1. Check that you understand the following words
and expressions, which you will meet in many
medical texts:
• lack supply admitted store
• survival rates onset outcome
• failure leads to recover

2. For the next slide you must match the phrase in
Column A with the most suitable conclusion in
Column B
For the solution to the exercises, go to the end of this presentation

3. Oxygen makes up 21% of the air and the victim will literally drown.
What does change is density and pressure, climbers breathe more deeply and rapidly.
If you aren't breathing enough oxygen, -more likely to clot - increasing the risk of
thrombosis and stroke.
If allowed to progress to its conclusion, which drops as you rise.
ensuring an increase in the number of red
To counter the lack of oxygen in the air, blood cells to capture that oxygen.
This increases the ratio of oxygen to carbon this fraction doesn't change wherever you
dioxide in the lungs are in the atmosphere.
But it also thickens the blood making it you run the risk of pulmonary oedema

4. Read the text Xtreme Everest and say whether the statements are True
or False
1 All patients in intensive care units suffer from low oxygen levels
2 It is thought that some people process oxygen better than others
3 The Xtreme Everest study has discovered how to improve survival
rates in patients in ICUs
4 Different cells store oxygen better than others
5 Hypoxia takes place specifically at cellular level
6 Climbers, like sick patients, often need extra oxygen
7 Those who die when swimming suffer from hypoxia
8 The hypoxia encountered in hospitals is usually very rapid
9 Giving oxygen via a mask does not always resolve the problem of
hypoxia
10 The problem of heart disease is that oxygenated and deoxygenated
blood is mixed in the lungs

5. Find words and expressions in the text Xtreme
Everest which mean the same as the following:
manage healthy adjust
are situated depend on
is broken down detaches
transportation slow speed
taken into steps aggravates
complication

6. •http://www.xtreme-everest.co.uk/ page 1 of 3
•Why going to Everest may help patients in intensive care
•One in six people are admitted to an intensive care unit in the United Kingdom during their life. Of these people, 20% will
die whilst on the intensive care unit. This equates to 20,000 deaths a year, In addition to this 20%, a further 10% will die
without leaving hospital.
•People are admitted to intensive care for a variety of reasons. They may have been in a car accident. They may have bled
after giving birth. They may have had a major operation, or they may be suffering from meningitis. Despite these very
different reasons for admission nearly all of them will suffer from low oxygen levels. These low oxygen levels are similar to
the low oxygen levels seen in people that go to high altitude.
•When people go to altitude, some people cope with low oxygen levels very well, and some people do not cope well at all.
This does not appear to be related to how fit they are. One hypothesis is that those that cope with low oxygen levels well do
so because their cells process oxygen more efficiently.
•The main aim of the Caudwell Xtreme Everest study is to measure how individuals’ bodies change as they are exposed to
lower and lower levels of oxygen. The expectation is that there will be a difference between those that adapt well, and
those that adapt poorly. If the Caudwell Xtreme Everest team can determine what that difference is, then they can start to
look at treatments that can help poor adaptors use oxygen more efficiently. This can be taken back to the intensive care unit
to improve survival rates in patients.

7. http://www.xtreme-everest.co.uk/ page 2 of 3
What is hypoxia?
Hypoxia, put simply, is a lack of oxygen. Oxygen forms approximately 21% of the air we breathe and is the part of the air
which is vital for human life. Every one of the millions of cells in our body requires a continuous supply of oxygen in order
to generate the energy which keeps them alive. A lack of oxygen leads to deterioration and eventually death of cells. It is
this deprivation of oxygen which cells can suffer which we specifically refer to as hypoxia. Depending on where in the
body these cells lie, parts of the body, just like the cells, will also deteriorate and die. The body cannot store oxygen in
any way so the cells rely on a continuous supply of oxygen to keep them healthy.
Oxygen is taken from the air and travels through the body to the cells in via a transport chain known as the 'oxygen
cascade' which is summarised in a simple form below:
Oxygen enters the body via the lungs in a process we call breathing.
In the tiny air sacs (alveoli) of the lungs oxygen dissolves into the passing blood.
Most of the oxygen within the blood combines with the haemoglobin contained in red blood cells.
The heart pumps blood containing red blood cells through the circulatory system (the arteries, veins and capillaries) to its
destination.
Oxygen detaches from red blood cells within the tissues that require it then diffuses through the tissue to the cells.
Hypoxia can occur as a result of failure at any of the above stages i.e. the lungs, heart, circulatory system or diffusion
through tissues. Hypoxia is a common problem in patients both at home and in hospital. Commonly these patients have
problems with their lungs which prevents effective oxygen entry into the body. These patients may require extra oxygen
from cylinders in order to maintain an adequate flow of oxygen to their cells (see 'Hypoxia and Medicine' for more
information).
At high altitude it is the availability of oxygen in the air which is reduced. Oxygen levels fall progressively as one ascends
to altitude, with life above the summit of Mount Everest being almost impossible as a result. If one ascends at a
reasonably gentle pace the body is able to adapt to the hypoxia in a process known as acclimatisation. Like sick patients
in hospital, climbers attempting to venture to extreme altitudes (over 8,000m) also tend to use extra oxygen to help them
climb. This is because of the severe levels of hypoxia experienced when trying to climb at these altitudes.

8. •http://www.xtreme-everest.co.uk/ page 3 of 3
•Hypoxia and Medicine
•Hypoxia, or lack of oxygen, is a very common phenomenon in medicine. Sudden and severe hypoxia such as drowning is
obvious and frequently fatal. The majority of hypoxia which we experience in medicine, however, tends to be of slower
onset. But if hypoxia is left untreated it can result in the same unfortunate outcome. As doctors it is our job to try to stop
and reverse hypoxia in order to ensure adequate oxygen levels in our patients.
•As explained above ('What is Hypoxia?') oxygen must be transported from the air to each of the millions of cells within our
body. Failure anywhere along this transport chain leads to hypoxia. The vital components of the transport process are the
lungs, heart, circulatory system (arteries and veins) and the red blood cells which travel within them. If any of the individual
components are affected by disease, hypoxia will ensue.
•Probably the commonest cause of hypoxia we see in hospitals is due to disease of the lungs. Smoking damages the lungs
over many years whereas an infection (pneumonia) can cause sudden deterioration. With defective lungs not enough
oxygen will be drawn into the body for the blood to circulate. Without treatment hypoxia may become progressively worse
causing debilitation and even death. Our first line of treatment for these individuals is to administer oxygen to them, usually
via a mask in hospital. By increasing the amount of oxygen available to the patient we hope to increase the amount which is
delivered to their tissues. Sometimes, however, this proves ineffective and more drastic measures must be taken. One such
measure is to breathe for the patient using a mechanical ventilator. In this way we are able to inflate and deflate the
patient's lungs with as much oxygen as we wish until such time that they recover from their underlying disease. Artificial
ventilation is a complicated process and can only be carried out by specially trained individuals on an intensive care unit.
•Heart disease can also lead to hypoxia and probably the most dramatic example of this is children born with heart defects.
In these children the heart, because of a structural defect, is unable to pump blood effectively around the body. There may
also be mixing of oxygenated blood from the lungs with deoxygenated blood from the body which compounds the problem.
Although oxygen may improve the situation temporarily, these children will eventually need surgery to correct the
abnormality.
•Many patients have long term disease which requires them to have oxygen at home. The need for a large cylinder of
oxygen in their home makes for a reasonably restricted lifestyle as they frequently cannot leave home with such a burden.
One of the Caudwell Xtreme Everest projects is looking into ways of delivering oxygen more efficiently to these patients
using a novel re-breathing circuit.
•So hypoxia can affect people in many ways. Extra oxygen may help ease the problem temporarily but more often than not
the underlying disease needs to be effectively treated before the hypoxia subsides.

9. High Alt Med Biol. 2008 Summer;9(2):123-9.
Genetophysiology: using genetic strategies to explore hypoxic adaptation.
Grocott M, Montgomery H.
The common inheritance of the ---1--- 20,000 to 25,000 genes defines us
as human.---2--- , substantial variation exists in the human genome, ---3---
determines how each of us will respond to any given (identical)
environmental stimulus. The interaction of this variation with diverse
environmental stimuli makes us all different ---4--- one another. Rapid
advances in the sequencing of the human genome and in the description
of the common variation ---5---it will help us identify genes and pathways
that regulate hypoxic (mal)adaptation. ---6---the contribution of any one
allelic variant to overall phenotypic variation may be small, this in no way
reduces the value of ---7---findings: the association of an allele with
variation in a phenotype of ---8--- magnitude confirms a role for that gene
and gene product, present in every human, relevant to physiological
regulation in us all. The resultant knowledge will be of relevance ---9--- to
mountaineers: many disease states are complicated by low cellular oxygen
availability, and a grasp of the mechanisms ---10--- which adaptation
occurs will offer new therapeutic targets

10. Insert the following words into the abstract
• from any through however
within not only such which
• same while

11. Design and conduct of Caudwell Xtreme Everest: an observational cohort
study of variation in human adaptation to progressive environmental
hypoxia
the Caudwell Xtreme Everest Research Group info@xtreme-everest.co.uk
• The aim of Caudwell Xtreme Everest (CXE) was to study, comprehensively and-
--1---, a large cohort of healthy humans exposed to progressive, sustained
environmental hypobaric hypoxia. The results will be used to ---2--- a
translational research agenda, with the aim of developing novel diagnostic and
therapeutic ----3--- or patients. ---4---hypotheses are as follows: (1)
Mechanisms ---5--- from those related to global oxygen transport will in part
explain inter-individual differences in adaptation (functional capacity, organ
specific adaptation, ---6--- of altitude illness) at high altitude, (2) genotype
differences will explain a substantial proportion of intra-individual variation in
environmentally induced phenotypes (gene-environment interactions).
Possible mechanisms ---7---hypothesis one include alterations in metabolic
efficiency and changes in microcirculatory function. Subsidiary aims include ---
8---the interaction between hypoxia and inflammation, identifying biomarkers
associated with beneficial and adverse hypoxic adaptation, and characterising
the physiological state of well-adapted individuals close to the limit of hypoxia
tolerance above 7500 metres. This paper describes the design and ---9--- of
the CXE study. We report the ---10--- of hypoxic exposure, characteristics of
the subject groups, and reasons for subject drop-outs. We also discuss the
strengths and limitations of the proposed model.

12. Insert the following words into the abstract
• core conduct prospectively
absence interventions underlying
drive distinct exploring pattern

13. For more about the ACE gene watch this BBC documentary with
English subtitles:
http://www.cornel1801.com/bbc/HOW-TO-BUILD-A-HUMAN/Predictor-movie-film.html
Watch BBC How To Build A Human Predictor movie - This remarkable journey to a world of
prediction starts in the human cell
http://downloads.bbc.co.uk/podcasts/radio4/tls/tls_20121009-0955a.mp3
The Life Scientific Duration: 28 mins
Jim Al-Khalili interviews Professor Hugh Montgomery about the gene for fitness and how
mountaineers have influenced intensive care medicine.

14. SOLUTIONS
Oxygen makes up 21% of the air and this fraction doesn't change wherever you are in the
atmosphere.
What does change is density and pressure, which drops as you rise.
If you aren't breathing enough oxygen, you run the risk of pulmonary oedema
If allowed to progress to its conclusion, the victim will literally drown.
To counter the lack of oxygen in the air, climbers breathe more deeply and rapidly.
This increases the ratio of oxygen to carbon dioxide in the lungs, ensuring an increase in the
number of red blood cells to capture that oxygen.
But it also thickens the blood making it harder to pump, and stickier - more likely to clot -
increasing the risk of thrombosis and stroke.

15. 1 All patients in intensive care units suffer
from low oxygen levels False
2 It is thought that some people process
oxygen better than others True
3 The Xtreme Everest study has discovered
how to improve survival rates in patients in
ICUs False
4 Different cells store oxygen better than
others False
5 Hypoxia takes place specifically at cellular
level False
6 Climbers, like sick patients, often need extra
oxygen True
7 Those who die when swimming suffer from
hypoxia True
8 The hypoxia encountered in hospitals is
usually very rapid False
9 Giving oxygen via a mask does not always
resolve the problem of hypoxia True
10 The problem of heart disease is that
oxygenated and deoxygenated blood is mixed
in the lungs False

16. It is always important to consider the
meaning in the specific context
manage - cope healthy -fit adjust – adapt
are situated - lie depend on – rely on
is broken down - dissolves detaches - separates
transportation - flow slow speed – gentle pace
taken into – drawn into steps - measures
aggravates - compounds
complication - burden

17. High Alt Med Biol. 2008 Summer;9(2):123-9.
Genetophysiology: using genetic strategies to explore hypoxic adaptation.
Grocott M, Montgomery H.
The common inheritance of the same 20,000 to 25,000 genes defines us as
human.However , substantial variation exists in the human genome, which determines
how each of us will respond to any given (identical) environmental stimulus. The
interaction of this variation with diverse environmental stimuli makes us all different
from one another. Rapid advances in the sequencing of the human genome and in the
description of the common variation within it will help us identify genes and pathways
that regulate hypoxic (mal)adaptation. While the contribution of any one allelic variant
to overall phenotypic variation may be small, this in no way reduces the value of such
findings: the association of an allele with variation in a phenotype of any magnitude
confirms a role for that gene and gene product, present in every human, relevant to
physiological regulation in us all. The resultant knowledge will be of relevance not only
to mountaineers: many disease states are complicated by low cellular oxygen
availability, and a grasp of the mechanisms through which adaptation occurs will offer
new therapeutic targets

18. Design and conduct of Caudwell Xtreme Everest: an observational cohort study of
variation in human adaptation to progressive environmental hypoxia
the Caudwell Xtreme Everest Research Group info@xtreme-everest.co.uk
The aim of Caudwell Xtreme Everest (CXE) [14] was to study, comprehensively and
prospectively, a large cohort of healthy humans exposed to progressive, sustained
environmental hypobaric hypoxia. The results will be used to drive a translational
research agenda, with the aim of developing novel diagnostic and therapeutic
interventions for patients. Core hypotheses are as follows: (1) Mechanisms distinct from
those related to global oxygen transport will in part explain inter-individual differences in
adaptation (functional capacity, organ specific adaptation, absence of altitude illness) at
high altitude, (2) genotype differences will explain a substantial proportion of intra-
individual variation in environmentally induced phenotypes (gene-environment
interactions). Possible mechanisms underlying hypothesis one include alterations in
metabolic efficiency and changes in microcirculatory function. Subsidiary aims include
exploring the interaction between hypoxia and inflammation, identifying biomarkers
associated with beneficial and adverse hypoxic adaptation, and characterising the
physiological state of well-adapted individuals close to the limit of hypoxia tolerance
above 7500 metres. This paper describes the design and conduct of the CXE study. We
report the pattern of hypoxic exposure, characteristics of the subject groups, and reasons
for subject drop-outs. We also discuss the strengths and limitations of the proposed
model.