Influence of Smoking and Alcohol Habits on Symptoms of Acute Mountain Sickness on Mount Fuji: A Questionnaire Survey-Based Pilot Study.

Horiuchi, Masahiro, Satomi Mitsui, and Tadashi Uno. Influence of smoking and alcohol habits on symptoms of acute mountain sickness on Mount Fuji: a questionnaire survey-based pilot study. High Alt Med Biol 00:000-000, 2024. Background: Acute cigarette smoking or alcohol intake would cause opposing vasculature effects that may influence acute mountain sickness (AMS). The present study aimed to investigate the effects of smoking and alcohol consumption behaviors, and acute smoking and consuming alcohol during ascent on AMS on Mount Fuji. Methods: This questionnaire survey study included 887 participants who climbed Mount Fuji and obtained information regarding sex, age, and smoking and alcohol habits, including behavior during ascent. Results: AMS prevalence was 45% for all participants. A univariate analysis revealed that younger participants (20-29 years) were associated with increased AMS prevalence (effect size [ES] = 0.102, p = 0.057) and severity (ES = 0.18, p = 0.01). A prediction model using multiple logistic regression indicated that several factors influenced AMS risk: younger age (p = 0.001), daily smoking habits (p = 0.021), no smoking (p = 0.033), or alcohol consumption during ascent (p = 0.096). Alcohol consumption during ascent had no effect on the increased AMS risk in younger participants (20-29 years), while alcohol consumption during ascent increased AMS risk for middle-age participants (50-59 years). Conclusion: Younger individuals are more likely to experience AMS. Smoking habits are associated with an increased AMS risk. It may be recommended that middle-aged climbers should ascend without consuming alcohol.

Influence of Step Frequency on the Dynamic Characteristics of Ventilation and Gas Exchange During Sinusoidal Walking in humans.

We tested the hypothesis that restricting either step frequency (SF) or stride length (SL) causes a decrease in ventilatory response with limited breath frequency during sinusoidal walking. In this study, 13 healthy male and female volunteers (mean ± SD; age: 21.5 ± 1.8 years, height: 168 ± 7 cm, weight: 61.5 ± 8.3 kg) participated. The walking speed was sinusoidally changed between 50 and 100 m⋅min-1 with periods from 10 to 1 min. Using a customized sound system, we fixed the SF at 120 steps⋅min-1 with SL variation (0.83-0.41 m) (SF fix ) or fixed the SL at 0.7 m with SF variation (143-71 steps⋅min-1) (SL fix ) during the subjects' sinusoidal walking. Both the subjects' preferred locomotion pattern without a sound system (Free) and the unprompted spontaneous locomotor pattern for each subject (Free) served as the control condition. We measured breath-by-breath ventilation [tidal volume (VT) and breathing frequency (Bf)] and gas exchange [CO2 output ( V . CO2), O2 uptake ( V . O2)]. The amplitude (Amp) and the phase shift (PS) of the fundamental component of the ventilatory and gas exchange variables were calculated. The results revealed that the SF fix condition decreased the Amp of the Bf response compared with SL fix and Free conditions. Notably, the Amp of the Bf response under SF fix was reduced by less than one breath at the periods of 5 and 10 min. In contrast, the SL fix condition resulted in larger Amps of Bf and V . E responses as well as Free. We thus speculate that the steeper slope of the V . E - V . CO2 relationship observed under the SL fix might be attributable to the central feed-forward command or upward information from afferent neural activity by sinusoidal locomotive cadence. The PSs of the V . E , V . O2, and V . CO2 responses were unaffected by any locomotion patterns. Such a sinusoidal wave manipulation of locomotion variables may offer new insights into the dynamics of exercise hyperpnea.

Associations between estimated and measured carotid-femoral pulse wave velocity in older Black and White adults: the atherosclerosis risk in communities (ARIC) study.

Introduction: Aortic stiffness offers important insight into vascular aging and cardiovascular disease (CVD) risk. The referent measure of aortic stiffness is carotid-femoral pulse wave velocity (cfPWV). cfPWV can be estimated (ePWV) from age and mean arterial pressure. Few studies have directly compared the association of ePWV to measured cfPWV, particularly in non-White adults. Moreover, whether ePWV and cfPWV correlate similarly with CVD risk remains unexplored. Aim: (1) To estimate the strength of the agreement between ePWV and cfPWV in both Black and White older adults; and (2) to compare the associations of ePWV and cfPWV with CVD risk factors and determine whether these associations were consistent across races. Methods and Results: We evaluated 4478 [75.2 (SD 5.0) years] Black and White older adults in the Atherosclerosis Risk in Communities (ARIC) Study. cfPWV was measured using an automated pulse waveform analyzer. ePWV was derived from an equation based on age and mean arterial pressure. Association and agreement between the two measurements were determined using Pearson's correlation coefficient (r), standard error of estimate (SEE), and Bland-Altman analysis. Associations between traditional risk factors with ePWV and cfPWV were evaluated using linear mixed regression models. We observed weak correlations between ePWV and cfPWV within White adults (r = 0.36) and Black adults (r = 0.31). The mean bias for Bland-Altman analysis was low at -0.17 m/s (95%CI: -0.25 to -0.09). However, the inspection of the Bland-Altman plots indicated systematic bias (P < 0.001), which was consistent across race strata. The SEE, or typical absolute error, was 2.8 m/s suggesting high variability across measures. In models adjusted for sex, prevalent diabetes, the number of prevalent cardiovascular diseases, and medication count, both cfPWV and ePWV were positively associated with heart rate, triglycerides, and fasting glucose, and negatively associated with body mass index (BMI) and smoking status in White adults (P < 0.05). cfPWV and ePWV were not associated with heart rate, triglycerides, and fasting glucose in Black adults, while both measures were negatively associated with BMI in Black adults. Conclusions: Findings suggest a weak association between ePWV and cfPWV in older White and Black adults from ARIC. There were similar weak associations between CVD risk factors with ePWV and cfPWV in White adults with subtle differences in associations in Black adults.

IgG4-related hypophysitis diagnosed by retroperitoneal mass biopsy in a patient presenting with abducens nerve palsy: A case report (CARE-compliant article).

RATIONALE: Immunoglobulin G4 (IgG4)-related hypophysitis is a rare disorder which often requires invasive pituitary gland biopsy to confirm its diagnosis. We present a case whereby peripheral organ lesion biopsy and imaging findings were sufficient for the diagnosis. PATIENT CONCERNS: A 77-year-old man with diplopia was referred to our department by an opthomologist who had diagnosed the patient with right abducens nerve palsy. DIAGNOSES: Head magnetic resonance imaging revealed enlargement of the pituitary gland and pituitary stalk, while hormonal analysis revealed panhypopituitarism, thereby indicating a diagnosis of hypophysitis. Abdominal computed tomography imaging revealed a solid mass that encompassed the left kidney ureter. Although the patient did not have an increase in serum IgG4, a biopsy of the periureteral mass revealed infiltrating plasma cells that were positive when stained for IgG4. INTERVENTIONS: The patient was given corticosteroid pulse therapy (methylprednisolone: 1 g × 3 days), followed by oral corticosteroids (prednisolone, 0.5 mg/kg/d). OUTCOMES: The right abducens nerve palsy improved and the pituitary lesion shrank after the initiation of corticosteroid treatment. CONCLUSION: Based on the diagnosis of IgG4-related disease in the retroperitoneal organ and response to corticosteroid treatment, this patient was diagnosed with IgG4-related hypophysitis. This hypophysitis caused enlargement of the pituitary gland with resulting nerve compression, causing abducens nerve palsy. When IgG4-related hypophysitis is suspected, a thorough examination of other organ lesions and biopsy should be considered.

[Longitudinally extensive transverse myelitis involving fifteen vertebral bodies positive for anti-myelin oligodendrocyte glycoprotein (MOG) antibody: a case report].

A 16-year-old male with no previous medical history developed sudden fever and urinary dysfunction. He was admitted to our hospital due to bilateral leg weakness and sensory disturbance on the third day of weakness onset. A sagittal T2-weighted image displayed a longitudinal extensive lesion of transverse myelitis in the spinal column from the upper cervical (C2) to the thoracic region (Th9). The patient was diagnosed with autoimmune myelitis and treated with four courses of intravenous methylprednisolone (1 g/day for three consecutive days per week). This improved his signs, and his serum sample tested negative for anti-aquaporin-4 (AQP-4) antibody but positive for anti-myelin oligodendrocyte glycoprotein (MOG) antibody in cell-based assays. We report this case of longitudinally extensive transverse myelitis involving fifteen vertebral bodies positive for anti-MOG antibody.

Clinicopathological features of acute autonomic and sensory neuropathy.

Acute autonomic and sensory neuropathy is a rare disorder that has been only anecdotally reported. We characterized the clinical, electrophysiological, pathological and prognostic features of 21 patients with acute autonomic and sensory neuropathy. An antecedent event, mostly an upper respiratory tract or gastrointestinal tract infection, was reported in two-thirds of patients. Profound autonomic failure with various degrees of sensory impairment characterized the neuropathic features in all patients. The initial symptoms were those related to autonomic disturbance or superficial sensory impairment in all patients, while deep sensory impairment accompanied by sensory ataxia subsequently appeared in 12 patients. The severity of sensory ataxia tended to become worse as the duration from the onset to the peak phase of neuropathy became longer (P<0.001). The distribution of sensory manifestations included the proximal regions of the limbs, face, scalp and trunk in most patients. It tended to be asymmetrical and segmental, rather than presenting as a symmetric polyneuropathy. Pain of the involved region was a common and serious symptom. In addition to autonomic and sensory symptoms, coughing episodes, psychiatric symptoms, sleep apnoea and aspiration, pneumonia made it difficult to manage the clinical condition. Nerve conduction studies revealed the reduction of sensory nerve action potentials in patients with sensory ataxia, while it was relatively preserved in patients without sensory ataxia. Magnetic resonance imaging of the spinal cord revealed a high-intensity area in the posterior column on T(2)*-weighted gradient echo image in patients with sensory ataxia but not in those without it. Sural nerve biopsy revealed small-fibre predominant axonal loss without evidence of nerve regeneration. In an autopsy case with impairment of both superficial and deep sensations, we observed severe neuronal cell loss in the thoracic sympathetic and dorsal root ganglia, and Auerbach's plexus with well preserved anterior hone cells. Myelinated fibres in the anterior spinal root were preserved, while those in the posterior spinal root and the posterior column of the spinal cord were depleted. Although recovery of sensory impairment was poor, autonomic dysfunction was ameliorated to some degree within several months in most patients. In conclusion, an immune-mediated mechanism may be associated with acute autonomic and sensory neuropathy. Small neuronal cells in the autonomic and sensory ganglia may be affected in the initial phase, and subsequently, large neuronal cells in the sensory ganglia are damaged.

Dose effect on intramuscular metabolic stress during low-intensity resistance exercise with blood flow restriction.

Our previous study reported that metabolic stress in skeletal muscle achieved by combining moderate blood flow restriction (BFR) with low-intensity resistance exercise at 20% of one repetition maximum (1 RM) could not reach the level achieved by high-intensity resistance exercise. Since the previous protocol is typical of current regimens of this type, we sought in this study to optimize the exercise protocol for low-intensity resistance exercise with BFR by examining the dose effects of exercise intensity and pressure. Twelve healthy subjects participated in this study. They were asked to perform unilateral plantar flexion for 2 min (30 repetitions/min) under six different conditions: two resistance exercises (20% 1 RM and 65% 1 RM) without BFR, and four BFR protocols. The four BFR protocols included three different exercise intensities (20, 30, and 40% 1 RM) with moderate pressure (MP) using 130% of systolic blood pressure (147+/-17 mmHg, mean+/-SD) and 20% 1 RM with high pressure at 200 mmHg. Intramuscular metabolites and pH were obtained by 31P-magnetic resonance spectroscopy. Significant dose effects on intramuscular metabolites and pH were observed for exercise intensity (P<0.001) but not for BFR pressure. The BFR protocol combining 30% 1 RM with MP had similar results as the high-intensity load at 65% 1 RM. Intramuscular metabolic stress during BFR exercise might be susceptible to increasing exercise intensity. To replace high-intensity resistance exercise, the BFR protocol might require an intensity of >or=30% 1 RM.

[A case of cerebral venous angioma with paresis of the left arm and face].

A 75-year-old woman was admitted to our hospital because of sudden onset of paresis in her left arm and face. She had untreated hypertension and hyperlipidemia. When she came back home after playing with children in the park, she felt weakness in her left hand. On admission, physical examination revealed that her blood pressure was very high (200/102 mmHg). Only slight weakness in her left arm and left facial palsy were recognized neurologically. An electroencephalogram showed normal findings. Brain CT and MRI revealed a venous angioma near the right central sulcus. Gadolinium-DTPA enhanced MRI showed a group of small radiating veins (so called "the caput medusae sign") connected to the venous angioma. The remaining symptoms decreased with the normalization of blood pressure. It is suggested the intracranial motor tracts of the face and arm in the precentral gyrus are adjacent to the location of this venous angioma. The dilation of venous angioma due to high blood pressure was thought to cause the paresis of face and arm in this patient.

[Analysis of brain images in patients with spinocerebellar degeneration; using statistical parametric mapping (SPM) and easy Z score imaging system (eZIS)].

In order to investigate the cerebral blood flow objectively, the easy Z score imaging system (eZIS), was developed, and has been applied in clinical practice. SPECT with 99mTc-ethyl cysteinate dimer (99mTc-ECD) was performed, and the images were analyzed using the SPM97 and the eZIS Ver. 2 to investigate cerebral blood flow in patients with two types of spino-cerebellar degeneration. We compared the distribution of cerebral blood flow between 13 patients with cortical cerebellar atrophy (CCA) and 26 patients with olivopontocerebellar atrophy (OPCA). In the both groups, cerebellar blood flow was decreased generally. In our evaluation using the eZIS Z score, the scores for the brain stem and cerebellar nucleus in the OPCA group were lower than those in the CCA group. This method facilitates the objective evaluation of cerebral blood flow in patients with spinocerebellar degeneration, and may be useful for analyzing the condition of these disease.