Exaggerated pulmonary hypertension during mild exercise in chronic mountain sickness.

BACKGROUND: Chronic mountain sickness (CMS) is an important public health problem and is characterized by exaggerated hypoxemia, erythrocytosis, and pulmonary hypertension. While pulmonary hypertension is a leading cause of morbidity and mortality in patients with CMS, it is relatively mild and its underlying mechanisms are not known. We speculated that during mild exercise associated with daily activities, pulmonary hypertension in CMS is much more pronounced. METHODS: We estimated pulmonary artery pressure by using echocardiography at rest and during mild bicycle exercise at 50 W in 30 male patients with CMS and 32 age-matched, healthy control subjects who were born and living at an altitude of 3,600 m. RESULTS: The modest, albeit significant difference of the systolic right-ventricular-to-right-atrial pressure gradient between patients with CMS and controls at rest (30.3 +/- 8.0 vs 25.4 +/- 4.5 mm Hg, P 5 .002) became more than three times larger during mild bicycle exercise (56.4 +/- 19.0 vs 39.8 +/- 8.0 mm Hg, P < .001). CONCLUSIONS: Measurements of pulmonary artery pressure at rest greatly underestimate pulmonary artery pressure during daily activity in patients with CMS. The marked pulmonary hypertension during mild exercise associated with daily activity may explain why this problem is a leading cause of morbidity and mortality in patients with CMS.

LIBERAÇÃO DE NUTRIENTES DA PALHADA DE FORRAGEIRAS CONSORCIADAS COM MILHO E SUCESSÃO COM SOJA

Em regiões de clima tropical ocorre rápida decomposição do material vegetal depositado sobre o solo, sendo a capacidade de reciclar nutrientes pela decomposição da palhada um dos aspectos mais importantes das plantas de cobertura. Objetivou-se avaliar a produtividade e a liberação de nutrientes de forrageiras consorciadas com milho para ensilagem, sucedido pela cultura da soja. Em área da Universidade Estadual Paulista, campus de Ilha Solteira, o experimento consistiu do consórcio de milho com quatro forrageiras: Urochloa brizantha cv. Marandu, Urochloa ruziziensis, Panicum maximum cv. Tanzânia e Panicum maximum cv. Áries, semeadas de três formas: na linha de semeadura do milho, misturada ao adubo; a lanço no mesmo dia da semeadura do milho; e a lanço no estádio V4 do milho, em delineamento de blocos casualizados com esquema fatorial 4 × 3 e quatro repetições. A avaliação da liberação de nutrientes foi realizada durante o cultivo da soja em sucessão aos consórcios pelo método do litter bag, aos 30, 60, 90 e 120 após a semeadura da soja. Panicum maximum cv. Tanzânia apresentou maior produtividade de matéria seca quando semeada a lanço por ocasião da semeadura do milho. A semeadura das forrageiras na linha do milho e a lanço simultaneamente ao milho proporcionaram maior produtividade de matéria seca para formação de palhada. O consórcio da cultura do milho com forrageiras no outono é alternativa para elevar a quantidade de palhada e ciclagem de macronutrientes em sistema plantio direto. O K foi o nutriente que apresentou maior acúmulo na palhada das forrageiras (até 150 kg ha-1), com 100 % de liberação aos 90 dias após a semeadura da soja, sendo excelente alternativa de ciclagem desse nutriente. Panicum maximum cv. Tanzânia semeada a lanço simultaneamente ao milho se destacou na ciclagem de P (13 kg ha-1). Panicum maximum cv. Tanzânia distribuída a lanço no estádio V4 do milho é a opção com menor potencial para produção de palhada e ciclagem de nutrientes, enquanto as demais opções (forrageiras e modalidades de semeadura) têm maior potencial de utilização, ficando a critério da disponibilidade dos maquinários para implantação do consórcio com a cultura do milho.

AGRUPAMENTO DE PEDONS DE CAMBISSOLOS HÚMICOS COM BASE EM ATRIBUTOS FÍSICOS E QUÍMICOS UTILIZANDO A ESTATÍSTICA MULTIVARIADA

Em um levantamento pedológico, a descrição detalhada do conjunto de atributos do solo é fundamental para se analisar e compreender as interações dos diversos processos que ocorrem no solo. Para tanto, a análise multivariada pode ser uma ferramenta estatística importante para interpretar e compreender melhor as relações e semelhanças entre pedons. Os objetivos deste trabalho foram diferenciar e agrupar pedons similares com base em atributos físicos e químicos usando a estatística multivariada. O estudo foi desenvolvido em Lages, SC, a 27º 48′ de latitude sul e 50º 20′ de longitude oeste, com 916 m de altitude média e clima mesotérmico úmido com verões frescos (Cfb). Sete pedons de Cambissolos desenvolvidos de siltito foram descritos e coletados em um levantamento detalhado de solos para o planejamento conservacionista com base na capacidade de uso das terras. Os atributos químicos e físicos analisados foram textura, densidade, porosidade, estabilidade de agregados em água, teores de carbono orgânico, P, Al, K, Na, Ca, Mg e acidez ativa e potencial. As variáveis de solo foram avaliadas por meio da análise de fatores e agrupamentos. A partir dessas análises, foi possível agrupar os pedons com base em seus atributos químicos e físicos e identificar aqueles que foram determinantes na discriminação dos pedons. Além disso, levou a uma melhor compreensão da natureza intrínseca de correlações entre os atributos físicos e químicos do solo, demonstrando que a análise multivariada é uma ferramenta eficaz no estabelecimento dos agrupamentos de solos.

Cardiorenal end points in a trial of aliskiren for type 2 diabetes.

BACKGROUND: This study was undertaken to determine whether use of the direct renin inhibitor aliskiren would reduce cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease, cardiovascular disease, or both. METHODS: In a double-blind fashion, we randomly assigned 8561 patients to aliskiren (300 mg daily) or placebo as an adjunct to an angiotensin-converting-enzyme inhibitor or an angiotensin-receptor blocker. The primary end point was a composite of the time to cardiovascular death or a first occurrence of cardiac arrest with resuscitation; nonfatal myocardial infarction; nonfatal stroke; unplanned hospitalization for heart failure; end-stage renal disease, death attributable to kidney failure, or the need for renal-replacement therapy with no dialysis or transplantation available or initiated; or doubling of the baseline serum creatinine level. RESULTS: The trial was stopped prematurely after the second interim efficacy analysis. After a median follow-up of 32.9 months, the primary end point had occurred in 783 patients (18.3%) assigned to aliskiren as compared with 732 (17.1%) assigned to placebo (hazard ratio, 1.08; 95% confidence interval [CI], 0.98 to 1.20; P=0.12). Effects on secondary renal end points were similar. Systolic and diastolic blood pressures were lower with aliskiren (between-group differences, 1.3 and 0.6 mm Hg, respectively) and the mean reduction in the urinary albumin-to-creatinine ratio was greater (between-group difference, 14 percentage points; 95% CI, 11 to 17). The proportion of patients with hyperkalemia (serum potassium level, ≥6 mmol per liter) was significantly higher in the aliskiren group than in the placebo group (11.2% vs. 7.2%), as was the proportion with reported hypotension (12.1% vs. 8.3%) (P<0.001 for both comparisons). CONCLUSIONS: The addition of aliskiren to standard therapy with renin-angiotensin system blockade in patients with type 2 diabetes who are at high risk for cardiovascular and renal events is not supported by these data and may even be harmful. (Funded by Novartis; ALTITUDE ClinicalTrials.gov number, NCT00549757.).

SPATIAL VARIABILITY OF SOIL PROPERTIES IN AN AGRARIAN REFORM SETTLEMENT

ABSTRACT The study of soil chemical and physical properties variability is important for suitable management practices. The aim of this study was to evaluate the spatial variability of soil properties in the Malhada do Meio settlement to subsidize soil use planning. The settlement is located in Chapadinha, MA, Brazil, and has an area of 630.86 ha. The vegetation is seasonal submontane deciduous forest and steppe savanna. The geology is formed of sandstones and siltstones of theItapecuru Formation and by colluvial and alluvial deposits. The relief consists of hills with rounded and flat tops with an average altitude of 67 m, and frequently covered over by ferruginous duricrusts. A total of 183 georeferenced soil samples were collected at the depth of 0.00-0.20 m inPlintossolos, Neossolo andGleissolo. The following chemical variables were analyzed: pH(CaCl2), H+Al, Al, SB, V, CEC, P, K, OM, Ca, Mg, SiO2, Al2O3, and Fe2O3; along with particle size variables: clay, silt, and sand. Descriptive statistical and geostatistical analyses were carried out. The coefficient of variation (CV) was high for most of the variables, with the exception of pH with a low CV, and of sand with a medium CV. The models fitted to the experimental semivariograms of these variables were the exponential and the spherical. The range values were from 999 m to 3,690 m. For the variables pH(CaCl2), SB, and clay, there are three specific areas for land use planning. The central part of the area (zone III), where thePlintossolos Pétricos and Neossolos Flúvicos occur, is the most suitable for crops due to higher macronutrient content, organic matter and pH. Zones I and II are indicated for environmental preservation.

O-chromosome lethal frequencies in Serbian and Montenegrin Drosophila subobscura populations

Lethal chromosomal frequencies were obtained from three Drosophila subobscura samples from the Mt. Avala (Serbia) population in September 2003 (0.218), June 2004 (0.204) and September 2004 (0.250). These values and those from other Balkan populations studied previously (Petnica, Kamariste, Zanjic and Djerdap) were used to analyze the possible effect of population, year, month and altitude above sea level on lethal chromosomal frequencies. According to ANOVAS no effect were observed. Furthermore, the lethal frequencies of the Balkan populations did not vary according to latitude. This is probably due to the relative proximity and high gene flow between these populations. From a joint study of all the Palearctic D. subobscura populations so far analyzed, it can be deduced that the Balkan populations are located in the central area of the species distribution. Finally, it seems that lethal chromosomal frequencies are a consequence of the genetic structure of the populations.

Training in hypoxia fails to further enhance endurance performance and lactate clearance in well-trained men and impairs glucose metabolism during prolonged exercise.

The aim of this study was to investigate the synergistic effects of endurance training and hypoxia on endurance performance in normoxic and hypoxic conditions (approximately 3000 m above sea level) as well as on lactate and glucose metabolism during prolonged exercise. For this purpose, 14 well-trained cyclists performed 12 training sessions in conditions of normobaric hypoxia (HYP group, n = 7) or normoxia (NOR group, n = 7) over 4 weeks. Before and after training, lactate and glucose turnover rates were measured by infusion of exogenous lactate and stable isotope tracers. Endurance performance was assessed during incremental tests performed in normoxia and hypoxia and a 40 km time trial performed in normoxia. After training, performance was similarly and significantly improved in the NOR and HYP groups (training, P < 0.001) in normoxic conditions. No further effect of hypoxic training was found on markers of endurance performance in hypoxia (training x hypoxia interaction, n.s.). In addition, training and hypoxia had no significant effect on lactate turnover rate. In contrast, there was a significant interaction of training and hypoxia (P < 0.05) on glucose metabolism, as follows: plasma insulin and glucose concentrations were significantly increased; glucose metabolic clearance rate was decreased; and the insulin to glucagon ratio was increased after training in the HYP group. In conclusion, our results show that, compared with training in normoxia, training in hypoxia has no further effect on endurance performance in both normoxic and hypoxic conditions or on lactate metabolic clearance rate. Additionally, these findings suggest that training in hypoxia impairs blood glucose regulation in endurance-trained subjects during exercise.

Potential hosts number in cuckoo bees (Psithyrus subgen.) increases toward higher elevations

In severe and variable conditions, specialized resource selection strategies should be less fre‐ quent because extinction risks increase for species that depend on a single and unstable resource. Psithyrus (Bombus subgenus Psithyrus) are bumblebee parasites that usurp Bombus nests and display inter‐specific variation in the number of hosts they parasitize. Using a phylogenetic comparative frame‐ work, we show that Psithyrus species at higher elevations display a higher number of hosts species com‐ pared with species restricted to lower elevations. Species inhabiting high elevations also cover a larger temperature range, suggesting that species able to occur in colder conditions may benefit from recruit‐ ment from populations occurring in warmer conditions. Our results provide evidence for an 'altitudinal niche breadth hypothesis' in parasitic species, showing a decrease in the parasites' specialization along the elevational gradient, and also suggesting that Rapoport's rule might apply to Psithyrus.

Géopatrimoines des trois Chablais. Identification et valorisation des témoins glaciaires

Cette recherche s'applique aux témoins glaciaires des Chablais dans quatre de leurs dimensions : géopatrimoine, connaissance objective, inventaire de géosites et valorisation. Elle est organisée sur le canevas d'un processus de patrimonialisation auquel elle participe et qu'elle interroge à la fois. En 2009, débutait le projet 123 Chablais, pour une durée de quatre ans. Il concernait l'ensemble du territoire chablaisien, réparti sur deux pays (France et Suisse) et trois entités administratives (département de la Haute-Savoie, cantons de Vaud et du Valais). Ce projet, élaboré dans le cadre du programme Interreg IV France-Suisse, avait pour but de dynamiser le développement économique local en s'appuyant sur les patrimoines régionaux. Le géopatrimoine, identifié comme une de ces ressources, faisait donc l'objet de plusieurs actions, dont cette recherche. En parallèle, le Chablais haut-savoyard préparait sa candidature pour rejoindre l'European Geopark Network (EGN). Son intégration, effective dès 2012, a fait de ce territoire le cinquième géoparc français du réseau. Le Geopark du Chablais fonde son identité géologique sur l'eau et la glace, deux thématiques intimement liées aux témoins glaciaires. Dans ce contexte d'intérêt pour le géopatrimoine local et en particulier pour le patrimoine glaciaire, plusieurs missions ont été assignées à cette recherche qui devait à la fois améliorer la connaissance objective des témoins glaciaires, inventorier les géosites glaciaires et valoriser le patrimoine glaciaire. Le premier objectif de ce travail était d'acquérir une vision synthétique des témoins glaciaires. Il a nécessité une étape de synthèse bibliographique ainsi que sa spatialisation, afin d'identifier les lacunes de connaissance et la façon dont ce travail pouvait contribuer à les combler. Sur cette base, plusieurs méthodes ont été mises en oeuvre : cartographie géomorphologique, reconstitution des lignes d'équilibre glaciaires et datations de blocs erratiques à l'aide des isotopes cosmogéniques produits in situ. Les cartes géomorphologiques ont été élaborées en particulier dans les cirques et vallons glaciaires. Les datations cosmogéniques ont été concentrées sur deux stades du glacier du Rhône : le Last Local Glacial Maximum (LLGM) et le stade de Monthey. Au terme de cette étape, les spécificités du patrimoine glaciaire régional se sont révélées être 1) une grande diversité de formes et des liens étroits avec différents autres processus géomorphologiques ; 2) une appartenance des témoins glaciaires à dix grandes étapes de la déglaciation du bassin lémanique. Le second objectif était centré sur le processus d'inventaire des géosites glaciaires. Nous avons mis l'accent sur la sélection du géopatrimoine en développant une approche basée sur deux axes (temps et espace) identifiés dans le volet précédent et avons ainsi réalisé un inventaire à thèmes, composé de 32 géosites. La structure de l'inventaire a également été explorée de façon à intégrer des critères d'usage de ces géosites. Cette démarche, soutenue par une réflexion sur les valeurs attribuées au géopatrimoine et sur la façon d'évaluer ces valeurs, nous a permis de mettre en évidence le point de vue anthropo - et scientifico - centré qui prévaut nettement dans la recherche européenne sur le géopatrimoine. L'analyse des résultats de l'inventaire a fait apparaître quelques caractéristiques du patrimoine glaciaire chablaisien, discret, diversifié, et comportant deux spécificités exploitables dans le cadre d'une médiation scientifique : son statut de « berceau de la théorie glaciaire » et ses liens étroits avec des activités de la vie quotidienne, en tant que matière première, support de loisir ou facteur de risque. Cette recherche a débouché sur l'élaboration d'une exposition itinérante sur le patrimoine glaciaire des Chablais. Ce produit de valorisation géotouristique a été conçu pour sensibiliser la population locale à l'impact des glaciers sur son territoire. Il présente une série de sept cartes de stades glaciaires, encadrées par les deux mêmes thématiques, l'histoire de la connaissance glaciaire d'une part, les témoins glaciaires et la société, d'autre part. -- This research focuses on glacial witnesses in the Chablais area according to four dimensions : geoheritage, objective knowledge, inventory and promotion of geosites. It is organized on the model of an heritage's process which it participates and that it questions both. In 2009, the project 123 Chablais started for a period of four years. It covered the entire chablaisien territory spread over two countries and three administrative entities (département of Haute-Savoie, canton of Vaud, canton of Valais). This project, developed in the framework of the Interreg IV France-Switzerland program, aimed to boost the local development through regional heritage. The geoheritage identified as one of these resources, was therefore the subject of several actions, including this research. In parallel, the French Chablais was preparing its application to join the European Geopark Network (EGN). Its integration, effective since 2012, made of this area the fifth French Geopark of the network. The Chablais Geopark geological identity was based on water and ice, two themes closely linked to the glacial witnesses. In this context of interest for the regional geoheritage and especially for the glacial heritage, several missions have been assigned to this research which should improve objective knowledge of glacial witnesses, inventory and assess glacial geosites. The objective knowledge's component was to acquire a synthetic vision of the glacial witnesses. It required a first bibliography synthesis step in order to identify gaps in knowledge and how this work could help to fill them. On this basis, several methods have been implemented: geomorphological mapping, reconstruction of the equilibrium-line altitude and dating of glacial erratic blocks using cosmogenic isotopes produced in situ. Geomorphological maps have been developed especially in glacial cirques and valleys. Cosmogenic datings were concentrated on two stages of the Rhone glacier: the Last Local Glacial Maximum (LLGM) and « the stage of Monthey ». After this step, the specificities of the regional glacial heritage have emerged to us as 1) a wide variety of forms and links to various other geomorphological processes; 2) belonging of glacial witnesses to ten major glacial stages of Léman Lake's deglaciation. In the inventory of glacial geosites component we focused on the selection of geoheritage. We developed an approach based on two axes (time and space) identified in the preceding components. We obtained a thematic inventory, consisting of 32 geosites. The structure of the inventory was also explored in the aim to integrate use criteria of geosites. This approach, supported by a thought on the values attributed to the geoheritage and how to assess these values allowed us to highlight the point of view much anthropological - and scientific -centered prevailing in the European research on geoheritage. The analysis of the inventory's results revealed some characteristics of chablaisien glacial heritage, discrete, diverse, and with two features exploitable in the context of a scientific mediation: its status as « cradle of the glacial theory » and its close links with activities of daily life, as raw material, leisure support and risk factor. This research leads to the development of a traveling exhibition on the glacial heritage of the Chablais area. It presents a series of seven glacial stage's cards, framed by the two themes mentioned above: « history of glacial knowledge » and « glacial witnesses and society ».

Energy expenditure of extreme competitive mountaineering skiing.

PURPOSE: Multi-hour ski mountaineering energy balance may be negative and intake below recommendations. METHODS: Athletes on the 'Patrouille des Glaciers' racecourses (17 on course Z, 27 km, +2,113 m; 11 on course A, 26 km, +1,881 m) volunteered. Pre-race measurements included body mass, stature, VO2max, and heart rate (HR) vs VO2 at simulated altitude; race measurements HR, altitude, incline, location, and food and drink intake (A). Energy expenditure (EE) was calculated from altitude corrected HR derived VO2. RESULTS: Race time was 5 h 7 min ± 44 min (mean ± SD, Z) and 5 h 51 min ± 53 min (A). Subjects spent 19.2 ± 3.2 MJ (Z), respectively, 22.6 ± 2.9 MJ (A) during the race. Energy deficit was -15.5 ± 3.9 MJ (A); intake covered 20 ± 7 % (A). Overall energy cost of locomotion (EC) was 9.9 ± 1.3 J m(-1) kg(-1) (Z), 8.0 ± 1.0 J m(-1) kg(-1) (A). Uphill EC was 11.7 ± 1 J m(-1) kg(-1) (Z, 13 % slope) and 15.7 ± 2.3 J m(-1) kg(-1) (A, 19 % slope). Race A subjects lost -1.5 ± 1.1 kg, indicating near euhydration. Age, body mass, gear mass, VO2max and EC were significantly correlated with performance; energy deficit was not. CONCLUSIONS: Energy expenditure and energy deficit of a multi-hour ski mountaineering race are very high and energy intake is below recommendations.

Lateglacial evolution of the Brenno glacier (Southern Swiss Alps) : preliminary results

The Lateglacial evolution of the Ticino glacier and tributaries is poorly known because of the lack of research by Quaternary geomorphologists during the last decades. In spite of the interest for the cryosphere reactions during the Lateglacial climate warming, only few scientific studies were carried out about the history of the northern valleys of the Ticino Alps during the deglaciation (e.g. Seiffert 1953, Renner 1982, Hantke 1983). Within the framework of geomorphological investigations on the Lateglacial and Holocene glacier/permafrost evolution in the Ticino Alps, the history of the Brenno glacier (Blenio Valley, Eastern Ticino Alps) during the end of the Pleistocene has been studied. The deglaciation sequence of the Blenio Valley is still not complete (Scapozza et al. 2009). Only the first glacial stadial of the Brenno glacier and the last Lateglacial stadials of the Greina region (northern Blenio valley, see Fontana et al. 2008) and of the upper Malvaglia Valley (eastern Blenio Valley, see Scapozza et al. 2008) have been unequivocally defined. For every stadial, the surface of the palaeoglacier and the depression of the Equilibrium Line Altitude (ELA) have been reconstructed on the base of geomorphological mapping. The first individual glacial stadial of the Brenno glacier corresponds to the Biasca stadial of the Ticino glacier defined by Hantke (1983). The ELA depression of 1100-1200 meters and its morphological and glaciological characteristics allow us to correlate this stadial with the Weissbad stadial defined by Keller (1988). In the Greina region, three stadials corresponding to the end of the Lateglacial have been identified, with an ELA depression of 110, 210 and 310-350 meters (Fontana et al. 2008). In the upper Malvaglia Valley, three stadials corresponding to the end of the Oldest Dryas and the Younger Dryas have been identified for the Orino glacier, with an ELA depression of 290, 400-420 and 470-560 meters (Scapozza et al. 2008). If we consider the other (fragmentary) glacial deposits of the Blenio Valley, it is possible to define a regression sequence of the Brenno glacier with 8 stadials, from the Biasca stadial to the end of the Younger Dryas. An attempt of correlation with the model "Gothard" developed by Renner (1982) and Hantke (1983) and with the model "Eastern Swiss Alps" developed by Maisch (1982) is proposed in Table 1. The following chronological conclusions are, therefore, proposed: (1) the Biasca stadial is probably the first stadial after the transition Pleniglacial - Lateglacial; (2) the stadials BRE 7 to BRE 3 are positioned between the beginning of the Lateglacial and the Bølling-Allerød interstadial; (3) the stadials BRE 2 and BRE 1 are assumed to be related to the Younger Dryas event.

Hypobaric versus normobaric hypoxia: same effects on postural stability?

AIMS: To test the hypothesis that postural stability would be more affected during acute exposure in hypobaric (HH) than in normobaric (NH) hypoxia.¦METHODS: In separate trials, 12 subjects stood on a posturographic platform for two successive 25.6 sec tests in three conditions: eyes open (EO), eyes closed (EC), and verbal dual task (DT). Ambient pressure in O(2) was matched between HH and NH at 1700 and 3000 m, respectively.¦RESULTS: Compared to NH, the length of Centre of Pression trajectory in Y-axis was increased (p<0.05) in HH for EO at 1700 m, EC at 1700 and 3000 m, and for DT at 1700 m, whereas the variance of speed of CoP was decreased (p<0.05) in EO, EC, and DT at 1700 m. Compared to normobaric normoxia (NN; 400 m), the surface of CoP trajectory was increased (p<0.05) in HH in EO and EC at 3000 m.¦CONCLUSIONS: HH deteriorated postural stability in the antero-posterior plane, for the variance of speed and the surface of CoP in 3 conditions, whereas no difference was observed between NH and NN. These results suggest that hypobaria instead of hypoxia per se plays an important role to the altered balance classically reported in altitude.

Systemic vascular dysfunction in patients with chronic mountain sickness.

ABSTRACT BACKGROUND: Chronic mountain sickness (CMS) is a major public health problem characterized by exaggerated hypoxemia and erythrocytosis. In more advanced stages, these patients often present functional and structural changes of the pulmonary circulation, but there is little information on the systemic circulation. In patients suffering from diseases associated with chronic hypoxemia at low altitude, systemic vascular function is altered. We hypothesized that patients with CMS display systemic vascular dysfunction that may predispose them to increased systemic cardiovascular morbidity. METHODS: To test this hypothesis, we assessed systemic endothelial function (by flow- mediated dilation, FMD), arterial stiffness and carotid intima-media thickness and arterial oxygenation (SaO(2)) in 23 patients with CMS without additional classical cardiovascular risk factors and 27 age-matched healthy mountain dwellers born and permanently living at 3600 m. For some analyses subjects were classified according to baseline SaO(2) quartiles; FMD of the highest quartile subgroup (SaO(2) ≥90%) was used as reference value for post-hoc comparisons. RESULTS: Patients with CMS displayed marked systemic vascular dysfunction, as evidenced by impaired FMD (4.6±1.2 vs. 7.6±1.9%, CMS vs. controls, P<0.0001), greater pulse wave velocity (10.6±2.1 vs. 8.4±1.0 m/s, P<0.001) and carotid intima-media thickness (690±120 vs. 570±110 μm, P=0.001). A positive relationship existed between SaO(2) and FMD (r=0.62, P<0.0001). Oxygen inhalation improved (P<0.001), but did not normalize FMD in patients with CMS; whereas it normalized FMD in hypoxemic controls (SaO(2) <90%) and had no detectable effect in normoxemic (SaO(2) ≥90%) control subjects. CONCLUSIONS: Patients with CMS display marked systemic vascular dysfunction. Structural and functional alterations contribute to this problem that may predispose these patients to premature cardiovascular disease. Clinical Trials Gov Registration # NCT01182792.

Training in hypoxia fails to further enhance endurance performance and lactate clearance in well-trained men and impairs glucose metabolism during prolonged exercise.

The aim of this study was to investigate the synergistic effects of endurance training and hypoxia on endurance performance in normoxic and hypoxic conditions (approximately 3000 m above sea level) as well as on lactate and glucose metabolism during prolonged exercise. For this purpose, 14 well-trained cyclists performed 12 training sessions in conditions of normobaric hypoxia (HYP group, n = 7) or normoxia (NOR group, n = 7) over 4 weeks. Before and after training, lactate and glucose turnover rates were measured by infusion of exogenous lactate and stable isotope tracers. Endurance performance was assessed during incremental tests performed in normoxia and hypoxia and a 40 km time trial performed in normoxia. After training, performance was similarly and significantly improved in the NOR and HYP groups (training, P < 0.001) in normoxic conditions. No further effect of hypoxic training was found on markers of endurance performance in hypoxia (training x hypoxia interaction, n.s.). In addition, training and hypoxia had no significant effect on lactate turnover rate. In contrast, there was a significant interaction of training and hypoxia (P < 0.05) on glucose metabolism, as follows: plasma insulin and glucose concentrations were significantly increased; glucose metabolic clearance rate was decreased; and the insulin to glucagon ratio was increased after training in the HYP group. In conclusion, our results show that, compared with training in normoxia, training in hypoxia has no further effect on endurance performance in both normoxic and hypoxic conditions or on lactate metabolic clearance rate. Additionally, these findings suggest that training in hypoxia impairs blood glucose regulation in endurance-trained subjects during exercise.

Changes in lung function during an extreme mountain ultramarathon.

This study aimed to assess the effects of an extreme mountain ultramarathon (MUM, 330 km, 24,000 D+) on lung function. Twenty-nine experienced male ultramarathon runners performed longitudinally [before (pre), during (mid), and immediately after (post) a MUM] a battery of pulmonary function tests. The tests included measurements of forced vital capacity, forced expiratory volume in 1 s, peak flow, inspiratory capacity, and maximum voluntary ventilation in 12 s (MVV12). A significant reduction in the running speed was observed (-43.0% between pre-mid and mid-post; P < 0.001). Expiratory function declined significantly at mid (P < 0.05) and at post (P < 0.05). A similar trend was observed for inspiratory function (P < 0.05). MVV12 declined at mid (P < 0.05) and further decreased at post (P < 0.05). Furthermore, there are significant negative correlations between performance time and MVV12 pre-race (R = -0.54, P = 0.02) as well as changes in MVV12 between pre- and post-race (R = -0.53, P = 0.009). It is concluded that during an extreme MUM, a continuous decline in pulmonary function was observed, likely attributable to the high levels of ventilation required during this MUM in a harsh mountainous environment.