Clinical effect of double plasma molecular adsorption system in treatment of patients with chronic liver failure in high-altitude areas / 临床肝胆病杂志

ObjectiveTo investigate the differences in clinical features and mortality rate between native patients with chronic liver failure （CHF） and migrated patients with CHF after treatment with double plasma molecular adsorption system （DPMAS） in high-altitude areas. MethodsA total of 63 patients with CHF who received DPMAS treatment in the intensive care unit of General Hospital of Tibet Military Command from January 2016 to December 2021 were enrolled， and according to their history of residence in high-altitude areas， they were divided into native group with 29 patients and migrated group with 34 patients. The two groups were compared in terms of baseline data and clinical features before and after DPMAS treatment. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the paired t-test was used for comparison before and after treatment within each group； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups， and the Wilcoxon signed rank sum test was used for comparison before and after treatment within each group； the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison of the risk of death. ResultsCompared with the native group， the migrated group had a significantly higher proportion of Chinese Han patients （χ2=41.729， P<0.001）， and compared with the migrated group， the native group had a significantly longer duration of the most recent continuous residence in high-altitude areas （Z=3.364， P<0.001）. Compared with the native group， the migrated group had significantly higher MELD score and incidence rates of hepatic encephalopathy， hepatorenal syndrome， and gastrointestinal bleeding （Z=2.318， χ2=6.903， 5.154， and 6.262， all P<0.05）. Both groups had significant changes in platelet count （PLT）， hemoglobin count （HGB）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， albumin， total bilirubin （TBil）， direct bilirubin （DBil）， lactate dehydrogenase （LDH）， creatinine （Cr）， and international normalized ratio （INR） after DPMAS treatment （all P<0.05）. Before DPMAS treatment， compared with the native group， the migrated group had significantly higher levels of ALT， AST， TBil， DBil， LDH， Cr， BUN， and INR （all P<0.05） and a significantly lower level of HGB （P<0.05）； after DPMAS treatment， compared with the native group， the migrated group had significantly greater reductions in PLT and HGB （both P<0.05） and still significantly higher levels of ALT， AST， TBil， DBil， LDH， BUN， and INR （all P<0.05）. The 60-day mortality rate of patients after DPMAS treatment was 52.5% （95% confidence interval ［CI］： 41.7 — 63.8） in the native group and 81.3% （95%CI： 77.9 — 85.6） in the migrated group. Compared with the native group （hazard ratio ［HR］=0.47， 95%CI： 0.23 — 0.95）， the migrated group had a significant increase in the risk of death on day 60 （HR=2.14， 95%CI： 1.06 — 4.32， P=0.039）. ConclusionCompared with the native patients with CHF in high-altitude areas， migrated patients have a higher degree of liver impairment， a lower degree of improvement in liver function after DPMAS treatment， and a higher mortality rate. Clinical medical staff need to pay more attention to migrated patients with CHF， so as to improve their survival rates.

¿Cuándo realizar biopsia renal en un paciente diabético?. A propósito de un caso en una ciudad de altura

Se reporta el caso de un paciente varón de 54 años, habitante de una ciudad de altura, con antecedentes de diabetes mellitus tipo 2 e hipertensión arterial en tratamiento, con microhematuria persistente, elevación de creatinina, presencia de proteinuria y ausencia de retinopatía diabética, a quien se le realizó biopsia renal por sospecha de glomerulopatía no diabética asociada. La biopsia renal confirmó el diagnóstico histopatológico de glomeruloesclerosis nodular diabética. Debido a que usualmente no se realiza biopsia renal en pacientes diabéticos, se presenta este caso y se revisa sus indicaciones. Asimismo, planteamos que la altura pudo influir en el deterioro de la función renal.

We report the case of a 54-year-old male patient, high altitude city dweller, with a history of type 2 diabetes mellitus and arterial hypertension in treatment, with persistent microscopic hematuria, creatinine elevation, presence of proteinuria and absence of diabetic retinopathy, who underwent renal biopsy for suspected associated non-diabetic glomerulopathy. Kidney biopsy confirmed the histopathological diagnosis of diabetic nodular glomerulosclerosis Because renal biopsy is usually not performed in diabetic patients, this case is presented and its indications are reviewed. Also, we propose that high altitude could influence in the renal function impairment.

Certain issues for medical evacuation and support after traumatic brain injury at high altitude / 中华创伤杂志

Traumatic brain injury (TBI) is much more complex considering the unique pathophysiological changes under high-altitude hypoxic environment. Moreover, because of limited source of medical transportation and facilities at high altitude, TBI patients often lack urgent and standard treatment and have to be transported to the district medical center at high altitude or even the neurotrauma center at plain region as soon as possible. The transportation has high risk and takes serious effect on lives and prognosis of the TBI patients. Up to date, the evacuation and support process for TBI patients in the western plateau region of China has been improved through years of practice, but there are still deficiencies compared to the Critical Care Air Transport Team (CCATT). The authors sought to discuss certain issues related to medical evacuation and support after TBI at high altitude from aspects of early damage control operation and timely safety medical transportation, aiming to improve the survival rate, neurological outcomes and life quality for these patients.

Bibliometric analysis of main diseases due to exposure to altitude in the world / Análise bibliométrica das principais doenças decorrentes da exposição à altitude no mundo

Introduction: Around 140 million people in the world live-in high-altitude regions; however, there are few bibliometric studies. Objective: Describe the scientific production of the main diseases due to exposure to altitude in the world. Methods: Observational study, bibliometric type. After a systematic search in Scopus, original articles were included, whose main variable was mountain sickness, high-altitude cerebral edema and high-altitude pulmonary edema. Characteristics of each study were manually extracted and analyzed using descriptive statistics. Results: 2305 articles were found on mountain sickness (n=1531), high-altitude pulmonary edema (n=549) and high-altitude cerebral edema (n=225), respectively, in Scopus. Regarding the most influential journal was High Altitude Medicine and Biology in all three diseases, the country with the highest number of articles was the United States (458, 168 and 75), the most used language was English (91.31%, 85.33% and 84.19%), the author with the highest number of publications was Bartsh P. (2.94%, 18.60% and 3.42%) and most of the articles were open access (41.08%, 42.06% and 76.53%), respectively. Conclusion: The scientific production of original articles on mountain sickness, high-altitude pulmonary edema and high-altitude cerebral edema in Scopus has increased in recent years; however, it is still scarce compared to other diseases.

Introdução: Cerca de 140 milhões de pessoas no mundo vivem em regiões de grande altitude, porém, existem poucos estudos bibliométricos. Objetivo: Descrever a produção científica sobre as principais doenças decorrentes da exposição à altitude no mundo. Métodos: Estudo observacional, do tipo bibliométrico. Após busca sistemática no Scopus, foram incluídos artigos originais, cuja variável principal foi mal da montanha, edema cerebral de altitude e edema pulmonar de altitude. As características de cada estudo foram extraídas manualmente e analisadas por meio de estatística descritiva. Resultados: Foram encontrados 2.305 artigos sobre mal da montanha (n=1.531), edema pulmonar de altitude (n=549) e edema cerebral de altitude (n=225), respectivamente no Scopus. Em relação ao periódico mais influente foi High Altitude Medicine and Biology nas três doenças, o país com maior número de artigos foi os Estados Unidos (458, 168 e 75), o idioma mais utilizado foi o inglês (91,31%, 85,33% e 84,19%), o autor com maior número de publicações foi Bartsh P. (2,94%, 18,60% e 3,42%) e a maioria dos artigos foi de acesso aberto (41,08%, 42,06% e 76,53%), respectivamente. Conclusão: A produção científica de artigos originais sobre mal da montanha, edema pulmonar de altitude e edema cerebral de altitude em Scopus tem aumentado nos últimos anos, porém ainda é escassa em comparação com outras doenças

Policitemia en pacientes con enfermedad renal crónica en hemodiálisis / Polycythemia in patients with chronic kidney disease in hemodialysis

RESUMEN Introducción: Los pacientes con enfermedad renal crónica cursan con anemia, la cual es menos frecuente en ciudades por encima de los 1000 metros de altitud sobre el nivel del mar. Objetivos: Determinar las características clínicas y de laboratorio de los pacientes en hemodiálisis, a gran altitud. Métodos: Estudio descriptivo, transversal y correlacional en 70 pacientes de un centro de diálisis (3 827 metros sobre el nivel del mar). Se dividió los pacientes según nivel de hemoglobina: grupo 1 (< 10 g/dl), grupo 2 (10 - 12 g/dl), grupo 3 (12 - 18 g/dl) y grupo 4 (≥ 18 g/dl). Se investigó variables epidemiológicas, clínicas y de laboratorio. Se calculó frecuencias absolutas y relativas, promedios y desviación estándar y se aplicó análisis descriptivo, test de ji cuadrado y ANOVA. Resultados: Se encontró predominio del sexo masculino (67 %) y una edad media de 60,7 ± 14,1 años. El 45 % de los pacientes fueron hipertensos, con diferencia significativa (p< 0,05) entre el grupo 1 y 2. La hemoglobina media fue de 12,99 ± 2,6 g/dl y se encontró que el 5,7 % de los estudiados presentaron hemoglobina ≥ 18 g/dl. Se observó una relación directa entre hemoglobina y el fósforo, aunque de baja intensidad (r< 0,300) y significativa (p< 0,05); es decir, existe una tendencia a la hiperfosfatemia en los pacientes con policitemia. Conclusiones: Más del 60 % de los pacientes con enfermedad renal crónica en hemodiálisis que viven a gran altitud, presentan cifras elevadas de hemoglobina, por encima de los niveles recomendados para esta población. Además, se estableció una relación entre policitemia y mayor edad, nivel de calcio, fósforo, albúmina y Kt/V y menor nivel de paratohormona.

ABSTRACT Introduction: Patients with chronic kidney disease have anemia, which is less frequent in cities above 1000 meters above sea level. Objectives: To determine the clinical and laboratory characteristics of patients on hemodialysis at high altitude. Methods: Descriptive, cross-sectional and correlational study in 70 patients from a dialysis center (3827 meters above sea level). Patients were divided according to hemoglobin level: Group 1 (< 10 g/dl), Group 2 (10 - 12 g/dl), Group 3 (12 - 18 g/dl) and Group 4 (≥ 18 g/dl). Epidemiological, clinical and laboratory variables were investigated. Absolute and relative frequencies, averages and standard deviation were calculated and descriptive analysis, chi-square test and ANOVA were applied. Results: We observed a predominance of men (67 %) and a mean age of 60.7 ± 14.1 years. 45 % of the patients were hypertensive, with a significant difference (p< 0,05) between group 1 and 2. The mean hemoglobin was 12,99 ± 2,6 g/dl, and we found that 5.7 % of the evaluated had hemoglobin ≥ 18 g/dL. A direct relationship between hemoglobin and phosphorus was observed, although of low intensity (r< 0,300) and significant (p< 0,05); that is, there is a tendency to hyperphosphatemia in patients with polycythemia. Conclusions: More than 60 % of patients with chronic kidney disease on hemodialysis who live at high altitude have high hemoglobin levels, above the recommended levels for this population. Furthermore, a relationship was established between polycythemia and older age, calcium, phosphorus, albumin and Kt/V levels and lower parathyroid hormone levels.

Prevention suggestion based on the correlation between epidemiological characteristics of blood pressure level and glucose metabolism in patients with altitude sickness / 公共卫生与预防医学

Objective To explore the epidemiological distribution characteristics of blood pressure in patients with altitude sickness, and the influence of abnormal glucose metabolism and other factors on abnormal blood pressure in patients with altitude sickness, so as to propose preventive plans. Methods From the 358 patients with altitude sickness diagnosed in our hospital from January 2017 to June 2021, 259 patients who met the inclusion criteria of this study were selected for analysis (99 patients with previously diagnosed hypertension were excluded, and the final 259 patients) The study selected 259 subjects, collected information on blood pressure, blood glucose levels, and other potential influencing factors, analyzed associations, and discussed reasonable prevention strategies. Statistics using SPSS19.0. Results The mean systolic blood pressure of newly diagnosed hypertensive patients was (154.36±12.58) mmHg, the diastolic blood pressure was (93.69±9.54) mmHg, and the pulse pressure difference was (61.25±10.28) mmHg, (compared with the control group t/P value: 16.505/ 1+0.130x2+0.874 x3+0.849x4+0.309x5+0.341x6+0.895x7-0.064x8 . Conclusion Strengthening the publicity and education of health knowledge related to chronic diseases in patients with altitude sickness, enhancing their awareness of high-risk factors such as hyperglycemia, and effective control of blood sugar and blood lipids have positive effects on preventing complicated hypertension.

Fisiología respiratoria hipoxemia / Hypoxemia

La hipoxemia ocurre producto de una inadecuada captación de oxígeno a nivel pulmonar y se manifiesta como presión arterial de oxígeno menor a 60 mmHg o saturación arterial de oxígeno menor de 90%. Los mecanismos fisiopatológicos por los cuales se puede producir hipoxemia son hipoventilación, alteración del equilibrio ventilación perfusión, shunt cardiaco, alteración de la difusión y disminución de la presión inspirada de oxígeno. La comprensión de estos mecanismos es fundamental para entender su presentación clínica en distintas enfermedades.

Hypoxemia is the name given to inadequate uptake in the lung and is defined as an arterial oxygen pressure less than 60 mmHg or arterial oxygen saturation less than 90%. The pathophysiological mechanisms that can produce hypoxemia are: hypoventilation, ventilation perfusion mismatch, cardiac shunt, diffusion impairment and decreased inspired oxygen pressure. Full comprehension of these mechanism facilitates the understanding of hypoxemia among different diseases.

Evaluación de variables cardiovasculares en una población calchaquí de media y alta montaña de Tucumán / Evaluation of Cardiovascular Variables in a Calchaquí Population in the Middle and High Mountains of Tucumán

RESUMEN Introducción: La comunidad Quilmes (Tucumán) abarca 2400 habitantes de media y alta montaña (1800 a 4000 metros sobre el nivel del mar). El objetivo del presente trabajo fue conocer su estado de salud cardiovascular. Material y métodos: Se efectuó una investigación cuantitativa descriptiva transversal en personas pertenecientes a dicha comunidad que asistieron voluntariamente en los días 27 a 29 de septiembre de 2018 a la evaluación prevista. Resultados: Se estudiaron 202 pobladores (125 mujeres y 77 varones; 48 ± 1,4 años). El 23% de ellos tenían hipertensión arterial (HTA); un 14% eran tabaquistas; el 4,9% tenían diabetes (DBT); el 18% presentaba dislipidemia (DLP); el 25% consumía alcohol rutinariamente (1,0 ± 0,4 L/día). Asimismo, el 29% presentaba sobrepeso y el 36% obesidad. Se registró presión arterial (PA) elevada en 48 personas al momento del estudio. La PA disminuyó en la tercera toma con respecto a la primera, pero la frecuencia cardíaca aumentó en la tercera toma (74 ± 1 latidos por minuto vs. 77 ± 1; p <0,01). La saturación de O2 (95,0 ± 0,2%) se correlacionó negativamente con la edad (Pearson r: −0,266; p <0,001). En los pobladores con PA normal, la relación E/A determinada ecográficamente fue mayor (1,2 ± 0,0) y el espesor de la pared posterior del ventrículo izquierdo fue menor (8,5 ± 0.5 mm) que en aquellos con PA elevada (0,92 ± 0,1 y 9,0 ± 0.3, respectivamente, p <0,001). El 24% presentó placas ateroscleróticas y 120 pobladores presentaron DLP. Conclusiones: La población Quilmes presenta una prevalencia de factores de riesgo cardiovascular similar a la de centros urbanos, los que podrían llevar en los próximos años a un incremento de la morbimortalidad cardiovascular en esta población

ABSTRACT Background: The Quilmes community includes 2,400 inhabitants of the middle and high mountains of Tucumán (1,800 to 4,000 meters above sea level). The purpose of the present study was to know their cardiovascular health status. Material and methods: A cross-sectional descriptive quantitative investigation was carried out in people belonging to the Quilmes community who voluntarily attended the planned evaluation on September 27-29, 2018. Results: Two hundred and two settlers were studied (125 women and 77 men; 48 ± 1.4 years), 23% of them had hypertension (HTN); 14% were smokers; 4.9% had diabetes; 18% had dyslipidemia (DLP) and 25% usually consumed alcohol (1.0 ± 0.4 L/day). Also, 29% were overweight and 36% obese. High blood pressure (BP) was recorded in 48 individuals at the time of the study. Blood pressure decreased in the third compared to the first measurement, whereas heart rate increased in the third assessment (74 ± 1 beats per minute vs. 77 ± 1; p <0.01). Oxygen saturation (95.0 ± 0.2%) was negatively correlated with age (Pearson r: −0.266; p <0.001). In individuals with normal BP, ultrasound E/ratio was higher (1.2 ± 0.0) and left ventricular posterior wall thickness was lower (8.5±0.5 mm) than in those with elevated BP (0.92±0.1 and 9.0 ± 0.3, respectively, p <0.001). Twenty-four percent of individuals had atherosclerotic plaques and 120 had DLP. Conclusions: The Quilmes population presents a prevalence of cardiovascular risk factors similar to that of urban centers, which could lead to an increase in cardiovascular morbidity and mortality in the coming years

Protective effects of active compounds from on heart and brain of mice at simulated high altitude / 浙江大学学报·医学版

To investigate the active compounds from on the heart and brain of mice at simulated high altitude.Fifty healthy male adult BALB/c mice were randomly divided into normal control group, hypoxic model group, acetazolamide group, petroleum ether extract of (PESI) group and octacosan group with 10 mice in each group. Acetazolamide group, PESI group and octacosan group were treated with acetazolamide PESI (200 mg/kg) or octacosan by single tail vein injection, respectively. Except normal control group, the mice were exposed to a simulated high altitude of for in an animal decompression chamber. After the mice were sacrificed by cervical dislocation, the heart and brain were histologically observed by HE staining; superoxide dismutase (SOD) activity, total anti-oxidant capacity (T-AOC) and the content of malondialdehyde (MDA) in plasma, heart and brain tissues were detected by WST-1 method, ABTS method and TBA method, respectively; lactic acid and lactate dehydrogenase (LDH) activity in plasma, heart and brain tissues were detected by colorimetric method and microwell plate method, respectively; ATP content and ATPase activity in heart and brain tissues were detected by colorimetric method. PESI and octacosane significantly attenuated the pathological damages of heart and brain tissue at simulated high altitude; increased SOD activity, T-AOC and LDH activity, and decreased the contents of MDA and lactic acid in plasma, heart and brain tissues; increased the content of ATP in heart and brain tissues; increased the activities of Na-K ATPase, Mg ATPase, Ca ATPase and Ca-Mg ATPase in myocardial tissue; and increased the activities of Mg ATPase, Ca-Mg ATPase in brain tissue. PESI and octacosan exert anti-hypoxic activity by improving the antioxidant capacity, reducing the free radical levels, promoting the anaerobic fermentation, and alleviating the energy deficiency and metabolic disorders caused by hypoxia in mice.

Alteraciones cardiovasculares en pacientes con eritrocitosis excesiva en residentes a 5 200 metros sobre el nivel del mar / Cardiovascular alterations in patients with excessive erythrocytosis in residents at 5,200 meters above the sea level

RESUMEN Objetivo: describir la función cardiovascular y determinar las alteraciones cardiacas en pacientes con y sin eritrocitosis excesiva (EE). Materiales y métodos: estudio de tipo prospectivo, transversal y analítico. La muestra fue de 61 pacientes residentes del Centro Poblado La Rinconada, localizado en Puno - Perú, ubicado a 5 200 m.s.n.m. Se utilizó una ficha de recolección de datos, se aplicó el score de mal de montaña crónico de Qinghai y un cardiólogo experimentado realizo las ecocardiografías. Resultados: el promedio de edad fue de 44 ± 7 años y el tiempo de residencia fue de 16 ± 9,8 años. Del total de pacientes, el 80,3% presentó mal de montaña crónico; de estos, el 68,9% fue de grado leve, 6,6% de grado moderado y el 4,9% de grado severo. Dentro de los hallazgos ecocardiográficos se encontraron: dilatación de cavidades cardiacas (16,4%), leve alteración del llenado del ventrículo derecho (3,27%), válvula aórtica bicúspide (3,27%), dificultad del llenado del ventrículo izquierdo (8,2%), leve alteración en la relajación y llenado del ventrículo izquierdo (1,6%), insuficiencia aórtica leve (1,6%) e hipertensión pulmonar (1,6%). El 83,6% presentaba hemoglobina ≥ 21 mg/dl. Conclusiones: el grupo con EE presentó más alteraciones cardiacas, la alteración cardiaca más frecuente fue la dilatación de cavidades cardiacas derechas.

ABSTRACT Objective: to describe cardiovascular function and determine cardiac disturbances in patients with and without excessive erythrocyteosis (EE). Materials and methods: a prospective, transversal and analytical type study. The sample was of 61 resident patients of the Centro Poblado La Rinconada, located in Puno - Peru, located at 5,200 meters above the sea level. A data collection sheet was used, Qinghai's chronic mountain sickness score was applied, and an experienced cardiologist performed echocardiographies. Results: the average age was 44 ± 7 years and the residence time was 16 ± 9.8 years. Of the total number of patients, 80.3% had chronic mountain sickness; of these, 68.9% were mild grade, 6.6% moderate grade and 4.9% severe grade. Among the echocardiographic findings were found: dilation of cardiac cavities (16.4%), slight alteration of the filling of the right ventricle (3.27%), bicuspid aortic valve (3.27%), difficulty filling the left ventricle (8.2%), slight alteration in relaxation and filling of the left ventricle (1.6%), mild aortic insufficiency (1.6%) pulmonary hypertension (1.6%). 83.6% had hemoglobin ≥ 21 mg/dL. Conclusions: the group with EE had more cardiac disturbances, the most common cardiac disturbance was the dilation of right heart chambers.

Edema agudo de pulmón por mal de altura: caso pediátrico / Acute pulmonary edema due to altitude sickness: pediatric case

Resumen: El edema pulmonar por mal de altura es una entidad no cardiogénica que se debe a hipoxia hipobárica y falta de adaptación pulmonar en los pacientes que retornan a altitudes mayores de 2.500 m luego de haber permanecido a nivel del mar por varios días. Esta entidad, frecuente en los niños, debido a sus características anatómicas y fisiológicas, suele ser subdiagnosticada o confundida con otras patologías que cursan con insuficiencia respiratoria. Presentamos el caso de un paciente de sexo masculino, 4 años de edad, atendido en Emergencias por dificultad respiratoria severa por mal de altura.

Abstract: Pulmonary edema by altitude sickness is a non-cardiogenic entity, due to lack of pulmonary adaptation and hypobaric hypoxia in patients who return to altitudes higher than 2,500 meters after staying for several days at sea level. This entity is frequent in children, given their physiological and anatomical characteristics. It tends to be underdiagnosed or confused with other pathologies associated with shortness of breath. We present the case of a four-year-old male patient, who attended the emergency department for severe respiratory distress caused by altitude sickness.

Edema pulmonar de altura. Reporte de un caso y revisión de la literatura / High Altitude Pulmonary Edema. Case Report and Bibliography Review

El edema pulmonar de altura ocurre en pacientes que estuvieron por algunos días en ciudades a nivel del mar y regresan a altitudes mayores a 2,500 msnm, secundario a la falta de adaptación pulmonar que conduce a hipoxia importante. Se presenta el caso de una niña de 15 años que luego de estar en la costa ecuatoriana regresó a la sierra en el cantón Guamote. El objetivo de reportar este caso clínico es conocer la fisiopatología, el abordaje diagnóstico y terapéutico del edema pulmonar de altura, porque es una condición frecuente en niños de la región y un tema desconocido para muchos profesionales de la salud, porque la mayoría de las ocasiones es subdiagnosticado o confundido con otras patologías que cursan con insuficiencia respiratoria.

High altitude pulmonary edema occurs in patients who were for some days in cities at the sea level and go back to altitudes over 2,500 mosl. This edema is secundary to a pulmonary maladjustment which leads to a significant hypoxia. It is presented a case of a 15 year old girl who after being in the Ecuadorian coast returned to the mountains at Guamote canton. The objective of this report is to know the pathophisiology, diagnostic and therapeutic approach of high altitute pulmonary edema since it is a frequent condition in children of the region and it is unknown by many health professionals. Most of the times it is under diagnosed or confused with other pathologies which present with respiratory failure.

Clinical study on SaO2combined with heart rate for diagnosing acute mountain sickness / 重庆医学

Objective To explore the clinical effect of SaO2and heart rate(HR)for the diagnosis of acute mountain sickness (AMS).Methods A total of 1 062 male soldiers on garrison duty in rapidly entering to high altitude at 3 700-5 400 m from May 2013 to August 2015 were included as the research subjects.The demography data were collected and the AMS symptoms investiga-tion was performed.SaO2and HR were detected and the relationship between SaO2and HR at different altitudes with AMS symp-tom score was analyzed.Results The cut-off value of SaO2for diagnosing AMS in rapidly entering to high altitude at 3 700-<4 300 m was 84.5%(AUC=0.781)with the screening sensitivity of 78.31% and specificity of 72.02%;which of HR for diag-nosing AMS was 89.5 times/min(AUC=0.640)with the screening sensitivity of 71.27% and specificity of 54.63%.When SaO2 was serially connected with HR,its sensitivity was 58.87% and the specificity was 89.23%,while the parallel connection yielded a sensitivity of 90.70% and a specificity of 37.43%.In rapidly entering the altitude at above 5000 m,the cut-off value of SaO2for di-agnosing AMS was 80.5%(AUC=0.825)with the screening sensitivity of 84.62% and specificity of 68.85%;which of HR for di-agnosing AMS was 93.5 times/min(AUC= 0.718)with the screening sensitivity of 53.00% and specificity of 85.25%;when SaO2was serially connected with HR,its sensitivity for diagnosing AMS was 47.01% and specificity was 93.44%,while the paral-lel connection yielded a sensitivity of 90.60% and a specificity of 60.66%.Conclusion SaO2combined with HR can serve as an ob-jective index for the on-site diagnosis of AMS and is convenient for the AMS preliminary screening of large populations.

Acute phase protein increase in high altitude mountaineers / Aumento da proteína de fase aguda em montanhistas de grandes altitudes / Aumento de la proteína de fase aguda en montañeros de gran altitud

ABSTRACT Introduction: Many middle-aged Turks go hiking in mountains to breathe some fresh air or to maintain fitness. Objective: This study investigated the effects of regular high altitude mountain climbing on the metabolic and hematological responses of mountaineers. Methods: Hematological and biochemical parameters were studied, as well as some hormonal values of 21 mountaineers and 16 healthy age-matched sedentary volunteers. Results: The neutrophil to lymphocyte ratio (NLR) was significantly lower (p<0.04) in mountaineers compared with the sedentary group. Total protein (p<0.001) and albumin (p<0.001) were lower, while the levels of ferritin (p<0.04), creatine (p<0.03) and creatine phosphokinase (p<0.01) were higher in mountaineers. Other hematological and biochemical parameters, i.e., erythrocytes, leukocytes, hemoglobin and hematocrit, did not change significantly. Conclusion: Our results show that regular exposure to high altitude increased the serum levels of some acute phase proteins with anti-inflammatory properties.

RESUMO Introdução: Muitos turcos de meia-idade fazem caminhadas em montanhas para respirar ar puro ou manter a boa forma física. Objetivo: Este estudo pesquisou os efeitos da escalada regular em grandes altitudes sobre as respostas metabólicas e hematológicas dos montanhistas. Métodos: Foram estudados parâmetros hematológicos e bioquímicos, assim como alguns valores hormonais de 21 montanhistas e 16 voluntários sedentários de mesma idade. Resultados: A razão entre neutrófilos e linfócitos (RNL) foi significantemente menor (p<0,04) nos montanhistas, em comparação com o grupo sedentário. A proteína total (p<0,001) e a albumina (p<0,001) foram mais baixas, enquanto os níveis de ferritina (p<0,04), creatina (p<0,03) e creatina fosfoquinase (p<0,01) foram mais altos nos montanhistas. Outros parâmetros hematológicos e bioquímicos, isto é, eritrócitos, leucócitos, hemoglobina e hematócrito não tiveram mudanças significantes. Conclusão: Nossos resultados mostram que a exposição regular a grandes altitudes aumentou os níveis séricos de algumas proteínas de fase aguda com propriedades anti-inflamatórias.

RESUMEN Introducción: Muchos turcos de mediana edad hacen caminatas en montaña para respirar aire puro o mantener la buena forma física. Objetivo: Este estudio ha investigado los efectos de la escalada regular en gran altitud sobre las respuestas metabólicas y hematológicas de los montañeros. Métodos: Se estudiaron parámetros hematológicos y bioquímicos, así como algunos valores hormonales de 21 montañistas y 16 voluntarios sedentarios de la misma edad. Resultados: El índice neutrófilo/linfocito (INL) fue significativamente menor (p<0,04) en los montañeros, en comparación con el grupo sedentario. La proteína total (p<0,001) y la albúmina (p<0,001) fueron más bajas, mientras que los niveles de ferritina (p<0,04), creatina (p<0,03) y creatina fosfoquinasa (p<0,01) fueron más altos en los montañistas. Otros parámetros hematológicos y bioquímicos, es decir, eritrocitos, leucocitos, hemoglobina y hematocrito no cambiaron significativamente. Conclusión: Nuestros resultados muestran que la exposición regular a grandes altitudes aumentó los niveles séricos de algunas proteínas de fase aguda con propiedades anti-inflamatorias.

Concentración de malondialdehido en sujetos que residen a gran altitud: estudio exploratorio / Concentration of Malondialdehyde in Subjects Living at High Altitudes: Exploratory Study

RESUMEN El objetivo fue investigar el comportamiento del malondialdehido (MDA), biomarcador de estrés oxidativo, a grandes altitudes (3500-4200 m de altitud). Se realizó un estudio exploratorio en 91 sujetos de las ciudades de La Paz y El Alto seleccionados a través de una encuesta y examen clínico; la determinación de MDA se realizó con una técnica colorimétrica. Las medidas de tendencia central, dispersión y porcentajes se usaron para la descripción de datos, la prueba de Mann Whitney y Kruscal Wallis para explorar diferencias entre varones y mujeres, grupo etario y altitud. La mediana de concentración de MDA fue de 4,1 µmol/L (RIC 2,4-5,4), la mayor concentración se encontró en mayores de 40 años. El valor de la media encontrada es mayor que los referidos para el nivel del mar y supone la influencia de la hipoxia sobre los valores del MDA, sin embargo, no se encontraron diferencias entre sexo y grupos etarios.

ABSTRACT The objective of this study was to determine the levels of malondialdehyde (MDA), an oxidative stress biomarker, in individuals living at high altitudes (3500-4200 m). This exploratory study evaluated 91 subjects from La Paz and El Alto using a questionnaire and clinical examination. MDA levels were measured using a colorimetric technique. Measures of central tendency, dispersion, and percentages were used to describe data, and the Mann-Whitney test and Kruskal-Wallis test were used to assess differences between the sexes, age groups, and altitudes. The median concentration of MDA was 4.1 μmol/L (RIC 2.4-5.4) and the highest concentration of MDA was found in individuals older than 40 years. The average MDA levels were higher than those found at sea level, a result we believe is due to the effect of hypoxia. However, there were no differences in the MDA levels between the sexes or age groups.

Entre la aclimatación a la altura, la antropología médica y la utopía civilizatoria: cartografía de la evolución del pensamiento de Carlos Monge Medrano sobre el proceso salud-enfermedad de poblaciones andinas / Between the acclimatization to high altitude, the medical anthropology and the civilizing utopia: mapping of the evolution of thought of Carlos Monge Medrano on the health-illness process of andean populations

El presente estudio tiene como objetivo describir cómo se van desarrollando las ideas de Carlos Monge sobre las enfermedades de altura y cómo estas se van desplegando en el marco de los debates sobre las condiciones de vida de las poblaciones indígenas en el periodo 1928-1963. Postulamos que la forma cómo se constituyó el paradigma propuesto por Monge, las tensiones producidas desde varias corrientes alternativas y la forma cómo se resolvieron dichas contradicciones fueron centrales, tanto para el desarrollo posterior de distintas disciplinas científicas, como para sus distintas expresiones institucionales en el Perú. Se describe la trayectoria evolutiva de las ideas de Monge sobre adaptación de las poblaciones indígenas a la altura y los debates surgidos con otros colectivos investigativos en torno al consumo de la hoja de coca. Se plantea un análisis de las limitaciones de una mirada biomédica de la salud de las poblaciones andinas que, progresivamente, va siendo influenciada por el cambiante escenario social y político peruano en el contexto de la guerra fría.

The main objective of this study is to describe how the ideas of Carlos Monge respect to high altitude sickness developed and how these were being deployed in the framework of the discussions on the living conditions of indigenous populations in the period 1928-1963. I postulate that the form how the Monge’s paradigm was proposed, the tensions produced by various alternative movements and the way these contradictions were resolved were central, both for the subsequent development of different scientific disciplines and for their different institutional expressions in Peru. In addition, this article describes the evolutionary trajectory of Monge’s ideas about the adaptation of indigenous populations to high altitude and the discussions that emerged with other research groups around the consumption of coca leaf. It also presents an analysis of the limitations of the biomedical view regarding the health of the Andean populations, a view that was progressively influenced by the changing social and political scenario in the context of the Cold War.

Effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment / 解放军医学杂志

Objective To study the effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment. Methods A total of 60 adult healthy male Wistar rats were randomly divided into normal (N) group, hypoxia model (M) group, rhodiola crenulata (RC) group, low dose of gastrodin (GAS-L) group, medium dose of gastrodin (GAS-M) group and high dose of gastrodin (GAS-H) group (10 for each group). The intragastric administration on rats was continued for 7 days timely in each day. Under simulated 8000m altitude using low pressure oxygen cabin, the arterial blood gas of each group were tested, pathological changes of brain tissues were observed and related indexes of brain were detected after 12h hypoxia. Results Comparing with group N, the blood oxygen partial pressure (PO2), value of blood oxygen saturation (SO2), oxygenation index (PO2/FIO2), Na+ concentration (Na+), actual bicarbonate radical (HCO3–) significantly decreased (P<0.01), lactic acid (Lac), hemoglobin concentration (Hb) significantly increased (P<0.01) and pathological damage was inflicted in group M; and contents of malondialdehyde (MDA), hydrogen peroxide (H2O2) in brain tissue significantly increased (P<0.01), content of glutathione(GSH) and activity of glutathione peroxidase (GSH-Px) in brain tissue significantly decreased (P<0.01) in group M. Compared with group M, PO2, SO2 and PO2/FIO2 significantly increased (P<0.01, P<0.05) in group GAS-L; Na+ and HCO3– significantly increased (P<0.01, P<0.05) in three dose groups of GAS; Lac significantly decreased (P<0.01, P<0.05) in group GAS-L and GAS-H. Hb significantly increased (P<0.01) in group GAS-H, a rising trend appeared in group GAS-L but with no statistical significance. Damages of brain tissue were alleviated in group RC and three dose groups of GAS comparing with group M. Compared with group M, MDA significantly decreased (P<0.01) in three dose groups of GAS; there was a decreasing trend of H2O2 but with no statistical significance in three dose groups of GAS; GSH and GSH-Px significantly increased (P<0.01, P<0.05) in three dose groups of GAS. However, three groups of GAS has no dose dependent. Conclusion There was an protective effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment.

Revisión sobre el uso del mate de hoja de coca en la prevención del mal agudo de montaña / Review on the use of coca tea in prevention of acute mountain sickness

El número de turistas que viajan a zonas de gran altitud en países andinos se está  incrementando en los últimos años, con aumento concomitante del riesgo de desarrollar el mal agudo de montaña. En las zonas alto andinas el mate de hoja de coca es usado frecuentemente para la prevención de este problema, pero las evidencias no soportan esta medida; se estima que, por el contrario, podría incrementar los síntomas del cuadro clínico que se intenta controlar por lo que se sugiere la conveniencia de no incentivar su uso.

In recent years, an increasing number of tourists visiting high altitude zones and places in Andean countries are, in turn, making a concomitantgreater risk of developing acute mountain sickness. In the Andean region, coca tea is frequently used for the prevention of this condition. However, existing evidence does not seem to support such use and, on the contrary, it is estimated that it may increase the symptoms. The convenience of not to encourage the use of coca tea forthe prevention of acute mountain sickness, is suggested.

Effect of hypoxic pulmonary vasoconstriction on hypoxic pulmonary hypertension / 中国药理学通报

Sustained hypoxic pulmonary vasoconstriction (HPV ) as experienced at high altitude can lead to hypoxic pulmonary hypertension(HPH).HPV,a special physiological phenomenon of lung,is the physiological reflex of organism in hypoxic envi-ronment.However,in high altitude hypoxic environment,the sustained HPV can lead to pulmonary vascular remodeling and right ventricular hypertrophy,at the same time,the degree of hypoxia in alveoli can be aggravated.Vicious circle of hypoxia is formed,further causing the severe high altitude sickness such as pulmonary edema and pulmonary heart disease.HPV appears in preliminary of HPH,but in the chronic phase,irreversible hy-poxic pulmonary vascular remodeling forms.Therefore,studying the mechanism of HPV and the effect of HPV in HPH can pro-vide targets and ideas for the prevention and treatment of high al-titude sickness. Additionally, in preliminary stage of HPV, prompt treatment is critical for the prevention of high altitude sickness.However,the mechanism of HPV and its roles in HPH are still not fully elucidated in current studies.This paper sum-marizes the studies about HPV in HPH of recent years,aiming to provide references for researchers and clinical treatment in this research field.

Hyperuricemia prevalence and genetic susceptibility of young han males at an altitude of 4520m / 解放军医学杂志

Objective To investigate the pathogenic characteristics of hyperuricemia and the correlation between hyperuricemia and the polymorphism of xanthine oxidase (XO) in young Han males at an altitude of 4520m. Methods Two hundred and forty Han Chinese young men, aged 16-36 years (mean 22.1 years), moved to an altitude of 4520m for 0.25-10.8 years (mean 2.3 years), were selected. The general information and physiological index were collected by using questionnaires and routine examination; Fasting venous blood was collected in the morning, serum uric acid and XO concentration were measured, and the rs17038412 polymorphism of XO gene was analyzed. Results There were 186 hyperuricemia patients (hyperuricemia group) in 240 subjects, accounting for 77.5%, and 54 people with normal serum uric acid (normal group, accounting for 22.5%). Compared with normal group, the concentrations of XO and hemoglobin were significantly higher, the blood oxygen saturation significantly lower (P<0.01), and blood uric acid concentration was positively correlated to both hemoglobin level and XO concentration in hyperuricemia group (P<0.01, P<0.001). The frequency of AT genotype was significantly higher in hyperuricemia group than in normal group (P<0.01). Logistic regression analysis showed that the AT genotype was a risk factor for hyperuricemia in the young Han men (OR=3.96, 95%CI 1.42-11.08). Conclusions Incidence rate of hyperuricemia is high in young Han men. Serum uric acid concentration is positively correlated with the concentrations of XO and hemoglobin. AT genotype at a polymorphic site rs17038412 in XO may be related to the risk of hyperuricemia in the young Han men.