Simulations of the human heat balance during Mount Everest summit attempts in spring and winter.

The majority of research dealing with the impacts of the Himalayan climate on human physiology focuses on low air temperature, high wind speed, and low air pressure and oxygen content, potentially leading to hypothermia and hypoxia. Only a few studies describe the influence of the weather conditions in the Himalayas on the body's ability to maintain thermal balance. The aim of the present research is to trace the heat exchange between humans and their surroundings during a typical, 6-day summit attempt of Mount Everest in the spring and winter seasons. Additionally, an emergency night outdoors without tent protection is considered. Daily variation of the heat balance components were calculated by the MENEX_HA model using meteorological data collected at automatic weather stations installed during a National Geographic expedition in 2019-2020. The data represent the hourly values of the measured meteorological parameters. The research shows that in spite of extreme environmental conditions in the sub-summit zone of Mount Everest during the spring weather window, it is possible to keep heat equilibrium of the climbers' body. This can be achieved by the use of appropriate clothing and by regulating activity level. In winter, extreme environmental conditions in the sub-summit zone make it impossible to maintain heat equilibrium and lead to hypothermia. The emergency night in the sub-peak zone leads to gradual cooling of the body which in winter can cause severe hypothermia of the climber's body. At altitudes < 7000 m, climbers should consider using clothing that allows variation of insulation and active regulation of their fit around the body.

Intranasal Therapy in Palliative Care.

In recent years, the use of the intranasal route has been actively explored as a possible drug delivery method in the palliative patient population. There are reports demonstrating the effectiveness of nasally administered medications that are routinely used in patients at the end of life. The subject of this study is the intranasal drug administration among palliative patients. The aim is to summarize currently used intranasal therapies among palliative patients, determine the benefits and difficulties, and identify potential areas for future research. A review of available medical literature published between 2013 and 2023 was performed using online scientific databases. The following descriptors were used when searching for articles: "palliative", "intranasal", "nasal", "end-of-life care", "intranasal drug delivery" and "nasal drug delivery". Out of 774 articles, 55 directly related to the topic were finally selected and thoroughly analyzed. Based on the bibliographic analysis, it was shown that drugs administered intranasally may be a good, effective, and convenient form of treatment for patients receiving palliative care, in both children and adults. This topic requires further, high-quality clinical research.

Recurrent Pulmonary Embolism at High Altitude in a Mountaineer with Hereditary Thrombophilia.

Szymczak, Robert K., Magdalena Sawicka, and Malgorzata Jelitto. Recurrent pulmonary embolism at high altitude in a mountaineer with hereditary thrombophilia. High Alt Med Biol. 00:000-000, 2024.-It is speculated that high-altitude travel is an independent risk factor for thrombosis. Mountaineering-specific factors, such as hypoxia, cold, and immobilization, may interact with patient-specific risk factors and contribute to thrombus formation. We present the case of a mountaineer with hereditary thrombophilia who experienced recurrent pulmonary embolism during high-altitude expeditions.

Heat Balance When Climbing Mount Everest.

Background: Mountaineers must control and regulate their thermal comfort and heat balance to survive the rigors of high altitude environment. High altitudes feature low air pressure and temperatures, strong winds and intense solar radiation, key factors affecting an expedition's success. All these climatic elements stress human heat balance and survival. We assess components of human heat balance while climbing Mt. Everest. Materials and Methods: We calculated climbers' heat balance using the Man-ENvironment heat EXchange model (MENEX-2005) and derived meteorological data from the National Geographic Expedition's in situ dataset. Three weather stations sited between 3810 and 7945 m a.s.l. provided data with hourly resolution. We used data for summer (1 May-15 August 2019) and winter (16 October 2019-6 January 2020) seasons to analyze heat balance elements of convection, evaporation, respiration and radiation (solar and thermal). Results: Meteorological and other factors affecting physiology-such as clothing insulation of 3.5-5.5 clo and activity levels of 3-5 MET-regulate human heat balance. Elevation above sea level is the main element affecting heat balance. In summer two to three times more solar radiation can be absorbed at the summit of the mountain than at the foot. Low air pressure reduces air density, which reduces convective heat loss at high altitude by up to half of the loss at lower locations with the same wind speed and air temperature. Conclusion: 1. Alpinists face little risk of overheating or overcooling while actively climbing Mt. Everest, despite the potential risk of overcooling at extreme altitudes on Mt. Everest in winter. 2. Convection and evaporation are responsible for most of the heat lost at altitude. 3. Levels of physical activity and clothing insulation play the greatest role in counteracting heat loss at high altitude.

Transient and Recurrent Vision Loss in a High-Altitude Porter from Pakistan on a Polish Winter Karakoram Expedition.

Visual sensations appear in most migraine auras, but binocular blindness is uncommon. We described a case of multiple transient losses of vision in a man on a winter expedition to K2. His symptoms were later diagnosed as recurrent visual auras without pain. Sojourns at altitude can induce migraine attack; therefore, susceptible individuals should avoid factors that might provoke migraines at high altitude, such as improper acclimatization, dehydration and an inadequate sleep regime.

Prolonged Sojourn at Very High Altitude Decreases Sea-Level Anaerobic Performance, Anaerobic Threshold, and Fat Mass.

Background: The influence of high altitude on an organism's physiology depends on the length and the level of hypoxic exposure it experiences. This study aimed to determine the effect of a prolonged sojourn at very high altitudes (above 3,500m) on subsequent sea-level physical performance, body weight, body composition, and hematological parameters. Materials and Methods: Ten alpinists, nine males and one female, with a mean age of 27±4years, participated in the study. All had been on mountaineering expeditions to 7,000m peaks, where they spent 30±1days above 3,500m with their average sojourn at 4,900±60m. Their aerobic and anaerobic performance, body weight, body composition, and hematological parameters were examined at an altitude of 100m within 7days before the expeditions and 7days after they descended below 3,500m. Results: We found a significant (p<0.01) decrease in maximal anaerobic power (MAPWAnT) from 9.9±1.3 to 9.2±1.3W·kg-1, total anaerobic work from 248.1±23.8 to 228.1±20.1J·kg-1, anaerobic threshold from 39.3±8.0 to 27.8±5.6 mlO2·kg-1·min-1, body fat mass from 14.0±3.1 to 11.5±3.3%, and a significant increase (p<0.05) in maximal tidal volume from 3.2 [3.0-3.2] to 3.5 [3.3-3.9] L after their sojourn at very high attitude. We found no significant changes in maximal aerobic power, maximal oxygen uptake, body weight, fat-free mass, total body water, hemoglobin, and hematocrit. Conclusion: A month-long exposure to very high altitude led to impaired sea-level anaerobic performance and anaerobic threshold, increased maximal tidal volume, and depleted body fat mass, but had no effect on maximal aerobic power, maximal oxygen uptake, or hemoglobin and hematocrit levels.

Death Zone Weather Extremes Mountaineers Have Experienced in Successful Ascents.

BACKGROUND: Few data are available on mountaineers' survival prospects in extreme weather above 8000 m (the Death Zone). We aimed to assess Death Zone weather extremes experienced in climbing-season ascents of Everest and K2, all winter ascents of 8000 m peaks (8K) in the Himalayas and Karakoram, environmental records of human survival, and weather extremes experienced with and without oxygen support. MATERIALS AND METHODS: We analyzed 528 ascents of 8K peaks: 423 non-winter ascents without supplemental oxygen (Everest-210, K2-213), 76 ascents in winter without oxygen, and 29 in winter with oxygen. We assessed environmental conditions using the ERA5 dataset (1978-2021): barometric pressure (BP), temperature (Temp), wind speed (Wind), wind chill equivalent temperature (WCT), and facial frostbite time (FFT). RESULTS: The most extreme conditions that climbers have experienced with and without supplemental oxygen were: BP 320 hPa (winter Everest) vs. 329 hPa (non-winter Everest); Temp -41°C (winter Everest) vs. -45°C (winter Nanga Parbat); Wind 46 m⋅s-1 (winter Everest) vs. 48 m⋅s-1 (winter Kangchenjunga). The most extreme combined conditions of BP ≤ 333 hPa, Temp ≤ -30°C, Wind ≥ 25 m⋅s-1, WCT ≤ -54°C and FFT ≤ 3 min were encountered in 14 ascents of Everest, two without oxygen (late autumn and winter) and 12 oxygen-supported in winter. The average extreme conditions experienced in ascents with and without oxygen were: BP 326 ± 3 hPa (winter Everest) vs. 335 ± 2 hPa (non-winter Everest); Temp -40 ± 0°C (winter K2) vs. -38 ± 5°C (winter low Karakoram 8K peaks); Wind 36 ± 7 m⋅s-1 (winter Everest) vs. 41 ± 9 m⋅s-1 (winter high Himalayan 8K peaks). CONCLUSIONS: 1.The most extreme combined environmental BP, Temp and Wind were experienced in winter and off-season ascents of Everest.2.Mountaineers using supplemental oxygen endured more extreme conditions than climbers without oxygen.3.Climbing-season weather extremes in the Death Zone were more severe on Everest than on K2.4.Extreme wind speed characterized winter ascents of Himalayan peaks, but severely low temperatures marked winter climbs in Karakoram.

Comparison of Environmental Conditions on Summits of Mount Everest and K2 in Climbing and Midwinter Seasons.

(1) Background: Today's elite alpinists target K2 and Everest in midwinter. This study aimed to asses and compare weather at the summits of both peaks in the climbing season (Everest, May; K2, July) and the midwinter season (January and February). (2) Methods: We assessed environmental conditions using the ERA5 dataset (1979-2019). Analyses examined barometric pressure (BP), temperature (Temp), wind speed (Wind), perceived altitude (Alt), maximal oxygen uptake (VO2max), vertical climbing speed (Speed), wind chill equivalent temperature (WCT), and facial frostbite time (FFT). (3) Results: Most climbing-season parameters were found to be more severe (p < 0.05) on Everest than on K2: BP (333 ± 1 vs. 347 ± 1 hPa), Alt (8925 ± 20 vs. 8640 ± 20 m), VO2max (16.2 ± 0.1 vs. 17.8 ± 0.1 ml·kg-1·min-1), Speed (190 ± 2 vs. 223 ± 2 m·h-1), Temp (-26 ± 1 vs. -21 ± 1°C), WCT (-45 ± 2 vs. -37 ± 2 °C), and FFT (6 ± 1 vs. 11 ± 2 min). Wind was found to be similar (16 ± 3 vs. 15 ± 3 m·s-1). Most midwinter parameters were found to be worse (p < 0.05) on Everest vs. K2: BP (324 ± 2 vs. 326 ± 2 hPa), Alt (9134 ± 40 vs. 9095 ± 48 m), VO2max (15.1 ± 0.2 vs. 15.3 ± 0.3 ml·kg-1·min-1), Speed (165 ± 5 vs. 170 ± 6 m·h-1), Wind (41 ± 6 vs. 27 ± 4 m·s-1), and FFT (<1 min vs. 1 min). Everest's Temp of -36 ± 2 °C and WCT -66 ± 3 °C were found to be less extreme than K2's Temp of -45 ± 1 °C and WCT -76 ± 2 °C. (4) Conclusions: Everest presents more extreme conditions in the climbing and midwinter seasons than K2. K2's 8° higher latitude makes its midwinter BP similar and Temp lower than Everest's. K2's midwinter conditions are more severe than Everest's in the climbing season.

Subjective sleep quality alterations at high altitude.

OBJECTIVE: Sleep pattern at high altitude has been studied, mainly with the use of polysomnography. This study aimed to analyze subjective sleep quality at high altitude using the following standardized scales: the Pittsburgh Sleep Quality Index (PSQI) and the Athens Insomnia Scale (AIS-8). METHODS: Thirty-two members of 2 expeditions--28 males and 4 females (mean age 31 years)--participated in this study conducted in Nepal, Himalayas (Lobuche East, 6119 m above sea level [masl]), Kyrgyzstan, Pamirs (Lenin Peak, 7134 masl), and Poland (sea level). The scales were administered twice, at high altitude (mean altitude 4524 masl) and at sea level. RESULTS: Both measures showed a decrease in sleep quality at high altitude (statistical significance, P < .001). Sleep problems affected general sleep quality and sleep induction. Sleep disturbances due to awakenings during the night, temperature-related discomfort, and breathing difficulties were reported. High altitude had no statistically significant effect on sleep duration or daytime dysfunction as measured by PSQI. CONCLUSIONS: The overall results of PSQI and AIS-8 confirm the data based on the climbers' subjective accounts and polysomnographic results reported in previous studies. The introduction of standardized methods of subjective sleep quality assessment might resolve the problem of being able to perform precise evaluations and research in the field of sleep disturbances at high altitude.