High-altitude exposure in patients with cardiovascular disease: risk assessment and practical recommendations.

Because of the development of modern transportation facilities, an ever rising number of individuals including many patients with preexisting diseases visit high-altitude locations (>2500 m). High-altitude exposure triggers a series of physiologic responses intended to maintain an adequate tissue oxygenation. Even in normal subjects, there is enormous interindividual variability in these responses that may be further amplified by environmental factors such as cold temperature, low humidity, exercise, and stress. These adaptive mechanisms, although generally tolerated by most healthy subjects, may induce major problems in patients with preexisting cardiovascular diseases in which the functional reserves are already limited. Preexposure assessment of patients helps to minimize risk and detect contraindications to high-altitude exposure. Moreover, the great variability and nonpredictability of the adaptive response should encourage physicians counseling such patients to adapt a cautionary approach. Here, we will briefly review how high-altitude adjustments may interfere with and aggravate/decompensate preexisting cardiovascular diseases. Moreover, we will provide practical recommendations on how to investigate and counsel patients with cardiovascular disease desiring to travel to high-altitude locations.

High altitude Chironomidae (Diptera) of Serra da Estrela (Portugal): Additions to the Portuguese and Iberian Peninsula fauna

A Chironomidae (Diptera) fauna list for headwater streams of high altitude areas in Serra da Estrela (Portugal) is presented, doubling the previously established species richness for the region. The findings include 17 new records for Portugal, which represent an increase to 219 species for the Continental Portugal Chironomidae fauna. Two new records were detected for the Iberian Peninsula: one species (Tvetenia duodenaria), and one subgenusPsectrocladius (Mesopsectrocladius); and the presence of the genus Natarsia is confirmed. The last two occurrences correspond to monoespecific taxa of the Palearctic region. However, as taxonomic identification has been based on larval material, instead of pupae, pupal exuviae or imagoes, species level assignment is still uncertain. Key words: Diptera, Chironomidae, high mountain streams, Serra da Estrela, Portugal, Iberian Peninsula. RESUMEN Quironómidos (Diptera, Chironomidae) de alta montaña de la Sierra de Estrela (Portugal) y adiciones a la fauna de Portugal y la Península Ibérica Se presenta una lista de especies de Chironomidae (Diptera) recolectados en los ríos de cabecera de zonas de alta montaña en la Serra da Estrela (Portugal). Con esta aportación se duplica la riqueza de especies regional conocida hasta el momento y se eleva la fauna de quironómidos del Portugal continental a 219 especies. Se incluyen dos nuevas citas para la Península Ibérica, una especie (Tvetenia duodenaria) y un subgéneroPsectrocladius (Mesopsectrocladius), y se confirma la presencia del género Natarsia. En los dos últimos casos se trata de larvas de taxones hasta el momento monoespecíficos en la región paleárctica, pero al no haberse recolectado pupas o adultos no se puede asegurar la identificación específica. Palabras clave: Diptera, Chironomidae, ríos de alta montaña, Serra da Estrela, Portugal,

On the use of mobile inflatable hypoxic marquees for sport-specific altitude training in team sports.

BACKGROUND/AIM: With the evolving boundaries of sports science and greater understanding of the driving factors in the human performance physiology, one of the limiting factors has now become the technology. The growing scientific interest on the practical application of hypoxic training for intermittent activities such as team and racket sports legitimises the development of innovative technologies serving athletes in a sport-specific setting. METHODS: Description of a new mobile inflatable simulated hypoxic equipment. RESULTS: The system comprises two inflatable units-that is, a tunnel and a rectangular design, each with a 215 m(3) volume and a hypoxic trailer generating over 3000 Lpm of hypoxic air with FiO₂ between 0.21 and 0.10 (a simulated altitude up to 5100 m). The inflatable units offer a 45 m running lane (width=1.8 m and height=2.5 m) as well as a 8 m × 10 m dome tent. FiO₂ is stable within a range of 0.1% in normal conditions inside the tunnel. The air supplied is very dry-typically 10-15% relative humidity. CONCLUSIONS: This mobile inflatable simulated hypoxic equipment is a promising technological advance within sport sciences. It offers an opportunity for team-sport players to train under hypoxic conditions, both for repeating sprints (tunnel configuration) or small-side games (rectangular configuration).

Características de frutos de genótipos de aceroleira cultivados sob elevada altitude

O objetivo deste trabalho foi avaliar as características físicas, físico-químicas e químicas de frutos de nove genótipos de acerola (Malpighia sp.) cultivados no Município de Anápolis, GO, localizado a 1.000 m de altitude. Os resultados mostraram que nessa região se consegue produção de frutos com elevados teores de vitamina C (acima de 1.000 mg/100 mL de suco). Há, entretanto, uma considerável variabilidade entre os genótipos estudados. Os genótiposde número2, 6, 3, 1 e 7 destacaram-se, atendendo àsprincipais exigências da indústria de suco.

Circulatory adaptation to long-term high altitude exposure in Aymaras and Caucasians.

About 30 million people live above 2500 m in the Andean Mountains of South America. Among them are 5.5 million Aymaras, an ethnic group with its own language, living on the altiplano of Bolivia, Peru, and northern Chile at altitudes of up to 4400 m. In this high altitude region traces of human population go back for more than 2000 years with constant evolutionary pressure on its residents for genetic adaptation to high altitude. Aymaras as the assumed direct descendents of the ancient cultures living in this region were the focus of much research interest during the last decades and several distinctive adaptation patterns to life at high altitude have been described in this ethnic group. The aim of this article was to review the physiology and pathophysiology of circulatory adaptation and maladaptation to longtime altitude exposure in Aymaras and Caucasians.

Potencial forrageiro de gramíneas em condições de baixas temperaturas e altitude elevada

O experimento foi conduzido no Município de Santo Antônio do Pinhal, localizado na Serra da Mantiqueira na região do Vale do Paraíba, SP, com o objetivo de estudar o potencial de gramíneas forrageiras, para identificar as espécies mais tolerantes ao frio e capazes de proporcionar boa cobertura vegetal ao solo. O delineamento experimental foi o de blocos ao acaso, em três repetições, com parcelas de 5 x 5 m. Os tratamentos consistiram de 16 gramíneas forrageiras. As espécies Hemarthria altissima e Setaria anceps se destacaram quanto à taxa mensal de produção de matéria seca, teor de proteína bruta, cobertura vegetal do solo e tolerância a geadas. Portanto, entre as espécies avaliadas, são estas as mais indicadas para a formação de pastagens nas áreas montanhosas da região do Vale do Paraíba.

Altitude e coordenadas geográficas na estimativa da temperatura mínima média decendial do ar no estado do Rio Grande do Sul

O objetivo deste trabalho foi verificar, com dados de temperatura mínima média decendial do ar (Tm) de 41 municípios do Estado do Rio Grande do Sul, de 1945 a 1974, se a Tm pode ser estimada em função da altitude, latitude e longitude. Para cada um dos 36 decêndios do ano, realizaram-se análise de correlação, análise de trilha das variáveis causais - altitude, latitude e longitude - sobre o efeito Tm, e estimaram-se os parâmetros do modelo das equações de regressão linear múltipla, pelo método passo a passo, com teste para saída de variáveis, considerando Tm como variável dependente e altitude, latitude e longitude como variáveis independentes. Na validação dos modelos de estimativa da Tm, usou-se o coeficiente de correlação linear de Pearson, entre a Tm estimada e a Tm observada em dez municípios do Estado, com dados da série de observações meteorológicas de 1975 a 2004. A temperatura mínima média decendial do ar pode ser estimada pelas coordenadas geográficas em qualquer local e decêndio, no Estado do Rio Grande do Sul. A altitude e latitude explicam melhor a variação da Tm.

Hipertensión y edema pulmonar de altura. Rol de la disfunción endotelial y de la programación fetal [Pulmonary hypertension and lung edema at high altitude. Role of endothelial dysfunction and fetal programming].

High altitude constitutes an exciting natural laboratory for medical research. While initially, the aim of high-altitude research was to understand the adaptation of the organism to hypoxia and find treatments for altitude-related diseases, over the past decade or so, the scope of this research has broadened considerably. Two important observations led to the foundation for the broadening of the scientific scope of high-altitude research. First, high-altitude pulmonary edema (HAPE) represents a unique model which allows studying fundamental mechanisms of pulmonary hypertension and lung edema in humans. Secondly, the ambient hypoxia associated with high-altitude exposure facilitates the detection of pulmonary and systemic vascular dysfunction at an early stage. Here, we review studies that, by capitalizing on these observations, have led to the description of novel mechanisms underpinning lung edema and pulmonary hypertension and to the first direct demonstration of fetal programming of vascular dysfunction in humans.

Training Diaries during Altitude Training Camp in Two Olympic Champions: An Observational Case Study.

Traditionally, Live High-Train High (LHTH) interventions were adopted when athletes trained and lived at altitude to try maximising the benefits offered by hypoxic exposure and improving sea level performance. Nevertheless, scientific research has proposed that the possible benefits of hypoxia would be offset by the inability to maintain high training intensity at altitude. However, elite athletes have been rarely recruited as an experimental sample, and training intensity has almost never been monitored during altitude research. This case study is an attempt to provide a practical example of successful LHTH interventions in two Olympic gold medal athletes. Training diaries were collected and total training volumes, volumes at different intensities, and sea level performance recorded before, during and after a 3-week LHTH camp. Both athletes successfully completed the LHTH camp (2090 m) maintaining similar absolute training intensity and training volume at high-intensity (> 91% of race pace) compared to sea level. After the LHTH intervention both athletes obtained enhancements in performance and they won an Olympic gold medal. In our opinion, LHTH interventions can be used as a simple, yet effective, method to maintain absolute, and improve relative training intensity in elite endurance athletes. Key PointsElite endurance athletes, with extensive altitude training experience, can maintain similar absolute intensity during LHTH compared to sea level.LHTH may be considered as an effective method to increase relative training intensity while maintaining the same running/walking pace, with possible beneficial effects on sea level performance.Training intensity could be the key factor for successful high-level LHTH camp.

Raleio de cachos em vinhedos de altitude e qualidade do vinho da cultivar Syrah

O objetivo deste trabalho foi avaliar o efeito de diferentes intensidades de raleio de cachos de uvas (Vitis vinifera L.), em vinhedos de altitude, sobre a evolução dos compostos fenólicos durante a maturação da uva. O experimento foi conduzido em São Joaquim, SC, a uma altitude média de 1.230 m, em videiras da cv.Syrah, enxertadas sobre 'Paulsen 1103', conduzidas em espaldeira, em duplo cordão esporonado, espaçadas em 3x1,2 m, com cobertura antigranizo. Os tratamentos de raleio foram definidos de modo a se ter redução da produtividade em 13,3, 26,6 e 40% em relação à produtividade do tratamento controle sem raleio, estimada em 15 Mg ha-1. Os tratamentos foram ajustados quando 50% das bagas encontravam-se em "véraison". Odelineamento foi o de blocos ao acaso, com quatro repetições e 40 plantas por tratamento. As avaliações foram feitas nas safras 2005/2006 e 2006/2007. Avaliou-se a evolução dos compostos fenólicos durante as oito semanas antecedentes à colheita. O raleio de cachos aumentou o conteúdo de antocianinas quando a produtividade estimada foi de 12 Mg ha-1, e melhorou a composição fenólica das bagas, atributos esses favoráveis à produção de vinhos tintos finos de qualidade.

Affections pulmonaires et attitude [High altitude and preexisting lung diseases].

Today, a growing number of people, some of them suffering from lung diseases, travel to high altitude resorts. It is sometimes not easy for the general practitioner to adequately counsel these patients. Based on our knowledge of physiopathology and clinical studies, the present paper addresses the effects of high altitude in patients with preexisting lung diseases and provides recommendations in order to optimize the sojourn at high altitude.

AltitudeOmics: enhanced cerebrovascular reactivity and ventilatory response to CO2 with high-altitude acclimatization and reexposure.

The present study is the first to examine the effect of high-altitude acclimatization and reexposure on the responses of cerebral blood flow and ventilation to CO2. We also compared the steady-state estimates of these parameters during acclimatization with the modified rebreathing method. We assessed changes in steady-state responses of middle cerebral artery velocity (MCAv), cerebrovascular conductance index (CVCi), and ventilation (V(E)) to varied levels of CO2 in 21 lowlanders (9 women; 21 ± 1 years of age) at sea level (SL), during initial exposure to 5,260 m (ALT1), after 16 days of acclimatization (ALT16), and upon reexposure to altitude following either 7 (POST7) or 21 days (POST21) at low altitude (1,525 m). In the nonacclimatized state (ALT1), MCAv and V(E) responses to CO2 were elevated compared with those at SL (by 79 ± 75% and 14.8 ± 12.3 l/min, respectively; P = 0.004 and P = 0.011). Acclimatization at ALT16 further elevated both MCAv and Ve responses to CO2 compared with ALT1 (by 89 ± 70% and 48.3 ± 32.0 l/min, respectively; P < 0.001). The acclimatization gained for V(E) responses to CO2 at ALT16 was retained by 38% upon reexposure to altitude at POST7 (P = 0.004 vs. ALT1), whereas no retention was observed for the MCAv responses (P > 0.05). We found good agreement between steady-state and modified rebreathing estimates of MCAv and V(E) responses to CO2 across all three time points (P < 0.001, pooled data). Regardless of the method of assessment, altitude acclimatization elevates both the cerebrovascular and ventilatory responsiveness to CO2. Our data further demonstrate that this enhanced ventilatory CO2 response is partly retained after 7 days at low altitude.

Elemental (C/N ratios) and isotopic (δ15N(org), δ13C(org)) compositions of sedimentary organic matter from a high-altitude mountain lake (Meidsee, 2661 m a.s.l., Switzerland): Implications for Lateglacial and Holocene Alpine landscape evolution

The deposition of Late Pleistocene and Holocene sediments in the high-altitude lake Meidsee (located at an altitude of 2661 m a.s.l. in the Southwestern Alps) strikingly coincided with global ice-sheet and mountain-glacier decay in the Alpine forelands and the formation of perialpine lakes. Radiocarbon ages of bottom-core sediments point out (pre-) Holocene ice retreat below 2700 m a.s.l., at about 16, 13, 10, and 9 cal. kyr BP. The Meidsee sedimentary record therefore provides information about the high-altitude Alpine landscape evolution since the Late Pleistocene/Holocene deglaciation in the Swiss Southwestern Alps. Prior to 5 cal. kyr BP, the C/N ratio and the isotopic composition of sedimentary organic matter (delta N-15(org), delta C-13(org)) indicate the deposition of algal-derived organic matter with limited input of terrestrial organic matter. The early Holocene and the Holocene climatic optimum (between 7.0 and 5.5 cal. kyr BP) were characterized by low erosion (decreasing magnetic susceptibility, chi) and high content of organic matter (C-org > 13 wt.%), enriched in C-13(org) (>-18 parts per thousand) with a low C/N (similar to 10) ratio, typical of modern algal matter derived from in situ production. During the late Holocene, there was a long-term increasing contribution of terrestrial organic matter into the lake (C/N > 11), with maxima between 2.4 and 0.9 cal. kyr BP. A major environmental change took place 800 years ago, with an abrupt decrease in the relative contribution of terrestrial organic material into the lake compared with aquatic organic material which subsequently largely dominated (C/N drop from 16 to 10). Nonetheless, this event was marked by a rise in soil erosion (chi), in nutrients input (N and P contents) and in anthropogenic lead deposition, suggesting a human disturbance of Alpine ecosystems 800 years ago. Indeed, this time period coincided with the migration of the Walser Alemannic people in the region, who settled at relatively high altitude in the Southwestern Alps for farming and maintaining Alpine passes.

Interpoladores geoestatísticos na análise da distribuição espacial da precipitação anual e de sua relação com altitude

O objetivo deste trabalho foi quantificar a contribuição da variável auxiliar altitude, na estimativa da distribuição espacial da precipitação anual média no Estado de São Paulo. A estatística quadrado médio do erro (QME) foi usada em dois conjuntos de observações de precipitação anual média (1957 a 1997): o completo, com 1.027 observações, e o reduzido, com 445. Bolsões de precipitação foram perfeitamente definidos nos mapas de variabilidade espacial que utilizaram o conjunto completo de dados, e indicaram a existência de possíveis microclimas. O interpolador geoestatístico de krigagem ordinária apresentou desempenho 82 vezes mais preciso que o interpolador do inverso do quadrado da distância, quando o QME foi usado como critério de comparação para o conjunto de dados completo. Para o conjunto reduzido, essa magnitude foi de duas vezes. Os erros de estimação obtidos por krigagem ordinária foram menores no conjunto completo, enquanto os obtidos por cokrigagem ordinária foram menores no reduzido. Isso indica que esses interpoladores devem ser usados para determinação da distribuição espacial da precipitação anual média. O uso da altitude como variável auxiliar beneficia o interpolador de cokrigagem ordinária e define microrregiões mais uniformes quanto à distribuição espacial da precipitação anual média.