Physiological aspects of high-altitude pulmonary edema.

High-altitude pulmonary edema (HAPE) develops in rapidly ascending nonacclimatized healthy individuals at altitudes above 3,000 m. An excessive rise in pulmonary artery pressure (PAP) preceding edema formation is the crucial pathophysiological factor because drugs that lower PAP prevent HAPE. Measurements of nitric oxide (NO) in exhaled air, of nitrites and nitrates in bronchoalveolar lavage (BAL) fluid, and forearm NO-dependent endothelial function all point to a reduced NO availability in hypoxia as a major cause of the excessive hypoxic PAP rise in HAPE-susceptible individuals. Studies using right heart catheterization or BAL in incipient HAPE have demonstrated that edema is caused by an increased microvascular hydrostatic pressure in the presence of normal left atrial pressure, resulting in leakage of large-molecular-weight proteins and erythrocytes across the alveolarcapillary barrier in the absence of any evidence of inflammation. These studies confirm in humans that high capillary pressure induces a high-permeability-type lung edema in the absence of inflammation, a concept first introduced under the term "stress failure." Recent studies using microspheres in swine and magnetic resonance imaging in humans strongly support the concept and primacy of nonuniform hypoxic arteriolar vasoconstriction to explain how hypoxic pulmonary vasoconstriction occurring predominantly at the arteriolar level can cause leakage. This compelling but as yet unproven mechanism predicts that edema occurs in areas of high blood flow due to lesser vasoconstriction. The combination of high flow at higher pressure results in pressures, which exceed the structural and dynamic capacity of the alveolar capillary barrier to maintain normal alveolar fluid balance.     

Activity profile of world-class professional surfers during competition: a case study

The activity profile of men's competitive surfing was investigated during an international contest. Forty-two male surfers were filmed during 42 elimination heats. Surfers' activities were classified into 1 of 4 distinct categories (paddling, wave riding, stationary, and miscellaneous). The surfers were paddling and stationary 51% (25-70%) and 42% (23-72%) of the total time, respectively. Wave riding accounted for 4% (2-7%) of the total time, whereas miscellaneous activity accounted for the remaining 2% (0.1-6%) of the total time. The frequency (average number of motions in a heat) of each activity was 26 for paddling (15-37); 17 for stationary (10-26); 5 for wave riding (2-8); and 6 for miscellaneous activity (1-13). The mean duration lengths of the activities were 30.1 seconds (1-286 seconds), 37.7 seconds (1-413 seconds), 11.6 seconds (1-44 seconds), and 5 seconds (1- 31 seconds) for paddling, stationary, wave riding, and miscellaneous activities, respectively. Most of the paddling bouts ( approximately 60%) were performed at time intervals of between 1 and 20 seconds. Approximately 50% (50.9%) of the rest intervals were between 1 and 20 seconds in duration. The results showed that surfing is an intermittent activity characterized by a large variability and random distribution of each parameter analyzed. This information can be used to assist in the development of fitness training programs and physiological testing for competitive surfers.     

Physiological and genetic convergence supports hypoxia resistance in high-altitude songbirds

Skeletal muscle plays a central role in regulating glucose uptake and body metabolism; however, highland hypoxia is a severe challenge to aerobic metabolism in small endotherms. Therefore, understanding the physiological and genetic convergence of muscle hypoxia tolerance has a potential broad range of medical implications. Here we report and experimentally validate a common physiological mechanism across multiple high-altitude songbirds that improvement in insulin sensitivity contributes to glucose homeostasis, low oxygen consumption, and relative activity, and thus increases body weight. By contrast, low-altitude songbirds exhibit muscle loss, glucose intolerance, and increase energy expenditures under hypoxia. This adaptive mechanism is attributable to convergent missense mutations in the BNIP3L gene, and METTL8 gene that activates MEF2C expression in highlanders, which in turn increases hypoxia tolerance. Together, our findings from wild high-altitude songbirds suggest convergent physiological and genetic mechanisms of skeletal muscle in hypoxia resistance, which highlights the potentially medical implications of hypoxia-related metabolic diseases.     

Control of ventilation in extreme-altitude climbers

Ten climbers who participated in the Nepal-Japan Kangchenjunga Expedition (altitude, 8,478-8,586 m) in 1984 were examined for their hypercapnic and isocapnic hypoxic ventilatory responses (HCVR and HVR) at sea level before and after the expedition. Five climbers who reached an altitude higher than 8,000 m, [designated high-performance climbers (HPC)] exhibited significantly higher HVR than five climbers who did not [low-performance climbers (LPC)]. On the other hand, no significant difference in HCVR was seen between HPC and LPC. Our results were in agreement with the findings reported by Schoene et al. (J. Appl. Physiol. 56: 1478-1483, 1984) obtained in the American Medical Research Expedition to Everest in 1981. Significant depression in HVR in five climbers was found even 35-40 days after the expedition, which was accompanied by decreased arterial partial pressure of CO2 and increased pH at rest. Hence, the effect of altitude acclimatization in the climbers exposed to extreme altitude may have still persisted at the time of the postexpedition study. Our results confirmed that HRV evaluated at sea level may be used as an indicator of a climber's capability at great high altitude.     

Kinetics of thigmocurvature in two tendril-bearing climbers

Abstract. Growth of marked zones of watermelon and passion fruit tendrils was measured following brief thigmostimulation. In each case, curvature involved growth promotion on the non-contact side of the tendril. Substantial shrinkage also occurred on the contact side of the passion fruit tendril but very little shrinkage took place in the watermelon tendril. Curvature was detected 10s and 1 min after the completion of stimulation in watermelon and passion fruit, respectively. The rapidity of this curvature argues against the mediation of the response by plant growth substances.     

Physiological profile of juvenile rats: effects of cage size and cage density

Although there is a general consensus that housing conditions affect the well-being of laboratory animals, the ideal cage size and density for housing laboratory rodents has not been established. The authors investigated the effects of cage size and cage density on growth, organ development, metabolic profile, and hemogram in juvenile Sprague-Dawley rats. Larger cages and increased cage density were associated with depressions in body weight and in the weights of several organs. In general, increasing group size and density correlated more strongly with detrimental effects on the growth of females than males, although hemogram values indicated that males are more prone to emotional stress and immune suppression than females in response to increasing group size and crowding.     

Prediction of indoor climbing performance in women rock climbers

In an attempt to more clearly understand the strength characteristics of female rock climbers and whether those variables affect and predict climbing performance, 2 indoor climbing performance tests (route and bouldering) were compared to a series of muscular strength tests performed by moderate (n = 6), intermediate (n = 6), and expert (n = 6) female rock climbers. Significant differences (p < 0.05) were found between the expert group and the moderate and intermediate groups for climbing specific hand strength, as well as 1-arm lock-off strength when expressed as a strength-to-weight ratio. Multiple correlations showed that these variables (r > 0.426) as well as a questionnaire of past climbing performance (r > 0.86) significantly correlated to the tests of indoor climbing performance. In conclusion, climbing-specific tests of hand strength and of one arm lock-off strength reliably and sensitively measured 2 significant variables in the performance of indoor rock climbing, and a questionnaire of past best performance may be an accurate tool for the prediction of indoor climbing performance.     

Dynamics of predominant microbiota in the human gastrointestinal tract and change in luminal enzymes and immunoglobulin profile during high-altitude adaptation

High-altitude (HA) visitors like pilgrims, trackers, scientists and military personnel face a group of nonspecific gastrointestinal (GI) symptoms during acclimatization to hypobaric hypoxia. In order to investigate the alteration of indigenous gastrointestinal microbiota in the development of such GI symptoms, an experiment was conducted for the enumeration of dominant cultivable faecal microbiota of 15 soldiers at base level (Delhi) and during their 15-day acclimatization at 3,505 m HA (Leh). At HA, faecal microbiota analysis revealed that total aerobes decreased significantly with increase of total and facultative anaerobes. The strict anaerobes like Bifidobacterium sp., Bacteroidetes sp. and Lactobacillus sp. exhibited positive growth direction index (GDI) like other predominant obligate anaerobes Clostridium perfringens and Peptostreptococcus sp. Different enzymes like amylase, proteinase and polyphenol hydrolase produced by different bacterial populations showed positive GDI, whereas phosphatase producers exhibited negative GDI. The levels of microbe-originated enzymes like amylase, proteinase, alkaline phosphatase and β-glucuronidase were also elevated during HA acclimatization. In addition, in vitro gas production ability was enhanced with increase of faecal immunoglobulins IgA and IgG. We demonstrated that hypoxic environment at HA had the potential to alter the gut microbial composition and its activities that may cause GI dysfunctions.     

Control of ventilation and aerobic work capacity in elite climbers

Hypoxic ventilatory response (HVR), hypercapnic ventilatory response (HCVR), and maximal oxygen uptake (VO2max) were measured in elite male climbers (Clim.: n = 4) and physically active controls (Con.: n = 8). Although mean value of S, an index of HCVR, showed almost the same values in both groups (Clim.: 2.26 +/- 0.62 vs. Con.: 1.85 +/- 0.58 l.min-1.Torr-1), mean value of A, an index of HVR, was significantly higher in climbers than controls (Clim.: 237.8 +/- 109.2 vs. Con.: 111.3 +/- 62.0 l.min-1.Torr-1). Mean value of VO2max in climbers was not different from that in controls (Clim.: 49.3 +/- 2.9 vs. Con.: 47.5 +/- 5.7 ml.kg-1.min-1). These results demonstrate that elite climbers are characterized by their enhanced ventilatory response to hypoxia rather than prominency in aerobic work capacity. It is speculated that enhanced HVR in climbers makes compensation for decreased VO2max at high altitude. The enhanced HVR in elite climbers who have ordinary values in VO2max may be one of factors in their successful performance at extreme altitude.     

Cognitive and psychomotor responses to high-altitude exposure in sea level and high-altitude residents of Ecuador

Background

High-altitude inhabitants have cardiovascular and respiratory adaptations that are advantageous for high-altitude living, but they may have impaired cognitive function. This study evaluated the influence of altitude of residence on cognitive and psychomotor function upon acute exposure to very high altitude.

Findings

Ecuadorians (31 residing at 0–1,500 m [LOW], 78 from 1,501–3,000 m [MOD], and 23 living >3,000 m [HIGH]) were tested upon their arrival to a hut at 4,860 m on Mount Chimborazo. Cognitive/psychomotor measurements included a go-no-go test (responding to a non-visual stimulus), a verbal fluency test (verbalizing a series of words specific to a particular category), and a hand movement test (rapidly repeating a series of hand positions). Mean differences between the three altitude groups on these cognitive/psychomotor tests were evaluated with one-way ANOVA. There were no significant differences (p = 0.168) between LOW, MOD, and HIGH for the verbal fluency test. However, the go-no-go test was significantly lower (p < 0.001) in the HIGH group (8.8 ± 1.40 correct responses) than the LOW (9.8 ± 0.61) or MOD (9.8 ± 0.55) groups, and both MOD (97.9 ± 31.2) and HIGH (83.5 ± 26.7) groups completed fewer correct hand movements than the LOW (136.6 ± 37.9) subjects (p < 0.001).

Conclusions

Based on this field study, high-altitude residents appear to have some impaired cognitive function suggesting the possibility of maladaptation to long-term exposure to hypobaric hypoxia.     

Genetic determinants of Tibetan high-altitude adaptation

Some highland populations have genetic adaptations that enable their successful existence in a hypoxic environment. Tibetans are protected against many of the harmful responses exhibited by non-adapted populations upon exposure to severe hypoxia, including elevated hemoglobin concentration (i.e., polycythemia). Recent studies have highlighted several genes subject to natural selection in native high-altitude Tibetans. Three of these genes, EPAS1, EGLN1 and PPARA, regulate or are regulated by hypoxia inducible factor, a principal controller of erythropoiesis and other organismal functions. Uncovering the molecular basis of hypoxic adaptation should have implications for understanding hematological and other adaptations involved in hypoxia tolerance. Because the hypoxia response involves a variety of cardiovascular, pulmonary and metabolic functions, this knowledge would improve our understanding of disease mechanisms and could ultimately be translated into targeted therapies for oxygen deprivation, cardiopulmonary and cerebral pathologies, and metabolic disorders such as diabetes and obesity.     

Comparison of the muscle mechanics of the forelimb of three climbers

The climbing behavior, muscle mechanics, and functional properties of selected forelimb muscles were examined to ascertain how three distantly related mammals may be adapted for climbing. To determine if features of the fox squirrel (Stalheim-Smith: J. Morphol. 180:55-68, '84) are general or unique features for a climber, two distantly related climbers, the raccoon (Procyon lotor) and the opossum (Didelphis virginiana), were studied. Muscle mechanics varied: the elbow flexors of the fox squirrel produced significantly more torque per unit mass than did the corresponding muscles of the opossum except at 80 degrees, but not more than the corresponding muscles of the raccoon. On the other hand, there were no statistically significant differences in torque per unit mass among the elbow extensors of the three climbers. Both elbow flexors and elbow extensor had faster contraction times and were more fatigable in the fox squirrel than in the opossum or in the raccoon. The data suggest that the musculoskeletal characteristics of the forelimbs of climbers vary according to behavioral, and possibly phylogenetic, differences.     

Biomechanical properties of the crimp grip position in rock climbers

Rock climbers are often using the unique crimp grip position to hold small ledges. Thereby the proximal interphalangeal (PIP) joints are flexed about 90 degrees and the distal interphalangeal joints are hyperextended maximally. During this position of the finger joints bowstringing of the flexor tendon is applying very high load to the flexor tendon pulleys and can cause injuries and overuse syndromes. The objective of this study was to investigate bowstringing and forces during crimp grip position. Two devices were built to measure the force and the distance of bowstringing and one device to measure forces at the fingertip. All measurements of 16 fingers of four subjects were made in vivo. The largest amount of bowstringing was caused by the flexor digitorum profundus tendon in the crimp grip position being less using slope grip position (PIP joint extended). During a warm-up, the distance of bowstringing over the distal edge of the A2 pulley increased by 0.6mm (30%) and was loaded about 3 times the force applied at the fingertip during crimp grip position. Load up to 116N was measured over the A2 pulley. Increase of force in one finger holds by the quadriga effect was shown using crimp and slope grip position.