Infarto esplénico por exposición a la altura / Splenic Infarction due to Exposure to Height

Introducción: El infarto esplénico es una de las enfermedades que se presentan secundarias al fallo de aclimatación. En la literatura revisada se relaciona con la presencia de un rasgo sicklémico y desde la década del 50 se tienen reportes de casos a nivel mundial. Objetivo: Describir un caso de infarto esplénico por exposición a la altura. Presentación del caso: Se expuso un paciente que presentó un infarto esplénico después de su exposición a la altura, el cual fue intervenido quirúrgicamente y se presentaron un grupo de complicaciones en el posoperatorio. En la literatura internacional esta enfermedad se relaciona con la presencia de la hemoglobina S, lo cual no concuerda con nuestro paciente, a pesar de no ser el estudio de elección. Sus antecedentes pudieron contribuir a la ocurrencia de esta complicación. Las complicaciones que aparecieron en el posoperatorio coincidieron con las comentadas por otros autores. Conclusiones: El infarto esplénico por exposición a la altura es una complicación que debe tenerse en cuenta cuando se presenta un paciente a su llegada a este ecosistema, aparece con dolor abdominal, donde la inmediatez en la conducta es fundamental para evitar complicaciones de mayor gravedad(AU)

Introduction: Splenic infarction is one of the diseases that occur secondary to failure of acclimatization. In the reviewed literature, it is related to the presence of a sicklemic trait and since the 1950s there have been case reports worldwide. Objective: To describe a case of splenic infarction due to exposure to high altitude. Case report: We report the case of a patient who had a splenic infarct after exposure to high altitude. This patient, who underwent surgery, had a group of complications during the postoperative period. The international literature associates this disease with the presence of hemoglobin S, which does not coincide with the case of our patient, despite not being the study of choice. His history could have contributed to the occurrence of this complication. Those that appeared in the postoperative period did agree with those commented by other authors. Conclusions: Splenic infarction due to exposure to altitude is a complication that must be taken into account when a patient has abdominal pain. Immediacy in behavior is essential to avoid more serious complications(AU)

Association between serum levels of osteopontin and systolic pulmonary artery pressure among healthy adults post acute high altitude exposure / 中华心血管病杂志

Objective: To explore the association between serum levels of osteopontin (OPN) and systolic pulmonary artery pressure (sPAP) in healthy men following acute high altitude exposure. Methods: According to the inclusion and exclusion criteria, this observational study included 94 male subjects (aged from 18 to 30 years, dwelling in lowland<500 m) who ascended to Litang (4 100 m) from Chongqing (400 m) by bus with a stair-like journey within 7 days in June 2013. Data including basic information, OPN, superoxide dismutase (SOD), and malondialdehyde (MDA) and echocardiographic derived sPAP were collected within 48 hours before ascent and within 2-7 hours after arrival. Accordingly, subjects were divided into 3 groups based on the tertiles of sPAP after acute high altitude exposure: low sPAP group (26.8-32.3 mmHg (1 mmHg=0.133 kPa)) (n=31), middle sPAP group (32.4-37.4 mmHg) (n=32) and high sPAP group (37.5-55.6 mmHg) (n=31). Associations of serum OPN and SOD levels with sPAP were analysed by univariate and multivariate linear regression analysis. Results: After acute high altitude exposure, the levels of sPAP were significantly increased (P<0.001). There were no differences in age, height, weight, body mass index, percent of Han nationality and smoking among 3 subgroups. However, following acute high altitude exposure, the levels of heart rate, systolic and diastolic blood pressure elevated (all P<0.05), whereas the levels of oxygen saturation were reduced in the total subjects and all subgroups (all P<0.05). Moreover, systolic blood pressure of subjects in the high sPAP group was higher than that in low and middle sPAP groups (both P<0.05), and diastolic blood pressure of subjects in high sPAP group was higher than that in low sPAP group (P<0.05). The serum levels of OPN were increased in total cohort(27.9 (22.5,34.0) μg/L vs. 25.6 (18.4, 33.1) μg/L, P<0.05)， and high sPAP group (P<0.05), whereas no differences were found in serum SOD and MDA levels among groups. Furthermore, the serum level of OPN in high sPAP group was higher than that in low sPAP group at high altitude (P<0.05), and there was a trend for decline in SOD level with increasing sPAP (P>0.05). Results from univariable linear regression analysis showed that the serum levels of OPN (r=0.32, P=0.002) and SOD (r=-0.22，P=0.032) were linearly correlated with sPAP in total cohort after high altitude exposure. Multivariate regression analysis showed that the serum levels of OPN(β=0.310，P=0.002) and SOD (β=-0.199，P=0.043) were independently associated with the levels of sPAP at high altitude. Conclusion: After acute high altitude exposure, the serum level of OPN is positively associated with sPAP, suggesting that OPN may be a novel bio-marker for predicting the increase of pulmonary pressure in response to acute high altitude exposure.

Echocardiogram evaluation of cardiovascular functions of acute mountain sickness patient before and after returning plain / 医疗卫生装备

Objective To investigate the values of echocardiogram for evaluating the changes of left ventricular structure and cardiovascular function of the acute mountain sickness (AMS) patient before and after returning the plain.Methods A total of 33 light AMS patients returning to the plain in time underwent echocardiogram examinations on some cardiovascular indexes before and after returning the plain,including stroke volume (SV),cardiac output (CO),left atrial volume index (LAVI),left ventricular end-diastolic volume (LVEDV),early diastolic mitral flow velocity (E),late diastolic mitral flow velocity (A) and so on.Results The values of heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP),CO,A and LAVI after going to the plateau were all significantly higher than those before going to the plateau (P＜0.05),while the values of SV,E,E/A and LVEDV were obviously lower (P＜0.05).The values of HR,SBP,DBP,CO,A,E and E/A recovered respectively 1 month after going to the plateau when compared with those before going to the plateau (P＜0.05),while did not restore to the ones before going to the plateau (P＜0.05),and the values of LVEDV,LAVI and SV reached the level before going to the plateau (P＜0.05).The values of LVEDV,SV,SBP,LAVI and E 1 week after returning to the plain came to the level before going to the plateau (P＜0.05),and the values of CO,HR,DBP and A were significantly higher (P＜0.05) while the value of E/A was statistically lower (P＜0.05).Conclusion Echocardiogram can be used to evaluate the left ventricular structure and cardiovascular function of the AMS patient,especially for those light AMS patients in acclimatization period or before and after returning to the plain.

Relationships between plasma EPO concentration and left ventricular function and AMS after high altitude exposure / 军事医学

Objective To investigate the effect of plasma erythropoietin ( EPO) concentration on left ventricular systolic function and its relationship with acute mountain sickness ( AMS ) .Methods A total of 289 healthy young men were recruited in this study and divided into five groups:plain control group (Ⅰ) with 55 subjects;acute high altitude exposure group(Ⅱ) with 74 subjects(3700 m exposure for 24 h); the group of acute exposure after acclimatization (Ⅲ) with 68 subjects(4400 m exposure for 24 h after 1 week acclimatization at 3700 m); high altitude migrate group (Ⅳ) with 19 subjects ( migration to 3700 m for more than 1 year ); and the group of exposure after migration (Ⅴ) with 73 subjects (4400 m exposure for 50 d after more than one year migration to 3700 m).Lake Louise Self-assessment Scoring System ( LLSS) was used to assess AMS .Plasma concentrations of EPO and echocardiography were also determined .Results EPO was significantly increased after acute high altitude exposure .There was no significant difference in EPO between groupⅡand Ⅲ(P>0.05), but significantly higher than in group Ⅰ (P0.05).In group Ⅱ, positive correlation was found between EPO concentration and stroke volume (SV) as well as left ventricular diastolic diameter (LVDD) (R=0.278 and 0.236,respectively,P<0.05), while negative correlation was expressed between EPO concentration and the AMS score (R=-0.249,P<0.05).In other groups,there was no relationship between EPO concentration and the index of left ventricular function .Conclusion EPO may work on AMS through left ventricular systolic function enhancement after acute high altitude exposure .

POSITIVE EFFECTS OF SHORT-TERM EXPOSURE TO ALTITUDE ON BLOOD LACTATE AND HEART RATE / 体力科学

The purpose of this study was to investigate the effects of short-term living and training at an altitude of 1, 300 to 1, 800 m on physiological responses of high school elite endurance athletes. Fifteen male and seven female senior high school elite athletes, aged from 15 to 18, from three different sports (cross-country skiing, long-distance running and endurance cycling), participated in our study. The short-term (6 days) altitude exposure did not elicit abnormal responses of body tempera-ture, body weight, blood pressure or urine samples. There were also no significant changes in blood parameters examined before and after altitude exposure. Resting heart rate (HR) increased at altitude and presented an initial peak value followed by a steady decline on the following days of altitude exposure. Blood lactate concentration and exercise peak llR examined by submaximal 20-m shuttle run test decreased after the ascent to altitude and still showed lower values at postaltitude than at prealtitude. We conclude that 6-day living and training at an altitude of 1, 300 to 1, 800 m elicits positive decrements of exercise blood lactate and exercise peak HR as well as adaptive changes of resting IlR for these high school elite endurance athletes, which are probably related to an attenuation of muscle glycogen utilization and alterations in the autonomic neural system taken at altitude.