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Yang X, Li J, Ma Y, Dong X, Qu J, Liang F, Liu J. Curcumin-mediated enhancement of lung barrier function in rats with high-altitude-associated acute lung injury via inhibition of inflammatory response. Respir Res 2024; 25:354. [PMID: 39342264 PMCID: PMC11439224 DOI: 10.1186/s12931-024-02975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Exposure to a hypobaric hypoxic environment at high altitudes can lead to lung injury. In this study, we aimed to determine whether curcumin (Cur) could improve lung barrier function and protect against high-altitude-associated acute lung injury. METHODS Two hundred healthy rats were randomly divided into standard control, high-altitude control (HC), salidroside (40 mg/kg, positive control), and Cur (200 mg/kg) groups. Each group was further divided into five subgroups. Basic vital signs, lung injury histopathology, routine blood parameters, plasma lactate level, and arterial blood gas indicators were evaluated. Protein and inflammatory factor (tumor necrosis factor α (TNF-α), interleukin [IL]-1β, IL-6, and IL-10) concentrations in bronchoalveolar lavage fluid (BALF) were determined using the bicinchoninic acid method and enzyme-linked immunosorbent assay, respectively. Inflammation-related and lung barrier function-related proteins were analyzed using immunoblotting. RESULTS Cur improved blood routine indicators such as hemoglobin and hematocrit and reduced the BALF protein content and TNF-α, IL-1β, and IL-6 levels compared with those in the HC group. It increased IL-10 levels and reduced pulmonary capillary congestion, alveolar hemorrhage, and the degree of pulmonary interstitial edema. It increased oxygen partial pressure, oxygen saturation, carbonic acid hydrogen radical, and base excess levels, and the expression of zonula occludens 1, occludin, claudin-4, and reduced carbon dioxide partial pressure, plasma lactic acid, and the expression of phospho-nuclear factor kappa. CONCLUSIONS Exposure to a high-altitude environment for 48 h resulted in severe lung injury in rats. Cur improved lung barrier function and alleviated acute lung injury in rats at high altitudes.
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Affiliation(s)
- Xinyue Yang
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command, Urumqi, 830000, China
- Graduate School , Xinjiang Medical University, Urumqi, 830000, China
| | - Jiajia Li
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command, Urumqi, 830000, China
- College of Pharmacy, Xinjiang Medical University, Urumqi, 830000, China
| | - Yan Ma
- Department of Anesthesiology, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, China
| | - Xiang Dong
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command, Urumqi, 830000, China
| | - Jinquan Qu
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command, Urumqi, 830000, China
| | - Feixing Liang
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command, Urumqi, 830000, China
| | - Jiangwei Liu
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command, Urumqi, 830000, China.
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Russell MK, Horton JF, Clermont CA, Demarty JM, Transfiguracion LC, Worobets BR, Pineda ME, Santaniemi N, Stergiou P, Asmussen MJ, Day TA. Validation of Polar Elixir™ Pulse Oximeter against Arterial Blood Gases during Stepwise Steady-State Inspired Hypoxia. Med Sci Sports Exerc 2024; 56:1585-1594. [PMID: 38635406 DOI: 10.1249/mss.0000000000003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of peripheral oxygen saturation (SpO 2 ) measurements from Polar Elixir™ pulse oximetry technology compared with arterial oxygen saturation (SaO 2 ) measurements during acute stepwise steady-state inspired hypoxia at rest. A post hoc objective was to determine if SpO 2 measurements could be improved by recalibrating the Polar Elixir™ algorithm with SaO 2 values from a random subset of participants. METHODS The International Organization for Standardization (ISO) protocol (ISO 80601-2-61:2017) for evaluating the SpO 2 accuracy of pulse oximeter equipment was followed whereby five plateaus of SaO 2 between 70% and 100% were achieved using stepwise reductions in inspired O 2 during supine rest. Blood samples drawn through a radial arterial catheter from 25 participants were first used to compare SaO 2 with SpO 2 measurements from Polar Elixir™. Then the Polar Elixir™ algorithm was recalibrated using SaO 2 data from 13 random participants, and SpO 2 estimates were recalculated for the other 12 participants. For SaO 2 values between 70% and 100%, root mean square error, intraclass correlation coefficients (ICC), Pearson correlations, and Bland-Altman plots were used to assess the accuracy, agreement, and strength of relationship between SaO 2 values and SpO 2 values from Polar Elixir™. RESULTS The initial root mean square error for Polar Elixir™ was 4.13%. After recalibrating the algorithm, the RMSE was improved to 2.67%. The ICC revealed excellent levels of agreement between SaO 2 and Polar Elixir™ SpO 2 values both before (ICC(1,3) = 0.837, df = 574, P < 0.001) and after (ICC(1,3) = 0.942, df = 287, P < 0.001) recalibration. CONCLUSIONS Relative to ISO standards, Polar Elixir™ yielded accurate SpO 2 measurements during stepwise inspired hypoxia at rest when compared with SaO 2 values, which were improved by recalibrating the algorithm using a subset of the SaO 2 data.
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Affiliation(s)
- Monica K Russell
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | - John F Horton
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | | | | | | | - Breann R Worobets
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | - Mark E Pineda
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
| | | | - Pro Stergiou
- Canadian Sport Institute Alberta-Sport Product Testing, Calgary, Alberta, CANADA
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Gatti M, Prete G, Perpetuini D, Bondi D, Verratti V, Quilici Matteucci F, Santangelo C, Annarumma S, Di Crosta A, Palumbo R, Merla A, Giaconia GC, Tommasi L, Mammarella N. The effects of real vs simulated high altitude on associative memory for emotional stimuli. Physiol Behav 2024; 287:114663. [PMID: 39128618 DOI: 10.1016/j.physbeh.2024.114663] [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: 07/08/2024] [Revised: 08/01/2024] [Accepted: 08/08/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION This study aimed to investigate the effects of normobaric hypoxia (NH) and hypobaric hypoxia (HH) on associative memory performance for emotionally valenced stimuli. METHODS Two experiments were conducted. In Study 1, n = 18 undergraduates performed an associative memory task under three NH conditions (FiO2= 20.9 %, 15.1 %, 13.6 %) using a tent with a hypoxic generator. In Study 2, n = 20 participants were assessed in a field study at various altitudes on the Himalayan mountains, including the Pyramid Laboratory (5000 m above sea level), using functional Near-Infrared Spectroscopy (fNIRS) and behavioral assessments. RESULTS Study 1 revealed no significant differences in recognition accuracy across NH conditions. However, Study 2 showed a complex relationship between altitude and memory for emotionally valenced stimuli. At lower altitudes, participants more accurately recognized emotional stimuli compared to neutral ones, a trend that reversed at higher altitudes. Brain oxygenation varied with altitude, indicating adaptive cognitive processing, as revealed by fNIRS measurements. CONCLUSIONS These findings suggest that hypoxia affects associative memory and emotional processing in an altitude-dependent manner, highlighting adaptive cognitive mechanisms. Understanding the effects of hypobaric hypoxia on cognition and memory can help develop strategies to mitigate its impact in high-altitude and hypoxic environments.
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Affiliation(s)
- Matteo Gatti
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy
| | - Giulia Prete
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy
| | - David Perpetuini
- Department of Engineering and Geology, University "G. d'Annunzio" Chieti-Pescara, Pescara, Italy
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Vittore Verratti
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy.
| | | | - Carmen Santangelo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Salvatore Annarumma
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy
| | - Adolfo Di Crosta
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy
| | - Rocco Palumbo
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy
| | - Arcangelo Merla
- Department of Engineering and Geology, University "G. d'Annunzio" Chieti-Pescara, Pescara, Italy
| | | | - Luca Tommasi
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy
| | - Nicola Mammarella
- Department of Psychology, University "G. d'Annunzio" Chieti-Pescara, 31, Via dei Vestini, Chieti I-66013, Italy
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Cerfoglio S, Verme F, Capodaglio P, Rossi P, Cvetkova V, Boldini G, Galli M, Cimolin V. Motor and Respiratory Tele-Rehabilitation in Patients with Long COVID-19 after Hospital Discharge: An Interventional Study. Life (Basel) 2024; 14:864. [PMID: 39063618 PMCID: PMC11277623 DOI: 10.3390/life14070864] [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: 06/04/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The persistence of symptoms following COVID-19 infection represents a significant challenge in healthcare management. During the outbreak, tele-rehabilitation emerged as a new tool to support healthcare structures in providing rehabilitation services. This study assessed the effectiveness and the feasibility of a 3-week home-based motor and respiratory rehabilitation program for individuals with long COVID-19 after traditional rehabilitation. Twenty-three patients completed the program and underwent functional tests at different time points (i.e., baseline, at discharge from in-hospital rehabilitation and after tele-rehabilitation). Motor function was evaluated using the instrumented Six-Minutes Walking Test (i6MWT), with monitored heart rate and oxygen saturation. Additionally, respiratory function was measured via forced vital capacity (FVC) and maximal voluntary ventilation (MVV) tests. Significant improvements (p < 0.05) in motor and respiratory function were observed throughout the intervention, including an 18.3% increase in walked distance from the baseline. The findings suggest that the proposed home-based tele-rehabilitation shows potential in enhancing motor and respiratory function in patients with long COVID. Despite limitations such as the small sample size, lack of control group and the preliminary nature of the outcomes observed, the overall findings seem to support the feasibility of the proposed tele-rehabilitation program in managing long COVID symptoms and promoting functional recovery. Nevertheless, further research is needed to validate these findings and explore tele-rehabilitation's potential in broader and different patient populations.
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Affiliation(s)
- Serena Cerfoglio
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (S.C.); (M.G.); (V.C.)
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, 28824 Piancavallo, Italy; (F.V.); (G.B.)
| | - Federica Verme
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, 28824 Piancavallo, Italy; (F.V.); (G.B.)
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, 28824 Piancavallo, Italy; (F.V.); (G.B.)
- Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Turin, 10126 Turin, Italy
| | - Paolo Rossi
- Clinica Hildebrand, Centro di Riabilitazione Brissago, CH-6614 Brissago, Switzerland; (P.R.); (V.C.)
| | - Viktoria Cvetkova
- Clinica Hildebrand, Centro di Riabilitazione Brissago, CH-6614 Brissago, Switzerland; (P.R.); (V.C.)
| | - Gabriele Boldini
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, 28824 Piancavallo, Italy; (F.V.); (G.B.)
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (S.C.); (M.G.); (V.C.)
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (S.C.); (M.G.); (V.C.)
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, 28824 Piancavallo, Italy; (F.V.); (G.B.)
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Strickland B, Small E, Ryan M, Paterson R. Effectiveness of Continuous Positive Airway Pressure in Alleviating Hypoxemia and Improving Exertional Capacity at Altitude. High Alt Med Biol 2024. [PMID: 38984416 DOI: 10.1089/ham.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Strickland, Brian, Elan Small, Mary Ryan, and Ryan Paterson. Effectiveness of continuous positive airway pressure in alleviating hypoxemia and improving exertional capacity at altitude. High Alt Med Biol. 00:000-000, 2024. Introduction: Decreased oxygen saturation and exercise tolerance are commonly experienced at high altitude. Continuous positive airway pressure (CPAP) devices have become increasingly portable and battery powered, providing a potentially unique new therapeutic modality for treatment of altitude-related illnesses. This study evaluated the potential use of CPAP devices to improve and maintain oxygen saturation at altitude, both at rest and with exertion, to evaluate the feasibility of using this device at altitude. Methods: Subjects were taken to Mount Blue Sky and monitored while they hiked to the summit (4,350 m), maintaining a consistent level of exertion. Subjects hiked for 0.7 km both with and without CPAP set to 10 cmH2O pressure. Continuous vital signs were collected during the hike and recovery period. Results: All subjects completed the hike wearing CPAP devices at a vigorous level of exertion. Mean oxygen saturation of the CPAP group (M = 83.8%, SD = 3.72) was significantly higher than that of the control group during exertion (M = 78.7%, SD = 2.97); p = 0.005. Recovery after exertion was quicker in the CPAP group than the control group. Three subjects experienced claustrophobia requiring a brief pause, but were able to complete their exercise trial without removing equipment or experiencing adverse events. When pauses from claustrophobia were excluded, there was no difference in completion time between the groups (p = 0.06). Conclusion: CPAP reliably improved oxygen saturation at rest and during vigorous exertion at high altitude. Its ability to correct hypoxemia, even with physical exertion, may prove useful after further study as a portable self-carried device to prevent and treat altitude-related illness, or to improve safety in high-altitude rescues.
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Affiliation(s)
- Brian Strickland
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elan Small
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Ryan
- Denver Health Medical Center, Denver, Colorado, USA
| | - Ryan Paterson
- Kaiser Permanente, University of Colorado, Denver, Colorado, USA
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de la Merced Díaz-González C, Pérez-Bello C, De la Rosa-Hormiga M, González-Henríquez JJ, de las Mercedes Reyes-Noha M. Hospital Environmental Factors That Influence Peripheral Oxygen Saturation Measurements: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:940. [PMID: 38727497 PMCID: PMC11083166 DOI: 10.3390/healthcare12090940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Pulse oximetry is a non-invasive, cost-effective, and generally reliable instrument measuring pulse rate and peripheral oxygen saturation (SpO2). However, these measurements can be affected by the patient's internal or external factors, including the type of pulse oximeter device (POD). (1) This study's objective was to identify potential environmental factors that may impact the measurements taken by three PODs. (2) Methods: A descriptive-analytical cross-sectional study was designed. The patients' SpO2 levels were measured using a standard monitor and two PODs owned by the professionals. The measurements were taken on the patients' fingers. Concurrently, we evaluated the surrounding environmental conditions, encompassing temperature, humidity, illuminance, and noise. (3) Results: This study involved 288 adult participants in the sample. For each 20-decibel increment in noise, there was a reduction in SpO2 by an average of 1%, whereas for every additional degree of ambient temperature, SpO2 decreased by an average of 2% (4) Conclusions: Significant correlations between SpO2 and age, as well as with noise and ambient temperature, were observed. No significant differences between oxygen saturation and lighting or humidity were observed. This study was prospectively registered with the Clinical Research Ethics Committee of Gran Canaria at the Dr. Negrín University Hospital, with protocol code 2019-247-1, and approved on 24 May 2019.
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Affiliation(s)
- Candelaria de la Merced Díaz-González
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
| | - Cristina Pérez-Bello
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
- Hospital Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Milagros De la Rosa-Hormiga
- Department of Nursing, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Canary Islands, Spain; (C.P.-B.); (M.D.l.R.-H.)
| | - Juan José González-Henríquez
- Department of Mathematics, Faculty of Mathematics, University of Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Canary Islands, Spain;
| | - María de las Mercedes Reyes-Noha
- Continuous Training Department, Primary Care Management, Gran Canaria Health Area, 35006 Las Palmas de Gran Canaria, Canary Islands, Spain;
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León-Valladares D, Barrio-Mateu LA, Cortés-Carmona N, Fuentes-Lizana G, Cabanas AM, Latorre-Progulakis K, Fuentes-Guajardo M, Martín-Escudero P. Determining factors of pulse oximetry accuracy: a literature review. Rev Clin Esp 2024; 224:314-330. [PMID: 38599519 DOI: 10.1016/j.rceng.2024.04.005] [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: 01/18/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Identify and reach consensus on the variables that affect the measurement of oxygen saturation using pulse oximetry. METHODS We applied inclusion and exclusion criteria to select relevant studies in databases such as Ebsco and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results. RESULTS 23 studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in oxygen saturation measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO2, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency >150 beats per minute, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal. CONCLUSIONS The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO2, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.
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Affiliation(s)
- D León-Valladares
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile.
| | - L A Barrio-Mateu
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - N Cortés-Carmona
- Estudiante Semillero de Investigación, Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - G Fuentes-Lizana
- Estudiante Semillero de Investigación, Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - A M Cabanas
- Departamento de Física, Facultad de Ciencias, Universidad de Tarapacá, Arica, Chile
| | - K Latorre-Progulakis
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - M Fuentes-Guajardo
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - P Martín-Escudero
- Escuela de Medicina del Deporte, Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Medicina. UCM
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Ali M, Choudhary R, Singh K, Kumari S, Kumar R, Graham BB, Pasha MAQ, Rabyang S, Thinlas T, Mishra A. Hypobaric hypoxia modulated structural characteristics of circulating cell-free DNA in high-altitude pulmonary edema. Am J Physiol Lung Cell Mol Physiol 2024; 326:L496-L507. [PMID: 38349115 DOI: 10.1152/ajplung.00245.2023] [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: 08/01/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 04/07/2024] Open
Abstract
The utility of cell-free (cf) DNA has extended as a surrogate or clinical biomarker for various diseases. However, a more profound and expanded understanding of the diverse cfDNA population and its correlation with physiological phenotypes and environmental factors is imperative for using its full potential. The high-altitude (HA; altitude > 2,500 m above sea level) environment characterized by hypobaric hypoxia offers an observational case-control design to study the differential cfDNA profile in patients with high-altitude pulmonary edema (HAPE) (number of subjects, n = 112) and healthy HA sojourners (n = 111). The present study investigated cfDNA characteristics such as concentration, fragment length size, degree of integrity, and subfractions reflecting mitochondrial-cfDNA copies in the two groups. The total cfDNA level was significantly higher in patients with HAPE, and the level increased with increasing HAPE severity (P = 0.0036). A lower degree of cfDNA integrity of 0.346 in patients with HAPE (P = 0.001) indicated the prevalence of shorter cfDNA fragments in circulation in patients compared with the healthy HA sojourners. A significant correlation of cfDNA characteristics with the peripheral oxygen saturation levels in the patient group demonstrated the translational relevance of cfDNA molecules. The correlation was further supported by multivariate logistic regression and receiver operating characteristic curve. To our knowledge, our study is the first to highlight the association of higher cfDNA concentration, a lower degree of cfDNA integrity, and increased mitochondrial-derived cfDNA population with HAPE disease severity. Further deep profiling of cfDNA fragments, which preserves cell-type specific genetic and epigenetic features, can provide dynamic physiological responses to hypoxia.NEW & NOTEWORTHY This study observed altered cell-free (cf) DNA fragment patterns in patients with high-altitude pulmonary edema and the significant correlation of these patterns with peripheral oxygen saturation levels. This suggests deep profiling of cfDNA fragments in the future may identify genetic and epigenetic mechanisms underlying physiological and pathophysiological responses to hypoxia.
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Affiliation(s)
- Manzoor Ali
- Cardio Respiratory Disease Unit, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Raushni Choudhary
- Cardio Respiratory Disease Unit, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Kanika Singh
- Cardio Respiratory Disease Unit, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Swati Kumari
- Cardio Respiratory Disease Unit, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rahul Kumar
- Department of Medicine, University of California, San Francisco, California, United States
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States
| | - Brian B Graham
- Department of Medicine, University of California, San Francisco, California, United States
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, United States
| | | | - Stanzen Rabyang
- Department of Medicine, Sonam Norboo Memorial Hospital, Leh, India
| | - Tashi Thinlas
- Department of Medicine, Sonam Norboo Memorial Hospital, Leh, India
| | - Aastha Mishra
- Cardio Respiratory Disease Unit, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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Guo Y, Liu X, Zhang Q, Shi Z, Zhang M, Chen J. Can acute high-altitude sickness be predicted in advance? REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:27-36. [PMID: 36165715 DOI: 10.1515/reveh-2022-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
In high-altitude environments, the oxygen and air density are decreased, and the temperature and humidity are low. When individuals enter high-altitude areas, they are prone to suffering from acute mountain sickness (AMS) because they cannot tolerate hypoxia. Headache, fatigue, dizziness, and gastrointestinal reactions are the main symptoms of AMS. When these symptoms cannot be effectively alleviated, they can progress to life-threatening high-altitude pulmonary edema or high-altitude cerebral edema. If the risk of AMS can be effectively assessed before people enter high-altitude areas, then the high-risk population can be promptly discouraged from entering the area, or drug intervention can be established in advance to prevent AMS occurrence and avoid serious outcomes. This article reviews recent studies related to the early-warning biological indicators of AMS to provide a new perspective on the prevention of AMS.
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Affiliation(s)
- Yan Guo
- Medical College of Soochow University, Suzhou, Jiangsu Province, China
- Department of Pathology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Xiao Liu
- Department of Basic Medical Sciences, The 960th Hospital of PLA, Jinan, Shandong Province, China
| | - Qiang Zhang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Zhongshan Shi
- Department of Intensive Care Medicine, Ge er mu People's Hospital, Ge er mu, Qinghai Province, China
| | - Menglan Zhang
- Department of Pathology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Jie Chen
- Department of Pathology, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
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10
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Liebold F, Adler W, Jansen S, Klussmann JP, Meyer M, Nehrlich L, Schmitz J, Vingerhoets A, Heindl LM, Hinkelbein J. Evaluation of colour vision impairment during acute hypobaric hypoxia in aviation medicine: a randomized controlled trial. J Physiol Sci 2024; 74:6. [PMID: 38311742 PMCID: PMC10840265 DOI: 10.1186/s12576-024-00898-4] [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: 09/16/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
The digitization of aircraft cockpits places high demands on the colour vision of pilots. The present study investigates colour vision changes upon acute exposure to hypobaric hypoxia. The digital Waggoner Computerized Color Vision Test and the Waggoner D-15 were performed by 54 healthy volunteers in a decompression chamber. Respective altitude levels were sea level, 10,000 or 15,000 ft for exposure periods of 15 and 60 min, respectively. As for 60 min of exposure a significant decrease in colour perception was found between subjects at 15,000 ft as compared to the control group as well as between subjects at 15,000 ft as compared to subjects at 10,000 ft. No significant difference was found in the comparison within the 15,000 ft groups across time points pre-, peri-, and post-exposure. Thus, pilots appear to experience only minor colour vision impairment up to an exposure altitude of 15,000 ft over 60 min of exposure.
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Affiliation(s)
- F Liebold
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Cologne, Cologne, Germany.
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - W Adler
- Institute for Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - S Jansen
- Department of Otorhinolaryngology, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - J P Klussmann
- Department of Otorhinolaryngology, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - M Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - L Nehrlich
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - J Schmitz
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
- Department of Sleep and Human Factor, German Aerospace Centre, Linder Höhe, 51147, Cologne, Germany
| | - A Vingerhoets
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - L M Heindl
- Department of Ophthalmology, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - J Hinkelbein
- Johannes Wesling Klinikum Minden, University Hospital, Ruhr University Bochum, Bochum, Germany
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11
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Liu M, Jiao X, Li R, Li J, Wang L, Wang L, Wang Y, Lv C, Huang D, Wei R, Wang L, Ji X, Guo X. Effects of acetazolamide combined with remote ischemic preconditioning on risk of acute mountain sickness: a randomized clinical trial. BMC Med 2024; 22:4. [PMID: 38166913 PMCID: PMC10762951 DOI: 10.1186/s12916-023-03209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We aimed to determine whether and how the combination of acetazolamide and remote ischemic preconditioning (RIPC) reduced the incidence and severity of acute mountain sickness (AMS). METHODS This is a prospective, randomized, open-label, blinded endpoint (PROBE) study involving 250 healthy volunteers. Participants were randomized (1:1:1:1:1) to following five groups: Ripc (RIPC twice daily, 6 days), Rapid-Ripc (RIPC four times daily, 3 days), Acetazolamide (twice daily, 2 days), Combined (Acetazolamide plus Rapid-Ripc), and Control group. After interventions, participants entered a normobaric hypoxic chamber (equivalent to 4000 m) and stayed for 6 h. The primary outcomes included the incidence and severity of AMS, and SpO2 after hypoxic exposure. Secondary outcomes included systolic and diastolic blood pressure, and heart rate after hypoxic exposure. The mechanisms of the combined regime were investigated through exploratory outcomes, including analysis of venous blood gas, complete blood count, human cytokine antibody array, ELISA validation for PDGF-AB, and detection of PDGF gene polymorphisms. RESULTS The combination of acetazolamide and RIPC exhibited powerful efficacy in preventing AMS, reducing the incidence of AMS from 26.0 to 6.0% (Combined vs Control: RR 0.23, 95% CI 0.07-0.70, P = 0.006), without significantly increasing the incidence of adverse reactions. Combined group also showed the lowest AMS score (0.92 ± 1.10). Mechanistically, acetazolamide induced a mild metabolic acidosis (pH 7.30 ~ 7.31; HCO3- 18.1 ~ 20.8 mmol/L) and improved SpO2 (89 ~ 91%) following hypoxic exposure. Additionally, thirty differentially expressed proteins (DEPs) related to immune-inflammatory process were identified after hypoxia, among which PDGF-AB was involved. Further validation of PDGF-AB in all individuals showed that both acetazolamide and RIPC downregulated PDGF-AB before hypoxic exposure, suggesting a possible protective mechanism. Furthermore, genetic analyses demonstrated that individuals carrying the PDGFA rs2070958 C allele, rs9690350 G allele, or rs1800814 G allele did not display a decrease in PDGF-AB levels after interventions, and were associated with a higher risk of AMS. CONCLUSIONS The combination of acetazolamide and RIPC exerts a powerful anti-hypoxic effect and represents an innovative and promising strategy for rapid ascent to high altitudes. Acetazolamide improves oxygen saturation. RIPC further aids acetazolamide, which synergistically regulates PDGF-AB, potentially involved in the pathogenesis of AMS. TRIAL REGISTRATION ClinicalTrials.gov NCT05023941.
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Affiliation(s)
- Moqi Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xueqiao Jiao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Rui Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jialu Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lu Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Liyan Wang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Yishu Wang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Chunmei Lv
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Dan Huang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Ran Wei
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Liming Wang
- Department of Internal Medicine, Beijing Xiaotangshan Hospital, Beijing, 102211, China
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiuhai Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
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12
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Zhao Y, Zou H, Fan W, Liu Y, Chen X, Huang Y, Yuan R. Patterns of Structural Changes in the Fundus Measured by Optical Coherence Tomography Angiography as Potential Markers of Acute Mountain Sickness. Transl Vis Sci Technol 2023; 12:15. [PMID: 38088829 PMCID: PMC10720760 DOI: 10.1167/tvst.12.12.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/03/2023] [Indexed: 12/17/2023] Open
Abstract
Purpose To use optical coherence tomography angiography (OCTA) to assess the pattern of changes in retinal and choroidal blood flow and structure in healthy volunteers who quickly went from sea level to a plateau and to determine the parameters associated with acute mountain sickness (AMS). Methods Forty-five individuals (89 eyes) were examined by OCTA and filled out the AMS questionnaire. One baseline examination was performed on the plain, followed by examinations at days 1, 3, and 5 after entering the plateau. Parameters were self-controlled to explore patterns of change, analyzed for correlation with AMS score, and modeled as a nomogram of AMS risk. Results On the plateau compared to the plain, vascular morphology showed dilated superficial macular retinal vessels and constricted deeper layers with increased vessel length density and fractal dimension; vessel density increased in all retinal strata and decreased in the choroidal macrovascular layer; and thickness increased except for a decrease in mean retinal thickness in the central macular sulcus. The rate of increase in retinal nerve fiber layer (RNFL) thickness in the inner and outer macular rings correlated with AMS score (r = -0.211). The nomogram showed moderate accuracy (AUC = 0.672) and consistency (C-index = 0.659) in assessing AMS risk. Conclusions In high-altitude hypoxia, retinal vessels dilate and distort, resulting in increased blood flow density and thickness. Increased RNFL thickness in the paracentral macula may be a marker of low AMS risk. Translational Relevance The changes in the retinal structure of the fundus can be used to assess the risk of developing AMS.
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Affiliation(s)
- Yuancheng Zhao
- Department of Ophthalmology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Huan Zou
- Department of Ophthalmology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Wei Fan
- Department of Ophthalmology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yuqi Liu
- Department of Ophthalmology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiaofan Chen
- Department of Ophthalmology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yanming Huang
- Department of Ophthalmology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Rongdi Yuan
- Department of Ophthalmology, Second Affiliated Hospital of Army Medical University, Chongqing, China
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13
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Litvinova O, Hammerle FP, Stoyanov J, Ksepka N, Matin M, Ławiński M, Atanasov AG, Willschke H. Patent and Bibliometric Analysis of the Scientific Landscape of the Use of Pulse Oximeters and Their Prospects in the Field of Digital Medicine. Healthcare (Basel) 2023; 11:3003. [PMID: 37998496 PMCID: PMC10671755 DOI: 10.3390/healthcare11223003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
This study conducted a comprehensive patent and bibliometric analysis to elucidate the evolving scientific landscape surrounding the development and application of pulse oximeters, including in the field of digital medicine. Utilizing data from the Lens database for the period of 2000-2023, we identified the United States, China, the Republic of Korea, Japan, Canada, Australia, Taiwan, and the United Kingdom as the predominant countries in patent issuance for pulse oximeter technology. Our bibliometric analysis revealed a consistent temporal trend in both the volume of publications and citations, underscoring the growing importance of pulse oximeters in digitally-enabled medical practice. Using the VOSviewer software(version 1.6.18), we discerned six primary research clusters: (1) measurement accuracy; (2) integration with the Internet of Things; (3) applicability across diverse pathologies; (4) telemedicine and mobile applications; (5) artificial intelligence and deep learning; and (6) utilization in anesthesiology, resuscitation, and intensive care departments. The findings of this study indicate the prospects for leveraging digital technologies in the use of pulse oximetry in various fields of medicine, with implications for advancing the understanding, diagnosis, prevention, and treatment of cardio-respiratory pathologies. The conducted patent and bibliometric analysis allowed the identification of technical solutions to reduce the risks associated with pulse oximetry: improving precision and validity, technically improved clinical diagnostic use, and the use of machine learning.
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Affiliation(s)
- Olena Litvinova
- Department of Management and Quality Assurance in Pharmacy, National University of Pharmacy, Ministry of Health of Ukraine, 61002 Kharkiv, Ukraine
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
| | - Fabian Peter Hammerle
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Anesthesia, General Intensiv Care and Pain Management, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Natalia Ksepka
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
| | - Maima Matin
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
| | - Michał Ławiński
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
- Department of General, Gastroenterologic and Oncologic Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Anesthesia, General Intensiv Care and Pain Management, Medical University of Vienna, 1090 Vienna, Austria
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14
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Prosperi P, Verratti V, Bondi D, Spacone A. On pulse oximetry and hypoxia. Respir Physiol Neurobiol 2023; 315:104111. [PMID: 37406841 DOI: 10.1016/j.resp.2023.104111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Pierpaolo Prosperi
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
| | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" Chieti - Pescara, 66100 Chieti, Italy.
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti - Pescara, 66100 Chieti, Italy.
| | - Antonella Spacone
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
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15
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Prosperi P, Verratti V, Taverna A, Rua R, Bonan S, Rapacchiale G, Bondi D, Di Giulio C, Lorkowski J, Spacone A. Ventilatory function and oxygen delivery at high altitude in the Himalayas. Respir Physiol Neurobiol 2023:104086. [PMID: 37257573 DOI: 10.1016/j.resp.2023.104086] [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: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
This study aimed to evaluate changes in lung function assessed by spirometry and blood gas content in healthy high-altitude sojourners during a trek in the Himalayas. A group of 19 Italian adults (11 males and 8 females, mean age 43 ±15 years, and BMI 24.2 ±3.7kg/m2) were evaluated as part of a Mount Everest expedition in Nepal. Spirometry and arterial blood gas content were evaluated at baseline in Kathmandu (≈1400m), at the Pyramid Laboratory - Observatory (peak altitude of ≈5000m), and on return to Kathmandu 2-3 days after arrival at each site. All participants took 250mg of acetazolamide per os once daily during the ascent. We found that arterial hemoglobin saturation, O2 and CO2 partial pressures, and the bicarbonate level all decreased (in all cases, p<0.001 with R2=0.70-0.90), while pHa was maintained stable at the peak altitude. Forced vital capacity (FVC) remained stable, while forced expiratory volume in 1sec (FEV1) decreased (p=0.010, n2p=0.228), resulting in a lower FEV1/FVC ratio (p<0.001, n2p=0.380). The best predictor for acute mountain sickness was the O2 partial pressure at the peak altitude (p=0.004, R2=0.39). Finger pulse oximetry overestimated peripheral saturation relative to arterial saturation. We conclude that high-altitude hypoxia alters the respiratory function and the oxygen saturation of the arterial blood hemoglobin. Additionally, air rarefaction and temperature reduction, favoring hypoxic bronchoconstriction, could affect respiration. Pulse oximetry seems not enough to assist medical decisions at high altitudes.
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Affiliation(s)
- Pierpaolo Prosperi
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
| | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Alberto Taverna
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy.
| | - Riccardo Rua
- Department of Anesthesia, Critical Care, and Emergency, University of Turin, 10126 Turin, Italy.
| | - Sofia Bonan
- Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Giorgia Rapacchiale
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Camillo Di Giulio
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Jacek Lorkowski
- Department of Orthopedics, Traumatology, and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, 02-507 Warsaw, Pol.
| | - Antonella Spacone
- Department of Pneumology and Respiratory Physiopathology, S. Spirito Hospital, 66020 Pescara, Italy.
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16
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Wu Y, Zhou S, Li Y, Huang P, Zhong Z, Dong H, Tian H, Jiang S, Xie J, Li P. Remote ischemic preconditioning improves spatial memory and sleep of young males during acute high-altitude exposure. Travel Med Infect Dis 2023; 53:102576. [PMID: 37068619 DOI: 10.1016/j.tmaid.2023.102576] [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: 01/20/2023] [Revised: 03/28/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The high-altitude hypoxia environment will cause poor acclimatization in a portion of the population. Remote ischemic preconditioning(RIPC)has been demonstrated to prevent cardiovascular and cerebrovascular diseases under ischemic or hypoxic conditions. However, its role in improving acclimatization and preventing acute mountain sickness (AMS) at high altitude has been undetermined. This study aims to estimate the effect of RIPC on acclimatization of individuals exposed to high altitude. METHODS The project was designed as a randomized controlled trial with 82 healthy young males, who received RIPC training once a day for 7 consecutive days. Then they were transported by aircraft to a high altitude (3680 m) and examined for 6 days. Lake Louise Score(LLS) of AMS, physiological index, self-reported sleep pattern, and Pittsburgh Sleep Quality Index(PSQI)score were applied to assess the acclimatization to the high altitude. Five neurobehavioral tests were conducted to assess cognitive function. RESULTS The result showed that the RIPC group had a significantly lower AMSscore than the control group (2.43 ± 1.58 vs 3.29 ± 2.03, respectively; adjusted mean difference-0.84, 95% confidence interval-1.61 to -0.06, P = 0.036). and there was no significant difference in AMS incidence between the two groups (25.0% vs 28.57%, P = 0.555). The RIPC group performed better than the control group in spatial memory span score (11[9-12] vs 10[7.5-11], P=0.025) and the passing digit (7[6-7.5] vs 6[5-7], P= 0.001). Spatial memory was significantly higher in the high-altitude RIPC group than in the low-altitude RIPC group (P<0.01). And the RIPC group obtained significantly lower self-reported sleep quality score (P = 0.024) and PSQI score (P = 0.031). CONCLUSIONS The RIPC treatment improved spatial memory and sleep quality in subjects exposed to acute hypoxic exposure and this may lead to improved performance at high altitude.
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Affiliation(s)
- Yu Wu
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China
| | - Simin Zhou
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China
| | - Yaling Li
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China
| | - Pei Huang
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China
| | - Zhifeng Zhong
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China
| | - Huaping Dong
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China
| | - Huaijun Tian
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China
| | - Shuai Jiang
- Department of Health, The 12th Integrated Training Base of Army, Chongqing, China
| | - Jiaxin Xie
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China.
| | - Peng Li
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University, Chongqing, China; Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China; Key Laboratory of High Altitude Medicine, Army Medical University, Chongqing, China.
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17
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Sharma KP. Temporary hypoxemia at high altitude in an intensive care unit physician. SAGE Open Med Case Rep 2023; 11:2050313X231153526. [PMID: 36776206 PMCID: PMC9909067 DOI: 10.1177/2050313x231153526] [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: 11/11/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
A 42-year-old pediatric intensive care unit physician traveled to Nepal and took a helicopter trip to Everest Base Camp. The helicopter reached an altitude of 5500 m during flight and descended at different destinations with varying altitudes. At Hotel Everest View at 3820 m, his oxygen saturation was 79%. He had mild tachypnea and deep breathing but was able to walk around, jump, and take photographs. He returned to Kathmandu (altitude, 1324 m) without using any supplemental oxygen during the entire trip. Based on calculations with the alveolar gas equation, he observed that he and his fellow passengers probably had hypoxemia during the trip. In summary, temporary hypoxemia associated with high altitude in healthy individuals without cardiorespiratory compromise may not require oxygen therapy. In contrast, intensive care unit patients who have respiratory failure may have similar oxygen saturation levels but may require oxygen therapy and mechanical ventilation. The oxygen saturation level must be interpreted in consideration of the clinical scenario before deciding about the need for oxygen therapy.
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Affiliation(s)
- Kamal P Sharma
- Kamal P Sharma, Children & Women’s Hospital, University of South Alabama College of Medicine, 1700 Center Street, Mobile, AL 36604, USA.
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Mallet RT, Burtscher J, Pialoux V, Pasha Q, Ahmad Y, Millet GP, Burtscher M. Molecular Mechanisms of High-Altitude Acclimatization. Int J Mol Sci 2023; 24:ijms24021698. [PMID: 36675214 PMCID: PMC9866500 DOI: 10.3390/ijms24021698] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
High-altitude illnesses (HAIs) result from acute exposure to high altitude/hypoxia. Numerous molecular mechanisms affect appropriate acclimatization to hypobaric and/or normobaric hypoxia and curtail the development of HAIs. The understanding of these mechanisms is essential to optimize hypoxic acclimatization for efficient prophylaxis and treatment of HAIs. This review aims to link outcomes of molecular mechanisms to either adverse effects of acute high-altitude/hypoxia exposure or the developing tolerance with acclimatization. After summarizing systemic physiological responses to acute high-altitude exposure, the associated acclimatization, and the epidemiology and pathophysiology of various HAIs, the article focuses on molecular adjustments and maladjustments during acute exposure and acclimatization to high altitude/hypoxia. Pivotal modifying mechanisms include molecular responses orchestrated by transcription factors, most notably hypoxia inducible factors, and reciprocal effects on mitochondrial functions and REDOX homeostasis. In addition, discussed are genetic factors and the resultant proteomic profiles determining these hypoxia-modifying mechanisms culminating in successful high-altitude acclimatization. Lastly, the article discusses practical considerations related to the molecular aspects of acclimatization and altitude training strategies.
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Affiliation(s)
- Robert T. Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, CH-1005 Lausanne, Switzerland
- Institute of Sport Sciences, University of Lausanne, CH-1005 Lausanne, Switzerland
| | - Vincent Pialoux
- Inter-University Laboratory of Human Movement Biology EA7424, University Claude Bernard Lyon 1, University of Lyon, FR-69008 Lyon, France
| | - Qadar Pasha
- Institute of Hypoxia Research, New Delhi 110067, India
| | - Yasmin Ahmad
- Defense Institute of Physiology & Allied Sciences (DIPAS), Defense Research & Development Organization(DRDO), New Delhi 110054, India
| | - Grégoire P. Millet
- Department of Biomedical Sciences, University of Lausanne, CH-1005 Lausanne, Switzerland
- Institute of Sport Sciences, University of Lausanne, CH-1005 Lausanne, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, A-6020 Innsbruck, Austria
- Austrian Society for Alpine and High-Altitude Medicine, A-6020 Innsbruck, Austria
- Correspondence:
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Furian M, Tannheimer M, Burtscher M. Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease. J Clin Med 2022; 11:6699. [PMID: 36431176 PMCID: PMC9697047 DOI: 10.3390/jcm11226699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and related VO2max in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO2, of VO2max and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases. Moreover, focus was set on potential differences with regard to baseline exercise performance, age and sex. Main findings of this review emphasize the close association between individual SpO2 and VO2max, and demonstrate similar altitude effects (acute and during acclimatization) in healthy people and those suffering from cardiovascular and metabolic diseases. However, in patients with ventilatory constrains, i.e., chronic obstructive pulmonary disease, steep decline in SpO2 and V̇O2max and reduced potential to acclimatize stress the already low exercise performance. Finally, implications for prevention and therapy are briefly discussed.
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Affiliation(s)
- Michael Furian
- Pulmonary Division, University Hospital Zurich, 8092 Zurich, Switzerland
- Research Department, Swiss University of Traditional Chinese Medicine, 5330 Bad Zurzach, Switzerland
| | - Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, 89075 Ulm, Germany
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
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20
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Pulse Oximeter Performance during Rapid Desaturation. SENSORS 2022; 22:s22114236. [PMID: 35684858 PMCID: PMC9185462 DOI: 10.3390/s22114236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
The reliability of pulse oximetry is crucial, especially in cases of rapid changes in body oxygenation. In order to evaluate the performance of pulse oximeters during rapidly developing short periods of concurrent hypoxemia and hypercapnia, 13 healthy volunteers underwent 3 breathing phases during outdoor experiments (39 phases in total), monitored simultaneously by five different pulse oximeters. A significant incongruity in values displayed by the tested pulse oximeters was observed, even when the accuracy declared by the manufacturers were considered. In 28.2% of breathing phases, the five used devices did not show any congruent values. The longest uninterrupted congruent period formed 74.4% of total recorded time. Moreover, the congruent periods were rarely observed during the critical desaturation phase of the experiment. The time difference between the moments when the first and the last pulse oximeter showed the typical study endpoint values of SpO2 85% and 75% was 32.1 ± 23.6 s and 24.7 ± 19.3 s, respectively. These results suggest that SpO2 might not be a reliable parameter as a study endpoint, or more importantly as a safety limit in outdoor experiments. In the design of future studies, more parameters and continuous clinical assessment should be included.
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21
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Cabanas AM, Fuentes-Guajardo M, Latorre K, León D, Martín-Escudero P. Skin Pigmentation Influence on Pulse Oximetry Accuracy: A Systematic Review and Bibliometric Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:3402. [PMID: 35591092 PMCID: PMC9102088 DOI: 10.3390/s22093402] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Nowadays, pulse oximetry has become the standard in primary and intensive care units, especially as a triage tool during the current COVID-19 pandemic. Hence, a deeper understanding of the measurement errors that can affect precise readings is a key element in clinical decision-making. Several factors may influence the accuracy of pulse oximetry, such as skin color, body temperature, altitude, or patient movement. The skin pigmentation effect on pulse oximetry accuracy has long been studied reporting some contradictory conclusions. Recent studies have shown a positive bias in oxygen saturation measurements in patients with darkly pigmented skin, particularly under low saturation conditions. This review aims to study the literature that assesses the influence of skin pigmentation on the accuracy of these devices. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to conduct a systematic review retrospectively since February 2022 using WOS, PubMed, and Scopus databases. We found 99 unique references, of which only 41 satisfied the established inclusion criteria. A bibliometric and scientometrics approach was performed to examine the outcomes of an exhaustive survey of the thematic content and trending topics.
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Affiliation(s)
- Ana M. Cabanas
- Departamento de Física, Universidad de Tarapacá, Arica 1010069, Chile
| | | | - Katina Latorre
- Departamento de Tecnología Médica, Universidad de Tarapacá, Arica 1010069, Chile; (M.F.-G.); (K.L.)
| | - Dayneri León
- Departamento de Educación Física, Universidad de Tarapacá, Arica 1010069, Chile;
| | - Pilar Martín-Escudero
- Medical School of Sport Medicine, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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22
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Martín-Escudero P, Cabanas AM, Fuentes-Ferrer M, Galindo-Canales M. Oxygen Saturation Behavior by Pulse Oximetry in Female Athletes: Breaking Myths. BIOSENSORS-BASEL 2021; 11:bios11100391. [PMID: 34677347 PMCID: PMC8534025 DOI: 10.3390/bios11100391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022]
Abstract
The myths surrounding women’s participation in sport have been reflected in respiratory physiology. This study aims to demonstrate that continuous monitoring of blood oxygen saturation during a maximal exercise test in female athletes is highly correlated with the determination of the second ventilatory threshold (VT2) or anaerobic threshold (AnT). The measurements were performed using a pulse oximeter during a maximum effort test on a treadmill on a population of 27 healthy female athletes. A common behavior of the oxygen saturation evolution during the incremental exercise test characterized by a decrease in saturation before the aerobic threshold (AeT) followed by a second significant drop was observed. Decreases in peripheral oxygen saturation during physical exertion have been related to the athlete’s physical fitness condition. However, this drop should not be a limiting factor in women’s physical performance. We found statistically significant correlations between the maximum oxygen uptake and the appearance of the ventilatory thresholds (VT1 and VT2), the desaturation time, the total test time, and between the desaturation time and the VT2. We observed a relationship between the desaturation time and the VT2 appearance. Indeed, a linear regression model between the desaturation time and the VT2 appearance can predict 80% of the values in our sample. Besides, we suggest that pulse oximetry is a simple, fairly accurate, and non-invasive technique for studying the physical condition of athletes who perform physical exertion.
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Affiliation(s)
- Pilar Martín-Escudero
- Professional Medical School of Physical Education and Sport, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-E.); (M.G.-C.)
| | - Ana María Cabanas
- Departamento de Física, Universidad de Tarapacá, Arica 1010064, Chile
- Correspondence:
| | - Manuel Fuentes-Ferrer
- Unit of Clinical Management (UGC), Department of Preventive Medicine, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Mercedes Galindo-Canales
- Professional Medical School of Physical Education and Sport, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (P.M.-E.); (M.G.-C.)
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23
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Schiefer LM, Treff G, Treff F, Schmidt P, Schäfer L, Niebauer J, Swenson KE, Swenson ER, Berger MM, Sareban M. Validity of Peripheral Oxygen Saturation Measurements with the Garmin Fēnix ® 5X Plus Wearable Device at 4559 m. SENSORS 2021; 21:s21196363. [PMID: 34640680 PMCID: PMC8513012 DOI: 10.3390/s21196363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/11/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Abstract
Decreased oxygen saturation (SO2) at high altitude is associated with potentially life-threatening diseases, e.g., high-altitude pulmonary edema. Wearable devices that allow continuous monitoring of peripheral oxygen saturation (SpO2), such as the Garmin Fēnix® 5X Plus (GAR), might provide early detection to prevent hypoxia-induced diseases. We therefore aimed to validate GAR-derived SpO2 readings at 4559 m. SpO2 was measured with GAR and the medically certified Covidien Nellcor SpO2 monitor (COV) at six time points in 13 healthy lowlanders after a rapid ascent from 1130 m to 4559 m. Arterial blood gas (ABG) analysis served as the criterion measure and was conducted at four of the six time points with the Radiometer ABL 90 Flex. Validity was assessed by intraclass correlation coefficients (ICCs), mean absolute percentage error (MAPE), and Bland–Altman plots. Mean (±SD) SO2, including all time points at 4559 m, was 85.2 ± 6.2% with GAR, 81.0 ± 9.4% with COV, and 75.0 ± 9.5% with ABG. Validity of GAR was low, as indicated by the ICC (0.549), the MAPE (9.77%), the mean SO2 difference (7.0%), and the wide limits of agreement (−6.5; 20.5%) vs. ABG. Validity of COV was good, as indicated by the ICC (0.883), the MAPE (6.15%), and the mean SO2 difference (0.1%) vs. ABG. The GAR device demonstrated poor validity and cannot be recommended for monitoring SpO2 at high altitude.
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Affiliation(s)
- Lisa M. Schiefer
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
- Ludwig Boltzmann Institute for Digital Health and Prevention, 5020 Salzburg, Austria;
| | - Gunnar Treff
- Division of Sports and Rehabilitation Medicine, University of Ulm, 89075 Ulm, Germany;
| | - Franziska Treff
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
| | - Peter Schmidt
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
| | - Larissa Schäfer
- Department of Anesthesiology, Critical Care and Pain Medicine, Paracelsus Medical University, 5020 Salzburg, Austria; (L.M.S.); (F.T.); (P.S.); (L.S.)
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, 5020 Salzburg, Austria;
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kai E. Swenson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Erik R. Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA 98108, USA;
| | - Marc M. Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg Essen, 45147 Essen, Germany;
| | - Mahdi Sareban
- Ludwig Boltzmann Institute for Digital Health and Prevention, 5020 Salzburg, Austria;
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-57-255-23200
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24
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Hypoxic Exercise Exacerbates Hypoxemia and Acute Mountain Sickness in Obesity: A Case Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179078. [PMID: 34501667 PMCID: PMC8430682 DOI: 10.3390/ijerph18179078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 12/21/2022]
Abstract
Acute mountain sickness (AMS) is a common syndrome characterized by headache, dizziness, loss of appetite, weakness, and nausea. As a major public health issue, obesity has increased in high altitude urban residents and intermittent commuters to high altitudes. The present study investigated acute hypoxic exposure and hypoxic exercise on hypoxemia severity and AMS symptoms in a physically active obese man. In this case analysis, peripheral oxygen saturation (SpO2) was used to evaluate hypoxemia, heart rate (HR) and blood pressure (BP) were used to reflect the function of autonomic nervous system (ANS), and Lake Louise scoring (LLS) was used to assess AMS. The results showed that acute hypoxic exposure led to severe hypoxemia (SpO2 = 72%) and tachycardia (HRrest = 97 bpm), and acute hypoxic exercise exacerbated severe hypoxemia (SpO2 = 59%) and ANS dysfunction (HRpeak = 167 bpm, SBP/DBP = 210/97 mmHg). At the end of the 6-h acute hypoxic exposure, the case developed severe AMS (LLS = 10) symptoms of headache, gastrointestinal distress, cyanosis, vomiting, poor appetite, and fatigue. The findings of the case study suggest that high physical activity level appears did not show a reliable protective effect against severe hypoxemia, ANS dysfunction, and severe AMS symptoms in acute hypoxia exposure and hypoxia exercise.
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25
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Beall CM, Childs G, Craig SR, Strohl KP, Quinn E, Basnyat B. Repeatability of adaptive traits among ethnic Tibetan highlanders. Am J Hum Biol 2021; 34:e23670. [PMID: 34424596 DOI: 10.1002/ajhb.23670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/31/2021] [Accepted: 08/11/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Connecting traits to biological pathways and genes relies on stable observations. Researchers typically determine traits once, expecting careful study protocols to yield measurements free of noise. This report examines that expectation with test-retest repeatability analyses for traits used regularly in research on adaptation to high-altitude hypoxia, often in settings without climate control. METHODS Two hundred ninety-one ethnic Tibetan women residing from 3500 to 4200 m in Upper Mustang District, Nepal, provided three observations of hemoglobin concentration, percent of oxygen saturation of hemoglobin, and pulse by noninvasive pulse oximetry under conditions designed to minimize environmental noise. RESULTS High-intraclass correlation coefficients and low within-subject coefficients of variation reflected consistent measurements. Percent of oxygen saturation had the highest intraclass correlation coefficient and the smallest within-subject coefficient of variability; measurement noise occurred mainly in the lower values. Hemoglobin concentration and pulse presented slightly higher within-subject coefficients of variation; measurement noise occurred across the range of values. The women had performed the same measurements 7 years earlier using the same devices and protocol. The sample means and SD observed across 7 years differed little. Hemoglobin concentration increased substantially after menopause. CONCLUSIONS Analyzing repeatability features of traits may improve our interpretation of statistical analyses and detection of variation from measurement or biology. The high levels of measurement repeatability and biological stability support the continued use of these robust traits for investigating human adaptation in this altitude range.
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Affiliation(s)
- Cynthia M Beall
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Geoff Childs
- Department of Anthropology, Washington University, St. Louis, Missouri, USA
| | - Sienna R Craig
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire, USA
| | - Kingman P Strohl
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Elizabeth Quinn
- Department of Anthropology, Washington University, St. Louis, Missouri, USA
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26
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Xiang ZQ, Huang YL, Luo GL, Ma HL, Zhang DL. Decreased Event-Related Desynchronization of Mental Rotation Tasks in Young Tibetan Immigrants. Front Hum Neurosci 2021; 15:664039. [PMID: 34276324 PMCID: PMC8278785 DOI: 10.3389/fnhum.2021.664039] [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: 02/04/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to explore the cortical activity underlying mental rotation in high-altitude immigrants via the event-related desynchronization (ERD), the electroencephalogram time–frequency analysis, and source localization based on electroencephalographic data. When compared with the low-altitude individuals, the reaction time of mental rotation tasks was significantly slower in immigrants who had lived in high-altitude areas for 3 years. The time–frequency analysis showed that the alpha ERD and the beta ERD within the time window (400–700 ms) were decreased during the mental rotation tasks in these immigrants. The decreased ERD was observed at the parietal–occipital regions within the alpha band and at the central–parietal regions within the beta band. The decreased ERD might embody the sensorimotor-related cortical activity from hypoxia, which might be involved in cognitive control function in high-altitude immigrants, which provided insights into the neural mechanism of spatial cognition change on aspect of embodied cognition due to high-altitude exposure.
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Affiliation(s)
- Zu-Qiang Xiang
- Department of Psychology, School of Education, Guangzhou University, Guangzhou, China
| | - Yi-Lin Huang
- Department of Psychology, School of Education, Guangzhou University, Guangzhou, China
| | - Guang-Li Luo
- Department of Psychology, School of Education, Guangzhou University, Guangzhou, China.,The Fourth Primary School of Qiaotou Town, Dongguan, China
| | - Hai-Lin Ma
- Plateau Brain Science Research Center, Tibet University, Lhasa, China.,Plateau Brain Science Research Center, South China Normal University, Guangzhou, China
| | - De-Long Zhang
- Plateau Brain Science Research Center, Tibet University, Lhasa, China.,Plateau Brain Science Research Center, South China Normal University, Guangzhou, China.,Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China.,School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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27
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Wearable, Multimodal, Biosignal Acquisition System for Potential Critical and Emergency Applications. Emerg Med Int 2021; 2021:9954669. [PMID: 34221510 PMCID: PMC8213464 DOI: 10.1155/2021/9954669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
For emergency or intensive-care units (ICUs), patients with unclear consciousness or unstable hemodynamics often require aggressive monitoring by multiple monitors. Complicated pipelines or lines increase the burden on patients and inconvenience for medical personnel. Currently, many commercial devices provide related functionalities. However, most devices measure only one biological signal, which can increase the budget for users and cause difficulty in remote integration. In this study, we develop a wearable device that integrates electrocardiography (ECG), electroencephalography (EEG), and blood oxygen machines for medical applications with the hope that it can be applied in the future. We develop an integrated multiple-biosignal recording system based on a modular design. The developed system monitors and records EEG, ECG, and peripheral oxygen saturation (SpO2) signals for health purposes simultaneously in a single setting. We use a logic level converter to connect the developed EEG module (BR8), ECG module, and SpO2 module to a microcontroller (Arduino). The modular data are then smoothly encoded and decoded through consistent overhead byte stuffing (COBS). This developed system has passed simulation tests and exhibited proper functioning of all modules and subsystems. In the future, the functionalities of the proposed system can be expanded with additional modules to support various emergency or ICU applications.
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