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Mao Z, Wang C, Liu J, Li X, Duan H, Ye Y, Liu H, Lv L, Xue G, He Z, Wuren T, Wang H. Superoxide dismutase 1-modified dental pulp stem cells alleviate high-altitude pulmonary edema by inhibiting oxidative stress through the Nrf2/HO-1 pathway. Gene Ther 2024; 31:422-433. [PMID: 38834681 DOI: 10.1038/s41434-024-00457-x] [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: 02/15/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
High-altitude pulmonary edema (HAPE) is a deadly form of altitude sickness, and there is no effective treatment for HAPE. Dental pulp stem cells (DPSCs) are a type of mesenchymal stem cell isolated from dental pulp tissues and possess various functions, such as anti-inflammatory and anti-oxidative stress. DPSCs have been used to treat a variety of diseases, but there are no studies on treating HAPE. In this study, Sprague-Dawley rats were exposed to acute low-pressure hypoxia to establish the HAPE model, and SOD1-modified DPSCs (DPSCsHiSOD1) were administered through the tail vein. Pulmonary arterial pressure, lung water content (LWC), total lung protein content of bronchoalveolar lavage fluid (BALF) and lung homogenates, oxidative stress, and inflammatory indicators were detected to evaluate the effects of DPSCsHiSOD1 on HAPE. Rat type II alveolar epithelial cells (RLE-6TN) were used to investigate the effects and mechanism of DPSCsHiSOD1 on hypoxia injury. We found that DPSCs could treat HAPE, and the effect was better than that of dexamethasone treatment. SOD1 modification could enhance the function of DPSCs in improving the structure of lung tissue, decreasing pulmonary arterial pressure and LWC, and reducing the total lung protein content of BALF and lung homogenates, through anti-oxidative stress and anti-inflammatory effects. Furthermore, we found that DPSCsHiSOD1 could protect RLE-6TN from hypoxic injury by reducing the accumulation of reactive oxygen species (ROS) and activating the Nrf2/HO-1 pathway. Our findings confirm that SOD1 modification could enhance the anti-oxidative stress ability of DPSCs through the Nrf2/HO-1 signalling pathway. DPSCs, especially DPSCsHiSOD1, could be a potential treatment for HAPE. Schematic diagram of the antioxidant stress mechanism of DPSCs in the treatment of high-altitude pulmonary edema. DPSCs can alleviate oxidative stress by releasing superoxide dismutase 1, thereby reducing ROS production and activating the Nrf2/HO-1 signalling pathway to ameliorate lung cell injury in HAPE.
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Affiliation(s)
- Zhuang Mao
- Beijing Institute of Radiation Medicine, Beijing, 100850, China
| | - Changyao Wang
- Beijing Institute of Radiation Medicine, Beijing, 100850, China
- School of Life Sciences, Hebei University, Baoding, 071002, China
| | - Juanli Liu
- Key Laboratory for Application of High-Altitude Medicine, Qinghai University, Xi'ning, 810008, China
- Research Center for High Altitude Medicine, Qinghai University, Xi'ning, 810008, China
- Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xi'ning, 810007, China
| | - Xue Li
- Beijing Institute of Radiation Medicine, Beijing, 100850, China
- College of Life Science, Anhui Medical University, Hefei, 230032, China
| | - Han Duan
- School of Life Sciences, Hebei University, Baoding, 071002, China
| | - Yi Ye
- Key Laboratory for Application of High-Altitude Medicine, Qinghai University, Xi'ning, 810008, China
- Research Center for High Altitude Medicine, Qinghai University, Xi'ning, 810008, China
| | - Huifang Liu
- Key Laboratory for Application of High-Altitude Medicine, Qinghai University, Xi'ning, 810008, China
- Research Center for High Altitude Medicine, Qinghai University, Xi'ning, 810008, China
| | - Lin Lv
- Beijing Institute of Radiation Medicine, Beijing, 100850, China
| | - Guanzhen Xue
- Key Laboratory for Application of High-Altitude Medicine, Qinghai University, Xi'ning, 810008, China
- Research Center for High Altitude Medicine, Qinghai University, Xi'ning, 810008, China
| | - Zhichao He
- Beijing Institute of Radiation Medicine, Beijing, 100850, China
- College of Life Science, Anhui Medical University, Hefei, 230032, China
| | - Tana Wuren
- Key Laboratory for Application of High-Altitude Medicine, Qinghai University, Xi'ning, 810008, China.
- Research Center for High Altitude Medicine, Qinghai University, Xi'ning, 810008, China.
| | - Hua Wang
- Beijing Institute of Radiation Medicine, Beijing, 100850, China.
- School of Life Sciences, Hebei University, Baoding, 071002, China.
- College of Life Science, Anhui Medical University, Hefei, 230032, China.
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Tenzing D, Suolang P, Gesang D, Suolang D, Duan G, Ciren W, Wang Y, Ni T. Effect of furosemide in the treatment of high-altitude pulmonary edema. BMC Pulm Med 2024; 24:109. [PMID: 38438895 PMCID: PMC10913242 DOI: 10.1186/s12890-024-02933-x] [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: 12/15/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND High-altitude pulmonary edema (HAPE) refers to the onset of breathlessness, cough, and fever at rest after arriving at high altitudes. It is a life-threatening illness caused by rapid ascent to high altitudes. Furosemide is controversial in HAPE treatment but is routinely used in China. Further research is needed to assess its efficacy and impact on HAPE management and prognosis. The aim of this study is to determine the effectiveness of furosemide for HAPE. METHODS A retrospective was conducted to analysis of patients with HAPE admitted to the People's Hospital of Shigatse City from January 2018 to September 2023. Patients were divided into furosemide group and non-furosemide group for further analysis. Clinical variables including demographic information, comorbidities, vital signs, inflammatory markers, biochemical analysis, CT severity score and prognostic indicators were collected. RESULTS A total of 273 patients were enrolled, with 209 patients in the furosemide group and 64 patients in the non-furosemide group. The furosemide group showed a significantly decrease in CT severity scores compared to the non-furosemide group. Subgroup analysis showed that the longer the duration of furosemide use, the more pronounced the improvement in lung CT severity scores. But there were no significant differences in length of hospital stay and in-hospital mortality between the two groups. CONCLUSION Furosemide helps alleviate pulmonary edema in HAPE patients, but further research is needed to clarify its impact on prognosis.
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Affiliation(s)
- Dava Tenzing
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China
| | - Pianduo Suolang
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China
| | - Deji Gesang
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China
| | - Duoji Suolang
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China
| | - Gaozhan Duan
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China
| | - Wangmu Ciren
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China
| | - Yihui Wang
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China.
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin er Road, Huangpu District, 200025, Shanghai, China.
| | - Tongtian Ni
- Department of Emergency, People's Hospital of Shigatse City, No. 1 Daqing East Road, Sangzhuzi District, Shigatse City, Tibet, China.
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin er Road, Huangpu District, 200025, Shanghai, China.
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Luks AM, Beidleman BA, Freer L, Grissom CK, Keyes LE, McIntosh SE, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update. Wilderness Environ Med 2024; 35:2S-19S. [PMID: 37833187 DOI: 10.1016/j.wem.2023.05.013] [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] [Received: 12/27/2022] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 10/15/2023]
Abstract
To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention, diagnosis, and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches for managing each form of acute altitude illness that incorporate these recommendations as well as recommendations on how to approach high altitude travel following COVID-19 infection. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine in 2010 and the subsequently updated WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2014 and 2019.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Beth A Beidleman
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Luanne Freer
- Everest ER, Himalayan Rescue Association, Kathmandu, Nepal
| | - Colin K Grissom
- Pulmonary and Critical Care Medicine, Intermountain Healthcare and the University of Utah, Salt Lake City, UT
| | - Linda E Keyes
- Department of Emergency Medicine, Section of Wilderness Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Scott E McIntosh
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - George W Rodway
- Department of Family Medicine-Sports Medicine, University of Nevada, Reno School of Medicine, Reno, NV
| | - Robert B Schoene
- Division of Pulmonary and Critical Care Medicine, Sound Physicians, St. Mary's Medical Center and Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
- Himalayan Rescue Association, Kathmandu, Nepal
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Subedi S, Regmi P, Bhandari SS, Dawadi S. Three rare presentations of high-altitude pulmonary edema at a high-altitude clinic in the Everest region (4371 m): A case series. Clin Case Rep 2023; 11:e7236. [PMID: 37113640 PMCID: PMC10126756 DOI: 10.1002/ccr3.7236] [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: 01/07/2023] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Diagnosis of HAPE can be challenging when the presentation deviates from usual natural history. Point of care ultrasonography serves as a great diagnostic tool in such settings. An umbrella treatment could be beneficial during such scenarios.
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Affiliation(s)
- Sachin Subedi
- Institute of Medicine, Tribhuvan UniversityMaharajgunjNepal
- Himalayan Rescue Association of NepalKathmanduNepal
| | | | - Sanjeeb S. Bhandari
- Himalayan Rescue Association of NepalKathmanduNepal
- Department of Emergency MedicineWestern Maryland Medical CenterCumberlandMarylandUSA
| | - Suvash Dawadi
- Himalayan Rescue Association of NepalKathmanduNepal
- CIWEC HospitalKathmanduNepal
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Lahham S, Moeller J, Choi H, Fischetti C, Myatt T, Bove N, Saadat S, Mazumder P, Algaze Gonzalez I, Kurzweil A, Fox J. Application of Point-of-care Ultrasound for Screening Climbers at High Altitude for Pulmonary B-lines. West J Emerg Med 2023; 24:359-362. [PMID: 36976605 PMCID: PMC10047746 DOI: 10.5811/westjem.2022.11.54300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/04/2022] [Indexed: 03/22/2023] Open
Abstract
Introduction: High-altitude pulmonary edema (HAPE) occurs as a result of rapid ascent to altitude faster than the acclimatization processes of the body. Symptoms can begin at an elevation of 2,500 meters above sea level. Our objective in this study was to determine the prevalence and trend of developing B-lines at 2,745 meters above sea level among healthy visitors over four consecutive days.
Methods: We performed a prospective case series on healthy volunteers at Mammoth Mountain, CA, USA. Subjects underwent pulmonary ultrasound for B-lines over four consecutive days.
Results: We enrolled 21 male and 21 female participants. There was an increase in the sum of B-lines at both lung bases from day 1 to day 3, with a subsequent decrease from day 3 to day 4 (P<0.001). By the third day at altitude, B-lines were detectable at base of lungs of all participants. Similarly, B-lines increased at apex of lungs from day 1 to day 3 and decreased on day 4 (P=0.004).
Conclusion: By the third day at 2,745 meters altitude, B-lines were detectable in the bases of both lungs of all healthy participants in our study. We assume that increasing the number of B-lines could be considered an early sign of HAPE. Point-of-care ultrasound could be used to detect and monitor B-lines at altitude to facilitate early detection of HAPE, regardless of pre-existing risk factors.
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Affiliation(s)
- Shadi Lahham
- Kaiser Permanente Orange County, Department of Emergency Medicine, Anaheim, California
| | - John Moeller
- Dartmouth-Hitchcock Medical Center, Department of Emergency Medicine, Lebanon, New Hampshire
| | - Heesun Choi
- Kingman Regional Medical Center, Department of Emergency Medicine, Kingman, Arizona; Midwestern University AZCOM, Department of Emergency Medicine, Glendale, Arizona; Touro University Nevada College of Osteopathic Medicine, Clark County, Nevada; University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Chanel Fischetti
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts; Harvard Medical School, Lecturer in Emergency Medicine, Boston, Massachusetts
| | - Toby Myatt
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Nicholas Bove
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Soheil Saadat
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Proma Mazumder
- Touro University Nevada College of Osteopathic Medicine, Clark County, Nevada
| | | | - Ami Kurzweil
- Eisenhower Health, Department of Emergency Medicine, Rancho Mirage, California
| | - John Fox
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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Adamo M, Prokopakis KE, Bolotin T. High Altitude Pulmonary Edema in a Healthy Pediatric Patient Traveling from Denver to Breckenridge. Open Access Emerg Med 2022; 14:1-4. [PMID: 35018124 PMCID: PMC8742613 DOI: 10.2147/oaem.s334485] [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: 08/16/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
A healthy 11-year-old boy presented with headache, nausea, and cough to a clinic at 2926 meters of altitude one day after ascending from his home altitude of 1578 meters. The patient had made multiple trips to the same altitude without any symptoms or sequelae throughout his childhood. Physical examination was significant for rales, tachycardia, and pulse oximetry level of 86% on room air. Radiographic evaluation with plain films revealed patchy alveolar opacities throughout the right lung. He received treatment with dexamethasone and high-flow face mask supplemental oxygen. In less than two hours, his rales had resolved, and his oxygen saturation had dramatically improved. He was discharged back to his native altitude and was at his baseline later the same day. High altitude pulmonary edema is a rare occurrence in children, but it is exceedingly rare for a healthy child with no history of pulmonary hypertension ascending only 1348 meters.
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Affiliation(s)
- Matthew Adamo
- Department of Emergency Medicine, Mercy Health St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | - Kayla E Prokopakis
- Department of Emergency Medicine, Mercy Health St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | - Todd Bolotin
- Department of Emergency Medicine, Mercy Health St. Elizabeth Boardman Hospital, Boardman, OH, USA.,Department of Emergency Medicine, Centura Health St. Anthony Breckenridge Mountain Clinic, Breckenridge, CO, USA
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Ma J, Zhang T, Wang W, Chen Y, Cai W, Zhu B, Xu L, Gao H, Zhang L, Li J, Gao X. Comparative Transcriptome Analyses of Gayal (Bos frontalis), Yak (Bos grunniens), and Cattle (Bos taurus) Reveal the High-Altitude Adaptation. Front Genet 2022; 12:778788. [PMID: 35087567 PMCID: PMC8789257 DOI: 10.3389/fgene.2021.778788] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Gayal and yak are well adapted to their local high-altitude environments, yet the transcriptional regulation difference of the plateau environment among them remains obscure. Herein, cross-tissue and cross-species comparative transcriptome analyses were performed for the six hypoxia-sensitive tissues from gayal, yak, and cattle. Gene expression profiles for all single-copy orthologous genes showed tissue-specific expression patterns. By differential expression analysis, we identified 3,020 and 1,995 differentially expressed genes (DEGs) in at least one tissue of gayal vs. cattle and yak vs. cattle, respectively. Notably, we found that the adaptability of the gayal to the alpine canyon environment is highly similar to the yak living in the Qinghai-Tibet Plateau, such as promoting red blood cell development, angiogenesis, reducing blood coagulation, immune system activation, and energy metabolism shifts from fatty acid β-oxidation to glycolysis. By further analyzing the common and unique DEGs in the six tissues, we also found that numerous expressed regulatory genes related to these functions are unique in the gayal and yak, which may play important roles in adapting to the corresponding high-altitude environment. Combined with WGCNA analysis, we found that UQCRC1 and COX5A are the shared differentially expressed hub genes related to the energy supply of myocardial contraction in the heart-related modules of gayal and yak, and CAPS is a shared differential hub gene among the hub genes of the lung-related module, which is related to pulmonary artery smooth muscle contraction. Additionally, EDN3 is the unique differentially expressed hub gene related to the tracheal epithelium and pulmonary vasoconstriction in the lung of gayal. CHRM2 is a unique differentially expressed hub gene that was identified in the heart of yak, which has an important role in the autonomous regulation of the heart. These results provide a basis for further understanding the complex transcriptome expression pattern and the regulatory mechanism of high-altitude domestication of gayal and yak.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Junya Li
- *Correspondence: Junya Li, ; Xue Gao,
| | - Xue Gao
- *Correspondence: Junya Li, ; Xue Gao,
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Point-of-Care Ultrasound Diagnosis of Acute High Altitude Illness: A Case Report. Wilderness Environ Med 2021; 32:204-209. [DOI: 10.1016/j.wem.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 02/04/2023]
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Modulation of lung cytoskeletal remodeling, RXR based metabolic cascades and inflammation to achieve redox homeostasis during extended exposures to lowered pO 2. Apoptosis 2021; 26:431-446. [PMID: 34002323 DOI: 10.1007/s10495-021-01679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Extended exposure to low pO2 has multiple effects on signaling cascades. Despite multiple exploratory studies, omics studies elucidating the signaling cascades essential for surviving extended low pO2 exposures are lacking. In this study, we simulated low pO2 (PB = 40 kPa; 7620 m) exposure in male Sprague-Dawley rats for 3, 7 and 14 days. Redox stress assays and proteomics based network biology were performed using lungs and plasma. We observed that redox homeostasis was achieved after day 3 of exposure. We investigated the causative events for this. Proteo-bioinformatics analysis revealed STAT3 to be upstream of lung cytoskeletal processes and systemic lipid metabolism (RXR) derived inflammatory processes, which were the key events. Thus, during prolonged low pO2 exposure, particularly those involving slowly decreasing pressures, redox homeostasis is achieved but energy metabolism is perturbed and this leads to an immune/inflammatory signaling impetus after third day of exposure. We found that an interplay of lung cytoskeletal elements, systemic energy metabolism and inflammatory proteins aid in achieving redox homeostasis and surviving extended low pO2 exposures. Qualitative perturbations to cytoskeletal stability and innate immunity/inflammation were also observed during extended low pO2 exposure in humans exposed to 14,000 ft for 7, 14 and 21 days.
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Sharma S, Singh Y, Sandhir R, Singh S, Ganju L, Kumar B, Varshney R. Mitochondrial DNA mutations contribute to high altitude pulmonary edema via increased oxidative stress and metabolic reprogramming during hypobaric hypoxia. BIOCHIMICA ET BIOPHYSICA ACTA-BIOENERGETICS 2021; 1862:148431. [PMID: 33862004 DOI: 10.1016/j.bbabio.2021.148431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
High altitude pulmonary edema (HAPE) is experienced by non-acclimatized sea level individuals on exposure to high altitude hypoxic conditions. Available evidence suggests that genetic factors and perturbed mitochondrial redox status may play an important role in HAPE pathophysiology. However, the precise mechanism has not been fully understood. In the present study, sequencing of mitochondrial DNA (mtDNA) from HAPE subjects and acclimatized controls was performed to identify pathogenic mutations and to determine their role in HAPE. Hypobaric hypoxia induced oxidative stress and metabolic alterations were also assessed in HAPE subjects. mtDNA copy number, mitochondrial oxidative phosphorylation (mtOXPHOS) activity, mitochondrial biogenesis were measured to determine mitochondrial functions. The data revealed that the mutations in Complex I genes affects the secondary structure of protein in HAPE subjects. Further, increased oxidative stress during hypobaric hypoxia, reduced mitochondrial biogenesis and mtOXPHOS activity induced metabolic reprogramming appears to contribute to mitochondrial dysfunctions in HAPE individuals. Haplogroup analysis suggests that mtDNA haplogroup H2a2a1 has potential contribution in the pathobiology of HAPE in lowlanders. This study also suggests contribution of altered mitochondrial functions in HAPE susceptibility.
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Affiliation(s)
- Swati Sharma
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India; Department of Biochemistry, Basic Medical Sciences Block II, Panjab University, Chandigarh 160014, India
| | - Yamini Singh
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India.
| | - Rajat Sandhir
- Department of Biochemistry, Basic Medical Sciences Block II, Panjab University, Chandigarh 160014, India
| | - Sayar Singh
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India
| | - Lilly Ganju
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India
| | - Rajeev Varshney
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India
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Lichtblau M, Bader PR, Carta AF, Furian M, Muralt L, Saxer S, Hartmann SE, Rawling JM, Poulin MJ, Bloch KE, Ulrich S. Extravascular lung water and cardiac function assessed by echocardiography in healthy lowlanders during repeated very high-altitude exposure. Int J Cardiol 2021; 332:166-174. [PMID: 33775791 DOI: 10.1016/j.ijcard.2021.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND High-altitude pulmonary edema is associated with elevated systolic pulmonary artery pressure (sPAP) and increased extravascular lung water (EVLW). We investigated sPAP and EVLW during repeated exposures to high altitude (HA). METHODS Healthy lowlanders underwent two identical 7-day HA-cycles, where subjects slept at 2900 m and spent 4-8 h daily at 5050 m, separated by a weeklong break at low altitude (LA). Echocardiography and EVLW by B-lines were measured at 520 m (baseline, LA1), on day one, two and six at 5050 m (HA1-3) and after descent (LA2). RESULTS We included 21 subjects (median 25 years, body mass index 22 kg/m2, SpO2 98%). SPAP rose from 21 mmHg at LA1 to 38 mmHg at HA1, decreased to 30 mmHg at HA3 (both p < 0.05 vs LA1) and normalized at 20 mmHg at LA2 (p = ns vs LA1). B-lines increased from 0 at LA1 to 6 at HA2 and 7 at HA3 (both p < 0.05 vs LA1) and receded to 1 at LA2 (p = ns vs LA1). Overall, in cycle two, sPAP did not differ (mean difference (95% confidence interval) -0.2(-2.3 to 1.9) mmHg, p = 0.864) but B-lines were more prevalent (+2.3 (1.4-3.1), p < 0.001) compared to cycle 1. Right ventricular systolic function decreased significantly but minimally at 5050 m. CONCLUSIONS Exposure to 5050 m induced a rapid increase in sPAP. B-lines rose during prolonged exposures to 5050 m, despite gradual decrease in sPAP, indicating excessive hydrostatic pressure might not be solely responsible for EVLW-development. Repeated HA-exposure had no acclimatization effect on EVLW. This may affect workers needing repetitive ascents to altitude and could indicate greater B-line development upon repeated exposure.
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Affiliation(s)
- Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Patrick R Bader
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Arcangelo F Carta
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Lara Muralt
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Sara E Hartmann
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Jean M Rawling
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Marc J Poulin
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
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12
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Tripathi A, Hazari PP, Mishra AK, Kumar B, Sagi SSK. Quercetin: a savior of alveolar barrier integrity under hypoxic microenvironment. Tissue Barriers 2021; 9:1883963. [PMID: 33632082 DOI: 10.1080/21688370.2021.1883963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
High altitude pulmonary edema (HAPE) is generally characterized by the loss of alveolar epithelial barrier integrity. The current study was undertaken to assess the noninvasive approaches of HAPE diagnosis and to evaluate the prophylactic potential of quercetin in preventing alveolar junction impairments. Male SD rats fed with quercetin 1 h prior to hypoxia (7,620 m, for 6 h) were selected. PET/CT imaging was performed to visualize the lung uptake of 18F-FDG in animals under hypoxia. Further, oxidant status, catalase activity, hematological & blood gas parameters were evaluated. Moreover, tight junction (TJ) proteins (ZO-1, JAM-C, Claudin-4, and occludin) expression analysis was accomplished using immune-blotting. The structural differences in lung epithelia were noted by TEM imaging. Quercetin prophylaxis has significantly reduced the FDG uptake in rat lungs under hypoxia. It has also dramatically alleviated the protein oxidation followed by an elevation in catalase activity in the lungs under hypoxia. The TJ protein expression in the lungs has also been restored to normal upon quercetin pre-treatment. Concomitantly, the quercetin preconditioning has elicited the stable blood gas and hematological parameters under hypoxia. The observations from TEM imaging have also implicated the normal lung epithelial structures in the quercetin pretreated animals under hypoxia. Quercetin prophylaxis has significantly restored alveolar epithelium integrity by abating oxidative stress in the lungs under hypoxia.Abbreviations: CT- Computed Tomography18F-FDG- Fluorodeoxyglucose (18FHAPE- High Altitude Pulmonary EdemaHb- HemoglobinHCT- HematocritHCO3- BicarbonateJAM- Junctional Adhesion MoleculeKBq- Killo BecquerelPaO2- Partial pressure of arterial oxygenPaCO2- Partial pressure of arterial carbon di-oxidePET- Positron Emission TomographyRBC- Red Blood CorpusclesSD- Sprague DawleyTJ- Tight JunctionsTEM- Transmission Electron MicroscopyWBC- White Blood CorpusclesZO- Zona Occludin.
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Affiliation(s)
- Ankit Tripathi
- Hematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur Delhi-India
| | - Puja P Hazari
- Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi-India
| | - Anil K Mishra
- Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi-India
| | - Bhuvnesh Kumar
- Hematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur Delhi-India
| | - Sarada S K Sagi
- Hematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur Delhi-India
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13
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Fu X, Yang C, Chen B, Zeng K, Chen S, Fu Y. Qi-Long-Tian formula extract alleviates symptoms of acute high-altitude diseases via suppressing the inflammation responses in rat. Respir Res 2021; 22:52. [PMID: 33579290 PMCID: PMC7881569 DOI: 10.1186/s12931-021-01645-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/31/2021] [Indexed: 01/05/2023] Open
Abstract
Background Chinese Yunnan Province, located in the Yunnan–Guizhou Plateau, is a famous tourist paradise where acute high-altitude illness common occurs among lowland people visitors due to non-acclimatization to the acute hypobaric hypoxia (AHH) conditions. Traditional Chinese medicine, such as Qi-Long-Tian (QLT) formula, has shown effectiveness and safety in the treatment of acute high-altitude diseases. The aim of this study was to clarify the therapeutic mechanisms of this traditional formula using a rat model in a simulated plateau environment. Methods Following testing, lung tissue samples were evaluated by hematoxylin–eosin staining and for biochemical characteristics. mRNA-Seq was used to compare differentially expressed genes in control rats, and in rats exposed to AHH and AHH with QLT treatment. Results Inflammation-related effectors induced following QLT treatment for AHH included MMP9 and TIMP1, and involved several phosphorylation signaling pathways implicated in AHH pathogenesis such as PI3K/AKT and MAPK signaling. Conclusion This study provides insights into the major signaling pathways induced by AHH and in the protective mechanisms involved in QLT formula activity.
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Affiliation(s)
- Xing Fu
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Chunyan Yang
- Division of Lung Disease, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, 650500, Yunnan, China
| | - Bing Chen
- Function Teaching and Research Section, School of Medicine, Kunming University, Kunming, 650214, Yunnan, China
| | - Kexing Zeng
- Yunnan University of Chinese Medicine, Kunming, 650500, Yunnan, China
| | - Siyuan Chen
- Yunnan University of Chinese Medicine, Kunming, 650500, Yunnan, China
| | - Yi Fu
- The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, No. 2628 Xiangyuan Street, Chenggong District, Kunming, 650500, Yunnan, China.
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14
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Abstract
Healthy children may present acute mountain sickness (AMS) within a few hours after arrival at high altitudes. In few cases, serious complications may occur, including high-altitude pulmonary edema and rarely high-altitude cerebral edema. Those with preexisting conditions especially involving hypoxia and pulmonary hypertension shall not risk travelling to high altitudes. Newborn from low altitude mothers may have prolonged time to complete postnatal adaptation. The number of children and adolescents traveling on commercial aircrafts is growing, and this poses a need for their treating physicians to be aware of the potential risks of hypoxia while air traveling.
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15
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Zhou Y, Li Z. Anti-fatigue activities and phytochemical compositions of turnip (brassica rapa l.) extracts. Pharmacogn Mag 2021. [DOI: 10.4103/pm.pm_470_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Lin X, Wang H, Pu X. Protective mechanism of fdft1 in steroid hormone synthesis pathway in SD rats with acute hypoxic injury. Genes Genomics 2020; 42:1319-1326. [PMID: 32980992 DOI: 10.1007/s13258-020-00999-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The acute hypoxic injury caused by the plain population entering the plateau in a short period of time has become the main cause of endangering the health of the people who rush into the plateau. OBJECTIVE The study aimed to identify the key genes which participate in resisting the acute hypoxic injury in SD Rats by transcriptomic profile analysis. METHODS 48 Sprague Dawley (SD) male rats were enrolled and randomly divided into four groups (0h, 24h, 48h, 72h) and housed in hypobaric hypoxia chamber with altitude 6000m for different periods of time to make them acute hypoxic injury. The transcriptomic profile of the lung tissue of the rats was analysed by RNA second-generation sequencing combined with bioinformatics analysis. RESULTS The results of GO and KEGG function classification analysis revealed that the differential expression genes enriched in steroid hormone synthesis pathway especially in 48h group compared to F0 group. Further analysis revealed that Farnesyl Diphosphate Farnesyl Transferase 1 (fdft1) gene encoding a rate-limiting enzyme in steroid hormone synthesis pathway was significant differently expressed between the groups. The expression levels of fdft1 gene were further verified by RT-PCR and Western-blot methods. CONCLUSIONS The results suggest that fdft1 gene plays an important role in responding to acute hypoxic injury by regulating steroid hormone biosynthesis.
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Affiliation(s)
- Xue Lin
- College of Medicine, Qinghai University, Xining, Qinghai, China
| | - Haiyan Wang
- College of Medicine, Qinghai University, Xining, Qinghai, China
| | - Xiaoyan Pu
- College of Medicine, Qinghai University, Xining, Qinghai, China. .,Qinghai Normal University, Xining, Qinghai, China.
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17
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Gojkovic M, Darmasaputra GS, Veliça P, Rundqvist H, Johnson RS. Deregulated hypoxic response in myeloid cells: A model for high-altitude pulmonary oedema (HAPE). Acta Physiol (Oxf) 2020; 229:e13461. [PMID: 32129933 PMCID: PMC8638671 DOI: 10.1111/apha.13461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
AIM High-altitude pulmonary oedema (HAPE) is a non-cardiogenic pulmonary oedema that can occur during rapid ascent to a high-altitude environment. Classically, HAPE has been described as a condition resulting from a combination of pulmonary vasoconstriction and hypertension. Inflammation has been described as important in HAPE, although as a side effect of pulmonary oedema rather than as a causative factor. In this study, we aim to understand the role of hypoxic response in myeloid cells and its involvement in pathogenesis of HAPE. METHODS We have generated a conditional deletion in mice of the von Hippel-Lindau factor (VHL) in myeloid cells to determine the effect of a deregulated hypoxic response in pulmonary oedema. RESULTS The deletion of VHL in pulmonary myeloid cells gave rise to pulmonary oedema, increased pulmonary vascular permeability and reduced performance during exertion. These changes were accompanied by reduced stroke volume in the left ventricle. CONCLUSION In this model, we show that a deregulated myeloid cell hypoxic response can trigger some of the most important symptoms of HAPE, and thus mice with a deletion of VHL in the myeloid lineage can function as a model of HAPE.
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Affiliation(s)
- Milos Gojkovic
- Department of Cell and Molecular Biology Karolinska Institute Stockholm Sweden
| | | | - Pedro Veliça
- Department of Cell and Molecular Biology Karolinska Institute Stockholm Sweden
| | - Helene Rundqvist
- Department of Physiology and Pharmacology Karolinska Institute Stockholm Sweden
| | - Randall S. Johnson
- Department of Cell and Molecular Biology Karolinska Institute Stockholm Sweden
- Department of Physiology Development and Neuroscience University of Cambridge Cambridge UK
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18
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Jha V, Jha A. Swine-influenza (H1N1 influenza) mimicking a case of high altitude pulmonary oedema (HAPO). BMJ Case Rep 2020; 13:13/6/e232564. [DOI: 10.1136/bcr-2019-232564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Here we present a case of a 37-year-old soldier of Indian Army, posted in high altitude area of Ladakh region (>4200 m), who after rejoining after a month leave, presented with dry cough, low-grade fever and dyspnoea on exertion while undergoing acclimatisation, and on examination, was detected to have hypoxaemia, fever and bilateral fine crepitations on chest auscultation. He was started on treatment for high altitude pulmonary oedema at a medical aid post, and later referred to General Hospital at Leh. The course of the illness was complicated by worsening hypoxaemia, continuous high-grade fever, leucopenia and hypotension. Focused medical history revealed that he had travelled to the state of Gujarat during his leave, where high incidence of H1N1 influenza was being reported during the ongoing pandemic. Oseltamivir was empirically started, in addition to parenteral antibiotics and he was started on inotropic support. In view of severe hypoxaemia, not responding to non-invasive ventilation, he was intubated and placed on mechanical ventilation. The patient turned out to be H1N1 positive and succumbed to his illness 3 days later.
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19
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Mulchrone A, Moulton H, Eldridge MW, Chesler NC. Susceptibility to high-altitude pulmonary edema is associated with increased pulmonary arterial stiffness during exercise. J Appl Physiol (1985) 2020; 128:514-522. [PMID: 31854245 DOI: 10.1152/japplphysiol.00153.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High-altitude pulmonary edema (HAPE), a reversible form of capillary leak, is a common consequence of rapid ascension to high altitude and a major cause of death related to high-altitude exposure. Individuals with a prior history of HAPE are more susceptible to future episodes, but the underlying risk factors remain uncertain. Previous studies have shown that HAPE-susceptible subjects have an exaggerated pulmonary vasoreactivity to acute hypoxia, but incomplete data are available regarding their vascular response to exercise. To examine this, seven HAPE-susceptible subjects and nine control subjects (HAPE-resistant) were studied at rest and during incremental exercise at sea level and at 3,810 m altitude. Studies were conducted in both normoxic (inspired Po2 = 148 Torr) and hypoxic (inspired Po2 = 91 Torr) conditions at each location. Here, we report an expanded analysis of previously published data, including a distensible vessel model that showed that HAPE-susceptible subjects had significantly reduced small distal artery distensibility at sea level compared with HAPE-resistant control subjects [0.011 ± 0.001 vs. 0.021 ± 0.002 mmHg-1; P < 0.001). Moreover, HAPE-susceptible subjects demonstrated constant distensibility over all conditions, suggesting that distal arteries are maximally distended at rest. Consistent with having increased distal artery stiffness, HAPE-susceptible subjects had greater increases in pulmonary artery pulse pressure with exercise, which suggests increased proximal artery stiffness. In summary, HAPE-susceptible subjects have exercise-induced increases in proximal artery stiffness and baseline increases in distal artery stiffness, suggesting increased pulsatile load on the right ventricle.NEW & NOTEWORTHY In comparison to subjects who appear resistant to high-altitude pulmonary edema, those previously symptomatic show greater increases in large and small artery stiffness in response to exercise. These differences in arterial stiffness may be a risk factor for the development of high-altitude pulmonary edema or evidence that consequences of high-altitude pulmonary edema are long-lasting after return to sea level.
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Affiliation(s)
- A Mulchrone
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - H Moulton
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - M W Eldridge
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin
| | - N C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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20
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Yanamandra U, Sharma M, Katoch D, Yanamandra S, Bhattachar SA, Gupta A, Patyal S, Grewal R, Kumar S, Nair V. High-altitude pulmonary oedema: Newer treatment modalities for an age-old problem. Indian J Med Res 2020; 149:778-782. [PMID: 31496531 PMCID: PMC6755783 DOI: 10.4103/ijmr.ijmr_1981_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives High-altitude pulmonary oedema (HAPE) continues to challenge the healthcare providers at remote, resource-constrained settings. High-altitude terrain itself precludes convenience of resources. This study was conducted to evaluate the rise in peripheral capillary saturation of oxygen (SpO2) by the use of a partial rebreathing mask (PRM) in comparison to Hudson's mask among patients with HAPE. Methods This was a single-centre, randomized crossover study to determine the efficiency of PRM in comparison to Hudson's mask. A total of 88 patients with HAPE referred to a secondary healthcare facility at an altitude of 11,500 feet from January to October 2013 were studied. A crossover after adequate wash-out on both modalities was conducted for first two days of hospital admission. All patients with HAPE were managed with bed rest and stand-alone oxygen supplementation with no adjuvant pharmacotherapy. Results The mean SpO2on ambient air on arrival was 66.92±10.8 per cent for all patients with HAPE. Higher SpO2values were achieved with PRM in comparison to Hudson's mask on day one (86.08±5.15 vs. 77.23±9.09%) and day two (89.94±2.96 vs. 83.39±5.93%). The difference was more pronounced on day one as compared to day two. Interpretation & conclusions Mean SpO2values were found to be significantly higher among HAPE patients using PRM compared to those on Hudson's mask. Further studies to understand the translation of this incremental response in SpO2to clinical benefits (recovery times, mortality rates and hospital stay) need to be undertaken.
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Affiliation(s)
- Uday Yanamandra
- Department of Medicine, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Manisha Sharma
- Military Nursing Services, Integrated HQ, Ministry of Defence, New Delhi, India
| | - Deeksha Katoch
- Station Medicare Centre, Air Force Station, Vadodara, India
| | - Sushma Yanamandra
- Department of Medicine, High Altitude Medical Research Centre, Leh, Ladakh, India
| | | | - Amul Gupta
- Department of Radiology, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Sagarika Patyal
- Department of 153 General Hospital, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Rajan Grewal
- Department of 153 General Hospital, High Altitude Medical Research Centre, Leh, Ladakh, India
| | - Suman Kumar
- Department of Hematology, Army Research & Referral Hospital, New Delhi, India
| | - Velu Nair
- Department of Medicine, Armed Forces Medical College, Pune, India
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21
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M T, T A, B S, Ak G, Sks S. Curcumin prophylaxis refurbishes alveolar epithelial barrier integrity and alveolar fluid clearance under hypoxia. Respir Physiol Neurobiol 2019; 274:103336. [PMID: 31778793 DOI: 10.1016/j.resp.2019.103336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022]
Abstract
We have studied the prophylactic efficacy of curcumin to ameliorate the impairment of tight junction protein integrity and fluid clearance in lungs of rats under hypoxia. A549 cells wereexposed to 3 % O2 for 1 h, 3 h, 6 h, 12 h, 24 h and 48 h and rats were exposed to 7620 m for 6 h. NF-κB, Hif-1α and their related genes, tight junction protein (TJ) (ZO-1, JAM-C, claudin-4 and claudin-5, claudin-18) expressions were determined in A549 cells and lungs of rats by western blotting, ELISA and their activity by reporter gene assay, siRNAp65 knock out. Tissue specific localization of tight junction protein was determined by immunohistochemistry and immunoflorescence. Further transmission electron microscopy (TEM) was used to visualize the TJ structures between pulmonary epithelial cells. Blood gas and hematological parameters were also assessed. Later we checked, whether prior treatment with curcumin can restore the altered alveolar epithelial barrier integrity that is compromised through inflammatory mediators under hypoxia, A549 cells were pre-treated (1 h) with 10 μM curcumin and rats with 50 mg curcumin/kg BW and exposed to hypoxia. Curcumin pre-treatment both in vitro and in vivo showed significant changes in TJ protein integrity, attenuated NF-κB activity with reduced expression of its regulatory genes in lung tissues, serum and bronchoalveolar lavage fluid (BALF) along with stabilized HIF-1α levels under hypoxia. NF-κB inhibitors MG132, SN50 or siRNA mediated p65 knock down significantly reduced the dextran FITC influx into the lungs. The present study indicates that, curcumin prophylaxis augments alveolar epithelial barrier integrity and alveolar fluid clearance under hypoxia.
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Affiliation(s)
- Titto M
- Haematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur, Delhi 110054, India.
| | - Ankit T
- Haematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur, Delhi 110054, India.
| | - Saumya B
- Haematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur, Delhi 110054, India.
| | - Gausal Ak
- Haematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur, Delhi 110054, India.
| | - Sarada Sks
- Haematology Division, Defence Institute of Physiology and Allied Sciences, Lucknow Road, Timarpur, Delhi 110054, India.
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22
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Tripathi A, Kumar B, Sagi SSK. Prophylactic efficacy of Quercetin in ameliorating the hypoxia induced vascular leakage in lungs of rats. PLoS One 2019; 14:e0219075. [PMID: 31251771 PMCID: PMC6599121 DOI: 10.1371/journal.pone.0219075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/14/2019] [Indexed: 01/20/2023] Open
Abstract
The objective of the study was to find out the prophylactic efficacy of Quercetin in ameliorating the hypoxia induced vascular leakage in lungs of rats. Male SD rats received different doses of quercetin @ 25mg, 50mg, 100mg and 200mg/Kg BW, 1h prior to hypobaric hypoxia exposure (7,620m, for 6h). Quercetin 50 mg/kg BW supplemented orally 1h prior to hypoxia exposure was considered to be the optimum dose, due to significant reduction (p<0.001) in lung water content and lung transvascular leakage compared to control (hypoxia, 6h). Further, biochemical analysis (ROS, MDA, GSH, GPx, LDH, and albumin) and differential expressions of proteins (IKK-α/β, NFĸB, Nrf-2,TNF-α, ICAM-1, VCAM, P-selectin, Hif-1α, VEGF, TNF-α, TGF-β, INF-γ and IL-4) were determined by western blotting and ELISA. Changes in lung parenchyma were assessed by histopathology. Quercetin (50 mg/kg BW) prophylaxis under hypoxia showed significant reduction in oxidative stress (ROS and MDA), concomitant increase in antioxidants (GSH, GPx and SOD) followed by decreased LDH and albumin extravasation in BAL fluid over hypoxia. Quercetin prophylaxis significantly down regulated hypoxia induced increase in IKKα/β and NFĸB expressions leading to reduction in the levels of pro-inflammatory cytokines (TNF-α and INF-γ) followed by up regulation of anti-inflammatory cytokines (IL-4 and INF-γ) in lungs. Further, hypoxia mediated increase in HIF-1α was stabilized and VEGF levels in lungs were significantly down regulated by quercetin supplementation, leading to reduction in vascular leakage in lungs of rats under hypoxia. However, Quercetin has also enacted as Nrf-2 activator which significantly boosted up the synthesis of GSH under hypoxic condition compared to hypoxia. Histopathological observations further confirmed that quercetin preconditioning has an inhibitory effect on progression of oxidative stress and inflammation via attenuation of NFκB and stabilization HIF-1α in lungs of rats under hypoxia.These studies indicated that quercetin prophylaxis abrogates the possibility of hypobaric hypoxia induced pulmonary edema in rats.
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Affiliation(s)
- Ankit Tripathi
- Nutrition Division, Defence Institute of Physiology and Allied Sciences, Timarpur, Delhi, India
| | - Bhuvnesh Kumar
- Nutrition Division, Defence Institute of Physiology and Allied Sciences, Timarpur, Delhi, India
| | - Sarada S. K. Sagi
- Nutrition Division, Defence Institute of Physiology and Allied Sciences, Timarpur, Delhi, India
- * E-mail:
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23
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Luks AM, Auerbach PS, Freer L, Grissom CK, Keyes LE, McIntosh SE, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update. Wilderness Environ Med 2019; 30:S3-S18. [PMID: 31248818 DOI: 10.1016/j.wem.2019.04.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 12/16/2022]
Abstract
To provide guidance to clinicians about best preventive and therapeutic practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. Recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each form of acute altitude illness that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in 2010 and subsequently updated as the WMS Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness in 2014.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Luanne Freer
- Yellowstone National Park, WY; Midway Atoll National Wildlife Refuge, Honolulu, HI; Everest ER, Himalayan Rescue Association, Kathmandu, Nepal
| | - Colin K Grissom
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT; Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Denver, CO; Boulder Community Health, Boulder, CO
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - George W Rodway
- University of California, Davis School of Nursing, Sacramento, CA
| | - Robert B Schoene
- Division of Pulmonary and Critical Care Medicine, Sound Physicians, St. Mary's Medical Center, San Francisco, CA
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA; Himalayan Rescue Association, Kathmandu, Nepal
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Molano Franco D, Nieto Estrada VH, Gonzalez Garay AG, Martí‐Carvajal AJ, Arevalo‐Rodriguez I. Interventions for preventing high altitude illness: Part 3. Miscellaneous and non-pharmacological interventions. Cochrane Database Syst Rev 2019; 4:CD013315. [PMID: 31012483 PMCID: PMC6477878 DOI: 10.1002/14651858.cd013315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND High altitude illness (HAI) is a term used to describe a group of mainly cerebral and pulmonary syndromes that can occur during travel to elevations above 2500 metres (˜ 8200 feet). Acute mountain sickness (AMS), high altitude cerebral oedema (HACE), and high altitude pulmonary oedema (HAPE) are reported as potential medical problems associated with high altitude ascent. In this, the third of a series of three reviews about preventive strategies for HAI, we assessed the effectiveness of miscellaneous and non-pharmacological interventions. OBJECTIVES To assess the clinical effectiveness and adverse events of miscellaneous and non-pharmacological interventions for preventing acute HAI in people who are at risk of developing high altitude illness in any setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) in January 2019. We adapted the MEDLINE strategy for searching the other databases. We used a combination of thesaurus-based and free-text search terms. We scanned the reference lists and citations of included trials and any relevant systematic reviews that we identified for further references to additional trials. SELECTION CRITERIA We included randomized controlled trials conducted in any setting where non-pharmacological and miscellaneous interventions were employed to prevent acute HAI, including preacclimatization measures and the administration of non-pharmacological supplements. We included trials involving participants who are at risk of developing high altitude illness (AMS or HACE, or HAPE, or both). We included participants with, and without, a history of high altitude illness. We applied no age or gender restrictions. We included trials where the relevant intervention was administered before the beginning of ascent. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures employed by Cochrane. MAIN RESULTS We included 20 studies (1406 participants, 21 references) in this review. Thirty studies (14 ongoing, and 16 pending classification (awaiting)) will be considered in future versions of this suite of three reviews as appropriate. We report the results for the primary outcome of this review (risk of AMS) by each group of assessed interventions.Group 1. Preacclimatization and other measures based on pressureUse of simulated altitude or remote ischaemic preconditioning (RIPC) might not improve the risk of AMS on subsequent exposure to altitude, but this effect is uncertain (simulated altitude: risk ratio (RR) 1.18, 95% confidence interval (CI) 0.82 to 1.71; I² = 0%; 3 trials, 140 participants; low-quality evidence. RIPC: RR 3.0, 95% CI 0.69 to 13.12; 1 trial, 40 participants; low-quality evidence). We found evidence of improvement of this risk using positive end-expiratory pressure (PEEP), but this information was derived from a cross-over trial with a limited number of participants (OR 3.67, 95% CI 1.38 to 9.76; 1 trial, 8 participants; low-quality evidence). We found scarcity of evidence about the risk of adverse events for these interventions.Group 2. Supplements and vitaminsSupplementation of antioxidants, medroxyprogesterone, iron or Rhodiola crenulata might not improve the risk of AMS on exposure to high altitude, but this effect is uncertain (antioxidants: RR 0.58, 95% CI 0.32 to 1.03; 1 trial, 18 participants; low-quality evidence. Medroxyprogesterone: RR 0.71, 95% CI 0.48 to 1.05; I² = 0%; 2 trials, 32 participants; low-quality evidence. Iron: RR 0.65, 95% CI 0.38 to 1.11; I² = 0%; 2 trials, 65 participants; low-quality evidence. R crenulata: RR 1.00, 95% CI 0.78 to 1.29; 1 trial, 125 participants; low-quality evidence). We found evidence of improvement of this risk with the administration of erythropoietin, but this information was extracted from a trial with issues related to risk of bias and imprecision (RR 0.41, 95% CI 0.20 to 0.84; 1 trial, 39 participants; very low-quality evidence). Regarding administration of ginkgo biloba, we did not perform a pooled estimation of RR for AMS due to considerable heterogeneity between the included studies (I² = 65%). RR estimates from the individual studies were conflicting (from 0.05 to 1.03; low-quality evidence). We found scarcity of evidence about the risk of adverse events for these interventions.Group 3. Other comparisonsWe found heterogeneous evidence regarding the risk of AMS when ginkgo biloba was compared with acetazolamide (I² = 63%). RR estimates from the individual studies were conflicting (estimations from 0.11 (95% CI 0.01 to 1.86) to 2.97 (95% CI 1.70 to 5.21); low-quality evidence). We found evidence of improvement when ginkgo biloba was administered along with acetazolamide, but this information was derived from a single trial with issues associated to risk of bias (compared to ginkgo biloba alone: RR 0.43, 95% CI 0.26 to 0.71; 1 trial, 311 participants; low-quality evidence). Administration of medroxyprogesterone plus acetazolamide did not improve the risk of AMS when compared to administration of medroxyprogesterone or acetazolamide alone (RR 1.33, 95% CI 0.50 to 3.55; 1 trial, 12 participants; low-quality evidence). We found scarcity of evidence about the risk of adverse events for these interventions. AUTHORS' CONCLUSIONS This Cochrane Review is the final in a series of three providing relevant information to clinicians, and other interested parties, on how to prevent high altitude illness. The assessment of non-pharmacological and miscellaneous interventions suggests that there is heterogeneous and even contradictory evidence related to the effectiveness of these prophylactic strategies. Safety of these interventions remains as an unclear issue due to lack of assessment. Overall, the evidence is limited due to its quality (low to very low), the relative paucity of that evidence and the number of studies pending classification for the three reviews belonging to this series (30 studies either awaiting classification or ongoing). Additional studies, especially those comparing with pharmacological alternatives (such as acetazolamide) are required, in order to establish or refute the strategies evaluated in this review.
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Affiliation(s)
- Daniel Molano Franco
- Fundacion Universitaria de Ciencias de la Salud, Hospital de San JoséDepartment of Critical CareCarrera 19 # 8‐32BogotaBogotaColombia11001
| | - Víctor H Nieto Estrada
- Los Cobos Medical Centre. Grupo Investigacion GRIBOSDepartment of Critical CareBogotaBogotaColombia
| | | | | | - Ingrid Arevalo‐Rodriguez
- Hospital Universitario Ramón y Cajal (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP)Clinical Biostatistics UnitCtra. Colmenar Km. 9,100MadridSpain28034
- Cochrane Associate Centre of MadridMadridSpain
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica EquinoccialCochrane EcuadorQuitoEcuador
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Bhattarai A, Acharya S, Yadav JK, Wilkes M. Delayed-Onset High Altitude Pulmonary Edema: A Case Report. Wilderness Environ Med 2019; 30:90-92. [PMID: 30642713 DOI: 10.1016/j.wem.2018.11.002] [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: 04/01/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 11/15/2022]
Abstract
High altitude pulmonary edema (HAPE) is a life-threatening altitude illness that usually occurs in insufficiently acclimatized climbers in the first few days at altitudes above 2500 m. Acetazolamide is recommended for prophylaxis of acute mountain sickness, but a role for acetazolamide in the prevention of HAPE has not been established. We report a case of a trekker with previous high altitude experience who developed HAPE 8 d after arrival to altitude despite what was believed to be a conservative ascent profile.
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Affiliation(s)
| | - Suman Acharya
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | | | - Matt Wilkes
- Department of Anesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
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Simancas‐Racines D, Arevalo‐Rodriguez I, Osorio D, Franco JVA, Xu Y, Hidalgo R. Interventions for treating acute high altitude illness. Cochrane Database Syst Rev 2018; 6:CD009567. [PMID: 29959871 PMCID: PMC6513207 DOI: 10.1002/14651858.cd009567.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute high altitude illness is defined as a group of cerebral and pulmonary syndromes that can occur during travel to high altitudes. It is more common above 2500 metres, but can be seen at lower elevations, especially in susceptible people. Acute high altitude illness includes a wide spectrum of syndromes defined under the terms 'acute mountain sickness' (AMS), 'high altitude cerebral oedema' and 'high altitude pulmonary oedema'. There are several interventions available to treat this condition, both pharmacological and non-pharmacological; however, there is a great uncertainty regarding their benefits and harms. OBJECTIVES To assess the clinical effectiveness, and safety of interventions (non-pharmacological and pharmacological), as monotherapy or in any combination, for treating acute high altitude illness. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, ISI Web of Science, CINAHL, Wanfang database and the World Health Organization International Clinical Trials Registry Platform for ongoing studies on 10 August 2017. We did not apply any language restriction. SELECTION CRITERIA We included randomized controlled trials evaluating the effects of pharmacological and non-pharmacological interventions for individuals suffering from acute high altitude illness: acute mountain sickness, high altitude pulmonary oedema or high altitude cerebral oedema. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of study reports, the risk of bias for each and performed the data extraction. We resolved disagreements through discussion with a third author. We assessed the quality of evidence with GRADE. MAIN RESULTS We included 13 studies enrolling a total of 468 participants. We identified two ongoing studies. All studies included adults, and two studies included both teenagers and adults. The 13 studies took place in high altitude areas, mostly in the European Alps. Twelve studies included participants with acute mountain sickness, and one study included participants with high altitude pulmonary oedema. Follow-up was usually less than one day. We downgraded the quality of the evidence in most cases due to risk of bias and imprecision. We report results for the main comparisons as follows.Non-pharmacological interventions (3 studies, 124 participants)All-cause mortality and complete relief of AMS symptoms were not reported in the three included trials. One study in 64 participants found that a simulated descent of 193 millibars versus 20 millibars may reduce the average of symptoms to 2.5 vs 3.1 units after 12 hours of treatment (clinical score ranged from 0 to 11 ‒ worse; reduction of 0.6 points on average with the intervention; low quality of evidence). In addition, no complications were found with use of hyperbaric chambers versus supplementary oxygen (one study; 29 participants; low-quality evidence).Pharmacological interventions (11 trials, 375 participants)All-cause mortality was not reported in the 11 included trials. One trial found a greater proportion of participants with complete relief of AMS symptoms after 12 and 16 hours when dexamethasone was administered in comparison with placebo (47.1% versus 0%, respectively; one study; 35 participants; low quality of evidence). Likewise, when acetazolamide was compared with placebo, the effects on symptom severity was uncertain (standardized mean difference (SMD) -1.15, 95% CI -2.56 to 0.27; 2 studies, 25 participants; low-quality evidence). One trial of dexamethasone in comparison with placebo in 35 participants found a reduction in symptom severity (difference on change in the AMS score: 3.7 units reported by authors; moderate quality of evidence). The effects from two additional trials comparing gabapentin with placebo and magnesium with placebo on symptom severity at the end of treatment were uncertain. For gabapentin versus placebo: mean visual analogue scale (VAS) score of 2.92 versus 4.75, respectively; 24 participants; low quality of evidence. For magnesium versus placebo: mean scores of 9 and 10.3 units, respectively; 25 participants; low quality of evidence). The trials did not find adverse events from either treatment (low quality of evidence). One trial comparing magnesium sulphate versus placebo found that flushing was a frequent event in the magnesium sulphate arm (percentage of flushing: 75% versus 7.7%, respectively; one study; 25 participants; low quality of evidence). AUTHORS' CONCLUSIONS There is limited available evidence to determine the effects of non-pharmacological and pharmacological interventions in treating acute high altitude illness. Low-quality evidence suggests that dexamethasone and acetazolamide might reduce AMS score compared to placebo. However, the clinical benefits and harms related to these potential interventions remain unclear. Overall, the evidence is of limited practical significance in the clinical field. High-quality research in this field is needed, since most trials were poorly conducted and reported.
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Affiliation(s)
- Daniel Simancas‐Racines
- Universidad Tecnológica EquinoccialCochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio EspejoQuitoEcuador
| | - Ingrid Arevalo‐Rodriguez
- Universidad Tecnológica EquinoccialCochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio EspejoQuitoEcuador
- Hospital Universitario Ramon y Cajal (IRYCIS)Clinical Biostatistics UnitMadridSpain
- CIBER Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Dimelza Osorio
- Universidad Tecnológica EquinoccialCochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio EspejoQuitoEcuador
| | - Juan VA Franco
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosí 4234Buenos AiresBuenos AiresArgentinaC1199ACL
| | - Yihan Xu
- Nanyang Technological UniversityWee Kim Wee School of Communication and InformationRoom 702, Building 5, #1277 Changning RoadSingapore CitySingapore637718
| | - Ricardo Hidalgo
- Universidad Tecnológica EquinoccialCochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio EspejoQuitoEcuador
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Gonzalez Garay AG, Molano Franco D, Nieto Estrada VH, Martí‐Carvajal AJ, Arevalo‐Rodriguez I. Interventions for preventing high altitude illness: Part 2. Less commonly-used drugs. Cochrane Database Syst Rev 2018; 3:CD012983. [PMID: 29529715 PMCID: PMC6494375 DOI: 10.1002/14651858.cd012983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND High altitude illness (HAI) is a term used to describe a group of mainly cerebral and pulmonary syndromes that can occur during travel to elevations above 2500 metres (˜ 8200 feet). Acute mountain sickness (AMS), high altitude cerebral oedema (HACE) and high altitude pulmonary oedema (HAPE) are reported as potential medical problems associated with high altitude ascent. In this second review, in a series of three about preventive strategies for HAI, we assessed the effectiveness of five of the less commonly used classes of pharmacological interventions. OBJECTIVES To assess the clinical effectiveness and adverse events of five of the less commonly used pharmacological interventions for preventing acute HAI in participants who are at risk of developing high altitude illness in any setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) in May 2017. We adapted the MEDLINE strategy for searching the other databases. We used a combination of thesaurus-based and free-text search terms. We scanned the reference lists and citations of included trials and any relevant systematic reviews that we identified for further references to additional trials. SELECTION CRITERIA We included randomized controlled trials conducted in any setting where one of five classes of drugs was employed to prevent acute HAI: selective 5-hydroxytryptamine(1) receptor agonists; N-methyl-D-aspartate (NMDA) antagonist; endothelin-1 antagonist; anticonvulsant drugs; and spironolactone. We included trials involving participants who are at risk of developing high altitude illness (AMS or HACE, or HAPE, or both). We included participants with and without a history of high altitude illness. We applied no age or gender restrictions. We included trials where the relevant medication was administered before the beginning of ascent. We excluded trials using these drugs during ascent or after ascent. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures employed by Cochrane. MAIN RESULTS We included eight studies (334 participants, 9 references) in this review. Twelve studies are ongoing and will be considered in future versions of this review as appropriate. We have been unable to obtain full-text versions of a further 12 studies and have designated them as 'awaiting classification'. Four studies were at a low risk of bias for randomization; two at a low risk of bias for allocation concealment. Four studies were at a low risk of bias for blinding of participants and personnel. We considered three studies at a low risk of bias for blinding of outcome assessors. We considered most studies at a high risk of selective reporting bias.We report results for the following four main comparisons.Sumatriptan versus placebo (1 parallel study; 102 participants)Data on sumatriptan showed a reduction of the risk of AMS when compared with a placebo (risk ratio (RR) = 0.43, CI 95% 0.21 to 0.84; 1 study, 102 participants; low quality of evidence). The one included study did not report events of HAPE, HACE or adverse events related to administrations of sumatriptan.Magnesium citrate versus placebo (1 parallel study; 70 participants)The estimated RR for AMS, comparing magnesium citrate tablets versus placebo, was 1.09 (95% CI 0.55 to 2.13; 1 study; 70 participants; low quality of evidence). In addition, the estimated RR for loose stools was 3.25 (95% CI 1.17 to 8.99; 1 study; 70 participants; low quality of evidence). The one included study did not report events of HAPE or HACE.Spironolactone versus placebo (2 parallel studies; 205 participants)Pooled estimation of RR for AMS was not performed due to considerable heterogeneity between the included studies (I² = 72%). RR from individual studies was 0.40 (95% CI 0.12 to 1.31) and 1.44 (95% CI 0.79 to 2.01; very low quality of evidence). No events of HAPE or HACE were reported. Adverse events were not evaluated.Acetazolamide versus spironolactone (1 parallel study; 232 participants)Data on acetazolamide compared with spironolactone showed a reduction of the risk of AMS with the administration of acetazolamide (RR = 0.36, 95% CI 0.18 to 0.70; 232 participants; low quality of evidence). No events of HAPE or HACE were reported. Adverse events were not evaluated. AUTHORS' CONCLUSIONS This Cochrane Review is the second in a series of three providing relevant information to clinicians and other interested parties on how to prevent high altitude illness. The assessment of five of the less commonly used classes of drugs suggests that there is a scarcity of evidence related to these interventions. Clinical benefits and harms related to potential interventions such as sumatriptan are still unclear. Overall, the evidence is limited due to the low number of studies identified (for most of the comparison only one study was identified); limitations in the quality of the evidence (moderate to low); and the number of studies pending classification (24 studies awaiting classification or ongoing). We lack the large and methodologically sound studies required to establish or refute the efficacy and safety of most of the pharmacological agents evaluated in this review.
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Affiliation(s)
- Alejandro G Gonzalez Garay
- National Institute of PediatricsMethodology Research UnitInsurgentes Sur 3700 ‐ CCol. Insurgentes Cuicuilco, CoyoacanMexico CityDistrito FederalMexico04530
| | - Daniel Molano Franco
- Fundacion Universitaria de Ciencias de la Salud, Hospital de San JoséDepartment of Critical CareCarrera 19 # 8‐32BogotaBogotaColombia11001
| | - Víctor H Nieto Estrada
- Fundacion Universitaria Sanitas, Colombia ClinicDepartment of Critical CareCarrera 19 # 8‐32BogotaBogotaColombia11001
| | | | - Ingrid Arevalo‐Rodriguez
- Universidad Tecnológica EquinoccialCochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio EspejoAv. Mariscal Sucre s/n y Av. Mariana de JesúsQuitoEcuador
- Hospital Universitario Ramon y Cajal (IRYCIS)Clinical Biostatistics UnitMadridSpain
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Kurtzman RA, Caruso JL. High-Altitude Illness Death Investigation. Acad Forensic Pathol 2018; 8:83-97. [PMID: 31240027 PMCID: PMC6474454 DOI: 10.23907/2018.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/05/2017] [Accepted: 02/06/2018] [Indexed: 11/12/2022]
Abstract
High altitude illness (HAI) is the current accepted clinical term for a group of disorders including acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE), which occur in travelers visiting high-altitude locations. High-altitude illness is due to hypobaric hypoxia, is not associated with age or physical conditioning, and mild forms are easily treated. High-altitude cerebral edema and HAPE are medical emergencies that are fatal if not promptly treated and fortunately are uncommon. The cause of most high-altitude fatalities is not related to HAI and can be easily distinguished from HACE and HAPE; however, other causes of death may have symptoms and physical findings that overlap with HAI, making postmortem diagnosis challenging. Fatalities due to HAPE and HACE are diagnoses of exclusion. Medical examiners and coroners who work in jurisdictions with high-altitude locations should be aware of the risk factors, physiology, pathology, differential diagnosis, and classification of HAI to accurately recognize HAI as a cause of death. Medical examiners who do not work in jurisdictions with high-altitude locations may be asked to evaluate deaths that occur overseas associated with high-altitude trekking and mountaineering activities.
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Yuhong L, Tana W, Zhengzhong B, Feng T, Qin G, Yingzhong Y, Wei G, Yaping W, Langelier C, Rondina MT, Ge RL. Transcriptomic profiling reveals gene expression kinetics in patients with hypoxia and high altitude pulmonary edema. Gene 2018; 651:200-205. [PMID: 29366758 DOI: 10.1016/j.gene.2018.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/12/2017] [Accepted: 01/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE High altitude pulmonary edema (HAPE) is a life threatening condition occurring in otherwise healthy individuals who rapidly ascend to high altitude. However, the molecular mechanisms of its pathophysiology are not well understood. The objective of this study is to evaluate differential gene expression in patients with HAPE during acute illness and subsequent recovery. METHODS Twenty-one individuals who ascended to an altitude of 3780 m were studied, including 12 patients who developed HAPE and 9 matched controls without HAPE. Whole-blood samples were collected during acute illness and subsequent recovery for analysis of the expression of hypoxia-related genes, and physiologic and laboratory parameters, including mean pulmonary arterial pressure (mPAP), heart rate, blood pressure, and arterial oxygen saturation (SpO2), were also measured. RESULTS Compared with control subjects, numerous hypoxia-related genes were up-regulated in patients with acute HAPE. Gene network analyses suggested that HIF-1α played a central role in acute HAPE by affecting a variety of hypoxia-related genes, including BNIP3L, VEGFA, ANGPTL4 and EGLN1. Transcriptomic profiling revealed the expression of most HAPE-induced genes was restored to a normal level during the recovery phase except some key hypoxia response factors, such asBNIP3L, EGR1, MMP9 and VEGF, which remained persistently elevated. CONCLUSIONS Differential expression analysis of hypoxia-related genes revealed distinct molecular signatures of HAPE during acute and recovery phases. This study may help us to better understand HAPE pathogenesis and putative targets for further investigation and therapeutic intervention.
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Affiliation(s)
- Li Yuhong
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China; Department of Respiratory Medicine, The Affiliated Hospital of Qinghai University, Xining 810001, China
| | - Wuren Tana
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China; Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Bai Zhengzhong
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China
| | - Tang Feng
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China
| | - Ga Qin
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China
| | - Yang Yingzhong
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China
| | - Guan Wei
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China; Department of Respiratory Medicine, The Affiliated Hospital of Qinghai University, Xining 810001, China
| | - Wang Yaping
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China
| | - Charles Langelier
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, California, USA
| | - Matthew T Rondina
- Division of General Internal Medicine, Department of Internal Medicine, Molecular Medicine Program at the University of Utah Health Sciences Center, Salt Lake City, UT, United States; GRECC at the George E. Wahlen VAMC, Salt Lake City, UT, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China.
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Nieto Estrada VH, Molano Franco D, Medina RD, Gonzalez Garay AG, Martí‐Carvajal AJ, Arevalo‐Rodriguez I. Interventions for preventing high altitude illness: Part 1. Commonly-used classes of drugs. Cochrane Database Syst Rev 2017; 6:CD009761. [PMID: 28653390 PMCID: PMC6481751 DOI: 10.1002/14651858.cd009761.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND High altitude illness (HAI) is a term used to describe a group of cerebral and pulmonary syndromes that can occur during travel to elevations above 2500 metres (8202 feet). Acute hypoxia, acute mountain sickness (AMS), high altitude cerebral oedema (HACE) and high altitude pulmonary oedema (HAPE) are reported as potential medical problems associated with high altitude. In this review, the first in a series of three about preventive strategies for HAI, we assess the effectiveness of six of the most recommended classes of pharmacological interventions. OBJECTIVES To assess the clinical effectiveness and adverse events of commonly-used pharmacological interventions for preventing acute HAI. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), LILACS and trial registries in January 2017. We adapted the MEDLINE strategy for searching the other databases. We used a combination of thesaurus-based and free-text terms to search. SELECTION CRITERIA We included randomized-controlled and cross-over trials conducted in any setting where commonly-used classes of drugs were used to prevent acute HAI. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included 64 studies (78 references) and 4547 participants in this review, and classified 12 additional studies as ongoing. A further 12 studies await classification, as we were unable to obtain the full texts. Most of the studies were conducted in high altitude mountain areas, while the rest used low pressure (hypobaric) chambers to simulate altitude exposure. Twenty-four trials provided the intervention between three and five days prior to the ascent, and 23 trials, between one and two days beforehand. Most of the included studies reached a final altitude of between 4001 and 5000 metres above sea level. Risks of bias were unclear for several domains, and a considerable number of studies did not report adverse events of the evaluated interventions. We found 26 comparisons, 15 of them comparing commonly-used drugs versus placebo. We report results for the three most important comparisons: Acetazolamide versus placebo (28 parallel studies; 2345 participants)The risk of AMS was reduced with acetazolamide (risk ratio (RR) 0.47, 95% confidence interval (CI) 0.39 to 0.56; I2 = 0%; 16 studies; 2301 participants; moderate quality of evidence). No events of HAPE were reported and only one event of HACE (RR 0.32, 95% CI 0.01 to 7.48; 6 parallel studies; 1126 participants; moderate quality of evidence). Few studies reported side effects for this comparison, and they showed an increase in the risk of paraesthesia with the intake of acetazolamide (RR 5.53, 95% CI 2.81 to 10.88, I2 = 60%; 5 studies, 789 participants; low quality of evidence). Budenoside versus placebo (2 parallel studies; 132 participants)Data on budenoside showed a reduction in the incidence of AMS compared with placebo (RR 0.37, 95% CI 0.23 to 0.61; I2 = 0%; 2 studies, 132 participants; low quality of evidence). Studies included did not report events of HAPE or HACE, and they did not find side effects (low quality of evidence). Dexamethasone versus placebo (7 parallel studies; 205 participants)For dexamethasone, the data did not show benefits at any dosage (RR 0.60, 95% CI 0.36 to 1.00; I2 = 39%; 4 trials, 176 participants; low quality of evidence). Included studies did not report events of HAPE or HACE, and we rated the evidence about adverse events as of very low quality. AUTHORS' CONCLUSIONS Our assessment of the most commonly-used pharmacological interventions suggests that acetazolamide is an effective pharmacological agent to prevent acute HAI in dosages of 250 to 750 mg/day. This information is based on evidence of moderate quality. Acetazolamide is associated with an increased risk of paraesthesia, although there are few reports about other adverse events from the available evidence. The clinical benefits and harms of other pharmacological interventions such as ibuprofen, budenoside and dexamethasone are unclear. Large multicentre studies are needed for most of the pharmacological agents evaluated in this review, to evaluate their effectiveness and safety.
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Affiliation(s)
- Víctor H Nieto Estrada
- Fundacion Universitaria Sanitas, Colombia ClinicDepartment of Critical CareCarrera 19 # 8‐32BogotaBogotaColombia11001
| | - Daniel Molano Franco
- Fundacion Universitaria de Ciencias de la Salud, Hospital de San JoséDepartment of Critical CareCarrera 19 # 8‐32BogotaBogotaColombia11001
| | - Roger David Medina
- Fundación Universitaria de Ciencias de la SaludDivision of ResearchCarrera 19 # 8‐32Bogotá D.C.Colombia
| | - Alejandro G Gonzalez Garay
- National Institute of PediatricsMethodology Research UnitInsurgentes Sur 3700 ‐ CCol. Insurgentes Cuicuilco, CoyoacanMexico CityDistrito FederalMexico04530
| | | | - Ingrid Arevalo‐Rodriguez
- Universidad Tecnológica EquinoccialCochrane Ecuador. Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio EspejoAv. Mariscal Sucre s/n y Av. Mariana de JesúsQuitoEcuador
- Hospital Universitario Ramon y Cajal (IRYCIS)Clinical Biostatistics UnitMadridSpain
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Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 2017; 14:108. [PMID: 28558815 PMCID: PMC5450087 DOI: 10.1186/s12974-017-0881-y] [Citation(s) in RCA: 325] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/15/2017] [Indexed: 02/08/2023] Open
Abstract
Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and fluid on the surface of the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. This review focuses on several key processes involved in CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic membrane surrounding the CSDH has been identified as a source of fluid exudation and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels within membrane walls, whilst fibrinolytic processes prevent clot formation resulting in continued haemorrhage. An abundance of inflammatory cells and markers have been identified within the membranes and subdural fluid and are likely to contribute to propagating an inflammatory response which stimulates ongoing membrane growth and fluid accumulation. Currently, the mainstay of treatment for CSDH is surgical drainage, which has associated risks of recurrence requiring repeat surgery. Understanding of the underlying pathophysiological processes has been applied to developing potential drug treatments. Ongoing research is needed to identify if these therapies are successful in controlling the inflammatory and angiogenic disease processes leading to control and resolution of CSDH.
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Affiliation(s)
- Ellie Edlmann
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Susan Giorgi-Coll
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Peter C. Whitfield
- Southwest Neurosurgical Centre, Plymouth Hospitals NHS Trust, Plymouth, PL6 8DH UK
| | - Keri L. H. Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
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Davis C, Hackett P. Advances in the Prevention and Treatment of High Altitude Illness. Emerg Med Clin North Am 2017; 35:241-260. [PMID: 28411926 DOI: 10.1016/j.emc.2017.01.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
High altitude illness encompasses a spectrum of clinical entities to include: acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These illnesses occur as a result of a hypobaric hypoxic environment. Although a mild case of acute mountain sickness may be self-limited, high altitude cerebral edema and high altitude pulmonary edema represent critical emergencies that require timely intervention. This article reviews recent advances in the prevention and treatment of high altitude illness, including new pharmacologic strategies for prophylaxis and revised treatment guidelines.
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Affiliation(s)
- Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, Aurora, CO 80045, USA.
| | - Peter Hackett
- Institute for Altitude Medicine, PO Box 1229, Telluride, CO 81435, USA
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Lawrence JS, Reid SA. Risk Determinants of Acute Mountain Sickness and Summit Success on a 6-Day Ascent of Mount Kilimanjaro (5895 m). Wilderness Environ Med 2017; 27:78-84. [PMID: 26948557 DOI: 10.1016/j.wem.2015.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aims of this study were to assess incidence of acute mountain sickness (AMS) and summit success on a 6-day ascent profile of Mt. Kilimanjaro and evaluate potential risk factors for these outcomes. METHODS All trekkers through a single Australian tour company between August 2012 and July 2014 were included. Participants ascended via the Rongai route and attempted the summit on day 6. Daily assessments were made using the self-reported Lake Louise score (LLS) questionnaire. Two different AMS diagnostic criteria (LLS ≥ 3 and LLS ≥ 5) were used for data analysis. Risk factors for development of AMS and summit success were analyzed. RESULTS Over the 24-month period a total of 175 participants undertook the trek. Incidence of AMS was 52.6% (LLS ≥ 3) and 22.9% (LLS ≥ 5). Summit success was 88%. Age, sex, body mass index, and acetazolamide use were not associated with risk of AMS development. Age ≥ 40 years (P = .0002) and female sex (P = .0004) were both significantly associated with reduced summit success rate. CONCLUSIONS Our cohort found a lower incidence of AMS and better summit success on a 6-day ascent of Mt Kilimanjaro than previously described in other groups on 4- and 5-day ascents. Female sex and age ≥ 40 years both predicted failure to summit, but did not increase risk of developing AMS. AMS is a common cause of morbidity on Mt. Kilimanjaro, and although the risk can be mitigated by a slower ascent, there is an ongoing need for education of individual trekkers, tour companies, and local authorities.
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Affiliation(s)
- James S Lawrence
- North Sydney Sports Medicine Centre, St. Leonards, Australia (Dr Lawrence).
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Lović J, Trišović N, Antanasijević J, Nikolić ND, Stevanović S, Mijin D, Vuković D, Mladenović A, Petrović S, Ivić MA. Electrochemical determination of sildenafil citrate as standard, in tablets and spiked with human serum at gold and cystein modified gold electrode. J Electroanal Chem (Lausanne) 2016. [DOI: 10.1016/j.jelechem.2016.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Atie M, Khoma O, Dunn G, Falk GL. Gastrointestinal tract obstruction secondary to post-operative oedema: does dexamethasone administration help? J Surg Case Rep 2016; 2016:rjw139. [PMID: 27554826 PMCID: PMC4994521 DOI: 10.1093/jscr/rjw139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oedema can occur in handled tissues following upper gastrointestinal surgery with anastomosis formation. Obstruction of the lumen may result in delayed return of enteric function. Intravenous steroid use may be beneficial. Three cases of delayed emptying following fundoplication, gastro-enteric and entero-enteric anastomoses are reviewed. Conservative management with supportive measures failed. Dexamethasone was administered to treat the oedematous obstruction. A literature review in PubMed, Cochrane database and Medline for English language publications on the use of dexamethasone in the treatment of acute post surgical oedema of the upper gastrointestinal was conducted. Administration of dexamethasone led to resolution of symptoms and successful outcome. No reports on the use of steroids in this context were identified in the literature. The use of dexamethasone may effectively treat intestinal obstruction due to inflammatory or oedematous cause in the early post-operative period.
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Affiliation(s)
- M Atie
- Department of Upper GI Surgery, Concord Repatriation General Hospital, Sydney, Australia
| | - O Khoma
- Department of Upper GI Surgery, Concord Repatriation General Hospital, Sydney, Australia
| | - G Dunn
- Department of Radiology, Concord Repatriation General Hospital, Sydney, Australia
| | - G L Falk
- Department of Upper GI Surgery, Concord Repatriation General Hospital, Sydney, Australia
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Nehra S, Bhardwaj V, Bansal A, Saraswat D. Nanocurcumin accords protection against acute hypobaric hypoxia induced lung injury in rats. J Physiol Biochem 2016; 72:763-779. [PMID: 27534650 DOI: 10.1007/s13105-016-0515-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
Decline in oxygen availability experienced under hypobaric hypoxia (HH) mediates imbalance in lung fluid clearance and is a causative agent of acute lung injury. Here, we investigate the pathological events behind acute HH mediated lung injury and assess the therapeutic efficacy of nanocurcumin in its amelioration. We assess the protective efficacy of nanotized curcumin (nanocurcumin) in ameliorating HH induced lung injury and compare to curcumin. Rats exposed to acute HH (6, 12, 24, 48 and 72 h) were subjected to histopathology, blood-gas analysis and clinical biochemistry, cytokine response and redox damage. HH induced lung injury was analysed using markers of lung injury due to pulmonary vasoconstriction (ET-1/2/3 and endothelin receptors A and B) and trans-vascular fluid balance mediator (Na+/K+ ATPase). The protective efficacy of nanocurcumin was analysed by examination of Akt/Erk signalling cascade by western blot. HH induced lung injury was associated with discrete changes in blood analytes, differential circulatory cytokine response and severe pulmonary redox damages. Up-regulation of ET-1/2/3 and its receptors along with down-regulation of Na+/K+ ATPase confirmed defective pulmonary fluid clearance which promoted edema formation. Nanocurcumin treatment prevented lung edema formation and restored expression levels of ET-1/2/3 and its receptors while restoring the blood analytes, circulatory cytokines and pulmonary redox status better than curcumin. Modulation in Akt/Erk signalling pathway in rat lungs under HH confirmed the protective efficacy of nanocurcumin.
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Affiliation(s)
- Sarita Nehra
- Experimental Biology Division, Department of Experimental Biology, Defence Institute of Physiology and Allied Science, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi-54, India
| | - Varun Bhardwaj
- Experimental Biology Division, Department of Experimental Biology, Defence Institute of Physiology and Allied Science, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi-54, India
| | - Anju Bansal
- Experimental Biology Division, Department of Experimental Biology, Defence Institute of Physiology and Allied Science, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi-54, India
| | - Deepika Saraswat
- Experimental Biology Division, Department of Experimental Biology, Defence Institute of Physiology and Allied Science, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi-54, India.
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Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, Zafren K, Hackett PH. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med 2015; 25:S4-14. [PMID: 25498261 DOI: 10.1016/j.wem.2014.06.017] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
Abstract
To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155.
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Affiliation(s)
- Andrew M Luks
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA (Drs Luks and Schoene).
| | | | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom)
| | - Paul S Auerbach
- Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Drs Auerbach and Zafren)
| | - George W Rodway
- Division of Health Sciences, University of Nevada, Reno, NV (Dr Rodway)
| | - Robert B Schoene
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA (Drs Luks and Schoene); East Bay Regional Pulmonary and Critical Care Medicine Associates, Berkeley, CA (Dr Schoene)
| | - Ken Zafren
- Department of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Drs Auerbach and Zafren); Himalayan Rescue Association, Kathmandu, Nepal (Dr Zafren)
| | - Peter H Hackett
- Division of Emergency Medicine, Altitude Research Center, University of Colorado School of Medicine, Aurora and the Institute for Altitude Medicine, Telluride, CO (Dr Hackett)
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An unusual case of unilateral pulmonary edema with contralateral bronchial obstruction. Am J Med Sci 2015; 349:455-8. [PMID: 24978146 DOI: 10.1097/maj.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 61 year-old man presented with progressive shortness of breath. Computed tomography scan of the chest showed diffuse ground glass infiltrates and dilated pulmonary vessels in the right lung in addition to bilateral pulmonary masses with obstruction of the left main pulmonary bronchus. The patient underwent bronchoscopy with destruction of the tumor obstructing the left main pulmonary bronchus, resulting in clinical improvement and resolution of the right pulmonary infiltrates. We hypothesize that the patient developed right pulmonary edema secondary to hypoxic vasoconstriction of the left lung. This case suggests a rare mechanism of unilateral pulmonary edema and supports inclusion of pulmonary edema in the differential diagnosis of unilateral pulmonary infiltrates in the setting of contralateral bronchial obstruction.
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Development and preliminary test of a new plateau hyperbaric chamber. Am J Emerg Med 2015; 33:1497-500. [PMID: 26277732 DOI: 10.1016/j.ajem.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The objective of this study is to validate the performance, define its limits, and provide details on a new plateau hyperbaric chamber at 355-, 2880-, and 4532-m high altitude. METHODS A new multiplace plateau hyperbaric chamber was designed to satisfy the needed of patients who have acute mountain sickness. Tests were conducted inside the chamber at 355-, 2880-, and 4532-m high altitude. The safely and conveniences of the new plateau hyperbaric chamber were estimated. RESULTS Minimum pressures of the main compartment can reach up to 0.029, 0.022, and 0.02 MPa at 355-, 2880-, and 4532-m high altitude. During pressurization, there was no leak of air around the chamber. The time lag of pressure equilibration between main and buffer compartment varies from 30.3±2.01 to 200.5±5.44 seconds and between buffer compartment and ambient pressure varies from 60.2±4.13 to 215.9±6.76 seconds. CONCLUSIONS The chamber can be applicated for acute mountain sickness treatment safety and convenience. However, further experience about animals and human within the chamber is needed to improve the hardware and establish conditions of effective utilization of this equipment in the high altitude.
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Korzeniewski K, Nitsch-Osuch A, Guzek A, Juszczak D. High altitude pulmonary edema in mountain climbers. Respir Physiol Neurobiol 2015; 209:33-8. [DOI: 10.1016/j.resp.2014.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 12/20/2022]
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Ringwood H, Khodaee M, Selenke DK. Acute Shortness of Breath in an Adult. Asian J Sports Med 2014; 5:e24051. [PMID: 25741415 PMCID: PMC4335476 DOI: 10.5812/asjsm.24051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 03/01/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Haley Ringwood
- School of Medicine, University of Colorado, Aurora, Colorado, United States
| | - Morteza Khodaee
- School of Medicine, University of Colorado, Aurora, Colorado, United States
- Corresponding author: Morteza Khodaee, School of Medicine, University of Colorado, Aurora, Colorado, United States. Tel: +1-7208489056, Fax: +1-7208489050, E-mail:
| | - Darcy K. Selenke
- School of Medicine, University of Colorado, Aurora, Colorado, United States
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Whitlow KS, Davis BW. High altitude pulmonary edema in an experienced mountaineer. possible genetic predisposition. West J Emerg Med 2014; 15:849-51. [PMID: 25493133 PMCID: PMC4251234 DOI: 10.5811/westjem.2014.7.22773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/12/2014] [Indexed: 11/11/2022] Open
Abstract
High altitude pulmonary edema (HAPE) is a form of high altitude illness characterized by cough, dyspnea upon exertion progressing to dyspnea at rest and eventual death, seen in patients who ascend over 2,500 meters, particularly if that ascent is rapid. This case describes a patient with no prior history of HAPE and extensive experience hiking above 2,500 meters who developed progressive dyspnea and cough while ascending to 3,200 meters. His risk factors included rapid ascent, high altitude, male sex, and a possible genetic predisposition for HAPE.
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Affiliation(s)
- Kenneth S. Whitlow
- Kaweah Delta Medical Center, Department of Emergency Medicine, Visalia, California
| | - Babette W. Davis
- Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
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de Mol P, de Vries ST, de Koning EJP, Gans ROB, Bilo HJG, Tack CJ. Physical activity at altitude: challenges for people with diabetes: a review. Diabetes Care 2014; 37:2404-13. [PMID: 25061142 DOI: 10.2337/dc13-2302] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A growing number of subjects with diabetes take part in physical activities at altitude such as skiing, climbing, and trekking. Exercise under conditions of hypobaric hypoxia poses some unique challenges on subjects with diabetes, and the presence of diabetes can complicate safe and successful participation in mountain activities. Among others, altitude can alter glucoregulation. Furthermore, cold temperatures and altitude can complicate accurate reading of glucose monitoring equipment and storage of insulin. These factors potentially lead to dangerous hyperglycemia or hypoglycemia. Over the last years, more information has become available on this subject. PURPOSE To provide an up-to-date overview of the pathophysiological changes during physical activity at altitude and the potential problems related to diabetes, including the use of (continuous) blood glucose monitors and insulin pumps. To propose practical recommendations for preparations and travel to altitude for subjects with diabetes. DATA SOURCES AND SYNTHESIS We researched PubMed, medical textbooks, and related Internet sites, and extracted human studies and data based on relevance for diabetes, exercise, and altitude. LIMITATIONS Given the paucity of controlled trials regarding diabetes and altitude, we composed a narrative review and filled in areas lacking diabetes-specific studies with data obtained from nondiabetic subjects. CONCLUSIONS Subjects with diabetes can take part in activities at high, and even extreme, altitude. However, careful assessment of diabetes-related complications, optimal preparation, and adequate knowledge of glycemic regulation at altitude and altitude-related complications is needed.
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Affiliation(s)
- Pieter de Mol
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Suzanna T de Vries
- Department of Cardiology, Tjongerschans Hospital, Heerenveen, the Netherlands
| | - Eelco J P de Koning
- Department of Endocrinology, Leiden University Medical Centre, Leiden, the NetherlandsDepartment of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Reinold O B Gans
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the NetherlandsDepartment of Internal Medicine, Isala Clinics, Zwolle, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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High altitude pulmonary edema (HAPE) in a Himalayan trekker: a case report. EXTREME PHYSIOLOGY & MEDICINE 2014; 3:6. [PMID: 24636661 PMCID: PMC3984695 DOI: 10.1186/2046-7648-3-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 03/05/2014] [Indexed: 11/21/2022]
Abstract
Introduction High altitude pulmonary edema is a non-cardiogenic form of pulmonary edema that develops in unacclimatized individuals at altitudes over 2500 m. Early recognition of symptoms and immediate descent are important for successful treatment. Despite early signs and symptoms of high altitude illness, many trekkers tend to push themselves to the maximum limit. Some of them, such as the case reported here, choose to ascend on horse-back which is extremely dangerous and can be fatal. Case presentation A 55 years of age Indian ethnic South African lady was emergency air-lifted from 4410 m altitude in the Nepal Himalayas to Kathamandu (1300 m) with a suspected case of high altitude pulmonary edema. She had continued ascending despite experiencing mild altitude symptoms at Namche (3440 m), and these symptoms worsened considerably at Tengboche (3860 m). At the very start of her trek, just after Lukla (2800 m), she suffered from sore throat, and had consequently begun a course of antibiotics (azithromycin) for a suspected throat infection. She had planned to continue ascending on horse back to complete the trek, however her condition deteriorated further and she had to be medically evacuated. On admission to the clinic her axillary temperature was 99.4 F, blood pressure 120/60 mmHg, pulse rate 72/min, respiratory rate of 25 breaths/min, and pulse oximeter showed saturation of 90% on room air at rest. Right sided crackles on the axillary and posterior region were heard on chest auscultation. Heel to toe test showed no signs of ataxia. The chest radiograph showed patchy infiltrates on the right side. An echocardiogram was done which revealed a high pulmonary artery pressure of 50 mm of Hg. She was diagnosed as resolving high altitude pulmornay edema. She was treated with bed rest, supplemental oxygen and sustained release nifedipine 20 mg (orally) twice a day. On the third day her crackles had cleared significantly and repeat chest radiograph as shown showed remarkable improvement. She felt much better. A repeat echocardiogram revealed a normal pulmonary artery pressure. Conclusion The case report highlights numerous points: 1) Many high altitude trekkers have invested significant time, money and physical efforts in in their ventures and are determined to ascend despite early warning and illnesses. 2) Despite no history of altitude illnesses in previous altitude exposure,inter-current illness (in this case a nonspecific respiratory tract infection) may contribute to the development of high altitude pulmonary edema. 3) Continuing ascent using other transport means, whilst suffering from symptoms of high altitude illness, worsens the condition and could be life threatening. 4) Acetazolamide does not prevent high altitude pulmonary edema–perhaps more so in the cases that have inter-current illness. 5) Descent is the golden rule in all altitude illnesses. Actually ‘descent’ is advised in any undiagnosed illness at high altitude among sojourners. 6) Finally, an experienced guide who has mountain medicine training is essential. They can be crucial in noticing early signs and symptoms of altitude illnesses to inform the client’s safety as in this case.
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Genome wide expression analysis suggests perturbation of vascular homeostasis during high altitude pulmonary edema. PLoS One 2014; 9:e85902. [PMID: 24465776 PMCID: PMC3899118 DOI: 10.1371/journal.pone.0085902] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 12/06/2013] [Indexed: 01/08/2023] Open
Abstract
Background High altitude pulmonary edema (HAPE) is a life-threatening form of non-cardiogenic edema which occurs in unacclimatized but otherwise normal individuals within two to four days after rapid ascent to altitude beyond 3000 m. The precise pathoetiology and inciting mechanisms regulating HAPE remain unclear. Methodology/Principle findings We performed global gene expression profiling in individuals with established HAPE compared to acclimatized individuals. Our data suggests concurrent modulation of multiple pathways which regulate vascular homeostasis and consequently lung fluid dynamics. These pathways included those which regulate vasoconstriction through smooth muscle contraction, cellular actin cytoskeleton rearrangements and endothelial permeability/dysfunction. Some notable genes within these pathways included MYLK; rho family members ARGEF11, ARHGAP24; cell adhesion molecules such as CLDN6, CLDN23, PXN and VCAM1 besides other signaling intermediates. Further, several important regulators of systemic/pulmonary hypertension including ADRA1D, ECE1, and EDNRA were upregulated in HAPE. We also observed significant upregulation of genes involved in paracrine signaling through chemokines and lymphocyte activation pathways during HAPE represented by transcripts of TNF, JAK2, MAP2K2, MAP2K7, MAPK10, PLCB1, ARAF, SOS1, PAK3 and RELA amongst others. Perturbation of such pathways can potentially skew vascular homeostatic equilibrium towards altered vascular permeability. Additionally, differential regulation of hypoxia-sensing, hypoxia-response and OXPHOS pathway genes in individuals with HAPE were also observed. Conclusions/Significance Our data reveals specific components of the complex molecular circuitry underlying HAPE. We show concurrent perturbation of multiple pathways regulating vascular homeostasis and suggest multi-genic nature of regulation of HAPE.
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Walmsley M. Continuous Positive Airway Pressure as Adjunct Treatment of Acute Altitude Illness. High Alt Med Biol 2013; 14:405-7. [DOI: 10.1089/ham.2013.1059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Megan Walmsley
- Himalayan Rescue Association, Kathmandu, Nepal
- Department of Anaesthetics, The Townsville Hospital, Townsville, Queensland, Australia
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She J, Bi J, Tong L, Song Y, Bai C. New insights of aquaporin 5 in the pathogenesis of high altitude pulmonary edema. Diagn Pathol 2013; 8:193. [PMID: 24274330 PMCID: PMC3937216 DOI: 10.1186/1746-1596-8-193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/26/2013] [Indexed: 11/28/2022] Open
Abstract
Background High altitude pulmonary edema (HAPE) affects individuals and is characterized by alveolar flooding with protein-rich edema as a consequence of blood-gas barrier disruption. In this study, we hypothesized that aquaporin 5 (AQP5) which is one kind of water channels may play a role in preservation of alveolar epithelial barrier integrity in high altitude pulmonary edema (HAPE). Methods Therefore, we established a model in Wildtype mice and AQP5 −/− mice were assingned to normoxic rest (NR), hypoxic rest (HR) and hypoxic exercise (HE) group. Mice were produced by training to walk at treadmill for exercising and chamber pressure was reduced to simulate climbing an altitude of 5000 m for 48 hours. Studies using BAL in HAPE mice to demonstrated that edema is caused leakage of albumin proteins and red cells across the alveolarcapillary barrier in the absence of any evidence of inflammation. Results In this study, the Lung wet/dry weight ratio and broncholalveolar lavage protein concentrations were slightly increased in HE AQP5 −/− mice compared to wildtype mice. And histologic evidence of hemorrhagic pulmonary edema was distinctly shown in HE group. The lung Evan’s blue permeability of HE group was showed slightly increased compare to the wildtype groups, and HR group was showed a medium situation from normal to HAPE development compared with NR and HE group. Conclusions Deletion of AQP5 slightly increased lung edema and lung injury compared to wildtype mice during HAPE development, which suggested that the AQP5 plays an important role in HAPE formation induced by high altitude simulation.
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Affiliation(s)
| | | | | | | | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, NO,180 Fenglin Road, Shanghai 200032, China.
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Chiu TF, Chen LLC, Su DH, Lo HY, Chen CH, Wang SH, Chen WL. Rhodiola crenulata extract for prevention of acute mountain sickness: a randomized, double-blind, placebo-controlled, crossover trial. Altern Ther Health Med 2013; 13:298. [PMID: 24176010 PMCID: PMC4228457 DOI: 10.1186/1472-6882-13-298] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/28/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rhodiola crenulata (R. crenulata) is widely used to prevent acute mountain sickness in the Himalayan areas and in Tibet, but no scientific studies have previously examined its effectiveness. We conducted a randomized, double-blind, placebo-controlled crossover study to investigate its efficacy in acute mountain sickness prevention. METHODS Healthy adult volunteers were randomized to 2 treatment sequences, receiving either 800 mg R. crenulata extract or placebo daily for 7 days before ascent and 2 days during mountaineering, before crossing over to the alternate treatment after a 3-month wash-out period. Participants ascended rapidly from 250 m to 3421 m on two separate occasions: December 2010 and April 2011. The primary outcome measure was the incidence of acute mountain sickness, as defined by a Lake Louise score ≥ 3, with headache and at least one of the symptoms of nausea or vomiting, fatigue, dizziness, or difficulty sleeping. RESULTS One hundred and two participants completed the trial. There were no demographic differences between individuals taking Rhodiola-placebo and those taking placebo-Rhodiola. No significant differences in the incidence of acute mountain sickness were found between R. crenulata extract and placebo groups (all 60.8%; adjusted odds ratio (AOR) = 1.02, 95% confidence interval (CI) = 0.69-1.52). The incidence of severe acute mountain sickness in Rhodiola extract vs. placebo groups was 35.3% vs. 29.4% (AOR = 1.42, 95% CI = 0.90-2.25). CONCLUSIONS R. crenulata extract was not effective in reducing the incidence or severity of acute mountain sickness as compared to placebo. TRIAL REGISTRATION ClinicalTrials.gov NCT01536288.
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Shen G, Wu X, Tang C, Yan Y, Liu J, Guo W, Jing D, Lei T, Tian Y, Xie K, Luo E, Zhang J. An oxygen enrichment device for lowlanders ascending to high altitude. Biomed Eng Online 2013; 12:100. [PMID: 24103365 PMCID: PMC4124732 DOI: 10.1186/1475-925x-12-100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When ascending to the high altitude, people living in low altitude areas will suffer from acute mountain sickness. The aim of this study is to test the hypothesis that whether an oxygen concentration membrane can be made and used to construct a new portable oxygen enrichment device for individuals in acute exposure to the high altitude. METHODS The membrane was fabricated using vinylsiloxane rubber, polyphenylene oxide hydrogen silicone polymers, chloroplatinic acid and isopropyl alcohol. The membrane was assembled in a frame and the performance was tested in terms of concentration of oxygen, flow rate of oxygen enriched air, pressure ratio across the membrane and ambient temperature. Furthermore, the oxygen concentration device was constructed using the membrane, a DC fan, vacuum pump and gas buffer. A nonrandomized preliminary field test was conducted, in which eight healthy male subjects were flown to Tibet (Lhasa, 3,700 m). First, subjects wore the oxygen enrichment device and performed an incremental exercise on cycle ergometer. The test included heart rate (HR), saturation of peripheral oxygen (SpO2) and physical work capacity (PWC). Then, after a rest period of 4 hours, the experimental protocol was repeated without oxygen enrichment device. RESULTS The testing showed that the membrane could increase the oxygen concentration by up to 30%. Simulation test indicated that although the performance of the oxygen enrichment device decreased with altitudes, the oxygen concentration could still maintain 28% with flow rate of enriched air 110 cm3/s at 5000 m. The field test showed that higher SpO2, lower HR, and better PWC (measured by the PWC-170) were observed from all the subjects using oxygen enrichment device compared with non-using (P < 0.01). CONCLUSIONS We concluded that the new portable oxygen enrichment device would be effective in improving exercise performance when ascending to the high altitude.
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Affiliation(s)
- Guanghao Shen
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi 710032, People's Republic of China.
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