Ri-Li Ge

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China IV: Comparison of food diversity and its relation to health of Han and Tibetan elderly

Aim:  To examine the association between food diversity and health status of Han and Tibetan elderly highlanders in Qinghai Plateau, China.

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China, III: Oxidative stress and aging in Tibetan and Han elderly highlanders

Background:  Although there are several factors which may contribute to oxidative stress at high altitude, little is known about the association between oxidative stress and aging in the community‐dwelling elderly in the Tibetan Plateau.

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China II: The association of polycythemia with lifestyle‐related diseases among the three ethnicities

Aim:  The objective of this study is to disclose the association of polycythemia with lifestyle‐related diseases (hypertension, obesity and glucose intolerance) among the three ethnicities in Qinghai, China.

Diabetes mellitus and hypertension in elderly highlanders in Asia.

To the Editor: We found the report of shorter life spans in elderly highlanders in Bolivia most interesting, but the actual prevalence rates of hypertension or diabetes mellitus (DM), which may be associated with life span, are unknown in elderly highlanders. Highlanders have long-term evolutionary and cultural adaptation to hypoxia and low natural food resources, although recently lifestyle changes appear to be entering highland areas. To investigate global socioeconomic influences on lifestyle-related diseases in highland people, the prevalence of DM and hypertension in elderly highlanders living in three areas in Asia with different altitudes was studied. The study population consisted of consecutive elderly volunteers aged 60 and older who took part in our medical camps held in three highland communities: 97 Tibetans (mean age SD, 66.6 5.2; male/female 64/34) living in a nomadic area in Haiyan county, China (altitude 3,000– 3,200 m), 209 Tibetans (66.1 5.9; 87/122) in Jiegu town in Yushu county, Qinghai, China (3,700 m), and 117 older Ladakhi adults (69.3 6.8, 48/69) in Domkhar Village, Ladakh, India (2,900–3,800 m). Blood pressure was examined twice in a sitting position, and a 75-g oral glucose tolerance test was administered for the diagnosis of DM or impaired glucose tolerance (IGT) under World Health Organization criteria. Body mass index (BMI; kg/m) was highest in the elderly subjects in Yushu (27.3 4.6) and lowest in those in Domkhar in Ladakh (22.1 3.1). Systolic and diastolic blood pressure (SBP/DBP; mmHg) (142 26/91 15) in the elderly subjects in Yushu and DBP (87 15) in those in Domkhar were significantly higher than those in Haiyan (130 26/79 15). The prevalence of hypertension (BP 4140/90 or taking hypertensive medicine) was highest in Yushu and lowest in Haiyan. Fasting blood sugar (mg/dL) and blood sugar 2 hours after intake of 75 g of glucose were highest in the elderly subjects in Yushu (110 34, 142 60). The prevalence of glucose intolerance (DM or IGT) was highest in those in Yushu. Prevalence of IGT in Domkhar was significantly higher than in Haiyan. Jiegu, with a population of 23,000, is the seat of Yushu County (population 67,000) in a nomadic area of Qinghai on the Tibetan plateau; with socioeconomic globalization, it is a rapidly developing area (population in 1996, 6,460). The participants in Jiegu had various occupational histories, including active or retired nomad, farmer, or official worker, although most elderly subjects now have with an urban lifestyle. Elderly subjects in Jiegu had the highest prevalence of obesity (BMI425.0), hypertension, and DM of the three areas. The conditions are highly suggestive of being closely associated with a modernized lifestyle with its various food markets and good accessibility to transportation. Domkhar in Ladakh, west Himalayas, is a rural village with a population of 1,500 people. It is not easily accessible to traffic. Domkhar has seen effects from socioeconomic globalization only in the past a few years. Most residents

Echinacoside induces rat pulmonary artery vasorelaxation by opening the NO-cGMP-PKG-BKca channels and reducing intracellular Ca2＋ levels

Aim:Sustained pulmonary vasoconstriction as experienced at high altitude can lead to pulmonary hypertension (PH). The main purpose of this study is to investigate the vasorelaxant effect of echinacoside (ECH), a phenylethanoid glycoside from the Tibetan herb Lagotis brevituba Maxim and Cistanche tubulosa, on the pulmonary artery and its potential mechanism.Methods:Pulmonary arterial rings obtained from male Wistar rats were suspended in organ chambers filled with Krebs-Henseleit solution, and isometric tension was measured using a force transducer. Intracellular Ca2+ levels were measured in cultured rat pulmonary arterial smooth muscle cells (PASMCs) using Fluo 4-AM.Results:ECH (30–300 μmol/L) relaxed rat pulmonary arteries precontracted by noradrenaline (NE) in a concentration-dependent manner, and this effect could be observed in both intact endothelium and endothelium-denuded rings, but with a significantly lower maximum response and a higher EC50 in endothelium-denuded rings. This effect was significantly blocked by L-NAME, TEA, and BaCl2. However, IMT, 4-AP, and Gli did not inhibit ECH-induced relaxation. Under extracellular Ca2+-free conditions, the maximum contraction was reduced to 24.54%±2.97% and 10.60%±2.07% in rings treated with 100 and 300 μmol/L of ECH, respectively. Under extracellular calcium influx conditions, the maximum contraction was reduced to 112.42%±7.30%, 100.29%±8.66%, and 74.74%±4.95% in rings treated with 30, 100, and 300 μmol/L of ECH, respectively. After cells were loaded with Fluo 4-AM, the mean fluorescence intensity was lower in cells treated with ECH (100 μmol/L) than with NE.Conclusion:ECH suppresses NE-induced contraction of rat pulmonary artery via reducing intracellular Ca2+ levels, and induces its relaxation through the NO-cGMP pathway and opening of K+ channels (BKCa and KIR).

Differential plasma proteome analysis in patients with high‑altitude pulmonary edema at the acute and recovery phases

This study aimed to investigate the differential expression of plasma proteins in patients suffering from high-altitude pulmonary edema (HAPE) at different phases. A complete proteomic analysis was performed using two-dimensional gel electrophoresis followed by mass spectrometry in three patients with HAPE at the acute stage and recovery phase. Comparisons between the expression patterns of the patients with HAPE at the two different phases led to the identification of eight protein spots with a >1.5-fold difference in expression between the acute and recovery phases. These differentially expressed proteins were apolipoproteins, serum amyloid P component, complement components and others. Apolipoprotein A-I (Apo A-I), serum amyloid P component and fibrinogen were overexpressed in the patients with HAPE in the acute stage compared with their expression levels in the recovery phase. However, Apo A-IV and antithrombin-III were overexpressed in the patients with HAPE in the recovery phase compared with their expression levels in the acute stage. The results indicate that the differential plasma proteome in patients with HAPE may be associated with the occurrence of HAPE, and the expression changes of Apo A-I and A-IV may offer further understanding of HAPE to aid its prognosis, diagnosis and treatment.

STRONG ASSOCIATION BETWEEN POLYCYTHEMIA AND GLUCOSE INTOLERANCE IN ELDERLY HIGH-ALTITUDE DWELLERS IN ASIA

and discontinuing the anticoagulant drugs, bowel rest, correction of PT with intravenous vitamin K with fresh-frozen plasma, and correction of anemia if present. Surgical intervention is indicated only if there is significant intramural hemorrhage, bowel perforation, ischemia, or peritonitis. Efforts to measure the quality of medication use in elderly patients have traditionally focused on inappropriate medications and doses, although a more-comprehensive approach to measuring the quality of medication use in elderly patients has been recommended. The most important determinant of risk for adverse drug reaction–related hospital admission in older patients is the number of drugs being taken. When considering only severe adverse drug reactions, risk is also related to age and frailty. In a previous study, poor adherence of elderly patients was responsible for 31% of overanticoagulation cases. These admissions could potentially be avoided with better anticoagulation control. Long-term warfarin use requires close monitoring of the coagulation profile to prevent this complication. Physician and patient awareness of the risk of bleeding when using warfarin is especially important for elderly patients. Clearer advice to older patients on the risk of nonadherence is important in such case.

Sleep disturbances in long-term immigrants with chronic mountain sickness: a comparison with healthy immigrants at high altitude.

The aim of this study was to examine sleep disturbances in patients with chronic mountain sickness (CMS). The sleep of 14 patients with CMS and 11 healthy controls with or without sleep disorders (control N: without sleep disorders; control D: with sleep disorders) was studied by polysomnography. Hypopnea was the sleep disorder most commonly suffered by CMS patients and control D subjects. No major differences were observed in sleep structure between CMS and control groups, with the exception of shorter rapid eye movement latency in controls and increased deep non-rapid eye movement in the control N group. Periodic breathing was observed in only two study participants, one each in the CMS and control D groups. The level of saturated oxygen was significantly lower in the CMS group during sleep than the control groups (P<0.05). CMS scores were positively correlated with the apnea-hypopnea index, and negatively correlated with saturated oxygen levels. These results demonstrate that sleep disorders and nocturnal hypoxia are important in the development of CMS.

Endothelial PAS Domain Protein 1 Chr2:46441523(hg18) Polymorphism Is Associated With Susceptibility to High Altitude Pulmonary Edema in Han Chinese

OBJECTIVE The purpose of this study was to test the hypothesis that polymorphisms in the endothelial PAS domain protein 1 (EPAS1) gene are associated with the susceptibility to high altitude pulmonary edema (HAPE) in Han Chinese. METHODS This study enrolled 153 HAPE patients (HAPE-p), matched with Han Chinese resistant to HAPE (HAPE-r) and local highland Tibetans from Yushu earthquake construction population in Qinghai where the altitude is more than 3500 m above sea level. The polymorphism of EPAS1 chr2:46441523(hg18) was genotyped by polymerase chain reaction restriction fragment length polymorphism and confirmed by DNA sequencing. RESULTS The frequencies of EPAS1 chr2:46441523(hg18) polymorphism C allele were significantly higher in the HAPE-p group than in the HAPE-r group (P < .001), but the frequencies of heterozygous C/G were significantly higher in the HAPE-r group than in the HAPE-p group (P < .001). Moreover, the frequencies of the EPAS1 chr2:46441523(hg18) polymorphism G allele were significantly higher in the highland Tibetan group than in the HAPE-p and HAPE-r groups. CONCLUSIONS The EPAS1 chr2:46441523(hg18) polymorphism C is strongly associated with susceptibility to HAPE in Han Chinese, and the EPAS1 chr2:46441523(hg18) polymorphism G is present at high frequency and may be associated with high altitude adaptation in the Tibetans.

EPAS1 Gene Polymorphisms Are Associated With High Altitude Polycythemia in Tibetans at the Qinghai-Tibetan Plateau

OBJECTIVE To test the hypothesis that the polymorphisms in the EPAS1 gene are associated with the susceptibility to high altitude polycythemia (HAPC) in Tibetans at the Qinghai-Tibetan Plateau. METHODS We enrolled 63 Tibetan HAPC patients and 131 matched healthy Tibetans as a control group, from the Yushu area in Qinghai where the altitude is greater than 3500 m. Eight single-nucleotide polymorphisms (SNPs) of the EPAS1 gene, including rs12619696, rs13420857, rs2881504, rs4953388, rs13419896, rs4953354, rs10187368, and rs7587138, were genotyped by the Sequenom MassARRAY SNP assay. RESULTS The frequencies of the G allele of EPAS1 SNP rs13419896 were significantly higher in the HAPC group than in the control group (P < .05). Moreover, the A alleles of rs12619696 and rs4953354 were prevalent in the HAPC group, and their counterpart homozygotes were prevalent in the normal Tibetan group (P < .05). CONCLUSIONS Compared with normal Tibetans, Tibetans with HAPC are maladapted and have a different haplotype in EPAS1 SNPs rs12619696, rs13419896, and rs4953354.