ABSTRACTS 7th World Congress of Mountain & Wilderness Medicine A combined meeting of the International Society for Mountain Medicine and the Wilderness Medical Society July 30-August 4, 2016 Telluride, Colorado.

Abstract

High Altitude Medicine & BiologyVol. 17, No. 3 Abstracts7th World Congress of Mountain & Wilderness MedicineJuly 30–August 4, 2016Telluride, ColoradoFree AccessABSTRACTS 7th World Congress of Mountain & Wilderness Medicine A combined meeting of the International Society for Mountain Medicine and the Wilderness Medical Society July 30–August 4, 2016 Telluride, ColoradoPublished Online:1 Sep 2016https://doi.org/10.1089/ham.2016.29011.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Every two years, the International Society for Mountain Medicine (ISMM) holds its World Congress of Mountain Medicine. The meetings attract scientists and clinicians interested in high altitude medicine, biology, and rescue operations, who provide care and promote safety and health in mountainous regions around the world. Every four years, the Wilderness Medical Society (WMS) sponsors a World Congress of Wilderness Medicine that deals with the latest research and clinical aspects of all wilderness environments. In 2016, the two organizations joined forces for the 7th World Congress on Mountain and Wilderness Medicine. Presentations by global experts addressed altitude medicine, mountain rescue, diving medicine, wilderness education, emerging diagnostic methods, improvised rescue techniques, disaster medicine, neglected tropical diseases, and more.The abstracts selected for publication are divided between High Altitude Medicine & Biology, featuring ISMM members and topics, and Wilderness & Environmental Medicine, featuring WMS members and topics. There is some subject overlap, and the reader is encouraged to refer to both journals for a complete picture of the breadth and excellence of work in these fields.001 EFFECT OF A 300 MBARS INCREASE IN BAROMETRIC PRESSURE ON FINGERS' MICROCIRCULATION IN HEALTHY SUBJECTS EXPOSED AT HIGH ALTITUDE—INTEREST OF USING A PORTABLE HYPERBARIC CHAMBER TO TREAT FROSTBITES AND HYPOTHERMIACauchy Emmanuel, MD, Leal Sandra, MD, Savina Yann, Zellner Pascal, MD, Nespoulet Hugo, PhD, Becker François, MD, PhDIFREMMONT (Institut de Formation et de Recherche en Médecine de Montagne), Hôpital de Chamonix, Chamonix, FranceIntroduction: Hypothermia and frostbites are due to a significant decrease in central and peripheral body temperatures in individuals exposed to a cold or windy environment or to high altitude in mountains. The use of a portable hyperbaric chamber is a well-known treatment against altitude intolerance through its ability to increase oxygen partial pressure. This study aimed to show that hyperbaric exposure could also be used as a treatment for hypothermia and frostbite.Methods: During a European research program (SOS-MAM, Flow Pulse study) investigations were made on 27 healthy non acclimatized subjects (21 males, 6 females mean age 41±17) at the altitude of 3800 meters (Chamonix Mountain LAB, Aiguille du Midi, France), right before and after spending 1 h in a portable hyperbaric chamber (+300 mbars, CertecR). We measured digits' skin temperature (T°cut), digits' blood flow (Fcut) and digits' tissue oxygenation (TcPO2) by laser doppler monitoring (PerimedR), (SpO2) by digital pulse oximeter (NoninR), heart rate (HR) and core temperature (CT°) (ZephyrR). Air temperature inside the chamber (T°chamb) was measured during the whole session.Results: We observed significant increases in T°chamb (+9.3°C), T°cut: +7,5°C (+/−6,2) (+71%), Fcut: +58AU (+/−89) (+379%), TcPO2: +18 mmHg (+/−11,9) (+304%), SatO2: +13%.Conclusion: This study shows that hyperbaric chamber could be used to treat frostbite and hypothermia in altitude when descent or rescue is impossible or even simply delayed.002 ALTITUDE AND SUICIDE: AN INTEGRATIVE REVIEWHonigman Benjamin, MD1, Brown Talia L, MS2, Betz Marian, MD, MPH11Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA2Colorado School of Public Health and Boulder County Public Health, Boulder, CO, USAIntroduction: Suicide rates are greater at altitude and some hypothesize that hypoxia is a primary cause. To better understand this relationship, we aimed to examine the associations between altitude and suicide.Methods: We conducted a comprehensive integrative review of all studies published on altitude and suicide. We abstracted and analyzed all studies that met inclusion criteria. We excluded foreign language studies and letters. The majority of the measurements and results were synthesized narratively.Results: Nineteen studies were found using an extensive list of keywords but only 5 met inclusion criteria. The sample size of subjects ranged from 8871 to 596,704. Where sample size was not documented, suicide rates were reported. Suicide risk was greater in all 5 studies in individuals living at higher elevation. Four of the studies used aggregate data on a county or state level to analyze variables such as age, gender, race, socio-economic factors and access to firearms. All studies found that altitude was independently associated with suicides. One study looked at individual characteristics of suicide victims and found a higher association of suicide at altitude but also found factors suggesting lack of access or barriers to mental health care as an important factor. Depression exacerbated by hypoxia was hypothesized as a possible biologic mechanism in 4 studies but only one study objectively measured depression in an elderly population and found no greater rate at altitude.Conclusion: Based on research studies published since 1980, there appears to be an association between altitude and suicide rates at the state or county level. There are not enough data to estimate the effect of altitude on an individual's suicide risk. Although the impact of hypoxia on mood and depression has been hypothesized as a cause, many other individual factors may play a more important role for this finding.003 FRIEDREICH'S ATAXIA AT ALTITUDE—OBSERVATIONS DURING A SUCCESSFUL ASCENT OF MT KILIMANJAROHaslam Nick R, BMBCh (Oxon.), DiMM, DTM&H1, Giunti Paola, PhD2, Montgomery Hugh, MD3, Parkinson Michael H, MBBS2, Panicker Jalesh, MD2, Pantazis Antonis, MD41Bart's London School of Anaesthesia, London, UK2National Hospital for Neurology and Neurosurgery, University College London, London, UK3Institute for Human Health and Performance, University College London, London, UK4The Heart Hospital, London, UKA 27-year-old male with Friedreich's ataxia (FRDA) and no previous high altitude experience successfully ascended Mt. Kilimanjaro in a wheelchair. High altitude environments present significant physiological challenges to such individuals who are therefore often denied the opportunity for such travel.Objective: Our mentally competent patient was determined to travel and we sought to support this aspiration in a manner that best mitigated risk.Methods: Neuro- and neuro-urological, cardiac, pulmonary and speech and language assessments were undertaken prior to departure. The subject was accompanied by four male adults aged 22, 23, 29 and 57. All participants took prophylactic acetazolamide during ascent. Vital signs and Lake Louise Scores (LLS) were recorded at sea level, 1400 m, 2650 m, 3479 m, 3979 m, 4700 m and 5895 m. The Scale for the Assessment and Rating of Ataxia (SARA) was recorded daily in the subject. The subject's vital signs were compared with the accompanying adults' at sea level, 3479 m, 3979 m and 4700 m using the Student's t-test with Bonferroni correction.Results: Cardiopulmonary screening was unremarkable. Neurological dysfunction, severe prior to departure (SARA = 28.5), did not deteriorate during or after ascent. LLS were consistently low (<5). SaO2 fell with ascent (97% at sea level vs 81% at 5895 m) as did the accompanying adults (98.25% (CI 95% 97.76–98.74) vs 69.75% (CI 95% 57.84–81.66)). Heart rate increased with ascent in both the subject (94 bpm at sea level vs 124 bpm at 5895 m) and adults (59.75 bpm (CI 95% 49.81 – 69.69) vs 119.5 bpm (CI 95% 112.78 – 125.72). SaO2 at sea level, 3479 m, 3979 m and 4700 m were similar to the accompanying adults' (p > 0.05).Conclusions: During ascent to 5895 m we observed no neurological nor cardiorespiratory deterioration, nor any other significant medical complication. Nevertheless such excursions are not without risk and it remains unclear whether other patient's with FRDA can safely travel to high altitude.004 PERCEIVED RISK OF HIGH ALTITUDE TREKKING IN THE HIMALAYAS; AN OBSERVATIONAL STUDY DURING AN EXPEDITION TO LADAKHHaslam Nick R, BMBCh (Oxon.), DiMM, DTM&H1, Davis Peter, FACEM. MRCGP, DiMM, IMC Dip, R&TM21Bart's London School of Anaesthesia, London, UK2Emergency Department, Southern General Hospital, Glasgow, UKAccurate risk assessment is vital for a successful expedition. Whilst figures regarding risk of illness and injury on expeditions have been reported, few studies have investigated the risk perception of medical issues by expedition members.Objective: To assess perceived risk of medical issues by expedition members before, and after, a 5 week, high altitude (3500 m-6000 m) expedition to Ladakh, Northern India.Methods: Observational study using a qualitative and quantitative questionnaire. Expedition members were asked to rate 8 relevant expedition and high altitude medical conditions in 5 domains - risk; severity; preventability; perceived ability to self-manage; and risk of evacuation.Population: 40 self-selected physically fit expedition members (45% female, 55% male) - 37.5% high altitude (>2500) and expedition naïve.Results: Participants considered risk of illness higher on expedition than at home (90% pre-expedition; 90.32% post-expedition) with two-thirds perceiving a higher risk of death (62.5% pre-expedition; 67.7% post-expedition). Risk of death when trekking in the Himalayas was most frequently believed to be 0.01% (52.5% pre-expedition; 41.9% post-expedition). Acute Mountain Sickness (AMS) and gastroenteritis were consistently selected as the most likely conditions to develop whilst the most severe were High Altitude Cerebral Oedema (HACE) and femur fracture. Notably the perceived ability to prevent AMS was comparable to HACE both pre-expedition [AMS 1.8/10 (95%CI (1.53–2.10)) vs HACE 2.3/10 (95%CI (1.98–2.65))] and post-expedition [AMS 2/10 (95%CI (1.63–2.51)) vs HACE 2.6/10 (95%CI (2.03–3.11))].Conclusions: Overall risk of ill-health during the expedition was considered to be greater than current estimates from the literature. Importantly participants considered their ability to prevent HACE (a life-threatening and mostly preventable condition) as equal to AMS - and these perceptions remained unchanged despite medical teaching during the expedition. Expedition members' perception of medical risk may not be consistent with the medical team and this should be addressed to prevent adverse health behaviours and unnecessary anxiety.ABSTRACT WITHDRAWN006 ALTITUDE ACCLIMATIZATIOIN PRACTICES OF THRU-HIKERS ON THE JOHN MUIR TRAILRozier Leslie1, Meyer Kenneth2, Papanek Paul3, Aksamit Inga41Prophase International, Pinedale, WY, USA2Software Engineer, Alta Dena, CA, USA3University of California, Irvine, CA, USA4Health Information Technology Consultant, Sonoma, CA, USAIntroduction: Each summer approximately 5,000 backpackers walk the John Muir Trail (JMT), a high-altitude section of the Pacific Crest Trail in California with 75% of the trail over 10,000 feet. Travel to altitudes around 8,000 feet is associated with an increased risk of developing acute mountain sickness (AMS). Prevention of AMS through acclimatization procedures such as gradual ascent and use of pharmacologic agents are key strategies for a successful high-altitude journey. Little is known about acclimatization practices of backpackers.Objective: The purpose of this study was to determine the acclimatization experiences/practices of thru-hikers on the JMT.Methods: The online Altitude Acclimatization Survey (AAS) was completed by volunteer respondents from John Ladd's 2015 John Muir Trail Survey of hikers attempting or completing thru-hikes on the 222 mile trail. Subjects completed the AAS after completion of the hike and were asked to recall hike details.Results: Of the 627 invitations, 330 (53%) completed the survey. Sixty-seven percent (n = 27) of hikers with mild AMS completed the hike with 41% (n = 7) reporting severe symptoms. Over half (63%) of the subjects did not take medications for acclimatization and 40% of the respondents reported encounters with someone on the trail experiencing a high-altitude illness. Slow altitude acclimatization did not sufficiently overcome a disposition for AMS based on ascent rates.Conclusions: Twenty one percent (21%) of the respondents in this survey reported mild to severe AMS symptoms suggesting a need for acclimatization education for thru-hikers on the JMT.007 ASSOCIATIONS BETWEEN THE DEGREE OF OXIDATIVE STRESS AND HEMOGLOBIN IN THE DIFFERENT GENDER OF CHINESE TIBETANS IN HIGH ALTITUDE AREADai Qingxiang, MD1, Xu Huining, MD1, Wang Hongxing, MD1, Li Zhanquan, MD1, Gao Jidong, MD1, Okumiya Kiyohito, PhD2, Matsubayashi Kozo, PhD2, Kimura Yumi, PhD2, Ma Ni, MD31Department of Geriatrics, Qinghai University Affiliated Hospital, Qinghai University, Xining, China2Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan3People's Hospital of Yushu County, Yushu Tibetan Autonomous Prefecture, Qinghai, ChinaIntroduction: To adapt to the high altitude hypoxia environment, the level of oxidative stress and hemoglobin of Tibetans are higher than people living in plain. However, the association between them is less documented in the medical literature.Objective: The purpose of this study is to know the degree of oxidative stress in different gender of Chinese Tibetans in a high altitude hypoxia environment and to describe the associations among the degree of oxidative stress, gender and hemoglobin.Methods: A total of 90 male and 86 female from Jiegu Town and Longbao Town (the average altitude are 3,700 and 4,800 meters respectively) of Yushu Tibetan Autonomous Prefecture were surveyed by random sampling. All these 176 native Tibetans were tested about the degree of oxidative stress and hemoglobin.Results: There were no significant differences in hemoglobin and d-ROMs among Tibetans from these two towns (P > 0.05). The level of d-ROMs in female, the group with higher level hemoglobin and the group with aged over 60 years were significantly higher than male, the group with normal level hemoglobin and the group with aged less than 60 years old separately (P < 0.05). Correlation analysis showed that d-ROMs have a negative correlation with gender (Correlation coefficient is −0.401). Logistic regression analysis showed that the female gender and people aged over 60 years old are the major influential factors to increase the level of d-ROMs (P < 0.05).Conclusion: Chinese Tibetans living in high altitude area have a higher level in oxidative stress, especially for female. The female gender and aged people over 60 years old are the major influential factors to increase the level of d-ROMs. The increasing of hemoglobin in a hypoxia environment may be one of the reasons for the developing of oxidative stress.008 INCREASING BCL-2 AND NEUROGLOBIN EXPRESSION IN HYPOXIC HIPPOCAMPAL NEURONS UNDER HYPOXIA PRECONDITIONING AND IN 3-N-BUTYLPHALIDE TREATED CELLS UNDER OXYGEN GLUCOSE DEPRIVATION/REOXYGENATIONWu ShiZhengQinghai Provincial People's Hospital, Xining Chengdong District, ChinaObjective: The purpose of this study is to observe neuroprotective effects of hypoxia preconditioning (HP) in primary culture newborn SD rat hippocampus neurons and 3-n-butylphalide (NBP) against oxygen glucose deprivation/reoxygenation (OGD/R) injury, and investigate the possible mechanisms against ischemic reperfusion injury.Methods: After 7-days culture, the hippocampal neurons were initially divided into three groups: normal control group, simple hypoxia group and HP group. Later, we established OGD30min/R8h model. So, the hippocampal neurons were eventually divided into five groups: normal control group, OGD/R model group, OGD/R+3-n-butylphalide (NBP) groups (0.1 μmol/L, 1 μmol/L and 10 μmol/L). Bcl-2 and neuroglobin (NGB) expression of cells in each group were analyzed by immunocytochemistry. The mRNA expression of Bcl-2 and NGB in each group was analyzed by RT-PCR.Results: The results showed that the protein and mRNA levels of Bcl-2 and NGB were significantly increased in the HP group compared to the hypoxia group (P < 0.01). In the OGD/R model, NBP groups also showed a significantly increased expression of proteins Bcl-2 and NGB compared to the OGD/R (P < 0.05); Different concentration of NBP drugs showed a significantly increased expression of proteins Bcl-2 and NGB with the increase in NBP concentration (P < 0.01).Conclusion: The neuroprotection of HP and NBP may share the same possible mechanisms and have endogenous neuroprotection by up regulating the mRNA and protein expression of Bcl-2 and NGB.Keywords: HP, OGD/R, 3-n-butylphalide, Hippocampal Neurons, Bcl-2, Neuroglobin.009 CEREBRAL VASOCONSTRICTION REACTIONS AND PLASMA LEVELS OF ETBR, ET-1, ENOS IN PATIENTS WITH CHRONIC MOUNTAIN SICKNESSWu ShiZhengQinghai Provincial People's Hospital, Xining Chengdong District, ChinaThe aim of this study is to identify the association of cerebral vasoconstriction in patients with chronic high altitude disease (Cerebrovascular reactivity, CVR), and to evaluate differences in Chronic Mountain Sickness (CMS) patients and healthy control populations brain vascular contractile reactivity changes. We simultaneously determine the changes of the endothelin and its receptor, endothelial (eNOS) levels in the plasma, to determine the cerebral reservation capacities in CMS patients. The transcranial doppler ultrasound (TCD) and carbon dioxide (CO2) analyze methods had been used to detect the CVR variances, at the same time the enzyme-linked immunosorbent assay (ELISA) approaches were also utilized to detect the endothelin and endothelin receptor B and the endothelial nitric oxide synthase (NOS) levels in serum of the CMS patients and healthy control subjects. The level of both CVR and CVRI in CMS patients were lower than healthy people (p < 0.05), but the level of eNOS and Endothelin-1 (ET-1) were no statistical significance differences between CMS and healthy controls (p > 0.05). However the level of ET receptor concentration was the higher in CMS than the healthy controls. ET-1 may be not a direct etiological variation but which have played the compensation roles in CMS patients. This study may provide scientific clues for prevention and treatment of CMS with the higher blood coagulation states of cerebral infarction in highlanders.Keyword: Chronic Mountain Sickness, Cerebrovascular reactivity, ET-1, ET receptor B, eNOS010 SERUM CONCENTRATIONS OF HMGB1, STREM1 AND INFLAMMATORY CYTOKINES CORRELATE WITH PULMONARY FUNCTION CHANGES AT MODERATE ALTITUDE IN PATIENTS WITH COPD EXACERBATIONSShang LingQinghai Provincial People's Hospital, Xining Chengdong District, ChinaObjective: To explore clinic markers of chronic obstructive pulmonary disease (COPD) in patients with acute exacerbation (AECOPD) at moderate altitude. The relationships between the serum concentrations of high mobility group protein 1 (HMGB1), soluble myeloid cells trigger receptor 1(sTREM-1) and inflammatory cytokines such as tumor necrosis factor (TNF-α), procalcitonin (PCT) and C-reactive protein (CRP) and the lung function parameters (FEV1 % predicted, FEV1/FVC) were investigated.Methods: We studied 50 patients with COPD at moderate altitude (elevation 2260 meters) (AECOPD- 25 cases, 25 cases of clinical stability), and a control group of 25 volunteers without COPD. We used ELISA to measurement the serum concentrations of HMGB1, sTREM-1, TNF-α, PCT and CRP level, and analyzed the relationship between them and FEV1 % predicted and FEV1/FVC.Results: At moderate altitude, the serum concentrations of HMGB1, sTREM-1, TNF-α, PCT and CRP level in patients with AECOPD was higher than the patients in a stable state and the control group (P < 0.05). HMGB1, sTREM-1, TNF-α, PCT and CRP in the stable COPD patients was higher than the healthy controls (P < 0.05). Correlation analysis suggests the serum concentrations of HMGB1, sTREM-1, TNF-α, PCT and CRP are negatively correlated with FEV1 % predicted and FEV1/FVC (P < 0.05) in the patients with AECOPD.Conclusion: High concentrations of serum HMGB1, sTREM- 1, TNF-α, PCT and CRP expression may be useful as indicators of acute inflammation and possibly of bacterial infection in patients with COPD at moderate altitude.011 CHARACTERISTICS OF BRAIN FUNCTION IN PATIENTS WITH CHRONIC MOUNTAIN SICKNESS BASED ON AMPLITUDE OF LOW FREQUENCY FLUCTUATION: RESTING STATE FMRIBao Hai Hua1, Wang Fang Fang1, Ge Ri-Li21Affiliated Hospital of Qinghai University, Xining, China2Research Center for High Altitude Medicine, Qinghai University, Xining, ChinaIntroduction: Brain is the most sensitive organ to hypoxia, and neurological symptoms such as headache and memory impairment are the most obvious symptoms in patients with chronic mountain sickness (CMS). The incidence of CMS is increasing with increased population of the Tibetan plateau. Therefore, this study explored the changes of brain function in CMS patients using fMRI.Objective: We wished to explore brain function in patients with CMS by using the amplitude of low frequency fluctuation method based on BOLD-fMRI imaging technology.Methods: Resting-state functional magnetic resonance imaging scan of whole brain was performed in twenty-four patients with diagnosed CMS and 25 normal volunteers matched for age, sex, years of education, and altitude. Resting state date was acquired, and then ALFF method was used for data analysis.Results: Compared with normal control group, CMS patients in resting state showed increased spontaneous brain activity in left supramarginal gyrus, right central sulcus cover, left parahippocampal gyrus, left middle temporal gyrus, and decreased spontaneous brain activity in right cerebellar amygdala and right supplementary motor area.Conclusion: CMS patients had obviously abnormal spontaneous brain activity in many brain areas, which indicated that changes in brain function of CMS patients might be associated with long-term chronic hypoxia.012 PERFUSION-CARDIAC MAGNETIC RESONANCE IMAGING (MRI) OF THE HEART IN PATIENTS WITH CHRONIC MOUNTAIN SICKNESS (CMS)Bao Hai Hua1, Xie Dong Mei1, Ge Ri-Li21Affiliated Hospital of Qinghai University, Xining, China2Research Center for High Altitude Medicine, Qinghai University, Xining, ChinaIntroduction: CMS is a common disease on the Tibetan plateau, and can cause heart, brain and lung damage. A longer duration of CMS can induce cardiac enlargement hypertrophy. MRI perfusion imaging can provide information on the location, extent, and degree of abnormality.Objective: To investigate the difference in heart perfusion and morphology between CMS patients and healthy subjects by dynamic contrast-enhanced MRI.Methods: Fifteen patients with CMS and 12 control subjects were recruited. 3T MRI was used for dynamic contrast enhanced imaging of the right ventricle. Five perfusion of left ventricle parameters and eight parameters in structure and function of right ventricular were assessed: LV rel max upslope (%, LVRMUS), max. upslope (S/s), time to 50% peak(s), time to peak(s), peak enhanced (S), right ventricular thickness (RVT), right ventricular mass (RVM), right ventricular papillary mass (RVPM), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF). Left and right ventricular data of patients and healthy subjects were compared by independent-sample t-test.Results: Respectively, LVRMUS, MUS, 50%TTP, TTP, PE of patients, were (11.43 ± 4.12) %, (79.21 ± 27.60) S/s, (7.52 ± 2.26) s, (17.73 ± 6.58) s, (642.03 ± 185.75) S; Respectively, the LVRMUS, MUS, 50%TTP, TTP, PE of healthy subjects were: (21.01 ± 5.19) %, (158.32 ± 49.71) S/s, (5.26 ± 0.97) s, (11.49 ± 1.84) s, (1190.97 ± 192.22). Thus, the perfusion indices showed delayed and diminished perfusion of the RV in CMS patients compared to controls. Right ventricular thickness (RVT), right ventricular mass (RVM), and right ventricular papillary mass (RVPM) of CMS patients were greater than controls indicative of RV hypertrophy. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) of the patients were (85.18 ± 31.94) ml, (40.94 ± 17.86) ml, (52.09 ± 13.27) %, (35.75 ± 21.09) ml, respectively, the RVEDV, RVESV, RVEF, RVSV of healthy subjects, were (74.87 ± 14.28) ml, (38.32 ± 12.79) ml, (49.40 ± 9.77) %, (34.32 ± 6.64) ml, RVEDV is higher than control, but RVESV, RVEF, RVSV were little higher than volunteers, but without significant difference between the two groups.Conclusions: The current study reveals RV hypertrophy with impairment of LV perfusion in patients with CMS, which might be associated with chronic myocardial hypoxia.013 B-LINES AFTER ASCENT TO HIGH ALTITUDE BY CLIMBING VS. BY FLIGHTStrapazzon Giacomo1, Vezzaro Roberto2, Hofer Georg3, Cappello Tomas Dal1, Pohl Michael1, Rauch Simon1, Procter Emily1, Brugger Hermann11EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy2University Hospital of Padova, Department of Radiology, Padova, Italy3General Hospital of Silandro, Department of Anesthesiology and Critical Care Medicine, Silandro, ItalyIntroduction: Increased extravascular lung water is seen as B-lines on chest ultrasonography also at high altitude, irrespective of the mechanism (cardiogenic or non-cardiogenic). Nevertheless, the importance of strenuous exercise in a hypoxic environment in this context is still debated.Objective: To compare the incidence of B-lines and changes in clinical parameters in participants acutely exposed to hypobaric hypoxia after ascending to high altitude by climbing vs. by flight.Methods: Chest ultrasonography, clinical parameters, and symptoms of acute mountain sickness (AMS) and high altitude edema (HAPE) were assessed by blinded investigators in 40 participants after ascent to 3830 m. 21 participants climbed up; 19 participants were transported by helicopter. Chi-square and Fisher's exact tests were used to compare proportions and the Mann-Whitney test to compare data of two groups.Results: Six of 40 participants (15%) developed AMS within 24 h after arrival at altitude and one (3%) had a clinical diagnosis of HAPE. The mean number of B-lines in participants who were flown by helicopter was similar to the number in participants who ascended by climbing (7.1 ± 5.7 vs. 7.9 ± 6.0, p > 0.05). The two groups did not differ in Lake Louise Score, peripheral oxygen saturation, heart rate, and breathing rate (p > 0.05 for all).Conclusion: Physical effort ascending to high altitude doesn't seem to increase B-lines compare to passive ascent. It is important to further investigate the clinical meaning of B-lines in subjects exposed to hypobaric hypoxia for work and training purposes.014 CHARACTERISTICS OF CARDIAC MORPHOLOGY AND FUNCTION IN PATIENTS WITH HIGH ALTITUDE HEART DISEASE: CMR COMPREHENSIVE EVALUATIONBao Hai Hua1, Meng Li1, Ge Ri-Li21Affiliated Hospital of Qinghai University, Xining, China2Research Center for High Altitude Medicine, Qinghai University, Xining, ChinaIntroduction: 3T MRI has a great advantage in evaluating the morphology, function and blood vessel of the heart. In this study, MRI was used to evaluate the High Altitude Heart Disease.Objective: To evaluate the changes of cardiac morphology and function in patients with high altitude heart disease (HAHD) by CMR.Methods: 20 cases clinically diagnosed with HAHD patients and 20 cases of gender, age and altitude matched normal volunteers were performed CMR scans. Using cine MR imaging post-processing software measurement of left and right ventricular systolic and diastolic volume, time-volume curve, left and right ventricular ejection score, ventricular wall thickness, pulmonary artery and aortic root diameter, interventricular septum thickness. All data were statistically analyzed.Result: Respectively, in the structure, the RVEDT, IVSd, LVES long trail, PAD (9.09 ± 1.94)mm, (11.74 ± 3.04)mm, (62.84 ± 10.80)mm, (31.05 ± 5.28)mm; Respectively, the RVEDT, IVSd, LVES long trail, PAD of volunteers were: (3.95 ± 0.59)mm, (8.09 ± 1.70)mm, (41.06 ± 16.22)mm, (25.20 ± 2.54)mm. In the function, the RVEDV, RVESV, LVSV, CO (76.96 ± 34.09)ml, (37.40 ± 15.14)ml, (4.81 ± 1.36)L/min, (64.75 ± 16.38) L/min; RVEDV, RVESV, LVSV, CO of volunteers were (39.18 ± 14.26)ml, (29.24 ± 4.93)ml, (3.09 ± 0.55)L/min, (45.06 ± 8.27)L/min. There is significant difference between HAHD patients and normal control group.Conclusion: HAHD patients with cardiac structure (especially the right ventricular wall), function and pulmonary trunk diameter were abnormal changes. CMR has a great advantage in the evaluation of, especially for the evaluation of right heart.Key words: HAHD; Structure and Function; CMR; Measure015 BIOELECTRICAL IMPEDANCE VECTOR ANALYSIS (BIVA) OF BODY WATER DYNAMICS AT HIGH ALTITUDE OVER THREE DAYSStrapazzon Giacomo1, Pun Matiram1, Hofer Georg2, Cappello Tomas Dal1, Balkenhol Karla1, Procter Emily1, Piccoli Antonio3, Brugger Hermann11EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy2General Hospital of Silandro, Department of Anesthesiology and Critical Care Medicine, Silandro, Italy3University Hospital of Padova, Department of Medicine DIMED, Padova, ItalyIntroduction: Acute altitude illnesses such as acute mountain sickness (AMS), high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE) typically develop within hours (AMS and HACE) to days (HACE and HAPE) among newly arr