Early Warning of Acute Altitude Sickness by Physiological Variables and Noninvasive Cardiovascular Indicators

Objective To examine if the variations at sea level would be able to predict subsequent susceptibility to acute altitude sickness in subjects upon a rapid ascent to high altitude.Methods One hundred and six Han nationality male individuals were recruited to this research.Dynamic electrocardiogram,treadmill exercise test,echocardiography,routine blood examination and biochemical analysis were performed when subjects at sea level and entering the plateau respectively.Then multiple regression analysis was performed to construct a multiple linear regression equation using the Lake Louise Score as dependent variable to predict the risk factors at sea level related to acute mountain sickness(AMS).Results Approximately 49.05%of the individuals developed AMS.The tricuspid annular plane systolic excursion(22.0+2.66 vs.23.2+3.19 mm,t=l.998,P=0.048)was significantly lower in the AMS group at sea level,while count of eosinophil[(0.264+0.393)×109/L vs.(0.126+0.084)×109/L,t=-2.040,P—0.045],percentage of diflerences exceeding 50 ms between adjacent normal number of intervals(PNN50,9.66%±5.40%vs.6.98%±5.66%,t=-2.229,P=0.028)and heart rate variability triangle index(57.1+16.1 vs.50.6+12.7,t=-2.271,P=0.025)were significantly higher.After acute exposure to high altitude,C-reactive protein(0.098+0.103 vs.0.062+0.045 g/L,t=-2.132,P=0.037),aspartate aminotransferase(19.7+6.7275.17,3±3.95 U/L,t=-2.231,P=0.028)and creatinine(85.1±12.9 vs.77.7±11.2 mmol/L,t=3.162,P=0.002)were significantly higher in the AMS group,while alkaline phosphatase(71.7+18.2 vs.80.6+20.2 U/L,t=2.389,P=0.019),standard deviation of normal-to-normal RR intervals(126.5+35.9 vs.143.3+36.4 ms,t—2.320,P—0.022),ejection time(276.9+50.8 vs.313.8+48.9 ms,t—3.641,P—0.001)and heart rate variability triangle index(37.1+12.9 vs.41.9+11.1,t=2.O2O,P=0.047)were significantly lower.Using the Lake Louise Score as the dependent variable,prediction equation were established to estimate AMS:Lake Louise Score=3.783+0.281Xeosinophil-0.219Xalkaline phosphatase+O.O32XPNN50.Conclusions We elucidated the differences of pl^siological variables as well as noninvasive cardiovascular indicators for subjects after high altitude exposure compared with those at sea level.We also created an acute high altitude reaction early warning equation based on the physiological variables and noninvasive cardiovascular indicators at sea level.

Clinical,Laboratory and Imaging Features of High Altitude Pulmonary Edema in Tibetan Plateau

Objective To analyze characteristics of high altitude pulmonary edema(HAPE)in Chinese patients.Methods We performed a retrospective study of 98 patients with HAPE.We reviewed the medical records and summarized the clinical,laboratory and imaging characteristics of these cases,and compared the results on admission with those determined before discharge.Results Forty-eight(49.0%)patients developed HAPE at the altitude of 2800 m to 3000 m.Ninty-five(96.9%)patients were man.Moist rales were audible from the both lungs,and moist rales over the right lung were clearer than those over the left lung in fourteen patients.The white blood cells[(12.83±5.55)versus(8.95±3.23)×109/L,P=0.001)]as well as neutrophil counts[(11.34±3.81)versus(7.49±2.83)×109/L,P=0.001)]were higher,whereas the counts of other subsets of white blood cells were lower on admission than those after recovery(all P<0.05).Serum levels of alkaline phosphatase(115.8±37.6 versus 85.7±32.4 mmol/L,P=0.020),cholinesterase(7226.2±1631.8 versus 6285.3±1693.3 mmol/L,P=0.040),creatinine(85.2±17.1 versus 75.1±12.8 mmol/L,P=0.021),uric acid(401.9±114.2 versus 326.0±154.3 mmol/L,P=0.041),and uric glucose(7.20±1.10 versus 5.51±1.11 mmol/L,P=0.001)were higher,but carbondioxide combining power(CO2CP,26.7±4.4 versus 28.9±4.5 mmol/L,P=0.042)and serous calcium(2.32±0.13 versus 2.41±0.10 mmol/L,P=0.006)were lower on admission.Arterial blood gas results showed hypoxemia and respiratory alkalosis on admission.Conclusions In the present research,men were more susceptible to HAPE than women,and in the process of HAPE,the lesions of the right lung were more serious than those of the left lung.Some indicators of routine blood test and blood biochemistry of HAPE patients changed.

2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

East Asians are the most populous race in the world and their health status is an important global issue.Compared with Caucasian populations, East Asian patients have a different benefit/risk ratio when using antithrombotic treatment. Despite this observation, treatment strategies in East Asian patients are mostly based on the American and European guidelines. Despite a lower platelet inhibitory response to clopidogrel, East Asian patients show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. For potent P2Y_(12) inhibitors(ticagrelor and prasugrel),East Asian patients have shown less favorable net clinical benefits compared with Caucasian patients,which may be related to differences in pharmacokinetic/pharmacodynamic profiles and therapeutic zone of antiplatelet effect. This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population. In addition, when East Asian patients are administered potent P2Y_(12) receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed.

Evaluation of the prognostic ability of serum uric acid for elderly acute coronary syndrome patients with diabetes mellitus:a prospective cohort study

Objective:This study evaluated the prognostic power of serum uric acid(UA)in predicting adverse events in elderly acute coronary syndrome(ACS)patients with diabetes mellitus(DM).Methods:The analysis involved 718 ACS patients>80 years old whose general clinical data and baseline blood biochemical indicators were collected prospectively from January 2006 to December 2012.These patients were classified into two groups based on DM status,and then followed up after discharge.The Kaplan-Meier method was used for major adverse cardiac event(MACE)rates and all-cause mortality.Multivariate Cox regression was performed to analyze the relationship between UA level and long-term clinical prognosis.Receiver operating characteristic(ROC)curves were analyzed to predict the cutoff value of UA in elderly ACS patients with DM.There were 242 and 476 patients in the DM and non-DM(NDM)groups,respectively,and the follow-up time after discharge was 40‒120 months(median,63 months;interquartile range,51‒74 months).Results:The all-cause mortality,cardiac mortality,and MACE rates in both DM and NDM patients were higher than those in the control group(P=0.001).All-cause mortalities,cardiac mortalities,and MACE rates in DM patients with moderate and high UA levels were significantly higher than those in the NDM group(P=0.001).Long-term survival rates decreased significantly with increased UA levels in the ACS groups(P=0.001).UA(odds ratio(OR)=2.106,95%confidence interval(CI)=1.244‒3.568,P=0.006)was found to be an independent risk factor for all-cause mortality and MACE in elderly ACS patients with DM.The cutoff value of UA was 353.6μmol/L(sensitivity,67.4%;specificity,65.7%).Conclusions:Serum UA level is a strong independent predictor of long-term all-cause death and MACE in elderly ACS patients with DM.

Pathogenesis of premature coronary artery disease:Focus on risk factors and genetic variants

The development of premature coronary artery disease(PCAD)is dependent on both genetic predisposition and traditional risk factors.Strategies for unraveling the genetic basis of PCAD have evolved with the advent of modern technologies.Genome-wide association studies(GWASs)have identified a considerable number of common genetic variants that are associated with PCAD.Most of these genetic variants are attributable to lipid and blood pressure-related single-nucleotide polymorphisms(SNPs).The genetic variants that predispose individuals to developing PCAD may depend on race and ethnicity.Some characteristic genetic variants have been identified in Chinese populations.Although translating this genetic knowledge into clinical applications is still challenging,these genetic variants can be used for CAD phenotype identification,genetic prediction and therapy.In this article we will provide a comprehensive review of genetic variants detected by GWASs that are predicted to contribute to the development of PCAD.We will highlight recent findings regarding CAD-related genetic variants in Chinese populations and discuss the potential clinical utility of genetic variants for preventing and managing PCAD.

Case Fatality Rate of Patients with Acute Myocardial Infarction in 253 Chest Pain Centers--China,2019-2020

Summary What is already known about this topic?Acute myocardial infarction(AMI)is the most serious form of cardiovascular diseases.The case fatality rate(CFR)of AMI patients is an important index to reflect the prognosis of AMI.What is added by this report?During the study period,the overall 30-day,60-day,and 90-day CFR of AMI was 5.9%,6.9%,and 7.6%,respectively.The CFRs in gradeⅢhospitals were lower than in gradeⅡhospitals,and the in-hospital CFR was significantly lower than that in post-discharge out-of-hospital.