HUIJIE, HUANG LAN. Genetic variants of endothelial PAS domain protein 1 are associated with susceptibility to acute mountain sickness in individuals unaccustomed to high altitude: A nested case-control study. Exp Ther Med 2015; 10:907-914. [PMID: 26622413 PMCID: PMC4533176 DOI: 10.3892/etm.2015.2611] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/15/2015] [Indexed: 01/25/2023] Open
Abstract
The endothelial PAS domain protein 1 (EPAS1) gene functions to sense the blood oxygen level by regulating the hypoxia-inducible transcription factor pathway, and single nucleotide polymorphisms (SNPs) of EPAS1 have been found to have a strong and positive selection in the adaptation of the native Tibetan highland population to high-altitude hypoxia. The aim of the present study was to investigate the effect of EPAS1 SNPs on the risk of acute mountain sickness (AMS) and the physiological responses to acute high-altitude hypoxia in lowland humans. Three tag SNPs (rs6756667, rs13419896 and rs4953354; minor allele frequency, ≥5%) were selected and genotyped in 603 unrelated Han Chinese men, who had traveled to Lhasa (a high-altitude hypoxia environment) by plane, using a matrix-assisted laser desorption/ionization time-of-flight mass spectrometry method. The data showed that the EPAS1 rs6756667 wild-type GG homozygous genotype was associated with elevated AMS risk compared with the AA and AG genotypes (odds ratio, 1.815; 95% confidence interval, 1.233-2.666; P=0.0023) using the dominant-model analysis. EPAS1 rs6756667 GG genotypes were also associated with higher levels of hemoglobin, red blood cells and hematocrit than those carrying the AG heterozygote during AMS development. These findings indicate that EPAS1 SNPs play a role in the physiological effects of AMS, and these effects could be further evaluated as a therapeutic strategy to control acute hypoxia-related human diseases.
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Affiliation(s)
- LI GUO
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - JIHANG ZHANG
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - JUN JIN
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - XUBIN GAO
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - JIE YU
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - QIANWEN GENG
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - HUIJIE LI
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
| | - LAN HUANG
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, P.R. China
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Pitman JT, Thapa GB, Stuart Harris N. Field Ultrasound Evaluation of Central Volume Status and Acute Mountain Sickness. Wilderness Environ Med 2015; 26:319-26. [DOI: 10.1016/j.wem.2015.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 11/26/2022]
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Guo G, Zhu G, Sun W, Yin C, Ren X, Wang T, Liu M. Association of arterial oxygen saturation and acute mountain sickness susceptibility: a meta-analysis. Cell Biochem Biophys 2015; 70:1427-32. [PMID: 24965166 DOI: 10.1007/s12013-014-0076-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acute mountain sickness (AMS) is the most common high altitude illnesses experienced during rapid ascent to a higher altitude without prior acclimation. It is mainly characterized by a headache which may be accompanied with nausea, vomiting, anorexia, dizziness, lethargy, fatigue, and sleep disturbance. If not diagnosed and treated in a timely manner, AMS can develop into deadly high altitude pulmonary edema or high altitude cerebral edema. In the previous studies of individual variation in susceptibility to AMS, arterial oxygen saturation (SO2) was identified as being associated with AMS. However, other studies have reported no association between AMS and arterial oxygen saturation. In this study, the association between SO2 and AMS was assessed through a meta-analysis of published data. The literature databases PubMed, Web of Science, LWW, Science Direct, and Embase were queried for papers published before 15 April 2014. A fixed-effects model and a random-effects model were applied (Revman 5.0) on the basis of heterogeneity, and the study quality was assessed in duplicate. Twelve studies with 614 AMS patients and 1,025 control subjects were analyzed. There was a significant association with differences in SO2 and the risk of developing AMS. SO2 values are associated with AMS incidence.
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Affiliation(s)
- Guoning Guo
- Department of Emergency, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
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MacInnis MJ, Koch S, MacLeod KE, Carter EA, Jain R, Koehle MS, Rupert JL. Acute mountain sickness is not repeatable across two 12-hour normobaric hypoxia exposures. Wilderness Environ Med 2014; 25:143-51. [PMID: 24631230 DOI: 10.1016/j.wem.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/11/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purposes of this experiment were to determine the repeatability of acute mountain sickness (AMS), AMS symptoms, and physiological responses across 2 identical hypoxic exposures. METHODS Subjects (n = 25) spent 3 nights at simulated altitude in a normobaric hypoxia chamber: twice at a partial pressure of inspired oxygen (PIO2) of 90mmHg (4000 m equivalent; "hypoxia") and once at a PIO2 of 132 mmHg (1000 m equivalent; "sham") with 14 or more days between exposures. The following variables were measured at hours 0 and 12 of each exposure: AMS severity (ie, Lake Louise score [LLS]), AMS incidence (LLS ≥3), heart rate, oxygen saturation, blood pressure, and the fraction of exhaled nitric oxide. Oxygen saturation and heart rate were also measured while subjects slept. RESULTS The incidence of AMS was not statistically different between the 2 exposures (84% vs 56%, P > .05), but the severity of AMS (ie, LLS) was significantly lower on the second hypoxic exposure (mean [SD], 3.1 [1.8]) relative to the first hypoxic exposure (4.8 [2.3]; P < .001). Headache was the only AMS symptom to have a significantly greater severity on both hypoxic exposures (relative to the sham exposure, P < .05). Physiological variables were moderately to strongly repeatable (intraclass correlation range 0.39 to 0.86) but were not associated with AMS susceptibility (P > .05). CONCLUSIONS The LLS was not repeatable across 2 identical hypoxic exposures. Increased familiarity with the environment (not acclimation) could explain the reduced AMS severity on the second hypoxic exposure. Headache was the most reliable AMS symptom.
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Affiliation(s)
- Martin J MacInnis
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sarah Koch
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristin E MacLeod
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric A Carter
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Radha Jain
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S Koehle
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jim L Rupert
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Luo Y, Wang Y, Lu H, Gao Y. ‘Ome’ on the range: update on high-altitude acclimatization/adaptation and disease. ACTA ACUST UNITED AC 2014; 10:2748-55. [DOI: 10.1039/c4mb00119b] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The main physiological challenge in high-altitude plateau environments is hypoxia.
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Affiliation(s)
- Yongjun Luo
- Department of Military Medical Geography
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
| | - Yuxiao Wang
- Department of Military Medical Geography
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
| | - Hongxiang Lu
- Department of Military Medical Geography
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
| | - Yuqi Gao
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude medicine (People's Liberation Army)
- Third Military Medical University
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18
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MacInnis MJ, Carter EA, Freeman MG, Pandit BP, Siwakoti A, Subedi A, Timalsina U, Widmer N, Thapa GB, Koehle MS, Rupert JL. A prospective epidemiological study of acute mountain sickness in Nepalese pilgrims ascending to high altitude (4380 m). PLoS One 2013; 8:e75644. [PMID: 24130729 PMCID: PMC3794000 DOI: 10.1371/journal.pone.0075644] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 08/16/2013] [Indexed: 01/14/2023] Open
Abstract
Background Each year, thousands of pilgrims travel to the Janai Purnima festival in Gosainkunda, Nepal (4380 m), ascending rapidly and often without the aid of pharmaceutical prophylaxis. Methods During the 2012 Janai Purnima festival, 538 subjects were recruited in Dhunche (1950 m) before ascending to Gosainkunda. Through interviews, subjects provided demographic information, ratings of AMS symptoms (Lake Louise Scores; LLS), ascent profiles, and strategies for prophylaxis. Results In the 491 subjects (91% follow-up rate) who were assessed upon arrival at Gosainkunda, the incidence of AMS was 34.0%. AMS was more common in females than in males (RR = 1.57; 95% CI = 1.23, 2.00), and the AMS incidence was greater in subjects >35 years compared to subjects ≤35 years (RR = 1.63; 95% CI = 1.36, 1.95). There was a greater incidence of AMS in subjects who chose to use garlic as a prophylactic compared to those who did not (RR = 1.69; 95% CI = 1.26, 2.28). Although the LLS of brothers had a moderate correlation (intraclass correlation = 0.40, p = 0.023), sibling AMS status was a weak predictor of AMS. Conclusions The incidence of AMS upon reaching 4380 m was 34% in a large population of Nepalese pilgrims. Sex, age, and ascent rate were significant factors in the development of AMS, and traditional Nepalese remedies were ineffective in the prevention of AMS.
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Affiliation(s)
- Martin J. MacInnis
- School of Kinesiology, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Eric A. Carter
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | | | - Bidur Prasad Pandit
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal
| | - Ashmita Siwakoti
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal
| | - Ankita Subedi
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal
| | - Utsav Timalsina
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal
| | - Nadia Widmer
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ghan Bahadur Thapa
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal
| | - Michael S. Koehle
- School of Kinesiology, University of British Columbia, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jim L. Rupert
- School of Kinesiology, University of British Columbia, Vancouver, Canada
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Horz HP, Ten Haaf A, Kessler O, Said Yekta S, Seyfarth I, Hettlich M, Lampert F, Küpper T, Conrads G. T-RFLP-based differences in oral microbial communities as risk factor for development of oral diseases under stress. ENVIRONMENTAL MICROBIOLOGY REPORTS 2012; 4:390-397. [PMID: 23760823 DOI: 10.1111/j.1758-2229.2012.00340.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The human oral microbiome is comprised of approximately 800 different bacterial species many of which are as yet uncultivated. Their dynamics and variability in relation to health and disease are still poorly understood. Here we tested the hypothesis that the emergence of stress-induced periodontal diseases is predictable based on the composition of the initial microbiota. As a model, we analysed 58 individuals performing a challenging expedition (exposure to various stress-factors due to changes in diet, hygiene, temperature, physical and mental stress) in remote regions of the Himalayans (Annapurna Himal). Plaque samples were taken at start (Bhulbule) and destination (3000 meter difference in altitude) seven days later (Manang). Twenty-eight individuals remained symptom-free (Group I) while 30 participants developed periodontal problems, mostly gingivitis (Group II). The microbiota was monitored via T-RFLP-analysis of amplified 16S rRNA genes directly from the plaque samples. Based on the Additive-Main-Effects-Multiplicative-Interactions-model (AMMI) using the T-Rex software variation from T-RF main effects was at least 95%, indicating that most variation was due to inherent differences in microbial communities among individuals. However, an interaction signal up to 3% was consistently observed between groups I and II but not between the two time points of sampling regardless of selected analytical parameters. The data, supported by heterogeneity, diversity and similarity indices indicated marked differences between groups I and II already prior the onset of clinical symptoms. These differences may provide the basis for using ecological parameters of oral microbial communities as early diagnostic marker for the onset of oral disorders and infections.
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Affiliation(s)
- H-P Horz
- Division of Oral Microbiology and Immunology, RWTH Aachen University Hospital, Germany Department of Operative and Preventive Dentistry & Periodontology, RWTH Aachen University Hospital, Germany Occupational Medicine, Sports Medicine, Mountain Medicine (UIAA), Travel Medicine (DFR), Institute of Occupational & Social Medicine, RWTH Aachen University, Germany
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