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Champigneulle B, Caton F, Seyve L, Stauffer É, Pichon A, Brugniaux JV, Furian M, Hancco I, Deschamps B, Kaestner L, Robach P, Connes P, Bouzat P, Polack B, Marlu R, Verges S. Are coagulation profiles in Andean highlanders with excessive erythrocytosis favouring hypercoagulability? Exp Physiol 2024; 109:899-914. [PMID: 38554124 PMCID: PMC11140178 DOI: 10.1113/ep091670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024]
Abstract
Chronic mountain sickness is a maladaptive syndrome that affects individuals living permanently at high altitude and is characterized primarily by excessive erythrocytosis (EE). Recent results concerning the impact of EE in Andean highlanders on clotting and the possible promotion of hypercoagulability, which can lead to thrombosis, were contradictory. We assessed the coagulation profiles of Andeans highlanders with and without excessive erythrocytosis (EE+ and EE-). Blood samples were collected from 30 EE+ and 15 EE- in La Rinconada (Peru, 5100-5300 m a.s.l.), with special attention given to the sampling pre-analytical variables. Rotational thromboelastometry tests were performed at both native and normalized (40%) haematocrit using autologous platelet-poor plasma. Thrombin generation, dosages of clotting factors and inhibitors were measured in plasma samples. Data were compared between groups and with measurements performed at native haematocrit in 10 lowlanders (LL) at sea level. At native haematocrit, in all rotational thromboelastometry assays, EE+ exhibited hypocoagulable profiles (prolonged clotting time and weaker clot strength) compared with EE- and LL (all P < 0.01). At normalized haematocrit, clotting times were normalized in most individuals. Conversely, maximal clot firmness was normalized only in FIBTEM and not in EXTEM/INTEM assays, suggesting abnormal platelet activity. Thrombin generation, levels of plasma clotting factors and inhibitors, and standard coagulation assays were mostly normal in all groups. No highlanders reported a history of venous thromboembolism based on the dedicated survey. Collectively, these results indicate that EE+ do not present a hypercoagulable profile potentially favouring thrombosis.
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Affiliation(s)
- Benoit Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
| | | | - Landry Seyve
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
| | - Émeric Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
- Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Aurélien Pichon
- Université de Poitiers, Laboratoire Move UR 20296, STAPS, Poitiers, France
| | | | - Michael Furian
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Ivan Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | - Lars Kaestner
- Dynamics of Fluids, Experimental Physics, Saarland University, Homburg, Germany
- Theoretical Medicine and Biosciences, Medical Faculty, Saarland University, Homburg, Germany
| | - Paul Robach
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Pierre Bouzat
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, Grenoble, France
| | - Benoit Polack
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Raphael Marlu
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Samuel Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
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Hameed S, Karim N, Wasay M, Venketasubramanian N. Emerging Stroke Risk Factors: A Focus on Infectious and Environmental Determinants. J Cardiovasc Dev Dis 2024; 11:19. [PMID: 38248889 PMCID: PMC10816862 DOI: 10.3390/jcdd11010019] [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: 11/22/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
This review focuses on emerging risk factors for stroke, including air pollution and climate change, gut microbiota, high altitude, and systemic infection. Up to 14% of all stroke-associated mortality is attributed to air pollution and is more pronounced in developing countries. Fine particulate matter and other air pollutants contribute to an increased stroke risk, and this risk appears to increase with higher levels and duration of exposure. Short term air pollution exposure has also been reported to increase the stroke risk. The gut microbiota is a complex ecosystem of bacteria and other microorganisms that reside in the digestive system and affect multiple body systems. Disruptions in the gut microbiota may contribute to stroke development, possibly by promoting inflammation and atherosclerosis. High altitudes have been associated with erythrocytosis and cerebrovascular sinus thrombosis, but several studies have reported an increased risk of thrombosis and ischemic stroke at high altitudes, typically above 3000 m. Systemic infection, particularly infections caused by viruses and bacteria, can also increase the risk of stroke. The risk seems to be greatest in the days to weeks following the infection, and the pathophysiology is complex. All these emerging risk factors are modifiable, and interventions to address them could potentially reduce stroke incidence.
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Affiliation(s)
- Sajid Hameed
- Department of Neurology, University of Virginia, Charlottesville, VA 22903, USA;
| | - Nurose Karim
- Department of Neurology, East Carolina University, Greenville, NC 27834, USA;
| | - Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi 74800, Pakistan;
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Xiao J, Li Z, Li X, Lei H, Meng F, Li C. Screening and Identifying Reference Genes for Erythrocyte Production from Cord Blood CD34+ Cells Exposed to Hypoxia. DNA Cell Biol 2024; 43:1-11. [PMID: 38011643 DOI: 10.1089/dna.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Cord blood (CB) CD34+ cells have the potential to be used to achieve artificial hematopoiesis because of their ability to expand and differentiate in multiple directions. However, the mechanism and molecular changes underlying such differentiation are still unclear. The differentiation of CB CD34+ cells is generally driven by subtle changes in gene expression. A crucial method for examining gene expression is quantitative real-time polymerase chain reaction, but the accuracy of the results is dependent on the use of reliable reference genes. Here, the transcription levels of 10 novel candidate reference genes (EIF4G2, DYNC1H1, LUC7L3, CD46, POLR1D, WSB1, GAPVD1, HGS, LGALS8, and RBM5) and 8 traditional reference genes (GAPDH, YWHAZ, ACTB, B2MG, TBP, HMBS, PPIA, HPRT1) in CB CD34+ cells under different oxygen concentrations were screened and evaluated by using the geNorm and NormFinder algorithms. Comprehensive analysis conducted by RefFinder online tool showed that TBP (a traditional reference gene) and EIF4G2 (a novel reference gene) had the most stable expression, whereas GAPDH and HMBS were the least suitable reference genes under these conditions. These results may serve as a basis for selecting reference genes with stable expression for more accurate normalization under different oxygen concentration stimulation during CB CD34+ cells differentiation.
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Affiliation(s)
- Jun Xiao
- Department of Blood Transfusion, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Zhicai Li
- The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Xiaowei Li
- Department of Blood Transfusion, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Huifen Lei
- Department of Blood Transfusion, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Fangyuan Meng
- Department of Blood Transfusion, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Cuiying Li
- Department of Blood Transfusion, Air Force Medical Center, Air Force Medical University, Beijing, China
- The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, China
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Ortiz-Prado E, Izquierdo-Condoy JS, Fernández-Naranjo R, Vásconez-González J, Cano L, González AC, Morales-Lapo E, Guerrero-Castillo GS, Duque E, Rosero MGD, Egas D, Viscor G. Epidemiological characterization of ischemic heart disease at different altitudes: A nationwide population-based analysis from 2011 to 2021 in Ecuador. PLoS One 2023; 18:e0295586. [PMID: 38157383 PMCID: PMC10756509 DOI: 10.1371/journal.pone.0295586] [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: 06/09/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Cardiovascular diseases, including ischemic heart disease, are the leading cause of premature death and disability worldwide. While traditional risk factors such as smoking, obesity, and diabetes have been thoroughly investigated, non-traditional risk factors like high-altitude exposure remain underexplored. This study aims to examine the incidence and mortality rates of ischemic heart disease over the past decade in Ecuador, a country with a diverse altitude profile spanning from 0 to 4,300 meters. METHODS We conducted a geographic distribution analysis of ischemic heart disease in Ecuador, utilizing hospital discharge and mortality data from the National Institute of Census and Statistics for the years 2011-2021. Altitude exposure was categorized according to two distinct classifications: the traditional division into low (< 2,500 m) and high (> 2,500 m) altitudes, as well as the classification proposed by the International Society of Mountain Medicine, which delineates low (< 1,500 m), moderate (1,500-2,500 m), high (2,500-3,500 m), and very high (3,500-5,800 m) altitudes. FINDINGS From 2011-2021, we analyzed 49,765 IHD-related hospital admissions and 62,620 deaths. Men had an age-adjusted incidence rate of 55.08/100,000 and a mortality rate of 47.2/100,000, compared to 20.77/100,000 and 34.8/100,000 in women. Incidence and mortality surged in 2020 by 83% in men and 75% in women. Altitudinal stratification revealed higher IHD rates at lower altitudes (<2500 m), averaging 61.65 and 121.8 per 100,000 for incidence and mortality, which declined to 25.9 and 38.5 at elevations >2500 m. Men had more pronounced rates across altitudes, exhibiting 138.7% and 150.0% higher incidence at low and high altitudes respectively, and mortality rates increased by 48.3% at low altitudes and 23.2% at high altitudes relative to women. CONCLUSION Ecuador bears a significant burden of ischemic heart disease (IHD), with men being more affected than women in terms of incidence. However, women have a higher percentage of mortality post-hospital admission. Regarding elevation, our analysis, using two different altitude cutoff points, reveals higher mortality rates in low-altitude regions compared to high-altitude areas, suggesting a potential protective effect of high elevation on IHD risk. Nevertheless, a definitive dose-response relationship between high altitude and reduced IHD risk could not be conclusively established.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | | | - Raúl Fernández-Naranjo
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | | | - Leonardo Cano
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | - Ana Carolina González
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
- Pós Graduação de Clinica Medica, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil
| | - Estefanía Morales-Lapo
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | | | - Erick Duque
- One Health Research Group, Faculty of Medicine, Universidad de las Américas, Quito, Ecuador
| | | | - Diego Egas
- Departamento de Cardiología, Hospital Metropolitano, Quito, Ecuador
| | - Ginés Viscor
- Departament de Biología Cel·lular, Fisiologia i Immunologia, Universitat de Barcelona, Barcelona, Spain
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Zheng B, Luo Y, Li Y, Gu G, Jiang J, Chen C, Chen Z, Wang J. Prevalence and risk factors of stroke in high-altitude areas: a systematic review and meta-analysis. BMJ Open 2023; 13:e071433. [PMID: 37734891 PMCID: PMC10514645 DOI: 10.1136/bmjopen-2022-071433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE The primary objective of this study is to investigate the prevalence and risk factors of stroke in high-altitude areas through a comprehensive systematic review and meta-analysis. DESIGN This study adopts a systematic review and meta-analysis design. DATA SOURCES A thorough search was conducted on databases including PubMed, Web of Science, Embase, Cochrane Library, MEDLINE and SCOPUS, covering the period up to June 2023. ELIGIBILITY CRITERIA Studies reporting the prevalence of stroke in high-altitude areas and exploring related risk factors were included, regardless of whether they involved clinical samples or the general population. Studies with incomplete, outdated or duplicate data were excluded. DATA EXTRACTION AND SYNTHESIS We performed eligibility screening, data extraction and quality evaluation of the retrieved articles. Meta-analysis was employed to estimate the prevalence and risk factors of stroke in high-altitude areas. The Newcastle-Ottawa Scale was used to assess the risk of bias. RESULTS A total of 17 studies encompassing 8 566 042 participants from four continents were included, with altitudes ranging from 1500 m to nearly 5000 m. The pooled prevalence of stroke in high-altitude areas was found to be 0.5% (95% CI 0.3%-7%). Notably, the prevalence was higher in clinical samples (1.2%; 0.4%-2.5%) compared with the general population (0.3%; 95% CI 0.1%-0.6%). When considering geographic regions, the aggregated data indicated that stroke prevalence in the Eurasia plate was 0.3% (0.2%-0.4%), while in the American region, it was 0.8% (0.4%-1.3%). Age (OR, 14.891), gender (OR, 1.289), hypertension (OR, 3.158) and obesity (OR, 1.502) were identified as significant risk factors for stroke in high-altitude areas. CONCLUSIONS The findings of this study provide insights into the pooled prevalence of stroke in high-altitude areas, highlighting variations based on geographic regions and sampling type. Moreover, age, gender, hypertension and obesity were found to be associated with the occurrence of stroke. PROSPERO REGISTRATION NUMBER CRD42022381541.
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Affiliation(s)
- Bo Zheng
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
| | - Yuding Luo
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
- Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Yan Li
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
| | - Gangfeng Gu
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
| | - Junyao Jiang
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
| | - Chuanli Chen
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
| | - Zhao Chen
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
| | - Jian Wang
- Department of Neurology, Ya'an Peoples Hospital, Ya'an, People's Republic of China
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Tu WJ, Xu Y, Fan Y, Zeng X, Zhao J. Impacts of exposure to ambient temperature and altitude on the burden of stroke. J Neurol 2023; 270:4214-4218. [PMID: 37166508 DOI: 10.1007/s00415-023-11742-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate the impact of ambient temperature and altitude exposure on the burden of stroke in a Chinese cohort. METHODS This study was conducted using data from the National Stroke High-Risk Population Screening System 2020, which assess the overall prevalence, incidence, and mortality rate of stroke in China. For this study, we obtained the annual mean ambient temperature, diurnal temperature range, and altitude for each city. Body mass index (BMI) of participants were calculated. RESULT The sample comprised 676,394 adults aged 40 years or older from 170 cities in 31 provinces in China. A negative linear relationship between mean ambient temperature and stroke risk (incidence and prevalence) as well as a negative association between mean ambient temperature and stroke mortality had been found. A nonlinear relationship with decreased risk in both high and low diurnal temperature range is observed for stroke burden (incidence, prevalence, and mortality). There is no significant correlation between city altitude and stroke burden. The U-shaped relationships of BMI with the incidence and prevalence of stroke indicate that the lowest incidence and prevalence are observed when BMI is approximately 20. CONCLUSION Overall, our study provides important insights into the environmental and individual factors that contribute to the burden of stroke in China, and may inform public health interventions aimed at reducing this burden.
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Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Four Ring West Road, Beijing, 100070, People's Republic of China.
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People's Republic of China.
| | - Yicheng Xu
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Yangyi Fan
- Department of Neurology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xianwei Zeng
- Department of Neurosurgery, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, No. 1 Ronghua Middle Rd, Daxing District, Beijing, 100176, People's Republic of China.
- Geriatrics Innovation Center, Weifang People's Hospital, Weifang, People's Republic of China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Four Ring West Road, Beijing, 100070, People's Republic of China
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Jiang Y, Ping J, Lu H, Zhang H, Liu M, Li Y, Zhou G. Associations between high-altitude adaptation and risk of cardiovascular diseases: a bidirectional Mendelian randomization study. Mol Genet Genomics 2023; 298:1007-1021. [PMID: 37233799 DOI: 10.1007/s00438-023-02035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
High-altitude adaptation (HAA) was reported to be significantly associated with reduced risks for multiple cardiovascular diseases (CVDs). However, the causality and direction of the associations are largely uncharacterized. We aimed to examine the potential causal relationships between HAA and six types of CVD, including coronary artery disease (CAD), cerebral aneurysm, ischemic stroke, peripheral artery disease, arrhythmia and atrial fibrillation. We obtained the summary data from largest available genome-wide association study of HAA and six types of CVD. Two-sample bidirectional Mendelian randomization (MR) analyses were performed to infer the causality between them. In the sensitivity analyses, MR-Egger regression analyses and MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO) global analyses were used to assess the pleiotropic effects; Cochran's Q tests were used to test the heterogeneity by inverse variance-weighted (IVW) and MR-Egger methods; and the leave-one-out analyses were used to examine whether some single nucleotide polymorphisms (SNPs) could influence the results independently. The MR main analyses showed that the genetically instrumented HAA was significantly causally associated with the reduced risks of CAD (odds ratio [OR] = 0.029; 95% confidence interval [CI] = 0.004-0.234; P = 8.64 × 10-4). In contrast, there was no statistically significant relationship between CVDs and HAA. Our findings provide evidence for the causal effects of HAA on the reduced risks of CAD. However, there is no causality of CVDs on HAA. These findings might be helpful in developing the prevention and intervention strategies for CAD.
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Affiliation(s)
- Yuqing Jiang
- Collaborative Innovation Center for Personalized Cancer Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing City, Jiangsu Province, 211166, People's Republic of China
| | - Jie Ping
- Department of Genetics and Integrative Omics, State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, People's Republic of China
| | - Hao Lu
- Department of Genetics and Integrative Omics, State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, People's Republic of China
| | - Haoxiang Zhang
- The No. 954 Hospital of PLA, Shannan City, 856100, People's Republic of China
| | - Mengyu Liu
- Department of Genetics and Integrative Omics, State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, People's Republic of China
| | - Yuanfeng Li
- Department of Genetics and Integrative Omics, State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, People's Republic of China.
| | - Gangqiao Zhou
- Collaborative Innovation Center for Personalized Cancer Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing City, Jiangsu Province, 211166, People's Republic of China.
- Department of Genetics and Integrative Omics, State Key Laboratory of Proteomics, National Center for Protein Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, People's Republic of China.
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Fukunaga A, Koyama H, Fuse T, Haraguchi A. The onset of cerebral infarction may be affected by differences in atmospheric pressure distribution patterns. Front Neurol 2023; 14:1230574. [PMID: 37583952 PMCID: PMC10423876 DOI: 10.3389/fneur.2023.1230574] [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: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Background Some papers have highlighted a possible causal relationship between the onset of ischemic stroke and weather conditions. This study aimed to elucidate the onset mechanism of cerebral infarction from a meteorological approach. We focused on the atmospheric pressure distribution patterns (APDPs). Methods The subjects are 221 cases diagnosed as cardiogenic cerebral embolism (Group A) and 612 cases diagnosed as atherosclerotic cerebral thrombosis (Group B). We investigated the APDP on the date closest to the date and time of onset of cerebral infarction in each patient on the website and chose the most similar one from the reported 11 APDPs. Groups A and B were compared for clinical characteristics and the appearance rate of each APDP in each group. Results The clinical characteristics of Groups A and B were consistent with some previously reported clinical characteristics of cerebral embolism and cerebral thrombosis except for smoking. The appearance rate of the other high-pressure type, which cannot be classified as either the anticyclone belt type or the migratory anticyclone type, in Group B was statistically significantly higher than that in Group A, and the appearance rate of the anticyclone belt type in Group A was statistically significantly higher than that in Group B (p < 0.05, Fisher's exact probability method, respectively). Conclusions Cerebral embolism and cerebral thrombosis exhibited significant differences in APDPs on the day of onset. Dehydration particularly in the other high-pressure type or in the anticyclone belt type should be prevented. Further investigation should focus on the other meteorological factors.
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Li X, Li Y, Zhao S, Chen X, Wang L, Zhang X. Early cognitive dysfunction after stroke and related risk factors in the high-altitude and multi-ethnic region of Qinghai, China: A multi-center cross-sectional study. Clin Neurol Neurosurg 2023; 225:107607. [PMID: 36696845 DOI: 10.1016/j.clineuro.2023.107607] [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: 05/19/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Cognitive impairment is a common outcome of stroke, but there is limited evidence regarding its prevalence at high altitude, especially within the context of specific ethnic groups or lifestyle habits. This prospective exploratory study investigated early cognitive impairment after stroke in Qinghai Province, 3000 m above sea level. METHODS Patients with acute stroke (n = 1047) were enrolled from 3 hospitals in Qinghai Province. Cognitive performance was measured by Montreal Cognitive Assessment (MoCA) scores within 5 days of stroke symptom onset; MoCA < 26 defined impairment. Patient data included demographics, education, vascular risk factors, diet, and activities of daily living rated by Barthel index. RESULTS Cognitive impairment within 5 days of stroke symptom onset affected 77.65% of these patients. The factors independently associated with early cognitive impairment were: older age (mean difference [MD]: -4.857, 95% confidence interval [CI]: 6.685-3.030, P < 0.001); female gender (odds ratio [OR]: 1.674, 95% CI: 1.212-2.313, P = 0.002); and a diet containing yak butter (OR: 1.587, 95% CI: 1.247-2.021, P < 0.001). Progressively lesser odds were accounted to beef (Yak) and mutton consumption (OR: 0.804, 95% CI: 0.655-0.987, P = 0.037); fruit (OR: 0.792, 95% CI: 0.672-0.933, P = 0.005); status as an immigrant (OR: 0.666, 95% CI: 0.445-0.996, P = 0.048); education (OR: 0.514, 95% CI: 0.400-0.660, P < 0.001); and multiple daily leisure activities (OR: 0.999, 95% CI: 0.999-0.999, P < 0.001). CONCLUSION Persons in Qinghai province who experience stroke are likely to show signs of early cognitive dysfunction. Preventive modifiable features include diet and daily activities.
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Affiliation(s)
- Xiaofang Li
- Qinghai Provincial People's Hospital, Xining 81007, China
| | - Yuemei Li
- Qinghai Provincial People's Hospital, Xining 81007, China
| | - Shengxiu Zhao
- Qinghai Provincial People's Hospital, Xining 81007, China.
| | | | - Limei Wang
- Third People's Hospital of Xining, Xining 81000, China
| | - Xiaoxia Zhang
- Qinghai Provincial People's Hospital, Xining 81007, China
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Shu J, Fei W, Zhang J, Li F, Hao Y, Ding Z, Tseyang, Drolma, Ji S, Zhao W, Hu Y, Sun W, Huang Y, Zhao Y, Zhang W. Cerebral small-vessel disease at high altitude: A comparison of patients from plateau and plain. Front Neurol 2023; 14:1086476. [PMID: 36970535 PMCID: PMC10034167 DOI: 10.3389/fneur.2023.1086476] [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: 11/01/2022] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Background and purpose Cerebral small-vessel disease (CSVD) is prevalent worldwide and one of the major causes of stroke and dementia. For patients with CSVD at high altitude, a special environmental status, limited information is known about their clinical phenotype and specific neuroimaging change. We investigated the clinical and neuroimaging features of patients residing at high altitude by comparing with those in the plain, trying to explore the impact of high altitude environment on CSVD. Methods Two cohorts of CSVD patients from the Tibet Autonomous Region and Beijing were recruited retrospectively. In addition to the collection of clinical diagnoses, demographic information and traditional vascular risk factors, the presence, location, and severity of lacunes and white matter hyperintensities were assessed by manual counting and using age-related white matter changes (ARWMC) rating scale. Differences between the two groups and influence of long-term residing in the plateau were analyzed. Results A total of 169 patients in Tibet (high altitude) and 310 patients in Beijing (low altitude) were enrolled. Fewer patients in high altitude group were found with acute cerebrovascular events and concomitant traditional vascular risk factors. The median (quartiles) ARWMC score was 10 (4, 15) in high altitude group and 6 (3, 12) in low altitude group. Less lacunes were detected in high altitude group [0 (0, 4)] than in low altitude group [2 (0, 5)]. In both groups, most lesions located in the subcortical (especially frontal) and basal ganglia regions. Logistic regressions showed that age, hypertension, family history of stroke, and plateau resident were independently associated with severe white matter hyperintensities, while plateau resident was negatively correlated with lacunes. Conclusion Patients of CSVD residing at high altitude showed more severe WMH but less acute cerebrovascular events and lacunes in neuroimaging, comparing to patients residing at low altitude. Our findings suggest potential biphasic effect of high altitude on the occurrence and progression of CSVD.
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Affiliation(s)
- Junlong Shu
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Wen Fei
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Jing Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yu Hao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Zhijie Ding
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Tseyang
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Drolma
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Shiyong Ji
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Weiwei Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Yaxiong Hu
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yuhua Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, China
- Yuhua Zhao
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
- *Correspondence: Wei Zhang
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Ortiz-Prado E, Villafuerte FC, Brugniaux JV, Izquierdo-Condoy J, Viscor G. Editorial: Stroke and infarction at high-altitude. Front Physiol 2022; 13:1114747. [PMID: 36569767 PMCID: PMC9782429 DOI: 10.3389/fphys.2022.1114747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de Las Américas, Quito, Ecuador,*Correspondence: Esteban Ortiz-Prado,
| | - Francisco C. Villafuerte
- Laboratorio de Fisiología Comparada-LID/Fisiología del Transporte de Oxígeno-IIA, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Juan Izquierdo-Condoy
- One Health Research Group, Faculty of Medicine, Universidad de Las Américas, Quito, Ecuador
| | - Ginés Viscor
- Dirección Nacional de Inteligencia de la Salud, Ministerio de Salud Púbica, Quito, Ecuador
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12
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Falla M, Strapazzon G, Angelini C, Giardini G. Re: "Stroke at Moderate and High Altitude" by Syed et al. High Alt Med Biol 2022; 23:380-381. [PMID: 36493369 DOI: 10.1089/ham.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,Department of Neurology, General Hospital of Bolzano, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Corrado Angelini
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Guido Giardini
- Mountain Medicine and Neurology Centre, Valle d'Aosta Regional Hospital, Aosta, Italy
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13
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Li Z, Hu Q, Ji W, Fan Q. Prevalence of stroke and associated risk factors: a population-based cross-sectional study from the Qinghai-Tibet Plateau of China. BMJ Open 2022; 12:e065605. [PMID: 36414281 PMCID: PMC9685268 DOI: 10.1136/bmjopen-2022-065605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The epidemiology of stroke at high altitudes has not been extensively studied, especially at heights of 4000 m and above. Thus, stroke prevention and treatment at high altitudes are challenging. We conducted a cross-sectional study to estimate the prevalence of stroke, the detection rate of individuals at high risk of stroke and the risk factors for stroke in the Qinghai-Tibet Plateau in China, a high altitude plateau that inhabits approximately 15 million people. DESIGN A population-based cross-sectional study in the Qinghai-Tibet Plateau. SETTING Data were collected from participants through face-to-face screening using a primary screening table. The table relied on the China National Stroke Screening and Prevention Project. PARTICIPANTS A total of 10 700 residents aged ≥40 years and living on the Qinghai-Tibet Plateau for more than 6 months participated from January 2019 to December 2021. MAIN OUTCOME MEASURES The primary screening table included basic demographic information, medical history information, personal lifestyle habits and physical examination information. RESULTS A total of 10 056 people were included in the analysis. The prevalence of stroke was 2.3% (95% CI 2.0% to 2.6%), and the detection rate of individuals at high risk of stroke was 26.2% (95% CI 25.3% to 27.0%). The prevalence of stroke and the detection rate of individuals at high risk of stroke increased with altitude (p<0.01), and the prevalence of stroke at high altitudes was almost 2.2 times that at mid-altitudes (p<0.01). After full adjustments, age, residence, hypertension, family history of stroke and smoking were significantly associated with stroke (p<0.05). CONCLUSIONS The prevalence of stroke, the related risk factors and the detection rate of high-risk individuals were clarified. The prevalence rates of hypertension, overweight or obesity and diabetes in the Qinghai-Tibet Plateau were all higher than the Chinese average. Higher-altitude exposure may be an independent risk factor for stroke.
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Affiliation(s)
| | - QuanZhong Hu
- Qinghai Provincial People's Hospital, Xining, China
| | - WeiZhong Ji
- Qinghai Provincial People's Hospital, Xining, China
| | - QingLi Fan
- Qinghai Provincial People's Hospital, Xining, China
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14
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Jiang B, Li Y, Ciren D, Dawa O, Feng Y, Laba C. Supraglottic jet oxygenation and ventilation decreased hypoxemia during gastrointestinal endoscopy under deep sedation at high altitudes: a randomized clinical trial. BMC Anesthesiol 2022; 22:348. [PMCID: PMC9661813 DOI: 10.1186/s12871-022-01902-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Hypobaric hypoxia is common at high altitudes. Whether this exacerbates hypoxia during procedural sedation and whether hypoxia can be alleviated by the use of supraglottic jet oxygenation and ventilation (SJOV) are unknown. This study aimed to compare the incidence of hypoxia during gastrointestinal endoscopy under deep sedation at high altitudes with oxygen supply techniques using either a nasal cannula or SJOV.
Methods
This study was conducted from April 2022 to July 2022 in a tertiary hospital located 3650 m above sea level. Adult patients scheduled for routine gastrointestinal endoscopy under sedation were enrolled and randomized 1:1 to receive SJOV or a nasal cannula during sedation. Moderate hypoxia was the primary outcome, defined as an SPO2 of 75–89% for < 60 s. The secondary outcomes were respiratory-, cardiovascular-, and SJOV-related complications. The influence of characteristics regarding acclimatization to high altitudes (Tibetan ethnic group and erythrocytosis) on the occurrence of hypoxia was analyzed.
Results
None of the patients were lost to follow-up. A total of 72 patients were included in the analysis (36 patients in each group). There were 20 (27.8%) patients who experienced moderate hypoxia events. Significantly fewer hypoxic events occurred in the SJOV group than in the nasal cannula group [3 (8.3%) vs. 17 (47.2%), absolute risk difference (95% CI): − 38.9 (− 57.5, − 20.2) %, risk ratio (RR, 95% CI): 0.18 (0.06, 0.55), P < 0.001]. Significantly fewer patients in the SJOV group experienced mild hypoxia (P < 0.001) and severe hypoxia (P = 0.002). No serious adverse events occurred in either of the groups. The Tibetan ethnic group (P = 0.086) and erythrocytosis (P = 0.287) were not associated with the occurrence of hypoxia events.
Conclusions
The incidence of hypoxia was lower with SJOV than with nasal cannula in patients undergoing gastrointestinal endoscopy under deep sedation at high altitudes. The Tibetan ethnic group and erythrocytosis did not influence the occurrence of hypoxia.
Trial registration
This study was registered at ClinicalTrials.gov (NCT05304923) before enrollment by Dr. Yi Feng on 31/03/2022.
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