High altitude medicine & biology最新文献

Reid, Ly-Anh, Jordan L. Rees, Miranda Kimber, Marina James, Graeme M. Purdy, Megan Smorschok, Lauren E. Maier, Normand G. Boulé, Trevor A. Day, Margie H. Davenport, and Craig D. Steinback. Blood glucose during high altitude trekking in young healthy adults. High Alt Med Biol. 26:30-36, 2025. Introduction: High altitude trekking is becoming more popular and accessible to an increased number of people. Simultaneously, there is a worldwide rise in the prevalence of metabolic diseases. The purpose of this study was to examine the impact of a gradual trekking ascent to high altitude on continuous glucose monitoring outcomes including fasting, mean 24-hour, postprandial, and post-75 g modified oral glucose tolerance test. This study also investigated the relationship between physical activity intensity, high altitude, and glucose concentrations. Methods: Individuals (n = 9) from Alberta, Canada participated in a 2-week trek in the Khumbu Valley in Nepal, ascending by foot from 2,860 m to 5,300 m (∼65 km) over 10 days. A standardized 75 g oral glucose load was given to participants at four different altitudes (1,130 m, 3,440 m, 3,820 m, 5,160 m). Physical activity (Actigraph accelerometry) and interstitial glucose (iPro2, Medtronic) were measured continuously during the trek. Results: Fasting and mean 24-hour glucose concentrations were not different between altitudes. However, 2-hour post dinner glucose and 2-hour post lunch glucose, AUC concentrations were different between altitudes. The relationship between physical activity intensity and glucose was not influenced by increasing altitudes. Conclusion: Our findings suggest that glucose regulation is largely preserved at high altitude; however, inconsistency in our postprandial glucose concentrations at altitude warrants further investigation.

Zengmei, Sun, Suyuan Wang, Hua He, Chenghui Zhang, Mingxia Li, Yan Ye, Huiqin Zhang, Xuanyu Yao, Shuyao Sun, Yuanze Du, Yang Zhong, and Yunhong Wu. Influence of high-altitude residential history on optimal HbA1c cutoff for detecting abnormal glucose metabolism. High Alt Med Biol. 26:45-54, 2025. Aims: To explore the influence of recent high-altitude residential history on the optimal cutoff of glycosylated hemoglobin (HbA1c) for detecting abnormal glucose metabolism. Methods: The study included 505 self-reported healthy Han participants of age 18-65 years, recruited in Chengdu and categorized based on recent (within 3 months) high-altitude (>2,500 m) residential history. The 1999 WHO criteria was used as the gold standard for defining prediabetes and diabetes. HbA1c test performance was assessed using receiver operating characteristic curve, with the optimal cutoff determined by Maximum Youden index. Propensity score matching with 0.02 calipers and nearest neighbor method was used to balance confounding factors between groups. Results: Of the participants, 238 (47.13%) were populations with recent high-altitude residential history (HA group), and 267 (52.87%) were low-altitude dwellers (LA group). The HA group had slightly higher HbA1c levels (p > 0.05) and higher erythrocyte and hemoglobin levels (p < 0.05), compared to the LA group. Weak correlations between prediabetes and HbA1c levels were observed in the HA group (r_s = 0.21, p < 0.05) and the LA group (r_s = 0.07, p = 0.25). The optimal cutoff for the detection of diabetes was 6.5% (area under the curve [AUC] 0.94) in the HA group and 5.9% (AUC 0.97) in the LA group, which remained unchanged after adjustment for confounders. Conclusions: The optimal cutoff of HbA1c for the detection of diabetes in populations with recent history of living at high altitude was higher than that in general populations living at low altitude, and the diagnostic value of HbA1c for prediabetes was also inadequate.

van Veelen, Michiel J., Rudolf Likar, Markus Tannheimer, Konrad E. Bloch, Silvia Ulrich, Michael Philadelphy, Barbara Teuchner, Thomas Hochholzer, Jacqueline Pichler Hefti, Urs Hefti, Peter Paal, and Martin Burtsche. Emergency Care for High-Altitude Trekking and Climbing. High Alt Med Biol. 26:70-86, 2025. Introduction: High altitude regions are characterized by harsh conditions (environmental, rough terrain, natural hazards, and limited hygiene and health care), which all may contribute to the risk of accidents/emergencies when trekking or climbing. Exposure to hypoxia, cold, wind, and solar radiation are typical features of the high altitude environment. Emergencies in these remote areas place high demands on the diagnostic and treatment skills of doctors and first-aiders. The aim of this review is to give insights on providing the best possible care for victims of emergencies at high altitude. Methods: Authors provide clinical recommendations based on their real-world experience, complemented by appropriate recent studies and internationally reputable guidelines. Results and Discussion: This review covers most of the emergencies/health issues that can occur when trekking or during high altitude climbing, that is, high altitude illnesses and hypothermia, freezing cold injuries, accidents, for example, with severe injuries due to falling, cardiovascular and respiratory illnesses, abdominal, musculoskeletal, eye, dental, and skin issues. We give a summary of current recommendations for emergency care and pain relief in case of these various incidents.

Foster, Katharine, James D. Anholm, Gary Foster, Suman Thapamagar, and Prajan Subedi. Effects of naltrexone on sleep quality and periodic breathing at high altitude. High Alt Med Biol. 26:13-19, 2025. Objective: This study examined the effects of naltrexone on breathing and sleep at high altitude. Mu-opioid receptor (MOR) agonists have a depressive effect on respiration. Naltrexone is known to block the MOR. We hypothesized that MOR blockade with naltrexone would result in higher nocturnal oxygen saturations, fewer apneas, and improved sleep at high altitude. Methods: This double-blind, placebo-controlled, crossover study included nine healthy volunteers (four females, five males) aged 27.9 (4.6) (mean [standard deviation]) years. Two overnight trips spaced at least 2 weeks apart took participants from Loma Linda, CA (355 m) to the Barcroft Laboratory, CA (3,810 m) for each arm. Participants ingested either 50 mg naltrexone or matching placebo at bedtime. Sleep metrics were recorded using an ambulatory physiological sleep monitor (APSM). Subjective data were measured with the Groningen Sleep Quality Scale, Stanford Sleepiness Scale, and the 2018 Lake Louise Score (LLS) for acute mountain sickness (AMS). Results: Mean overnight SpO₂ was lower after taking naltrexone, 81% (6) versus 83% (4) (mean difference 1.9% [2.1, 95% confidence interval or CI = 0.1-3.6, p = 0.040]). The lowest overnight SpO₂ (nadir) was lower on naltrexone 70% (6) versus 74% (4) (dif. 4.6% [4.3], CI = 1.0-8.2, p = 0.020). Total sleep time and total apnea-hypopnea index were unchanged. Subjective sleep quality was significantly worse on naltrexone measured via the Groningen Sleep Quality Scale (p = 0.033) and Stanford Sleepiness Scale (p = 0.038). AMS measured via LLS was significantly worse while taking naltrexone (p = 0.025). Conclusion: Contrary to our hypothesis, this study demonstrated a significant decrease in nocturnal oxygen saturation, worse sleep quality, and AMS scores. Further characterization of the MOR's effects on sleep and AMS is needed to evaluate potential exacerbating mechanisms for AMS and poor sleep quality at altitude.

Miserocchi, Giuseppe. Physiopathology of high-altitude pulmonary edema. High Alt Med Biol. 26:1-12, 2025.-The air-blood barrier is well designed to accomplish the matching of gas diffusion with blood flow. This function is achieved by maintaining its thickness at ∼0.5 µm, a feature implying to keep extravascular lung water to the minimum. Exposure to hypobaric hypoxia, especially when associated with exercise, is a condition potentially leading to the development of the so-called high-altitude pulmonary edema (HAPE). This article presents a view of the physiopathology of HAPE by merging available data in humans exposed to high altitude with data from animal experimental approaches. A model is also presented to characterize HAPE nonsusceptible versus susceptible individuals based on the efficiency of alveolar-capillary oxygen uptake and estimated morphology of the air-blood barrier.

Vasdeki, Dimitra, Georgios Tsamos, Kleoniki I. Athanasiadou, Vasiliki Michou, Evangelos Botsarakos, Michael Doumas, Kalliopi Kotsa, and Theocharis Koufakis. Above the clouds with diabetes: from pathophysiological considerations to practical recommendations for safe flights. High Alt Med Biol. 26:87-98, 2025. Background: The prevalence of diabetes mellitus has been following an increasing trend in the last decades, leading to a growing number of travelers with diabetes seeking pretravel advice from medical professionals. Methods: This narrative review summarizes the existing evidence on the intriguing association between diabetes and air travel, analyzes safety and certification protocols, and provides practical recommendations for the management of diabetes during flights. Results: During air travel, individuals with diabetes face challenges arising from inappropriate dietary options, restricted access to medications and healthcare services, disruption of medication dosing intervals, and exposure to hypobaric conditions in the airplane cabin. In addition, people with diabetes, especially those treated with insulin, have traditionally been considered ineligible to become professional pilots. However, this approach gradually changes and numerous countries are now implementing strict protocols to determine the eligibility of pilots with diabetes to operate flights. Conclusions: Given the increasing use of technology and new drugs in daily clinical practice, there is a need for further research in the field to shed light on existing knowledge gaps and ensure safe flights for people with diabetes.

Tian, Lu, Guiqin Liu, Qin Zhao, Junjun Han, Yue Lin, Wang, Jia, Delong Duo, Duan Yabin, Zhu Junbo, and Li Xiangyang. Pharmacokinetics of midazolam in plasma and brain tissue of rats after exposure to acute and chronic high altitude hypoxia. High Alt Med Biol. 00:00-00, 2025. Background: Midazolam effectively improves sleep quality under high altitude hypoxia by reducing central nervous system excitability. Methods: Field modeling and sample collection were performed at an altitude of 4,300 m in a high altitude hypoxic environment with a pressure of inspired oxygen of 107 mmHg. Pharmacokinetic alterations of midazolam in high altitude hypoxic rats are determined by high performance liquid chromatography-mass spectrometry. Quantitative real-time polymerase chain reaction and Western blot were used to confirm the connection with drug metabolism and alterations in hypoxia CYP3A4 and P-glycoprotein (P-gp) expression. Results: This study demonstrated that high altitude hypoxia increased blood-brain barrier permeability in rats, caused brain tissue damage, and altered the expression of inflammatory cytokines in the brain. In the acute high altitude group and the chronic high altitude group, the area under the curve and T_max of plasma midazolam revealed substantial increases of 88.6% and 283% and 28.6% and 85.3%, respectively. The clearance rate reduced by 47.3% and 90.0%, while the brain-blood drug concentration ratio (C_brain/C_plasma) diminished by 11.4% and 82.1%, respectively. The relative expression of CYP3A1 mRNA in the brain tissue of high altitude rats decreased by 42.4% and 66.8%, respectively, and the protein expression was downregulated, while the relative expression of P-gp mRNA increased by 61.3% and 91.2%, respectively (p < 0.05 for all parameters), and the protein expression was upregulated. High altitude hypoxia altered CYP3A1 and P-gp expression and activity, causing alterations in midazolam metabolism. Conclusions: This research provided a new reference for the rational use of midazolam in highland areas.

Brazo-Sayavera, Javier, Alba Camacho-Cardenosa, Talita Morais Fernandes, Jamille Guedes Malta Argolo, Ana Paula Morais Fernandes, Carlos Arterio Sorgi, Elisângela Aparecida da Silva Lizzi, and Átila Alexandre Trapé. Effects of moderate-intensity cyclic normobaric hypoxic training on cardiovascular disease risk factors of patients recovered from COVID-19: The AEROBICOVID randomized controlled trial. High Alt Med Biol. 00:00-00, 2025. Objectives: The aim was to analyze the effects of a training program under hypoxic conditions compared with a control and normoxia training program on cardiovascular disease risk factors in patients recovered from COVID-19. Methods: A total of 67 patients were randomly assigned to the control group, training and recovery with hypoxia (T_H:R_H), training in normoxia (T_N) and recovery with hypoxia (R_H), and T_N and recovery in normoxia (R_N). Anthropometric, body composition, respiratory, and cardiometabolic risk factors were analyzed before and after intervention. Results: All intervention groups had positive effects on various health outcomes in patients recovered from COVID-19. The reduction in waist, hip, and waist/hip ratio, glycaemia, total cholesterol, and low-density lipoprotein-cholesterol indicates improvements in cardiovascular health. The increase in the forced expiratory volume in 1 second suggests improvements in respiratory health. In addition, the decrease in cardiovascular disease risk score indicates a reduction in overall cardiovascular disease risk. Conclusions: The study provides evidence to support the clinical benefits of moderate-intensity intermittent hypoxic training as a part of the treatment of patients recovered from COVID-19. It may also provide evidence on the efficacy and safety of intermittent hypoxic training in different health conditions. The study was registered at the Brazilian Clinical Trials Registry (RBR-5d7hkv).

Jiaojiao Yin, Yuhang Wang, Bing Li, Xiaoyan Hu, Yao Ma, Chong Zhang, Xiaoqin Ha, Linyan Wang, and Yaozhu Pan. Hypobaric hypoxia increased autophagy and apoptosis in PC12 rat pheochromocytoma cells more than normobaric hypoxia. High Alt Med Biol. 00:00-00, 2025. Purpose: Currently, in vitro studies have focused on hypoxia injury in acute mountain sickness (AMS), but little effort has been made to assess the effects of hypobaric hypoxia. AMS is a neurological disorder, and rat pheochromocytoma (PC12) cells are a model to study neuronal survival and apoptosis. Here, we developed a novel cell culture method that mimics hypobaric hypoxia at high attitude and compared the effects of hypobaric hypoxia and normobaric hypoxia on autophagy and apoptosis of PC12 cells. Methods: PC12 cells were cultured under normal conditions, normobaric hypoxia, and hypobaric hypoxia. Autophagy was observed by transmission electron microscopy and immunofluorescence microscopy. The hypoxia-inducible factor1-α (HIF1-α), LC3, caspase-3, and cleaved caspase-3 expression levels were determined by Western blot. Results: The cell culture chamber mimicking hypobaric hypoxia at high attitude perfectly maintained the air pressure at 41.1 kPa and the oxygen density at 1% (PO₂ around 3.08 mmHg). Hypobaric hypoxic treatment of PC12 cells at 0, 4, 8, 16, 24, and 48 hours resulted in an increase in HIF1-α and LC3Ⅱ protein levels, and the ratio of HIF1-α/actin and LC3Ⅱ/actin both peaked at 16 hours (p < 0. 01) when the cell viability was 88.02%. There was a 1.5-fold increase in LC3Ⅱ expression, a 2-fold increase in LC3B-positive spots, and an increase in autophagosome accumulation at hypobaric hypoxia compared to PC12 cells at normobaric hypoxia for 16 hours (p < 0.001). Interestingly, the promotion of autophagy (coculture with rapamycin or 3-MA) in PC12 cells under normobaric hypoxia reduced cleaved caspase-3 expression (the ratio of cleaved caspase-3/caspase-3 decreased, p < 0.01). However, under hypobaric hypoxia, the promotion of autophagy inversely increased cleaved caspase-3 (the ratio of cleaved caspase-3/caspase-3 increased, p < 0.01), and the inhibition of autophagy (hydroxychloroquine [HCQ] coculture) decreased cleaved caspase-3 (the ratio of cleaved caspase-3/caspase-3 decreased, p < 0.01). Conclusions: Compared with normobaric hypoxia cells, hypobaric hypoxia cells cultured in vitro exhibited increased autophagy and apoptosis.

Ri-Li Ge. Medical problems of chronic hypoxia in highlanders living on the tibetan plateau. High Alt Med Biol. 00:00-00, 2024.-Health issues at high altitudes arise due to the lower atmospheric pressure and subsequent reduction in the partial pressure of oxygen in ambient air. While much research has been published on health problems of lowlanders who move to high altitudes, less is known about the medical challenges faced by long-term and permanent high-altitude residents, especially in the Qinghai-Tibetan plateau. In this review, we briefly summarized the chronic hypoxia-related health issues in highlanders, focusing on the specific population of the Qinghai-Tibetan plateau. It deals with important health problems for highlanders, including the main disease categories, from chronic mountain sicknesses and pulmonary hypertension (PH) to kidney, neurocognitive impairments, perinatal problems, and congenital heart defect. However, the most hallmark of disorders is excessive erythrocytosis associated with specific symptoms and signs, and high-altitude heart disease is characterized by excessive PH, right ventricular hypertrophy, and right heart failure. We also provide information on potential treatment strategies, including some traditional Tibetan medical practices and also a combination of Western medicine and traditional Chinese medicine to prevent and treat these conditions effectively. This mini-review is heavily based on a couple of decades of research carried out by Chinese high-altitude medical research groups at the Qinghai-Tibetan Plateau. We believe that this review will provide valuable perspective to researchers whose study interest and base lie in high altitude.