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Chen M, Yi F, Qi Y, Zhao B, Zhang Z, He X, Yuan D, Jin T. Whole-exome sequencing in searching for novel variants associated with the development of high altitude pulmonary edema. Gene 2023; 870:147384. [PMID: 37001572 DOI: 10.1016/j.gene.2023.147384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND High altitude pulmonary edema (HAPE) is a high-altitude idiopathic disease with serious consequences due to hypoxia at high altitude, and there is individual genetic susceptibility. Whole-exome sequencing (WES) is an effective tool for studying the genetic etiology of HAPE and can identify potentially novel mutations that may cause protein instability and may contribute to the development of HAPE. MATERIALS AND METHODS A total of 50 unrelated HAPE patients were examined using WES, and the available bioinformatics tools were used to perform an analysis of exonic regions. Using the Phenolyzer program, disease candidate gene analysis was carried out. SIFT, PolyPhen-2, Mutation Taster, CADD, DANN, and I-Mutant software were used to assess the effects of genetic variations on protein function. RESULTS The results showed that rs368502694 (p. R1022Q) located in NOS3, rs1595850639 (p. G61S) located in MYBPC3, and rs1367895529 (p. R333H) located in ITGAV were correlated with a high risk of HAPE, and thus could be regarded as potential genetic variations associated with HAPE. CONCLUSION WES was used in this study for the first time to directly screen genetic variations related to HAPE. Notably, our study offers fresh information for the subsequent investigation into the etiology of HAPE.
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Affiliation(s)
- Mingyue Chen
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Faling Yi
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Yijin Qi
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Beibei Zhao
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Zhanhao Zhang
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Xue He
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Dongya Yuan
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China.
| | - Tianbo Jin
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China; Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Northwest University, Xi'an, Shaanxi 710069, China; Shaanxi Provincial Key Laboratory of Biotechnology, Northwest University, Xi'an, Shaanxi 710069, China.
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Gao H, Xu J, Ma Q, Tang F, Ga Q, Li Y, Guan W, Ge RL, Yang YZ. Association Between the Polymorphism of Steroid Hormone Metabolism Genes and High-Altitude Pulmonary Edema in the Chinese Han Population. Int J Gen Med 2022; 15:787-794. [PMID: 35087285 PMCID: PMC8787081 DOI: 10.2147/ijgm.s345495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Steroid hormone metabolism plays an essential role in high-altitude pulmonary edema (HAPE) progression. This study aimed to investigate the association between polymorphism in seven steroid hormone metabolism genes (STAR, HSD3B1, HSD3B2, CYP17A1, CYP21A2, CYP11B1, and CYP11B2) and HAPE susceptibility among Han Chinese. Patients and Methods A total of 41 tagSNPs in the seven genes were genotyped using Sequenom MassARRAY SNP assays from 169 HAPE patients (HAPE-p) and 309 matched Han Chinese individuals resistant to HAPE (HAPE-r). The genotypic and allele frequencies, odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated. Results Four SNPs, including the allele C of rs6203 (p = 0.034, OR [95% CI] = 1.344 [1.022−1.767]) in HSD3B1, allele G of rs3740397 (p = 0.044, OR [95% CI] = 1.314 [1.007−1.714]) and allele C of rs10786712 (p = 0.039, OR [95% CI] = 0.751 [0.572−0.986]) in CYP17A1, and allele T of rs6402 (p = 0.006, OR [95% CI] = 0.504 [0.306−0.830]) in CYP11B1, were significantly associated with HAPE. The distribution of the genotypes of these SNPs also significantly differed between the HAPE-p and HAPE-r groups. Moreover, six haplotypes (the linkage disequilibrium block including rs10883783, rs4919686, rs3740397, rs3824755, and rs10786712) of CYP17A1 were also significantly associated with HAPE. Conclusion The four SNPs located in HSD3B1 (rs6203), CYP17A1 (rs3740397 and rs10786712), and CYP11B1 (rs6402) and the six haplotypes of CYP17A1 are likely to have an effect on HAPE.
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Affiliation(s)
- Hui Gao
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
- Basic Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
| | - Jin Xu
- Basic Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
| | - Qiang Ma
- Basic Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
| | - Feng Tang
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
| | - Qin Ga
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
| | - Yuhong Li
- Department of Respiration, Affiliated Hospital, Qinghai University, Qinghai, People’s Republic of China
| | - Wei Guan
- Department of Respiration, Affiliated Hospital, Qinghai University, Qinghai, People’s Republic of China
| | - Ri-Li Ge
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
| | - Ying-Zhong Yang
- Research Center for High Altitude Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
- Basic Medical Sciences, School of Medicine, Qinghai University, Qinghai, People’s Republic of China
- Correspondence: Ying-Zhong Yang Tel/Fax +86 971 6143168 Email
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Sharma M, Singh K, Himashree G, Bhaumik G, Kumar B, Sethy NK. Estrogen receptor (ESR1 and ESR2)-mediated activation of eNOS-NO-cGMP pathway facilitates high altitude acclimatization. Nitric Oxide 2020; 102:12-20. [PMID: 32544536 DOI: 10.1016/j.niox.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 02/01/2023]
Abstract
Higher levels of circulatory nitric oxide (NO) and NO metabolites reportedly facilitate high altitude acclimatization. But the underlying factors and molecular pathways promoting NO production at high altitude has been poorly characterized. Studying healthy lowlanders at sea level (C, lowlander) and high altitude (3500 m, after day 1, 4 and 7 of ascent), we report higher protein levels of eNOS and eNOSSer1177, higher plasma levels of BH4, NOx (nitrate and nitrites), cGMP and lower levels of endogenous eNOS inhibitor ADMA during healthy high altitude acclimatization. Our qRT-PCR-based gene expression studies identified higher levels of eNOS/NOS3 mRNA along with several other eNOS pathway genes like CALM1, SLC7A1 and DNM2. In addition, we observed higher mRNA levels of estrogen (E2) receptors ERα/ESR1 and ERβ/ESR2 at high altitude that transcriptionally activates NOS3. We also observed higher mRNA level of membrane receptor ERBB2 that phosphorylates eNOS at Ser1177 and thus augments NO availability. Evaluating E2 biosynthesis at high altitude, we report higher plasma levels of CYP11A1, CYP19A1, E2, lower levels of testosterone (T) and T/E2 ratio as compared to sea level. Correlation studies revealed moderate positive correlation between E2 and NOx (R = 0.68, p = 0.02) after day 4 and cGMP (R = 0.69, p = 0.02) after day 7 at high altitude. These findings suggest a causative role of E2 and its receptors ESR1 and ESR2 in augmenting eNOS activity and NO availability during healthy high altitude ascent. These results will aid in better understanding of NO production during hypobaric hypoxia and help in designing better high altitude acclimatization protocols.
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Affiliation(s)
- Manish Sharma
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation, Lucknow Road, Timarpur, Delhi, 110054, India
| | - Krishan Singh
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation, Lucknow Road, Timarpur, Delhi, 110054, India; High Altitude Medical Research Centre (HAMRC), C/o 56 APO, Leh-Ladakh, 901205, India
| | - Gidugu Himashree
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation, Lucknow Road, Timarpur, Delhi, 110054, India; Military Hospital, Nasirabad, Rajasthan, 305601, India
| | - Gopinath Bhaumik
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation, Lucknow Road, Timarpur, Delhi, 110054, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation, Lucknow Road, Timarpur, Delhi, 110054, India
| | - Niroj Kumar Sethy
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation, Lucknow Road, Timarpur, Delhi, 110054, India.
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Genetic and epigenetic polymorphisms of eNOS and CYP2D6 in mainland Chinese Tibetan, Mongolian, Uygur, and Han populations. THE PHARMACOGENOMICS JOURNAL 2019; 20:114-125. [PMID: 31616043 DOI: 10.1038/s41397-019-0104-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 09/09/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022]
Abstract
Cytochrome P450 2D6 (CYP2D6) and endothelial nitric oxide synthase (eNOS) are important in the cardiovascular disease susceptibility and drug response. The methylation of cytosine in the promoter of genes could influence expression. The interindividual differences of drug response could only be explained partly by the polymorphisms of drug disposition genes. This study was aimed to investigate the genetic and epigenetic polymorphisms of CYP2D6 and eNOS in Chinese Tibetan, Mongolian, Uygur, and Han volunteers. Blood samples were collected from 842 unrelated Chinese healthy subjects (323 Tibetan, 134 Mongolian, 162 Uygur, and 223 Han) for genotyping and part of the DNA samples were subjected to cytosine methylation analysis. Significant genetic and epigenetic interethnic polymorphisms of eNOS and CYP2D6 were found in the four Chinese groups. The 4b-G-T wild-type haplotype of eNOS was the most common in Chinese Tibetan (87.1%), Mongolian (79.9%), Uygur (76.4%), and Han (79.5%), respectively. eNOS T-786C creates a new CpG site and a significantly higher methylation level was found in -786CC than that in -786TC in Chinese Han (P = 0.0485) and total Chinese (P = 0.0104). CYP2D6 A-678 (rs28633410) makes the symmetrical CpG site changed to be an asymmetrical CpA site, and the methylation level of cytosine in the CpG context of G-678A was significantly higher than that in the CpA. The results of the present study could be useful for understanding the interindividual disparity of cardiovascular disease susceptibility and drug response among different Chinese ethnic groups and would provide more evidences for the precise medication of Chinese.
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Joyce K, Lucas S, Imray C, Balanos G, Wright AD. Advances in the available non-biological pharmacotherapy prevention and treatment of acute mountain sickness and high altitude cerebral and pulmonary oedema. Expert Opin Pharmacother 2018; 19:1891-1902. [DOI: 10.1080/14656566.2018.1528228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- K.E. Joyce
- School of Sport, Exercise, & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - S.J.E. Lucas
- School of Sport, Exercise, & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - C.H.E. Imray
- Department of Vascular Surgery, University Hospitals of Coventry and Warwickshire; Warwick Medical School, Coventry, UK
| | - G.M Balanos
- School of Sport, Exercise, & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A. D. Wright
- Department of Medicine, University of Birmingham, Edgbaston, UK
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Wang Y, Lu H, Chen Y, Luo Y. The association of angiotensin-converting enzyme gene insertion/deletion polymorphisms with adaptation to high altitude: A meta-analysis. J Renin Angiotensin Aldosterone Syst 2016; 17:1470320315627410. [PMID: 27009284 PMCID: PMC5843938 DOI: 10.1177/1470320315627410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/22/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Fluid retention is linked to the physiology and pathophysiology of humans at high altitude (HA). The angiotensin-converting enzyme (ACE) gene plays a role in the regulation of plasma volume and vascular tone. Materials and methods: In this meta-analysis, eligible studies published before 1 September 2015 that focused on the association between the ACE insertion/deletion (I/D) polymorphism and HA adaption were identified by searching the PubMed, Web of Science, Embase and Medline online databases. We used a fixed-effects model and assessed the study qualities multiple times. Results: The seven selected studies included a total of 582 HA-native individuals and 497 low-altitude controls, and these subjects were analyzed for the ACE I/D gene polymorphism. A significant association was found between the ACE DD genotype and HA maladaptation. The results for genotype DD versus ID + II were as follows: Odds ratio (OR) = 0.46; 95% CI 0.31–0.70; p = 0.0002. The results for genotype ID versus DD were as follows: OR = 1.97; 95% CI 1.27–3.06; p = 0.002. Conclusions: Our findings suggested that the DD genotype of ACE is a risk factor for HA maladaptation and that the presence of fewer ACE DD allele carriers in a population indicates a greater ability of that population to adapt to HA.
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Affiliation(s)
- Yuxiao Wang
- Department of Military Medical Geography, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China Battalion 5 Cadet Brigade, Third Military Medical University, Chongqing, China Key Laboratory of High-altitude Medicine, Ministry of Education, Third Military Medical University, Chongqing, China
| | - Hongxiang Lu
- Department of Military Medical Geography, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China Battalion 5 Cadet Brigade, Third Military Medical University, Chongqing, China Key Laboratory of High-altitude Medicine, Ministry of Education, Third Military Medical University, Chongqing, China
| | - Yu Chen
- Key Laboratory of High-altitude Medicine, Ministry of Education, Third Military Medical University, Chongqing, China
| | - Yongjun Luo
- Department of Military Medical Geography, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China Key Laboratory of High-altitude Medicine, Ministry of Education, Third Military Medical University, Chongqing, China
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Xu C, Lu HX, Wang YX, Chen Y, Yang SH, Luo YJ. Association between smoking and the risk of acute mountain sickness: a meta-analysis of observational studies. Mil Med Res 2016; 3:37. [PMID: 27980800 PMCID: PMC5146861 DOI: 10.1186/s40779-016-0108-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People rapidly ascending to high altitudes (>2500 m) may suffer from acute mountain sickness (AMS). The association between smoking and AMS risk remains unclear. Therefore, we performed a meta-analysis to evaluate the association between smoking and AMS risk. METHODS The association between smoking and AMS risk was determined according to predefined criteria established by our team. Meta-analysis was conducted according to the PRISMA guidelines. We included all relevant studies listed in the PubMed and Embase databases as of September 2015 in this meta-analysis and performed systemic searches using the terms "smoking", "acute mountain sickness" and "risk factor". The included studies were required to provide clear explanations regarding their definitions of smoking, the final altitudes reached by their participants and the diagnostic criteria used to diagnose AMS. Odds ratios (ORs) were used to evaluate the association between smoking and AMS risk across the studies, and the Q statistic was used to test OR heterogeneity, which was considered significant when P < 0.05. We also computed 95% confidence intervals (CIs). Data extracted from the articles were analyzed with Review Manager 5.3 (Cochrane Collaboration, Oxford, UK). RESULTS We used seven case-control studies including 694 smoking patients and 1986 non-smoking controls to analyze the association between smoking and AMS risk. We observed a significant association between AMS and smoking (OR = 0.71, 95% CI 0.52-0.96, P = 0.03). CONCLUSIONS We determined that smoking may protect against AMS development. However, we do not advise smoking to prevent AMS. More studies are necessary to confirm the role of smoking in AMS risk.
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Affiliation(s)
- Chen Xu
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Battalion 5 of Cadet Brigade, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Hong-Xiang Lu
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Yu-Xiao Wang
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Yu Chen
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
| | - Sheng-Hong Yang
- Mountain Sickness Research Institute, 18th Hospital of PLA, Yecheng, Xinjiang 844900 China
| | - Yong-Jun Luo
- Department of Military Medical Geography, Third Military Medical University, Chongqing, 400038 China ; Key Laboratory of High Altitude Environmental Medicine (Ministry of Education), Third Military Medical University, Chongqing, 400038 China
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Tang E, Chen Y, Luo Y. Dexamethasone for the prevention of acute mountain sickness: Systematic review and meta-analysis. Int J Cardiol 2014; 173:133-8. [DOI: 10.1016/j.ijcard.2014.03.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/01/2014] [Accepted: 03/09/2014] [Indexed: 01/28/2023]
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Luo Y, Wang Y, Lu H, Gao Y. ‘Ome’ on the range: update on high-altitude acclimatization/adaptation and disease. ACTA ACUST UNITED AC 2014; 10:2748-55. [DOI: 10.1039/c4mb00119b] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The main physiological challenge in high-altitude plateau environments is hypoxia.
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Affiliation(s)
- Yongjun Luo
- Department of Military Medical Geography
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
| | - Yuxiao Wang
- Department of Military Medical Geography
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
| | - Hongxiang Lu
- Department of Military Medical Geography
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
| | - Yuqi Gao
- Key Laboratory of High Altitude Medicine (Ministry of Education)
- Third Military Medical University
- Chongqing 400038, China
- Key Laboratory of High Altitude medicine (People's Liberation Army)
- Third Military Medical University
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Yang YZ, Wang YP, Qi YJ, Du Y, Ma L, Ga Q, Ge RL. Endothelial PAS Domain Protein 1 Chr2:46441523(hg18) Polymorphism Is Associated With Susceptibility to High Altitude Pulmonary Edema in Han Chinese. Wilderness Environ Med 2013; 24:315-20. [DOI: 10.1016/j.wem.2013.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
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Luo Y, Yang X, Gao Y. Strategies for the prevention of acute mountain sickness and treatment for large groups making a rapid ascent in China. Int J Cardiol 2013; 169:97-100. [PMID: 24095160 DOI: 10.1016/j.ijcard.2013.08.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/09/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
Approximately 26.8% of China's land area has an elevation of 3000 m above sea level or higher. Because of recent demands for economic development and new construction in highland areas, many people have relocated from the plains to high plateau regions and have to face the possibility of contracting acute mountain sickness. Therefore, prevention and treatment strategies are necessary to reduce the incidence of acute mountain sickness in people who rapidly ascend to plateau areas. This paper describes the Chinese experience when large numbers of people moved to the plateau and the steps that were taken to deal with this illness. These steps included implementing basic prevention measures, increasing medical awareness among populations ascending to high altitudes, and installing standardized medical management systems to prevent and treat acute mountain sickness before, during, and after ascent. The incidence of acute mountain sickness can be reduced by improving prevention and treatment and by implementing the recommendations described in this manuscript.
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Affiliation(s)
- Yongjun Luo
- Department of Military Medical Geography, Third Military Medical University, Chongqing 400038, China; Key Laboratory of High Altitude Medicine (Ministry of Education), Third Military Medical University, Chongqing 400038, China; Key Laboratory of High Altitude Medicine (People's Liberation Army), Third Military Medical University, Chongqing 400038, China
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Abstract
Altitude physiology began with Paul Bert in 1878. Chronic mountain sickness (CMS) was defined by Carlos Monge in the 1940s in the Peruvian Andes as consisting of excess polycythemia. Hurtado et al performed studies in the Peruvian Andes in the 1950s to 1960s which defined acclimatization in healthy altitude natives, including polycythemia, moderate pulmonary hypertension, and low systemic blood pressure (BP). Electrocardiographic changes of right ventricular hypertrophy (RVH) were noted. Acclimatization of newcomers to altitude involves hyperventilation stimulated by hypoxia and is usually benign. Acute mountain sickness (AMS) in travelers to altitude is characterized by hypoxia-induced anorexia, dyspnea, headache, insomnia, and nausea. The extremes of AMS are high-altitude cerebral edema and high-altitude pulmonary edema. The susceptible high-altitude resident can lose their tolerance to altitude and develop CMS, also referred to as Monge disease. The CMS includes extreme polycythemia, severe RVH, excess pulmonary hypertension, low systemic BP, arterial oxygen desaturation, and hypoventilation.
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Affiliation(s)
- Thomas F Whayne
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
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