Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness

Background

Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide.

Efficacy of Acetazolamide for the Prophylaxis of Acute Mountain Sickness: A Systematic Review,Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials

BackgroundAcute mountain sickness (AMS) is a benign and self-limiting syndrome but can progress to life-threatening conditions if leave untreated. This study aimed to assess the efficacy of acetazolamide for the prophylaxis of AMS and disclose potential factors that affect the treatment effect of acetazolamide.Materials and MethodsRandomized controlled trials comparing the use of acetazolamide versus placebo for the prevention of AMS were included. The incidence of AMS was the primary endpoint. Meta-regression analysis was conducted to explore potential factors associated with acetazolamide efficacy. Trial sequential analysis (TSA) was conducted to estimate the statistical power of the available data.ResultsA total of 22 trials were included. Acetazolamide at 125, 250, and 375 mg/ twice daily (bid) significantly reduced incidence of AMS compared to placebo. TAS indicated that the current evidence was adequate confirming the efficacy of acetazolamide at 125, 250, and 375 mg/bid in lowering incidence of AMS. There was no evidence of an association between efficacy and dose of acetazolamide, timing at start of acetazolamide treatment, mode of ascent, AMS assessment score, timing of AMS assessment, baseline altitude, and endpoint altitude.ConclusionAcetazolamide is effective prophylaxis for the prevention of AMS in doses of 125, 250, and 375 mg/bid. Future investigations should focus on personal characteristics, disclosing the correlation between acetazolamide efficacy and body mass, height, degree of prior acclimatization, individual inborn susceptibility, and history of AMS.     

高原外训军人心理健康、认知因素与急性高山病的相关性

目的:探讨高原外训军人心理健康、认知因素与急性高山病的相关性。方法:采用基本信息问卷、Lake Louise急性高山病评分量表(AMS)、症状自评量表(SCL-90)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对191名急进高原进行高原适应性训练的军人施以团体测验。结果:研究样本SCL-90的躯体化因子显著高于全国正常成人常模(t=5.019,P0.001)。AMS症状阳性组与阴性两组样本在文化程度(t=2.385,P0.05)、社会支持中的倾诉方式(t=2.542,P0.05)、求助方式(t=2.133,P0.05)、对AMS的认知(t=2.423,P0.05)、SCL-90总分(t=-4.936,P0.001)及各因子分均有显著差异。SCL-90总分、对AMS应对策略的认知对预测AMS症状总分有一定的预测作用。结论:高原外训军人心理健康水平、认知因素对AMS有显著的影响,运用合理的心理干预技术,可降低AMS的发生率,增强高原作战部队的战斗力。     

急性高原反应症状学评分与地理因素关系的多元回归分析

目的探讨人群乘飞机进入高原时急性高原病(acute mountain sickness,AMS)发生情况与其所生活地理环境的关系。方法对373名世居平原青年男性乘飞机进藏后急性高原病发生情况进行评分,将评分与其进入高原前所长期居住地区的地理因素进行多元回归分析。结果得到回归方程=7.231-2.323 X1-7.012 X2+9.810 X3+16.144 X4-7.148 X5+2.379 X7。结论人群对高原环境的适应能力与其长期生活的地理环境中的海拔、气压、年平均气温、经度、纬度、年极端最低气温等因素相关。可以根据回归方程预测在不同地区生活的青年男性群体进入高原急性高原病整体发病水平,并采取针对性的预防措施,以更好的提高急性高原反应防治效果。     

Nrf2基因单核苷酸多态性与急性高原病相关性研究

目的：探讨中国汉族人群中Nrf2基因多态性与急性高原病（ AMS）易感性的关系。方法采用巢式病例研究方法,以603名急进3700 m高原的中国汉族青年男性为研究对象,根据路易斯湖评分系统（ LLSS）分为病例组（n＝369）和对照组（n＝234）,采用Sequenom Mass Array 质谱阵列技术检测两组人群Nrf2基因位点rs10497511和rs2364722的基因多态性。结果病例组与对照组中rs10497511和rs2364722位点分别检测出T、C和A、G等位基因;两位点等位基因频率在两组间差异无统计学意义（P＞0．05）。进一步对2个位点的基因型共显性模型、显性模型和隐性模型分析也未提示差异有统计学意义（P＞0．05）。结论 Nrf2基因rs10497511和rs2364722位点多态性与中国汉族男性人群AMS发病可能无相关性。     

Elevated plasma S100B levels in high altitude hypobaric hypoxia do not correlate with acute mountain sickness

Abstract

Objectives:

Ascent to high altitude may result in a hypobaric hypoxic brain injury. The development of acute mountain sickness (AMS) is considered a multifactorial process with hypoxia-induced blood–brain barrier (BBB) dysfunction and resultant vasogenic oedema cited as one potential mechanism. Peripheral S100B is considered a biomarker of BBB dysfunction. This study aims to investigate the S100B release profile secondary to hypoxic brain injury and comment on BBB disturbance and AMS.

Methods:

A prospective field study of 12 subjects who ascended Mt Fuji (3700 m) was undertaken.

Results:

The mean baseline plasma S100B level was 0·11 μg/l (95% CI 0·09–0·12), which increased to 0·22 μg/l (95% CI 0·17–0·27) at the average of three high altitude levels (2590, 3700, and 2590 m on descent) (P < 0·001). The mean level for the seven subjects who experienced AMS rose from 0·10 to 0·19 μg/l compared to 0·12 to 0·25 μg/l for the five subjects who did not develop AMS (P = 0·33).

Conclusion:

Ascending to 3700 m resulted in elevated plasma S100B levels but this was not associated with AMS.     

广东云浮市大金山药用植物资源调查研究

目的查清大金山药用植物资源现状。方法野外调查和室内资料整理相结合,并应用植物分类学方法进行归类整理。结果发现大金山有药用植物91科217种。结论既为大金山的药用植物资源的研究、开发和保护提供了科学依据,又为中医临床用药寻找到新的药源。     

Oxygen enrichment and its application to life support systems for workers in high-altitude areas

Background:

Workers coming from lowland regions are at risk of developing acute mountain sickness (AMS) when working in low oxygen high-altitude areas.

Objectives:

The aim of this study was to improve the conditions that lead to hypoxia and ensure the safety of the high-altitude workers. We analyzed the influence of low atmospheric pressure on the oxygen enrichment process in high-altitude areas using an engineering method called low-pressure swing adsorption (LPSA).

Methods:

Fourteen male subjects were screened and divided into three groups by type of oxygen supply system used: (1) oxygen cylinder group; (2) LPSA oxygen dispersal group; and (3) control group. These tests included arterial oxygen saturation (SaO₂), pulse rate (PR), breaths per minute (BPM), and blood pressure (BP).

Results:

The results showed that after supplying oxygen using the LPSA method at the tunnel face, the SaO₂ of workers increased; the incidence of acute mountain sickness, PR, and BPM significantly decreased.

Conclusions:

The LPSA life support system was found to be a simple, convenient, efficient, reliable, and applicable approach to ensure proper working conditions at construction sites in high-altitude areas.     

慢性高原病与视网膜改变

目的探讨慢性高原病(CMS)患者视网膜改变的特征,为高原眼病临床诊断提供参考依据。方法对移居海拔4300m、5100m、5380m10个月以上的407名男性青年采用CMS国际诊断标准[1]进行流行病学调查,将确诊为CMS的179人采用YZ-6B型强光源检眼镜分别进行视网膜检测,并行图表式记录。结果CMS患者眼底视网膜乳头充血、动脉痉挛、静脉怒张、视网膜渗出程度均为,发生率100%。结论CMS患者眼底呈暗红色,主要以动静脉比例增大为主,血管柱紫青或紫黑色,尤其是静脉增宽,似腊肠状,出现血管增多,并见乳头显著充血,网膜渗出。与急性缺氧期视网膜改变极其相似。