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    A revision of maximal oxygen consumption and exercise capacity at altitude 70 years after the first climb of Mount Everest

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    On the 70th anniversary of the first climb of Mount Everest by Edmund Hillary and Tensing Norgay, we discuss the physiological bases of climbing Everest with or without supplementary oxygen. After summarizing the data of the 1953 expedition and the effects of oxygen administration, we analyse the reasons why Reinhold Messner and Peter Habeler succeeded without supplementary oxygen in 1978. The consequences of this climb for physiology are briefly discussed. An overall analysis of maximal oxygen consumption (VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}) at altitude follows. In this section, we discuss the reasons for the non-linear fall of VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} at altitude, we support the statement that it is a mirror image of the oxygen equilibrium curve, and we propose an analogue of Hill's model of the oxygen equilibrium curve to analyse the VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} fall. In the following section, we discuss the role of the ventilatory and pulmonary resistances to oxygen flow in limiting VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}, which becomes progressively greater while moving toward higher altitudes. On top of Everest, these resistances provide most of the VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} limitation, and the oxygen equilibrium curve and the respiratory system provide linear responses. This phenomenon is more accentuated in athletes with elevated VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}, due to exercise-induced arterial hypoxaemia. The large differences in VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} that we observe at sea level disappear at altitude. There is no need for a very high VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} at sea level to climb the highest peaks on Earth. imageAbstract figure legend Maximal oxygen consumption (VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}) shows a non-linear fall with altitude that is a mirror image of the oxygen equilibrium curve. Di Prampero and Ferretti were the first to associate the non-linear behaviour of the respiratory system to the oxygen equilibrium curve. On the other hand, Wagner constructed his convective curve accounting for the effects of the oxygen equilibrium curve. The decrease is more accentuated in athletic subjects with elevated VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} compared to those who are non-athletic, so that the large differences in VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} that are observed at sea level disappear at altitude. Such consequences are due to the effect of ventilatory and pulmonary resistances to oxygen flow in limiting VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}, which becomes progressively greater while moving toward higher altitudes compared to that of the cardiovascular resistance. On top of Everest, the pulmonary resistances provide most of the VO2maxV˙O2max{\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}} limitation and the respiratory system provides linear responses. imag

    Going Beyond Counting First Authors in Author Co-citation Analysis

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    The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed

    Acute mountain sickness in a subject with metabolic syndrome at high altitude

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    Visitors at high altitude are increasing in age and comorbidities, which can lead to a failure in acclimatization. We describe the development of acute mountain sickness (AMS) in a 44-year-old man with metabolic syndrome and the time- and altitude-dependent correlation between the development of AMS and blood pressure and heart rate changes. Our observations support a dominant role of endothelial dysfunction in the pathogenesis of AMS and suggest new behavioral indications
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