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Chen VY, Siegfried LG, Tomic-Canic M, Stone RC, Pastar I. Cutaneous changes in diabetic patients: Primed for aberrant healing? Wound Repair Regen 2023; 31:700-712. [PMID: 37365017 PMCID: PMC10966665 DOI: 10.1111/wrr.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 06/28/2023]
Abstract
Cutaneous manifestations affect most patients with diabetes mellitus, clinically presenting with numerous dermatologic diseases from xerosis to diabetic foot ulcers (DFUs). Skin conditions not only impose a significantly impaired quality of life on individuals with diabetes but also predispose patients to further complications. Knowledge of cutaneous biology and the wound healing process under diabetic conditions is largely limited to animal models, and studies focusing on biology of the human condition of DFUs remain limited. In this review, we discuss the critical molecular, cellular, and structural changes to the skin in the hyperglycaemic and insulin-resistant environment of diabetes with a focus specifically on human-derived data. Elucidating the breadth of the cutaneous manifestations coupled with effective diabetes management is important for improving patient quality of life and averting future complications including wound healing disorders.
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Affiliation(s)
- Vivien Y Chen
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lindsey G Siegfried
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rivka C Stone
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Perrault D, Cobert J, Gadiraju V, Sharma A, Gurtner G, Pham T, Sheckter C. Foot Burns in Persons with Diabetes—Outcomes from the National Trauma Data Bank. J Burn Care Res 2022; 43:541-547. [DOI: 10.1093/jbcr/irac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Diabetes Mellitus (DM) complicates the treatment of burn injuries. Foot burns in diabetic patients are challenging problems with unfavorable outcomes. National-scale evaluations are needed, especially with regard to limb salvage. We aim to characterize lower extremity burns in persons with DM and evaluate the likelihood of amputation. The National Trauma Data Bank (NTDB) was queried from 2007-2015 extracting encounters with primary burn injuries of the feet using International Classification of Diseases (ICD) 9 th Edition codes. Logistic regression modeled predictors of lower extremity amputation. Covariables included age, sex, race/ethnicity, comorbidities including DM, % burn total body surface area (TBSA), mechanism, and region of burn center. Poisson regression evaluated temporal incidence rate changes in DM foot burns. Of 116,796 adult burn encounters, 7,963 (7%) had foot burns. Of this group, 1,308 (16%) had DM. 5.6% of encounters with DM foot burns underwent amputation compared to 1.5% of non-DM encounters (p<0.001). Independent predictors of lower extremity amputation included DM (OR 3.70, 95% CI 2.98 – 4.59), alcohol use, smoking, chronic kidney disease, burn size >20%, African American/Black race, male sex, and age>40 years (all p<0.01). The incidence of DM foot burns increased over the study period with an incidence rate ratio (IRR) of 1.07 (95% CI 1.05 – 1.10, p<0.001). In conclusion, DM was associated with nearly a 4-fold increase in amputation after adjusting for covariables. Furthermore, the incidence of DM foot burns is increasing. Strategies for optimizing care in persons with DM foot burns are need to improve limb salvage.
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Affiliation(s)
| | | | | | | | | | - Tam Pham
- Department of Surgery. University of Washington
- Harborview Injury Prevention and Research Center (HIPRC). University of Washington
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3
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The influence of sock composition on the appearance of foot blisters in hikers. J Tissue Viability 2022; 31:315-318. [DOI: 10.1016/j.jtv.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/10/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
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Impact of Heat Stress on Meat Quality and Antioxidant Markers in Iberian Pigs. Antioxidants (Basel) 2021; 10:antiox10121911. [PMID: 34943014 PMCID: PMC8750345 DOI: 10.3390/antiox10121911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Heat stress is associated with impaired meat quality and disruption of redox balance. This study investigated the effect of chronic exposure to high temperature on meat quality and antioxidant markers of muscles (longissimus lumborum and gluteus medius) of growing Iberian pigs. Twenty-four pure Iberian pigs were allocated during 28 days to one of three treatments (n = 8/treatment): thermoneutral conditions (20 °C) and ad libitum feeding (TN), heat stress conditions (30 °C) and ad libitum feeding (HS) and thermoneutral and pair-fed with HS (TN-pf). Muscles of the HS group had greater intramuscular fat content than the TN-pf group and higher Zn levels than TN and TN-pf, whereas differences on fatty acid composition were negligible. Heat exposure did not affect pH, color coordinates of redness (a*) and yellowness (b*) and MDA values but had a positive influence on lightness and drip losses. Moreover, chronic heat stress stimulated the activity of antioxidant defenses SOD, CAT and GPx. The statistical factor analysis adequately classified the muscles studied, but was unable to differentiate samples according with treatments. Findings of the present study support an adaptive response of the Iberian pig to high temperatures and show the high Iberian meat quality even under adverse climate situations.
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Torreblanca González J, Gómez-Martín B, Hernández Encinas A, Martín-Vaquero J, Queiruga-Dios A, Martínez-Nova A. The Use of Infrared Thermography to Develop and Assess a Wearable Sock and Monitor Foot Temperature in Diabetic Subjects. SENSORS (BASEL, SWITZERLAND) 2021; 21:1821. [PMID: 33807804 PMCID: PMC7961733 DOI: 10.3390/s21051821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
One important health problem that could affect diabetics is diabetic foot syndrome, as risk of ulceration, neuropathy, ischemia and infection. Unnoticed minor injuries, subsequent infection and ulceration may end in a foot amputation. Preliminary studies have shown a relationship between increased skin temperature and asymmetries between the same regions of both feet. In the preulceration phase, to develop a smart device able to control the temperature of these types of patients to avoid this risk might be very useful. A statistical analysis has been carried out with a sample of foot temperature data obtained from 93 individuals, of whom 44 are diabetics and 49 nondiabetics and among them 43% are men and 57% are women. Data obtained with a thermographic camera has been successful in providing a set of regions of interest, where the temperature could influence the individual, and the behavior of several variables that could affect these subjects provides a mathematical model. Finally, an in-depth analysis of existing sensors situated in those positions, namely, heel, medial midfoot, first metatarsal head, fifth metatarsal head, and first toe has allowed for the development of a smart sock to store temperatures obtained every few minutes in a mobile device.
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Affiliation(s)
- José Torreblanca González
- School of Industrial Engineering, University of Salamanca, E37700 Salamanca, Spain; (J.T.G.); (A.Q.-D.)
| | - Beatriz Gómez-Martín
- Department of Nursing, Centro Universitario de Plasencia, University of Extremadura, E10600 Plasencia, Spain; (B.G.-M.); (A.M.-N.)
| | | | - Jesús Martín-Vaquero
- School of Industrial Engineering, University of Salamanca, E37700 Salamanca, Spain; (J.T.G.); (A.Q.-D.)
| | - Araceli Queiruga-Dios
- School of Industrial Engineering, University of Salamanca, E37700 Salamanca, Spain; (J.T.G.); (A.Q.-D.)
| | - Alfonso Martínez-Nova
- Department of Nursing, Centro Universitario de Plasencia, University of Extremadura, E10600 Plasencia, Spain; (B.G.-M.); (A.M.-N.)
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Jorge J, Harford M, Villarroel M, Chaichulee S, Davidson S, Finnegan E, Clark SH, Young JD, Watkinson PJ, Tarassenko L. Non-Contact Assessment of Peripheral Artery Haemodynamics Using Infrared Video Thermography. IEEE Trans Biomed Eng 2020; 68:276-288. [PMID: 32746016 DOI: 10.1109/tbme.2020.2999539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Skin temperature has long been used as a natural indicator of vascular diseases in the extremities. Considerable correlation between oscillations in skin surface temperature and oscillations of skin blood flow has previously been demonstrated. We hypothesised that the impairment of blood flow in stenotic (subcutaneous) peripheral arteries would influence cutaneous temperature such that, by measuring gradients in the temperature distribution over skin surfaces, one may be able to diagnose or quantify the progression of vascular conditions in whose pathogenesis a reduction in subcutaneous blood perfusion plays a critical role (e.g. peripheral artery disease). As proof of principle, this study investigates the local changes in the skin temperature of healthy humans (15 male, [Formula: see text] years old, BMI [Formula: see text] kg/m 2) undergoing two physical challenges designed to vary their haemodynamic status. Skin temperature was measured in four central regions (forehead, neck, chest, and left shoulder) and four peripheral regions (left upper arm, forearm, wrist, and hand) using an infrared thermal camera. We compare inter-region patterns. Median temperature over the peripheral regions decreased from baseline after both challenges (maximum decrease: [Formula: see text] °C at 60 s after exercise; [Formula: see text] and [Formula: see text] °C at 180 s of cold-water immersion; [Formula: see text]). Median temperature over the central regions showed no significant changes. Our results show that the non-contact measurement of perfusion-related changes in peripheral temperature from infrared video data is feasible. Further research will be directed towards the thermographic study of patients with symptomatic peripheral vascular disease.
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Abdelbasset WK, Abdelhalim NM. Assessing the effects of 6 weeks of intermittent aerobic exercise on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study. Burns 2020; 46:1193-1200. [DOI: 10.1016/j.burns.2019.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/27/2019] [Accepted: 12/22/2019] [Indexed: 12/30/2022]
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Neves EB, Martinez EC, Meneck FD, Reis VM. Superficial thermal response to CrossFit® workout. MOTRIZ: REVISTA DE EDUCACAO FISICA 2020. [DOI: 10.1590/s1980-65742020000400157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Eduardo Borba Neves
- Exército Brasileiro, Brazil; Universidade Tecnológica Federal do Paraná (UTFPR), Brazil
| | | | | | - Victor Machado Reis
- Universidade de Trás-os-Montes e Alto Douro, Portugal; Centro de Investigação em Ciências do Desporto, Portugal
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Microclimate: A critical review in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2018; 59:62-70. [PMID: 30199821 DOI: 10.1016/j.clinbiomech.2018.09.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
Pressure ulcers are caused by sustained mechanical loading and deformation of the skin and subcutaneous layers between internal stiff anatomical structures and external surfaces or devices. In addition, the skin microclimate (temperature, humidity and airflow next to the skin surface) is an indirect pressure ulcer risk factor. Temperature and humidity affect the structure and function of the skin increasing or lowering possible damage thresholds for the skin and underlying soft tissues. From a pressure ulcer prevention research perspective, the effects of humidity and temperature next to the skin surface are inextricably linked to concurrent soft tissue deformation. Direct clinical evidence supporting the association between microclimate and pressure ulceration is sparse and of high risk of bias. Currently, it is recommended to keep the skin dry and cool and/or to allow recovery periods between phases of occlusion. The stratum corneum must be prevented from becoming overhydrated or from drying out but exact ranges of an acceptable microclimate are unknown. Therefore, vague terms like 'microclimate management' should be avoided but product and microclimate characteristics should be explicitly stated to allow an informed decision making. Pressure ulcer prevention interventions like repositioning, the use of special support surfaces, cushions, and prophylactic dressings are effective only if they reduce sustained deformations in soft tissues. This mode of action outweighs possible undesirable microclimate properties. As long as uncertainty exists efforts must be taken to use as less occlusive materials as possible. There seems to be individual intrinsic characteristics making patients more vulnerable to microclimate effects.
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Petrofsky JS, Laymon M, Alshammari F, Khowailed IA, Lee H. Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2018; 30:889-896. [PMID: 28282796 DOI: 10.3233/bmr-160577] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.
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Affiliation(s)
| | - Michael Laymon
- School of Physical Therapy, Touro University, Henderson, NV, USA
| | - Faris Alshammari
- Department of Physical Therapy, Hashemite University, Zarqa, Jordan
| | | | - Haneul Lee
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Korea
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11
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Ludwig N, Trecroci A, Gargano M, Formenti D, Bosio A, Rampinini E, Alberti G. Thermography for skin temperature evaluation during dynamic exercise: a case study on an incremental maximal test in elite male cyclists. APPLIED OPTICS 2016; 55:D126-D130. [PMID: 27958445 DOI: 10.1364/ao.55.00d126] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of thermal imaging in monitoring the dynamic of skin temperature during prolonged physical exercise is central to assess athletes' ability to dissipate heat from the skin surface to the environment. In this study, seven elite cyclists completed an incremental maximal cycling test to evaluate their skin temperature response under controlled-environment conditions. Thermal images have been analyzed using a method based on maxima detection (Tmax). Data confirmed a reduction in skin temperature due to vasoconstriction during the exercise, followed by a temperature increment after exhaustion. A characteristic hot-spotted thermal pattern was found over the skin surface in all subjects. This research confirmed also the notable ability by highly trained cyclists to modify skin temperature during an incremental muscular effort. This study gives additional contributions for understanding the capability of the Tmax method applied to the thermoregulatory physiological processes.
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12
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Furlan RMMM, Giovanardi RS, Britto ATBDOE, Britto DBDOE. The use of superficial heat for treatment of temporomandibular disorders: an integrative review. Codas 2015; 27:207-12. [DOI: 10.1590/2317-1782/20152014148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/12/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose: To perform an integrative review of scientific bibliographic production on the use of superficial heat treatment for temporomandibular disorders. Research strategy : Literature review was accomplished on PubMed, LiLACS, SciELO, Bireme, Web of Science, and BBO databases. The following descriptors were used: hot temperature, hyperthermia induced, heat transference, temporomandibular joint, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, and their equivalents in Portuguese and Spanish. Selection criteria : Articles that addressed the superficial heat for the treatment of temporomandibular disorders, published in English, Spanish, or Portuguese, between 1980 and 2013. Data analysis : The following data were collected: technique of applying superficial heat, duration of application, stimulated body area, temperature of the stimulus, frequency of application, and benefits. Results : initially, 211 studies were found, but just 13 contemplated the proposed selection criteria. Data were tabulated and presented in chronological order. Conclusion: Several techniques for superficial heat application on treatment of temporomandibular disorders were found in the literature. The moist heat was the most widely used technique. Many studies suggested the application of heat for at least 20 minutes once a day. Most authors recommended the application of heat in facial and cervical regions. The heat treatment resulted in significant relief of pain, reduced muscle tension, improved function of the mandible, and increased mouth opening.
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13
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Chen TH, Chen WP, Wang MJJ. The effect of air permeability and water vapor permeability of cleanroom clothing on physiological responses and wear comfort. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2014; 11:366-376. [PMID: 24380506 DOI: 10.1080/15459624.2013.875181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The function of cleanroom clothing is to protect the product from contamination by people, and to dissipate electrostatic discharge. People in the cleanroom work environment often complain about the discomforts associated with the wearing of cleanroom clothing. The purpose of this study is to investigate the effect of air permeability and water vapor permeability of cleanroom clothing on the subject's physiological and subjective responses. Five male and five female subjects participated in this study. The experimental goal was to simulate the operator's regular tasks in a semiconductor manufacturing cleanroom. Each subject completed three treatment combinations with three different cleanroom clothing types. A three-factor experiment was designed (significance level p = 0.05). The independent variables included gender, cleanroom clothing, and duration. The dependent measures included heart rate, core temperature, skin temperature, micro-climate relative humidity, micro-climate temperature, and subjective responses. A total of 40 min was involved for each treatment condition. The results indicate that skin temperature, micro-climate temperature and micro-climate relative humidity were lower while wearing cleanroom clothing with high air permeability and high water vapor permeability. The significant gender difference was found in skin temperature. As the task time increased, the micro-climate temperature also increased but the micro-climate relative humidity decreased at first and then increased. In addition, the physiological responses showed significant positive correlations with the subjective perception of clothing comfort. The findings of this study may provide useful information for cleanroom clothing design and selection.
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Affiliation(s)
- Te-Hung Chen
- a Department of Industrial Engineering and Engineering Management , National Tsing Hua University , Taiwan , Republic of China
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Petrofsky J, Berk L, Bains G, Khowailed IA, Hui T, Granado M, Laymon M, Lee H. Moist heat or dry heat for delayed onset muscle soreness. J Clin Med Res 2013; 5:416-25. [PMID: 24171053 PMCID: PMC3808259 DOI: 10.4021/jocmr1521w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 02/04/2023] Open
Abstract
Background Heat is commonly used in physical therapy following exercise induced delayed onset muscle soreness (DOMS). Most heat modalities used in a clinical setting for DOMS are only applied for 5 to 20 minutes. This minimal heat exposure causes little, if any, change in deep tissue temperature. For this reason, long duration dry chemical heat packs are used at home to slowly and safely warm tissue and reduce potential heat damage while reducing pain associated from DOMS. Clinically, it has been shown that moist heat penetrates deep tissue faster than dry heat. Therefore, in home use chemical moist heat may be more efficacious than dry heat to provide pain relief and reduce tissue damage following exercise DOMS. However, chemical moist heat only lasts for 2 hours compared to the 8 hours duration of chemical dry heat packs. The purpose of this study was to compare the beneficial effect of dry heat versus moist heat on 100 young subjects after exercise induce DOMS. Methods One hundred subjects exercised for 15 minutes accomplishing squats. Before and for 3 days after, strength, muscle soreness, tissue resistance, and the force to passively move the knee were recorded. Heat and moist heat were applied in different groups either immediately after exercise or 24 hours later. Results The research results of this study showed that immediate application of heat, either dry (8 hours application) or moist (2 hours application), had a similar preservation of quadriceps muscle strength and muscle activity. Results also revealed that the greatest pain reduction was shown after immediate application of moist heat. Never the less, immediate application of dry heat had a similar effect but to a lesser extent. Conclusion It should be noted that moist heat had not only similar benefits of dry heat but in some cases enhanced benefits, and with only 25% of the time of application of the dry heat.
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Affiliation(s)
- Jerrold Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, California, USA
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15
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Liu Y, Wang L, Liu J, Di Y. A study of human skin and surface temperatures in stable and unstable thermal environments. J Therm Biol 2013. [DOI: 10.1016/j.jtherbio.2013.06.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Liu Y, Wang L, Di Y, Liu J, Zhou H. The effects of clothing thermal resistance and operative temperature on human skin temperature. J Therm Biol 2013. [DOI: 10.1016/j.jtherbio.2013.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Liu Y, Wang L, Liu J, Di Y. Human behavior in different TDRAs. Physiol Behav 2013; 119:25-9. [DOI: 10.1016/j.physbeh.2013.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
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Yim J, Petrofsky J, Berk L, Daher N, Lohman E. Differences in endothelial function between Korean-Asians and Caucasians. Med Sci Monit 2012; 18:CR337-43. [PMID: 22648248 PMCID: PMC3560726 DOI: 10.12659/msm.882902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The vascular endothelium plays an integral role in maintaining vascular homeostasis, including the regulation of blood flow, vascular tone, and platelet aggregation. The aim of this study was to see if there were any differences in endothelial function between Koreans and Caucasians. Material/Methods This was accomplished by 2 measures of endothelial function – the response to local heat and the response to vascular occlusion. Ten Caucasian and 10 Korean male and female subjects participated (<35 years old). Endothelial function was assessed by the skin blood flow response to local heat using a thermode for 6 minutes at 3 temperatures (38°C, 40°C and 42°C) and by vascular occlusion for 4 minutes followed by release and measurement of skin blood flow for 2 minutes. Results When applying 6 minutes of local heat at 3 different temperatures (38°C, 40°C, and 42°C), the skin blood flows were significantly higher for all temperatures in Caucasians as compared with Koreans, with peak blood flow of 223±48.1, 413.7±132.1, and 517.4±135.8 flux in Caucasians and 126.4±41.3, 251±77.9, and 398±97.2 flux in Koreans, respectively (p=0.001). Results of this study support the idea that the skin blood flow response to occlusion was significantly higher in Caucasians (peak 411.9±88.9 flux) than Koreans (peak 332.4±75.8 flux) (p=0.016). Conclusions These findings suggest that Koreans may have lower endothelial function than Caucasians, which may be explained, in part, by genetic variations between the 2 ethnic groups.
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Affiliation(s)
- Jongeun Yim
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA 92350, USA
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Anburajan M, Sivanandam S, Bidyarasmi S, Venkatraman B, Menaka M, Raj B. Changes of skin temperature of parts of the body and serum asymmetric dimethylarginine (ADMA) in type-2 diabetes mellitus Indian patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:6254-9. [PMID: 22255768 DOI: 10.1109/iembs.2011.6091544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In India, number of people with type 2 Diabetes Mellitus (DM) would be 87 million by the year 2030. DM disturbs autonomic regulation of skin micro-circulation, and causes decrease in resting blood flows through the skin. The skin blood flow has a major effect on its temperature. The aim of the study was to evaluate changes of skin temperature of all parts of the body and serum asymmetric dimethylarginine, ADMA (μmol/L) in type-2 DM Indian patients. Group-I: Normal (n = 17; M/F: 10/15, mean ± SD = 43.2 ± 9.4 years); Group-II: Type-2 DM without cardiovascular (CV) complications (n = 15; M/F: 10/7, mean ± SD = 46.3 ± 14.0 years); Thermograms of all parts of the body were acquired using a non-contact infrared (IR) thermography camera (ThermaCAM T400, FLIR Systems, Sweden). Blood parameters and thyroid hormone were measured biochemically. Indian diabetic risk score (IDRS) was calculated for each subject. In type-2 DM patients without CV group (n = 15), there was a statistically significant (p = 0.01) negative correlations between HbA(1c) and skin temperature of eye and nose (r = -0.57 and r = -0.55 respectively). ADMA was correlated significantly (p = 0.01) with HbA(1c) (r = 0.65) and estimated average glucose, eAG (r = 0.63). In normal subjects, mean minimum and maximum values of skin temperatures were observed at posterior side of sole (26.89 °C) and ear (36.85 °C) respectively. In type-2 DM without CV, mean values of skin temperature in different parts of the body from head to toe were lesser than those values in control group; but this decreases were statistically significant in nose (32.66 Vs 33.99 °C, p = 0.024) as well as in tibia (32.78 Vs 33.13 °C, p = 0.036) regions.
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Affiliation(s)
- M Anburajan
- Department of Biomedical Engineering, SRM University, Kattankulathur 603203, Chennai, Tamil Nadu, India.
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Petrofsky JS, Berk L, Alshammari F, Lee H, Hamdan A, Yim JE, Kodawala Y, Patel D, Nevgi B, Shetye G, Moniz H, Chen WT, Alshaharani M, Pathak K, Neupane S, Somanaboina K, Shenoy S, Cho S, Dave B, Desai R, Malthane S, Al-Nakhli H. The interrelationship between air temperature and humidity as applied locally to the skin: the resultant response on skin temperature and blood flow with age differences. Med Sci Monit 2012; 18:CR201-8. [PMID: 22460091 PMCID: PMC3560817 DOI: 10.12659/msm.882619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Most studies of the skin and how it responds to local heat have been conducted with either water, thermodes, or dry heat packs. Very little has been accomplished to look at the interaction between air humidity and temperature on skin temperature and blood flow. With variable air temperatures and humidity's around the world, this, in many ways, is a more realistic assessment of environmental impact than previous water bath studies. MATERIAL/METHODS Eight young and 8 older subjects were examined in an extensive series of experiments where on different days, air temperature was 38, 40, or 42°C. and at each temperature, humidity was either 0%, 25%, 50%, 75%, or 100% humidity. Over a 20 minute period of exposure, the response of the skin in terms of its temperature and blood flow was assessed. RESULTS For both younger and older subjects, for air temperatures of 38 and 40°C., the humidity of the air had no effect on the blood flow response of the skin, while skin temperature at the highest humidity was elevated slightly. However, for air temperatures of 42°C., at 100% humidity, there was a significant elevation in skin blood flow and skin temperature above the other four air humidity's (p<0.05). In older subjects, the blood flow response was less and the skin temperature was much higher than younger individuals for air at 42°C. and 100% humidity (p<0.05). CONCLUSIONS Thus, in older subjects, warm humid air caused a greater rise in skin temperature with less protective effect of blood flow to protect the skin from overheating than is found in younger subjects.
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Affiliation(s)
- Jerrold S Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, CA 92350, USA.
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The influence of autonomic dysfunction associated with aging and type 2 diabetes on daily life activities. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:657103. [PMID: 22566994 PMCID: PMC3332074 DOI: 10.1155/2012/657103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/28/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
Type 2 diabetes (T2D) and ageing have well documented effects on every organ in the body. In T2D the autonomic nervous system is impaired due to damage to neurons, sensory receptors, synapses and the blood vessels. This paper will concentrate on how autonomic impairment alters normal daily activities. Impairments include the response of the blood vessels to heat, sweating, heat transfer, whole body heating, orthostatic intolerance, balance, and gait. Because diabetes is more prevalent in older individuals, the effects of ageing will be examined. Beginning with endothelial dysfunction, blood vessels have impairment in their ability to vasodilate. With this and synaptic damage, the autonomic nervous system cannot compensate for effectors such as pressure on and heating of the skin. This and reduced ability of the heart to respond to stress, reduces autonomic orthostatic compensation. Diminished sweating causes the skin and core temperature to be high during whole body heating. Impaired orthostatic tolerance, impaired vision and vestibular sensing, causes poor balance and impaired gait. Overall, people with T2D must be made aware and counseled relative to the potential consequence of these impairments.
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Petrofsky J, Berk L, Alshammari F, Lee H, Hamdan A, Yim JE, Patel D, Kodawala Y, Shetye G, Chen WT, Moniz H, Pathak K, Somanaboina K, Desai R, Dave B, Malthane S, Alshaharani M, Neupane S, Shenoy S, Nevgi B, Cho S, Al-Nakhli H. The effect of moist air on skin blood flow and temperature in subjects with and without diabetes. Diabetes Technol Ther 2012; 14:105-16. [PMID: 22017463 DOI: 10.1089/dia.2011.0128] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Endothelial function is known to be impaired in response to heat in people with diabetes, but little has been done to see how air humidity alters the skin blood flow response to heat. METHODS Seventeen male and female subjects were divided in two groups, one with type 2 diabetes and the other the control subjects without diabetes, age-matched to the diabetes group. All subjects participated in a series of experiments to determine the effect of the warming of the skin by air on skin temperature and skin blood flow. On different days, skin temperature was warmed with air that was 38°C, 40°C, or 42°C for 20 min. Also, on different days, at each temperature, the air humidity was adjusted to 0%, 25%, 50%, 75%, or 100% humidity. Skin blood flow and temperature were measured throughout the exposure period. This allowed the interactions between air humidity and temperature to be assessed. RESULTS For the control subjects, the moisture in the air had no different effect on skin blood flow at air temperatures of 38°C and 40°C (analysis of variance, P>0.05), although skin blood flow progressively increased at each air temperature that was applied. But for the warmest air temperature, 42°C, although the four lower humidities had the same effect on skin blood flow, air at 100% humidity caused the largest increase in skin blood flow. In contrast, in the subjects with diabetes, blood flow was always significantly less at any air temperature applied to the skin than was observed in the control subjects (P<0.05), and skin blood flow was significantly higher for the two higher humidities for the two higher air temperatures. Skin temperature paralleled these findings. CONCLUSION These data show that individuals with diabetes do not tolerate moist, warm air above 50% humidity as well as controls without diabetes.
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Affiliation(s)
- Jerrold Petrofsky
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California 92350, USA.
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Petrofsky JS. The effect of type-2-diabetes-related vascular endothelial dysfunction on skin physiology and activities of daily living. J Diabetes Sci Technol 2011; 5:657-67. [PMID: 21722580 PMCID: PMC3192631 DOI: 10.1177/193229681100500319] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A common factor contributing to organ damage in type 2 diabetes mellitus (T2DM) is impaired tissue blood flow caused by damage to vascular endothelial cells (VECs). Damage can occur even before the clinical diagnosis of diabetes. It can be caused by both a high average blood glucose concentration and/or large daily spikes in blood glucose. While much of the present literature focuses on the damage to VECs and organs from these large glucose excursions, this review will focus on the consequence of this damage, that is, how endothelial cell damage in diabetes affects normal daily activities (e.g., exercise, reaction to typical stimuli) and various treatment modalities (e.g.. contrast baths and electrical stimulation therapy). It is important to understand the effects of VEC damage such as poor skin blood flow, compromised thermoregulation, and altered response to skin pressure in designing diabetes technologies as simple as heating pads and as complex as continuous glucose monitors. At the simplest level, people with diabetes have poor circulation to the skin and other organs. In the skin, even the blood flow response to locally applied pressure, such as during standing, is different than for people who do not have T2DM. Simple weight bearing on the foot can occlude the skin circulation. This makes the skin more susceptible to damage. In addition, endothelial damage has far-reaching effects on the whole body during normal activities of daily living, including an impaired response to local heat, such as hot packs and contrast baths, and higher body temperatures during whole body heating due to impaired blood flow and a reduced ability to sweat. Finally, because of multiple organ damage, people with T2DM have poor balance and gait and impaired exercise performance.
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Affiliation(s)
- Jerrold Scott Petrofsky
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California, USA.
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Petrofsky J, Paluso D, Anderson D, Swan K, Alshammari F, Katrak V, Murugesan V, Hudlikar AN, Chindam T, Trivedi M, Lee H, Goraksh N, Yim JE. The ability of different areas of the skin to absorb heat from a locally applied heat source: the impact of diabetes. Diabetes Technol Ther 2011; 13:365-72. [PMID: 21291332 DOI: 10.1089/dia.2010.0161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND When heat is applied to the skin, heat is conducted away because of the latent heat transfer properties of the skin and an increase in skin circulation, but little attention has been paid to the heat transfer properties of skin in different areas of the body and in people with diabetes. research design: Thirty subjects in the age range of 20-75 years had a thermode (44°C) applied to the skin of their arm, leg, foot, and back for 6 min to assess the heat transfer characteristics of skin in these four areas of the body. Skin blood flow and skin temperature were monitored over the 6-min period. RESULTS For the younger subjects, blood flow was not statistically different in response to heat in three areas of the body, starting at less than 200 flux measured by a laser Doppler imager and ending at approximately 1,200 flux after heat exposure. The foot had higher resting blood flow and higher blood flow in response to heat. Temperature and the rate of rise of temperature were also not different in any of the areas. The heat added to raise temperature, however, varied by body region. The arm required the least, whereas the leg and foot required the most. For the older group and subjects with diabetes, the heat required for any region of the body was much less to achieve the same increase in skin temperature, and blood flows were also much less; the subjects with diabetes showed the least blood flow and required the fewest calories to heat the skin. Whereas the foot required the greatest number of calories to heat the tissue in younger and older subjects, in subjects with diabetes, the foot took proportionally fewer calories. CONCLUSION Thus, specific areas of the body are damaged more by diabetes than other areas.
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Affiliation(s)
- Jerrold Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, California, USA.
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Petrofsky J, Lee H, Trivedi M, Hudlikar AN, Yang CH, Goraksh N, Alshammari F, Mohanan M, Soni J, Agilan B, Pai N, Chindam T, Murugesan V, Yim JE, Katrak V. The influence of aging and diabetes on heat transfer characteristics of the skin to a rapidly applied heat source. Diabetes Technol Ther 2010; 12:1003-10. [PMID: 21128847 DOI: 10.1089/dia.2010.0152] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Numerous studies have examined the blood flow of the skin at rest and in response to sustained heat and shown that, in older people and people with diabetes, the skin blood flow response to heat is diminished compared to younger people. It is not sustained heat, however, that usually causes burns; it is a more rapid application of heat. SUBJECTS AND METHODS Ten younger subjects, 10 older subjects, and 10 subjects with diabetes were examined before and after applying a water-filled thermode to the skin above the quadriceps muscle to observe the changes in skin temperature and skin blood flow and the ability of the skin to absorb heat after a 2-min heat exposure with water at 44°C. RESULTS Skin temperature rose from 31.2°C at rest to 38.3°C after 2 min of heat application in all subjects (P > 0.05 between groups). The calories required in the younger group of subjects was 2.26 times the calories required in the older group of subjects for the same change in skin temperature and 13.8 times the calories needed to increase skin temperature in the subjects with diabetes. Furthermore, the blood flow at rest was lower in people with diabetes than older subjects and both groups less than that seen in younger subjects. The blood flow response to heat was slower in the subjects with diabetes compared to the older subjects and much slower than that seen in the younger subjects. CONCLUSIONS Reduced skin blood flow of older and subjects with diabetes, decreased thickness of the dermal layer, and increased subcutaneous fat, as well as damage to transient receptor potential vanilloid 1 receptors, may account for some of the differences between the groups.
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Affiliation(s)
- Jerrold Petrofsky
- Department of Physical Therapy, Loma Linda University, Loma Linda, CA 92350, USA.
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McLellan K, Petrofsky JS, Zimmerman G, Lohman E, Prowse M, Schwab E, Lee S. The influence of environmental temperature on the response of the skin to local pressure: the impact of aging and diabetes. Diabetes Technol Ther 2009; 11:791-8. [PMID: 20001680 DOI: 10.1089/dia.2009.0097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To protect against ischemia, pressure-induced vasodilation (PIV) causes an increase in skin blood flow. Endothelial dysfunction, which is commonly found in older patients and those with diabetes, and global temperatures can affect the resting blood flow in skin, which may reduce the blood flow during and after the application of local pressure. The present study investigated the PIV of the skin with exposure to three global temperatures in younger and older populations and those with diabetes. MATERIALS AND METHODS Older subjects (n = 15, mean age 64.2 +/- 14.0 years), subjects with diabetes (n = 15, mean age 62 +/- 5.9 years, mean duration 13.2 +/- 9.1 years), or younger subjects (n = 15, mean age 25.7 +/- 2.9 years) participated. An infrared laser Dopler flow meter was used to measure skin blood flow on the bottom of the foot, lower back, and hand during and after applications of pressure at 7.5, 15, 30, 45, and 60 kPa at 16 degrees C, 24 degrees C, and 32 degrees C global temperatures. RESULTS The resting blood flow for all subjects was significantly lower in the 16 degrees C environment (P < 0.05). Blood flow in the group with diabetes was significantly lower at rest, during the application of all pressure, and after the release of pressure in all global temperatures (P < 0.05). The younger group showed a significant increase in blood flow after every pressure application, except 7.5 kPa, in all global conditions (P < 0.001). Older subjects and patients with diabetes did not have a significant reactive hyperemia, especially in the 16 degrees C environment. CONCLUSION The protective mechanism of PIV is severely reduced in older populations and those with diabetes, especially in colder environments where skin blood flow is already diminished.
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Affiliation(s)
- Katie McLellan
- Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California 92350, USA
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Petrofsky JS, Bains G, Raju C, Lohman E, Berk L, Prowse M, Gunda S, Madani P, Batt J. The effect of the moisture content of a local heat source on the blood flow response of the skin. Arch Dermatol Res 2009; 301:581-5. [PMID: 19415313 DOI: 10.1007/s00403-009-0957-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/03/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
Abstract
Numerous studies have examined the effect of local and global heating of the body on skin blood flow. However, the effect of the moisture content of the heat source on the skin blood flow response has not been examined. Thirty-three subjects, without diabetes or cardiovascular disease, between the ages of 22 and 32 were examined to determine the relationship between the effects of dry vs. moist heat applied for the same length of time and with the skin clamped at the same skin temperature on the blood flow response of the skin. The skin, heated with an infrared heat lamp (skin temperature monitored with a thermocouple) to 40 degrees C for 15 min, was either kept moist with wet towels or, in a separate experiment, kept dry with Drierite (a desiccant) between the towels to remove any moisture. Before and after heat exposure of the forearm, blood pressure, heart rate, skin moisture content, skin temperature, and skin blood flow were recorded. The results of the experiment showed that there was no change in skin moisture after 15 min exposure to dry heat at 40 degrees C. However, with moist heat, skin moisture increased by 43.7%, a significant increase (P < 0.05). With dry heat, blood flow increased from the resting value by 282.3% whereas with moist heat, blood flow increased by 386% over rest, a significant increase over dry heat (P < 0.05). Thus, with a set increase in skin temperature, moist heat was a better heating modality than dry heat. The reason may be linked to moisture sensitivity in calcium channels in the vascular endothelial cell.
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