The purpose of this study is to investigate the serum inflammatory factors in patients with high-altitude polycythemia (HAPC) and their correlation with cognitive function. The subjects were recruited and placed into a HAPC group and control group. Serum samples were collected, and inflammatory factors (interleukin-1beta [IL-1β], monocyte chemoattractant protein-1 [MCP-1], and tumor necrosis factor-alpha [TNF-α]) were measured using ELISA kits. The mini-mental State Examination (MMSE) was used to assess cognitive function. According to the MMSE scores, HAPC group was further divided into normal cognitive function group (HNCF) and cognitive dysfunction group (HCDF). In comparison with the control group, the MMSE scores in the HAPC group were significantly low (P < .05), whereas the serum levels of IL-1β, MCP-1, and TNF-α were significantly high (P < .01). Among the HAPC group (n = 60), 21 belonged to the HCDF and 39 belonged to the HNCF. Compared with the HNCF, the IL-1β, MCP-1, and TNF-α in the HCDF were significantly increased (P < .01). The Pearson correlation analysis showed that inflammatory factors were positively correlated with hemoglobin, and negatively correlated with MMSE. Serum inflammatory cytokines IL-1, MCP-1, and TNF-α were increased in HAPC, and HAPC exhibited cognitive dysfunction. Considering chronic hypoxia environment influences the change of the red blood cell metabolic and inflammatory factor, red blood cells and inflammatory factor in plateau is likely to be affected by patients with vascular lesions, increase cognitive impairment.

Pulmonary edema refers to the accumulation of excessive fluid in the alveolar walls and alveolar spaces of the lungs. It is a life-threatening condition with a high mortality rate and requires immediate assessment and management. Use of intravenous nitroglycerin has been advocated for such cases. The authors present a case series of 3 patients who presented to the emergency department with sympathetic crashing acute pulmonary edema (SCAPE) and were managed with high-dose intravenous nitroglycerin and bilevel positive airway pressure support using the SCAPE treatment protocol, leading to early correction of blood pressure, avoidance of endotracheal intubation, and no episodes of hypotension or rebound hypertension. The authors recommend emergency physicians utilize the SCAPE treatment protocol while managing patients with SCAPE.

Treatment of high altitude pulmonary edema (HAPE) can be challenging and is further complicated in the pediatric patient in the prehospital environment. The following case presents a decompensating pediatric patient with HAPE in the prehospital aeromedical environment. It illustrates the potential benefit of continuous positive airway pressure (CPAP) as a treatment modality in the treatment of HAPE.

Wang, Si-Yang, Jun Liang, and Jing-Hong Zhao. A Case of High-Altitude Renal Syndrome. High Alt Med Biol. 00:000-000, 2024.-Epidemiological studies have confirmed that high-altitude exposure increases the risk of proteinuria. The concept of high-altitude renal syndrome (HARS) was proposed in 2011. HARS is a group of clinical syndromes consisting of high-altitude polycythemia, hyperuricemia, systemic hypertension, and microalbuminuria. At present, no standardized and unified treatment methods of HARS have been proposed. We report a case of HARS without other organ involvement in a young man exposed to high altitude. Decreasing the red blood cell count and hemodynamic changes as soon as possible may be of great importance for reducing proteinuria. In addition, angiotensin receptor blockers are effective in the treatment of HARS.

High-altitude cerebral edema (HACE) is serious, sometimes fatal clinical condition visualized in unacclimatized individuals climbing high altitudes. The current case report highlights a 39 year old male with a recent history of high-altitude mountain climbing and presented with memory impairment. The radiological findings revealed edema and microhemorrhages at genu and splenium of corpus callosum. Two months later the subject displayed complete resolution of edema, with persistent microhemorrhages. Herein, we report the radiological features of this rare clinical event. The lack of advanced imaging centers at higher altitudes elicit this clinical condition as less described entity.

High-altitude pulmonary edema (HAPE) is a serious life-threatening disease that occurs after rapid ascent to high altitude; its main early-stage presentations include fatigue, headache, low-grade fever, dyspnea, and cough. X-ray and computed tomography (CT) images show pulmonary shadows and patches, which may be localized (initial right lung field predomination) or generalized to the bilateral lung base.
In this report, we present a case of a 25-year-old man diagnosed with HAPE combined with spontaneous pneumomediastinum. After a quick descent and effective medical treatment, this patient made a full recovery. The case may provide helpful information for the prevention and treatment of this disease since an increased number of people, especially young men, currently travel and work at high altitudes.
After accurate clinical diagnosis with the help of CT or X-ray, immediate descent and appropriate oxygen supplementation are the most effective treatments for HAPE at high altitude.

Pigoń, Katarzyna, Ryszard Grzanka, Ewa Nowalany-Kozielska, and Andrzej Tomasik. Severe respiratory failure developing in the course of high-altitude pulmonary edema in an alpinist with COVID-19 pneumonia: a case report. High Alt Med Biol. 23:372-376, 2022.-The case of a 38-year-old Polish alpinist, evacuated from base camp (4,200 m) under Lenin\'s Peak due to severe high-altitude pulmonary edema (HAPE) and symptoms of acute mountain sickness/high-altitude cerebral edema (HACE), is presented. Starting the expedition, the man was asymptomatic and had a negative COVID-19 molecular test. After a few days of trekking, he developed typical HAPE and HACE. After evacuation to the hospital in Bishkek, a diagnosis of acute bronchopneumonia was made by computed tomography (CT) imaging. A COVID-19 test was not performed at that time. After returning to Poland, a complete noninvasive cardiac and pulmonary assessment disclosed no pathology. The initial chest CT reassessment was read as demonstrating the densities typical for COVID-19 pneumonia, and a SARS-CoV-2 antibody test corroborated the diagnosis. Pre-existing lung disease increases the risk of developing HAPE. In the era of the COVID-19 pandemic, people traveling at a high altitude and unaware of the infection are at particular risk.

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Uber, Amy, and Claire Twark. Symptom overlap of acute mountain sickness and lithium toxicity: a case report. High Alt Med Biol. 23:291-293, 2022.-Mild lithium toxicity and acute mountain sickness share multiple overlapping features. We report a case of a patient with bipolar disorder on lithium who hiked to altitude and experienced symptoms that are shared by both conditions. We review the literature on lithium fluctuations under similar conditions showing that acute altitude exposure may elevate serum lithium levels and excess sweating may lower lithium levels, despite the prevailing thought that fluid loss concentrates serum lithium levels. We advise individualized testing of athletes\' lithium levels in response to exercise and altitude, and we recommend physicians counsel their patients on ways to maintain therapeutic lithium levels during their athletic pursuits, including the importance of hydration and avoidance of nonsteroidal anti-inflammatory drugs. Further research is needed on lithium pharmacokinetics in conditions of exercise and altitude exposure.

Acute mountain sickness (AMS) is a common syndrome characterized by headache, dizziness, loss of appetite, weakness, and nausea. As a major public health issue, obesity has increased in high altitude urban residents and intermittent commuters to high altitudes. The present study investigated acute hypoxic exposure and hypoxic exercise on hypoxemia severity and AMS symptoms in a physically active obese man. In this case analysis, peripheral oxygen saturation (SpO2) was used to evaluate hypoxemia, heart rate (HR) and blood pressure (BP) were used to reflect the function of autonomic nervous system (ANS), and Lake Louise scoring (LLS) was used to assess AMS. The results showed that acute hypoxic exposure led to severe hypoxemia (SpO2 = 72%) and tachycardia (HRrest = 97 bpm), and acute hypoxic exercise exacerbated severe hypoxemia (SpO2 = 59%) and ANS dysfunction (HRpeak = 167 bpm, SBP/DBP = 210/97 mmHg). At the end of the 6-h acute hypoxic exposure, the case developed severe AMS (LLS = 10) symptoms of headache, gastrointestinal distress, cyanosis, vomiting, poor appetite, and fatigue. The findings of the case study suggest that high physical activity level appears did not show a reliable protective effect against severe hypoxemia, ANS dysfunction, and severe AMS symptoms in acute hypoxia exposure and hypoxia exercise.