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Lei W, Yiming S, Qiang P, Xin C, Peng G, Baofeng Z. Unleashing the Neurotherapeutic Potential: The Crucial Role of miR-206-3p in Facilitating Hsp90aa1-Mediated Central Nervous System Injuries During Heat Stroke. Mol Neurobiol 2024:10.1007/s12035-024-04342-x. [PMID: 38995443 DOI: 10.1007/s12035-024-04342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
This study aims to explore the molecular mechanisms of miR-206-3p in regulating Hsp90aa1 and its involvement in the central nervous system (CNS) injury in heat stroke. Weighted gene co-expression network analysis (WGCNA) was performed on the GSE64778 dataset of heat stroke to identify module genes most closely associated with disease characteristics. Through the selection of key genes and predicting upstream miRNAs using RNAInter and miRWalk databases, the regulatory relationship between miR-206-3p and Hsp90aa1 was determined. Through in vitro experiments, various methods, including bioinformatics analysis, dual-luciferase reporter gene assay, RIP experiment, and RNA pull-down experiment, were utilized to validate this regulatory relationship. Furthermore, functional experiments, including CCK-8 assay to test neuron cell viability and flow cytometry to assess neuron apoptosis levels, confirmed the role of miR-206-3p. Transmission electron microscopy, real-time quantitative PCR, DCFH-DA staining, and ATP assay were employed to verify neuronal mitochondrial damage. Heat stroke rat models were constructed, and mNSS scoring and cresyl violet staining were utilized to assess neural functional impairment. Biochemical experiments were conducted to evaluate inflammation, brain water content, and histopathological changes in brain tissue using H&E staining. TUNEL staining was applied to detect neuronal apoptosis in brain tissue. RT-qPCR and Western blot were performed to measure gene and protein expression levels, further validating the regulatory relationship in vivo. Bioinformatics analysis indicated that miR-206-3p regulation of Hsp90aa1 may be involved in CNS injury in heat stroke. In vivo, animal experiments demonstrated that miR-206-3p and Hsp90aa1 co-localized in neurons of the rat hippocampal CA3 region, and with prolonged heat stress, the expression of miR-206-3p gradually increased while the expression of Hsp90aa1 gradually decreased. Further in vitro cellular mechanism validation and functional experiments confirmed that miR-206-3p could inhibit neuronal cell viability and promote apoptosis and mitochondrial damage by targeting Hsp90aa1. In vivo, experiments confirmed that miR-206-3p promotes CNS injury in heat stroke. This study revealed the regulatory relationship between miR-206-3p and Hsp90aa1, suggesting that miR-206-3p could regulate the expression of Hsp90aa1, inhibit neuronal cell viability, and promote apoptosis, thereby contributing to CNS injury in heat stroke.
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Affiliation(s)
- Wang Lei
- Department of Emergency Medicine, Nantong First People's Hospital, Nantong, 226001, Jiangsu, China
| | - Shen Yiming
- Department of Emergency Medicine, Nantong First People's Hospital, Nantong, 226001, Jiangsu, China
| | - Peng Qiang
- Department of Emergency Medicine, Nantong First People's Hospital, Nantong, 226001, Jiangsu, China
| | - Chu Xin
- Department of Emergency Medicine, Nantong First People's Hospital, Nantong, 226001, Jiangsu, China
| | - Gu Peng
- Department of Emergency Medicine, Nantong First People's Hospital, Nantong, 226001, Jiangsu, China
| | - Zhu Baofeng
- Department of Emergency Medicine, Nantong First People's Hospital, Nantong, 226001, Jiangsu, China.
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Watanabe H, Kadokura Y, Sugi T, Saito K, Nagashima K. Influence of sustained mild dehydration on thermoregulatory and cognitive functions during prolonged moderate exercise. Eur J Appl Physiol 2024:10.1007/s00421-024-05548-6. [PMID: 38985305 DOI: 10.1007/s00421-024-05548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE The current study investigated whether sustained mild dehydration affects thermoregulatory function and cognitive performance during prolonged exercise. METHODS Twelve young adults performed a test consisting of three sets of 20-min exercise with 2-min intervals under euhydrated (control, CON) and mildly dehydrated conditions (MDEH) at an ambient temperature of 30 °C and 60% relative humidity. MDEH was established by restricting water intake for 24 h, resulting in urine specific gravity of ≥ 1.020. Heart rate (HR), mean arterial blood pressure (MAP), skin blood flow (SkBF), sweat rate (SR) on the chest and forearm, and ear canal and mean skin surface temperatures (Tear and mean Tskin, respectively) were continuously recorded. For each exercise set, thermal and humid sensations and thermal discomfort were assessed using visual analog scales (VAS), and the rating of perceived exertion (RPE) was estimated. Cognitive performance on the Go/No-Go (easy) and incongruent Stroop (difficult) tasks was assessed before and after the test. RESULTS No differences were observed in HR, MAP, SkBF, SR, Tear, and mean Tskin between the CON and MDEH. Thermal and humidity sensations, thermal discomfort, and RPE were higher in MDEH than in CON. Moreover, response time to the Stroop task was prolonged in MDEH. CONCLUSION These findings suggest that sustained mild dehydration does not affect autonomic thermoregulation during exercise. Augmented thermal perception and perceived exertion, which are necessary for behavioral thermoregulation, were noted; however, cognitive function may be attenuated under MDEH.
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Affiliation(s)
- Hironori Watanabe
- Institute for Energy and Environmental System, Sustainable Energy & Environmental Society Open Innovation Research Organization, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 1698555, Japan
- Advanced Research Center for Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 3591192, Japan
- Body Temperature and Fluid Laboratory, Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 3591192, Japan
| | - Yuma Kadokura
- Infrastructure Systems Research & Development Center, Toshiba Infrastructure Systems & Solutions Corporation, Kawasaki, Kanagawa, 2129595, Japan
| | - Taisuke Sugi
- Body Temperature and Fluid Laboratory, Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 3591192, Japan
| | - Kiyoshi Saito
- Institute for Energy and Environmental System, Sustainable Energy & Environmental Society Open Innovation Research Organization, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 1698555, Japan
- Department of Applied Mechanics and Aerospace Engineering, School of Fundamental Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 1698555, Japan
| | - Kei Nagashima
- Institute for Energy and Environmental System, Sustainable Energy & Environmental Society Open Innovation Research Organization, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 1698555, Japan.
- Body Temperature and Fluid Laboratory, Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 3591192, Japan.
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Anwar A, Sawlani A, Fatima F. Cooling Modality Effectiveness and Mortality Associate With Prehospital Care of Exertional Heat Stroke Casualities. J Emerg Med 2024; 66:e736-e737. [PMID: 38839132 DOI: 10.1016/j.jemermed.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/04/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Amna Anwar
- Institute: Jinnah Medical and Dental College, Karachi, Pakistan.
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Koo CJ, Hintz C, Butler CR. Return to Duty Following Exertional Heat Stroke: A Review. Mil Med 2024; 189:e1312-e1317. [PMID: 37776525 DOI: 10.1093/milmed/usad388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/28/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION Exertional heat stroke (EHS), which presents with extreme hyperthermia and alteration to the central nervous system, disproportionately affects the military, where warfighters are expected to perform in all types of environmental conditions. Because of an incomplete understanding of individualized recovery from EHS, there are several shortcomings with the current guidance on return to duty (RTD) following an EHS. The purpose of this manuscript is to provide an updated literature review of best practices for return to duty following EHS to guide decision making regarding EHS and explore areas of future research for medical staff who work with warfighters. MATERIALS AND METHODS A literature review related to EHS in both athlete and military populations, as well as any existing guidelines for RTD, was conducted using PubMed and Covidence. RESULTS Twenty-one articles were identified for this updated review on EHS and RTD, with recommendations focused during and after an EHS event, as well as the role of heat tolerance testing (HTT). CONCLUSIONS EHS has a high morbidity and mortality rate if not treated rapidly. Because the extent of end-organ damage is dependent on the amount of time that the individual is hyperthermic, rapid diagnosis via rectal thermometry, and efficient cooling methods are imperative to the wellbeing of EHS patients. Following EHS, gradual RTD recommendations within the limits of operational demand should be implemented to reduce the risk for a subsequent heat injury event. While many versions of HTT, most notably the Israeli Defense Force (IDF) protocol, have been created to guide RTD recommendations, a universal assessment for heat tolerance has yet to be adopted. As such, medical personnel should apply a multifactorial approach to ensure safe RTD.
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Affiliation(s)
- Caitlyn J Koo
- F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Courtney Hintz
- Special Warfare Training Wing, Special Warfare Human Performance Support Group, JBSA-Lackland, TX 78236, USA
| | - Cody R Butler
- Special Warfare Training Wing, Special Warfare Human Performance Support Group, JBSA-Lackland, TX 78236, USA
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Dervišević E. Hyperthermia: Is it always an accidental death? Leg Med (Tokyo) 2024; 68:102418. [PMID: 38335833 DOI: 10.1016/j.legalmed.2024.102418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION The research aimed to determine individual variations in different core temperature measurements before the experiment, after submersion, after 20 min of exposure for heat stroke. METHODS Rats were divided into three groups depending on the temperature and length of exposure to water: CG, G41-20 and G41-UD. The protocol was made according to the earlier described methodology of heat shock induction. RESULTS A significant difference was observed in the G41-UD group; p < 0.0005. The lowest body temperature of the rats was observed, from normothermia, and the highest temperature after death, 37.87 ± 0.62 °C vs 41.20 ± 0.76 °C, the difference between all three groups is p < 0.0005. CONCLUSION Exposure of Wistar rats to water temperatures in the CG and G41 groups led to a significant change in core temperature. In the control group, the thermoregulatory mechanism firmly established normothermia, while hyperthermia was revealed in the G41 group during the 20-minute exposure.
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Affiliation(s)
- Emina Dervišević
- Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Hartinger SM, Palmeiro-Silva YK, Llerena-Cayo C, Blanco-Villafuerte L, Escobar LE, Diaz A, Sarmiento JH, Lescano AG, Melo O, Rojas-Rueda D, Takahashi B, Callaghan M, Chesini F, Dasgupta S, Posse CG, Gouveia N, Martins de Carvalho A, Miranda-Chacón Z, Mohajeri N, Pantoja C, Robinson EJ, Salas MF, Santiago R, Sauma E, Santos-Vega M, Scamman D, Sergeeva M, Souza de Camargo T, Sorensen C, Umaña JD, Yglesias-González M, Walawender M, Buss D, Romanello M. The 2023 Latin America report of the Lancet Countdown on health and climate change: the imperative for health-centred climate-resilient development. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100746. [PMID: 38800647 PMCID: PMC11117061 DOI: 10.1016/j.lana.2024.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 05/29/2024]
Abstract
In 2023, a series of climatological and political events unfolded, partly driving forward the global climate and health agenda while simultaneously exposing important disparities and vulnerabilities to climate-related events. On the policy front, a significant step forward was marked by the inaugural Health Day at COP28, acknowledging the profound impacts of climate change on health. However, the first-ever Global Stocktake showed an important gap between the current progress and the targets outlined in the Paris Agreement, underscoring the urgent need for further and decisive action. From a Latin American perspective, some questions arise: How do we achieve the change that is needed? How to address the vulnerabilities to climate change in a region with long-standing social inequities? How do we promote intersectoral collaboration to face a complex problem such as climate change? The debate is still ongoing, and in many instances, it is just starting. The renamed regional centre Lancet Countdown Latin America (previously named Lancet Countdown South America) expanded its geographical scope adding Mexico and five Central American countries: Costa Rica, El Salvador, Guatemala, Honduras, and Panama, as a response to the need for stronger collaboration in a region with significant social disparities, including research capacities and funding. The centre is an independent and multidisciplinary collaboration that tracks the links between health and climate change in Latin America, following the global Lancet Countdown's methodologies and five domains. The Lancet Countdown Latin America work hinges on the commitment of 23 regional academic institutions, United Nations agencies, and 34 researchers who generously contribute their time and expertise. Building from the first report, the 2023 report of the Lancet Countdown Latin America, presents 34 indicators that track the relationship between health and climate change up to 2022, aiming at providing evidence to public decision-making with the purpose of improving the health and wellbeing of Latin American populations and reducing social inequities through climate actions focusing on health. This report shows that Latin American populations continue to observe a growing exposure to changing climatic conditions. A warming trend has been observed across all countries in Latin America, with severe direct impacts. In 2022, people were exposed to ambient temperatures, on average, 0.38 °C higher than in 1986-2005, with Paraguay experiencing the highest anomaly (+1.9 °C), followed by Argentina (+1.2 °C) and Uruguay (+0.9 °C) (indicator 1.1.1). In 2013-2022, infants were exposed to 248% more heatwave days and people over 65 years old were exposed to 271% more heatwave days than in 1986-2005 (indicator 1.1.2). Also, compared to 1991-2000, in 2013-2022, there were 256 and 189 additional annual hours per person, during which ambient heat posed at least moderate and high risk of heat stress during light outdoor physical activity in Latin America, respectively (indicator 1.1.3). Finally, the region had a 140% increase in heat-related mortality from 2000-2009 to 2013-2022 (indicator 1.1.4). Changes in ecosystems have led to an increased risk of wildfires, exposing individuals to very or extremely high fire danger for more extended periods (indicator 1.2.1). Additionally, the transmission potential for dengue by Aedes aegypti mosquitoes has risen by 54% from 1951-1960 to 2013-2022 (indicator 1.3), which aligns with the recent outbreaks and increasing dengue cases observed across Latin America in recent months. Based on the 2023 report of the Lancet Countdown Latin America, there are three key messages that Latin America needs to further explore and advance for a health-centred climate-resilient development. Latin American countries require intersectoral public policies that simultaneously increase climate resilience, reduce social inequities, improve population health, and reduce greenhouse gas (GHG) emissions. The findings show that adaptation policies in Latin America remain weak, with a pressing need for robust vulnerability and adaptation (V&A) assessments to address climate risks effectively. Unfortunately, such assessments are scarce. Up to 2021, Brazil is the only country that has completed and officially reported a V&A to the 2021 Global Survey conducted by the World Health Organization (WHO). Argentina, Guatemala, and Panama have also conducted them, but they have not been reported (indicator 2.1.1). Similarly, efforts in developing and implementing Health National Adaptation Plans (HNAPs) are varied and limited in scope. Brazil, Chile, and Uruguay are the only countries that have an HNAP (indicator 2.1.2). Moreover, self-reported city-level climate change risk assessments are very limited in the region (indicator 2.1.3). The collaboration between meteorological and health sectors remains insufficient, with only Argentina, Brazil, Colombia, and Guatemala self-reporting some level of integration (indicator 2.2.1), hindering comprehensive responses to climate-related health risks in the region. Additionally, despite the urgent need for action, there has been minimal progress in increasing urban greenspaces across the region since 2015, with only Colombia, Nicaragua, and Venezuela showing slight improvements (indicator 2.2.2). Compounding these challenges is the decrease in funding for climate change adaptation projects in Latin America, as evidenced by the 16% drop in funds allocated by the Green Climate Fund (GCF) in 2022 compared to 2021. Alarmingly, none of the funds approved in 2022 were directed toward climate change and health projects, highlighting a critical gap in addressing health-related climate risks (indicator 2.2.3). From a vulnerability perspective, the Mosquito Risk Index (MoRI) indicates an overall decrease in severe mosquito-borne disease risk in the region due to improvements in water, sanitation, and hygiene (WASH) (indicator 2.3.1). Brazil and Paraguay were the only countries that showed an increase in this indicator. It is worth noting that significant temporal variation within and between countries still persists, suggesting inadequate preparedness for climate-related changes. Overall, population health is not solely determined by the health sector, nor are climate policies a sole responsibility of the environmental sector. More and stronger intersectoral collaboration is needed to pave development pathways that consider solid adaptation to climate change, greater reductions of GHG emissions, and that increase social equity and population health. These policies involve sectors such as finance, transport, energy, housing, health, and agriculture, requiring institutional structures and policy instruments that allow long-term intersectoral collaboration. Latin American countries need to accelerate an energy transition that prioritises people's health and wellbeing, reduces energy poverty and air pollution, and maximises health and economic gains. In Latin America, there is a notable disparity in energy transition, with electricity generation from coal increasing by an average of 2.6% from 1991-2000 to 2011-2020, posing a challenge to efforts aimed at phasing out coal (indicator 3.1.1). However, this percentage increase is conservative as it may not include all the fossil fuels for thermoelectric electricity generation, especially during climate-related events and when hydropower is affected (Panel 4). Yet, renewable energy sources have been growing, increasing by an average of 5.7% during the same period. Access to clean fuels for cooking remains a concern, with 46.3% of the rural population in Central America and 23.3% in South America lacking access to clean fuels in 2022 (indicator 3.1.2). It is crucial to highlight the concerning overreliance on fossil fuels, particularly liquefied petroleum gas (LPG), as a primary cooking fuel. A significant majority of Latin American populations, approximately 74.6%, rely on LPG for cooking. Transitioning to cleaner heating and cooking alternatives could also have a health benefit by reducing household air pollution-related mortality. Fossil fuels continue to dominate road transport energy in Latin America, accounting for 96%, although some South American countries are increasing the use of biofuels (indicator 3.1.3). Premature mortality attributable to fossil-fuel-derived PM2.5 has shown varied trends across countries, increasing by 3.9% from 2005 to 2020 across Latin America, which corresponds to 123.5 premature deaths per million people (indicator 3.2.1). The Latin American countries with the highest premature mortality rate attributable to PM2.5 in 2020 were Chile, Peru, Brazil, Colombia, Mexico, and Paraguay. Of the total premature deaths attributable to PM2.5 in 2020, 19.1% was from transport, 12.3% from households, 11.6% from industry, and 11% from agriculture. From emission and capture of GHG perspective, commodity-driven deforestation and expansion of agricultural land remain major contributors to tree cover loss in the region, accounting for around 80% of the total loss (indicator 3.3). Additionally, animal-based food production in Latin America contributes 85% to agricultural CO2 equivalent emissions, with Argentina, Brazil, Panama, Paraguay, and Uruguay ranking highest in per capita emissions (indicator 3.4.1). From a health perspective, in 2020, approximately 870,000 deaths were associated with imbalanced diets, of which 155,000 (18%) were linked to high intake of red and processed meat and dairy products (indicator 3.4.2). Energy transition in Latin America is still in its infancy, and as a result, millions of people are currently exposed to dangerous levels of air pollution and energy poverty (i.e., lack of access to essential energy sources or services). As shown in this report, the levels of air pollution, outdoors and indoors, are a significant problem in the whole region, with marked disparities between urban and rural areas. In 2022, Peru, Chile, Mexico, Guatemala, Colombia, El Salvador, Brazil, Uruguay, Honduras, Panama, and Nicaragua were in the top 100 most polluted countries globally. Transitioning to cleaner sources of energy, phasing out fossil fuels, and promoting better energy efficiency in the industrial and housing sectors are not only climate mitigation measures but also huge health and economic opportunities for more prosperous and healthy societies. Latin American countries need to increase climate finance through permanent fiscal commitments and multilateral development banks to pave climate-resilient development pathways. Climate change poses significant economic costs, with investments in mitigation and adaptation measures progressing slowly. In 2022, economic losses due to weather-related extreme events in Latin America were US$15.6 billion -an amount mainly driven by floods and landslides in Brazil-representing 0.28% of Latin America's Gross Domestic Product (GDP) (indicator 4.1.1). In contrast to high-income countries, most of these losses lack insurance coverage, imposing a substantial financial strain on affected families and governments. Heat-related mortality among individuals aged 65 and older in Latin America reached alarming levels, with losses exceeding the equivalent of the average income of 451,000 people annually (indicator 4.1.2). Moreover, the total potential income loss due to heat-related labour capacity reduction amounted to 1.34% of regional GDP, disproportionately affecting the agriculture and construction sectors (indicator 4.1.3). Additionally, the economic toll of premature mortality from air pollution was substantial, equivalent to a significant portion of regional GDP (0.61%) (indicator 4.1.4). On a positive note, clean energy investments in the region increased in 2022, surpassing fossil fuel investments. However, in 2020, all countries reviewed continued to offer net-negative carbon prices, revealing fossil fuel subsidies totalling US$23 billion. Venezuela had the highest net subsidies relative to current health expenditure (123%), followed by Argentina (10.5%), Bolivia (10.3%), Ecuador (8.3%), and Chile (5.6%) (indicator 4.2.1). Fossil fuel-based energy is today more expensive than renewable energy. Fossil fuel burning drives climate change and damages the environment on which people depend, and air pollution derived from the burning of fossil fuels causes seven million premature deaths each year worldwide, along with a substantial burden of disease. Transitioning to sustainable, zero-emission energy sources, fostering healthier food systems, and expediting adaptation efforts promise not only environmental benefits but also significant economic gains. However, to implement mitigation and adaptation policies that also improve social wellbeing and prosperity, stronger and solid financial systems are needed. Climate finance in Latin American countries is scarce and strongly depends on political cycles, which threatens adequate responses to the current and future challenges. Progress on the climate agenda is lagging behind the urgent pace required. While engagement with the intersection of health and climate change is increasing, government involvement remains inadequate. Newspaper coverage of health and climate change has been on the rise, peaking in 2022, yet the proportion of climate change articles discussing health has declined over time (indicator 5.1). Although there has been significant growth in the number of scientific papers focusing on Latin America, it still represents less than 4% of global publications on the subject (indicator 5.3). And, while health was mentioned by most Latin American countries at the UN General Debate in 2022, only a few addressed the intersection of health and climate change, indicating a lack of awareness at the governmental level (indicator 5.4). The 2023 Lancet Countdown Latin America report underscores the cascading and compounding health impacts of anthropogenic climate change, marked by increased exposure to heatwaves, wildfires, and vector-borne diseases. Specifically, for Latin America, the report emphasises three critical messages: the urgent action to implement intersectoral public policies that enhance climate resilience across the region; the pressing need to prioritise an energy transition that focuses on health co-benefits and wellbeing, and lastly, that need for increasing climate finance by committing to sustained fiscal efforts and engaging with multilateral development banks. By understanding the problems, addressing the gaps, and taking decisive action, Latin America can navigate the challenges of climate change, fostering a more sustainable and resilient future for its population. Spanish and Portuguese translated versions of this Summary can be found in Appendix B and C, respectively. The full translated report in Spanish is available in Appendix D.
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Affiliation(s)
- Stella M. Hartinger
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Yasna K. Palmeiro-Silva
- Institute for Global Health, University College London, London, UK
- Centro de Políticas Públicas UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Llerena-Cayo
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luciana Blanco-Villafuerte
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis E. Escobar
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, USA
| | - Avriel Diaz
- Columbia University, International Research Institute for Climate and Society New York, USA
| | | | - Andres G. Lescano
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Oscar Melo
- Centro Interdisciplinario de Cambio Global, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Rojas-Rueda
- Environmental and Radiological Health Sciences, Colorado State University, CO, USA
- Colorado School of Public Health, Colorado State University, CO, USA
| | - Bruno Takahashi
- Departament of Communication, Michigan State University, MI, USA
| | - Max Callaghan
- Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany
| | - Francisco Chesini
- Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Shouro Dasgupta
- Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Venice, Italy
- Grantham Research Institute on Climate Change and the Environment, London School of Economics and Political Science (LSE), London, UK
| | - Carolina Gil Posse
- Facultad de Ciencias Sociales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nelson Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Nahid Mohajeri
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, UK
| | - Chrissie Pantoja
- Nicholas School of the Environment and Sanford School of Policy Policy, Duke University, Durham, NC, USA
- Departamento Académico de Economía, Universidad del Pacífico, Lima, Peru
| | - Elizabeth J.Z. Robinson
- Grantham Research Institute on Climate Change and the Environment, London School of Economics and Political Science (LSE), London, UK
| | | | - Raquel Santiago
- Faculdade de Nutrição, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Enzo Sauma
- Engineering Faculty, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Santos-Vega
- Grupo de Biología y Matemática Computacional (BIOMAC), Universidad de los Andes, Bogotá, Colombia
- Departamento Ciencias Biológicas, Universidad de Los Andes, Bogotá, Colombia
| | - Daniel Scamman
- Institute for Sustainable Resources, University College London, London, UK
| | | | | | - Cecilia Sorensen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, Department of Emergency Medicine, Columbia Irving Medical Center, NY, USA
| | - Juan D. Umaña
- Grupo de Biología y Matemática Computacional (BIOMAC), Universidad de los Andes, Bogotá, Colombia
| | - Marisol Yglesias-González
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Walawender
- Institute for Global Health, University College London, London, UK
| | - Daniel Buss
- Pan American Health Organization, Washington, DC, USA
| | - Marina Romanello
- Institute for Global Health, University College London, London, UK
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Pompeo A, Afonso J, Cirillo ELR, Costa JA, Vilaça-Alves J, Garrido N, González-Víllora S, Williams AM, Casanova F. Impact of temperature on physical and cognitive performance in elite female football players during intermittent exercise. Scand J Med Sci Sports 2024; 34:e14646. [PMID: 38700046 DOI: 10.1111/sms.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/22/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
There is limited research on female football players, especially related to their physical and cognitive performance under different climactic conditions. We analyzed the impact of a hot environmental temperature on physical performance and anticipation in elite female football players during a fatigue-inducing intermittent protocol. Elite female players (n = 21) performed the countermovement jump (CMJ) and responded to filmed sequences of offensive play under two distinct environmental temperatures (i.e., mild environment temperature- 20°C and 30% rh versus hot environment temperature- 38°C and 80% rh), interspersed by 1-week interval. Linear mixed models were used. CMJ performance declined following the intermittent protocol on both temperature conditions (p < 0.05). Moreover, there were significant main effects for protocol on CMJ speed (m/s) (p = 0.001; ηp 2 = 0.12), CMJ power (p = 0.002; ηp 2 = 0.11), and CMJ Heightmax (p = 0.002; ηp 2 = 0.12). After performing the intermittent protocol, exposure to a hot temperature caused a greater decline in anticipation accuracy (mild temperature = 64.41% vs. hot temperature = 53.44%; p < 0.001). Our study shows impaired performance in elite female football players following an intermittent protocol under hot compared with mild environmental conditions. We report decreased performance in both CMJ and anticipation performance under hotter conditions. The results reveal that exposure to hot temperatures had a negative effect on the accuracy of their anticipatory behaviors. We consider the implication of the work for research and training interventions.
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Affiliation(s)
- Alberto Pompeo
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Lusófona University, Lisbon, Portugal
| | - José Afonso
- Centre for Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto, Porto, Portugal
| | - Everton Luis Rodrigues Cirillo
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Lusófona University, Lisbon, Portugal
- State University of Londrina (UEL)/Sports Science Department, Londrina, Brazil
| | - Júlio A Costa
- Portugal Football School, Portuguese Football Federation, Oeiras, Portugal
| | - José Vilaça-Alves
- Department of Sport-Sciences, Exercise and Health, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Research Center in Sports, Health, and Human Development (CIDESD), Vila Real, Portugal
| | - Nuno Garrido
- Department of Sport-Sciences, Exercise and Health, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Research Center in Sports, Health, and Human Development (CIDESD), Vila Real, Portugal
| | - Sixto González-Víllora
- Sport and Physical Activity Education Research Group, Faculty of Education, University of Castilla-La Mancha, Albacete, Spain
| | - Andrew Mark Williams
- Department of Healthspan, Resilience, and Performance Group, Institute for Human and Machine Cognition, Pensacola, Florida, USA
| | - Filipe Casanova
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Lusófona University, Lisbon, Portugal
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8
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Wang F, Gong F, Shi X, Yang J, Qian J, Wan L, Tong H. Monocyte HLA-DR level on admission predicting in-hospital mortality rate in exertional heatstroke: A 12-year retrospective study. Immun Inflamm Dis 2024; 12:e1240. [PMID: 38629749 PMCID: PMC11022625 DOI: 10.1002/iid3.1240] [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: 05/08/2023] [Revised: 12/12/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Exertional heatstroke (EHS), a fatal illness, pronounces multiple organ dysfunction syndrome (MODS) and high mortality rate. Currently, no ideal factor prognoses EHS. Decreased monocyte human leukocyte-DR antigen (mHLA-DR) has been observed in critically ill individuals, particularly in those with sepsis. While most research focus on the pro-inflammatory response exploration in EHS, there are few studies related to immunosuppression, and no report targeted on mHLA-DR in EHS. The present study tried to explore the prognostic value of mHLA-DR levels in EHS patients. METHODS This was a single-center retrospective study. Clinical data of EHS patients admitted to the intensive care unit of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed. RESULTS Seventy patients with 54 survivors and 16 nonsurvivors were ultimately enrolled. Levels of mHLA-DR in the nonsurvivors (41.8% [38.1-68.1]%) were significantly lower than those in the survivors (83.1% [67.6-89.4]%, p < 0.001). Multivariate logistic regression indicated that mHLA-DR (odds ratio [OR] = 0.939; 95% confidence interval [CI]: 0.892-0.988; p = 0.016) and Glasgow coma scale (GCS) scores (OR = 0.726; 95% CI: 0.591-0.892; p = 0.002) were independent risk factors related with in-hospital mortality rate in EHS. A nomogram incorporated mHLA-DR with GCS demonstrated excellent discrimination and calibration abilities. Compared to the traditional scoring systems, the prediction model incorporated mHLA-DR with GCS had the highest area under the curve (0.947, 95% CI: [0.865-0.986]) and Youden index (0.8333), with sensitivity of 100% and specificity of 83.33%, and a greater clinical net benefit. CONCLUSION Patients with EHS were at a risk of early experiencing decreased mHLA-DR early. A nomogram based on mHLA-DR with GCS was developed to facilitate early identification and timely treatment of individuals with potentially poor prognosis.
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Affiliation(s)
- Fanfan Wang
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Intensive Care UnitGeneral Hospital of Southern Theatre Command of PLAGuangzhouChina
| | - Fanghe Gong
- Department of NeurosurgeryGeneral Hospital of Southern Theatre Command of PLAGuangzhouChina
| | - Xuezhi Shi
- Department of Intensive Care UnitGeneral Hospital of Southern Theatre Command of PLAGuangzhouChina
| | - Jiale Yang
- Department of Intensive Care UnitGeneral Hospital of Southern Theatre Command of PLAGuangzhouChina
| | - Jing Qian
- Department of Intensive Care UnitGeneral Hospital of Southern Theatre Command of PLAGuangzhouChina
| | - Lulu Wan
- Department of Intensive Care UnitGeneral Hospital of Southern Theatre Command of PLAGuangzhouChina
| | - Huasheng Tong
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Intensive Care UnitGeneral Hospital of Southern Theatre Command of PLAGuangzhouChina
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9
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Taylor KM, Giersch GEW, Caldwell AR, Epstein Y, Charkoudian N. Relation of body surface area-to-mass ratio to risk of exertional heat stroke in healthy men and women. J Appl Physiol (1985) 2024; 136:549-554. [PMID: 38234291 PMCID: PMC11219003 DOI: 10.1152/japplphysiol.00597.2023] [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: 08/28/2023] [Revised: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
Risk of exertional heat stroke (EHS) is an ongoing challenge for United States military personnel, for athletes and for individuals with occupational stressors that involve prolonged activity in hot environments. Higher body mass index (BMI) is significantly associated with increased risk for EHS in activity duty U.S. Soldiers. During exercise, heat is generated primarily by contracting skeletal muscle (and other metabolically active body mass) and dissipated based on body surface area (BSA). Thus, in compensable environments, a higher BSA·mass-1 may be a benefit to heat dissipation and decrease the risk of EHS. The purpose of the present analysis was to test the hypothesis that BSA·mass-1 ratio is an important biophysical characteristic contributing to the risk of EHS. We employed a matched case-control approach, where each individual with a diagnosis of EHS was matched to five controls who were never diagnosed with EHS but were in the same unit and had the same job title. We used a multivariate conditional logistic regression model including variables of BSA·mass-1, sex, age, military rank, and race. BSA·mass-1 significantly predicted EHS risk (P = 0.006), such that people with higher BSA·mass-1 were at lower risk of developing EHS when controlling for other potential factors such as age and race. This relationship persisted after adjustment for other anthropometric measures of body size including weight, BMI, and BSA. These data suggest that biophysical factors play an important role in EHS risk, particularly in a healthy military-aged cohort of men and women.NEW & NOTEWORTHY With the impacts of climate change yielding higher average ambient temperatures over time, the incidence of EHS for individuals participating in outdoor activities may consequently increase. With the larger sample size in this study compared with prior research in this field, we were able to use various methods that had not been applied before. For example, we were able to mutually adjust for different measurements of body size to understand which metric had the highest association with EHS risk. Understanding factors that may be modifiable may be important for developing interventions to counteract the increased risk of EHS associated with climate change.
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Affiliation(s)
- Kathryn M Taylor
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Gabrielle E W Giersch
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Aaron R Caldwell
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Yoram Epstein
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
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10
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Laukkanen JA, Kunutsor SK. The multifaceted benefits of passive heat therapies for extending the healthspan: A comprehensive review with a focus on Finnish sauna. Temperature (Austin) 2024; 11:27-51. [PMID: 38577299 PMCID: PMC10989710 DOI: 10.1080/23328940.2023.2300623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/22/2023] [Indexed: 04/06/2024] Open
Abstract
Passive heat therapy is characterized by exposure to a high environmental temperature for a brief period. There are several types of passive heat therapy which include hot tubs, Waon therapy, hydrotherapy, sanarium, steam baths, infrared saunas and Finnish saunas. The most commonly used and widely studied till date are the Finnish saunas, which are characterized by high temperatures (ranging from 80-100°C) and dry air with relative humidity varying from 10-20%. The goal of this review is to provide a summary of the current evidence on the impact of passive heat therapies particularly Finnish saunas on various health outcomes, while acknowledging the potential of these therapies to contribute to the extension of healthspan, based on their demonstrated health benefits and disease prevention capabilities. The Finnish saunas have the most consistent and robust evidence regarding health benefits and they have been shown to decrease the risk of health outcomes such as hypertension, cardiovascular disease, thromboembolism, dementia, and respiratory conditions; may improve the severity of musculoskeletal disorders, COVID-19, headache and flu, while also improving mental well-being, sleep, and longevity. Finnish saunas may also augment the beneficial effects of other protective lifestyle factors such as physical activity. The beneficial effects of passive heat therapies may be linked to their anti-inflammatory, cytoprotective and anti-oxidant properties and synergistic effects on neuroendocrine, circulatory, cardiovascular and immune function. Passive heat therapies, notably Finnish saunas, are emerging as potentially powerful and holistic strategies to promoting health and extending the healthspan in all populations.
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Affiliation(s)
- Jari A. Laukkanen
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
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11
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Lin L, Deng K, Gong Z, Fan H, Zhang D, Lu G. Sinensetin Attenuated Macrophagic NLRP3 Inflammasomes Formation via SIRT1-NRF2 Signaling. ACS OMEGA 2023; 8:33514-33525. [PMID: 37744845 PMCID: PMC10515189 DOI: 10.1021/acsomega.3c03319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023]
Abstract
Macrophage-mediated inflammation plays essential roles in multiple-organ injury. Sinensetin (SNS) at least exhibits anti-inflammation, antioxidant, and antitumor properties. However, the underlying mechanism of SNS-targeted macrophage-mediated inflammation remains elusive. In the present study, our results showed that SNS suppressed lipopolysaccharide (LPS)-induced inflammation to ameliorate lung and liver injuries. Mechanistically, SNS significantly inhibited M1-type macrophage polarization and its NLRP3 inflammasome formation to significantly decrease tumor necrosis factor α (TNFα) and IL-6 expression, while increasing IL-10 expression. Moreover, SNS interacted and activated SIRT1 to promote NRF2 and its target gene SOD2 transcription, which subsequently decreased LPS-induced inflammation. SIRT1 knockdown impaired the effects of SNS on the inhibition of macrophage polarization, NLRP3 inflammasome formation, and NRF2/SOD2 signaling. Taken together, our results showed that SNS is a potential and promising natural active ingredient to ameliorate inflammatory injury via activating SIRT1/NRF2/SOD2 signaling.
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Affiliation(s)
- Lin Lin
- Department of Respiration,
Guangzhou Women and Children’s Medical Centre, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Kuimiao Deng
- Department of Respiration,
Guangzhou Women and Children’s Medical Centre, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Zongrong Gong
- Department of Respiration,
Guangzhou Women and Children’s Medical Centre, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Huifeng Fan
- Department of Respiration,
Guangzhou Women and Children’s Medical Centre, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Dongwei Zhang
- Department of Respiration,
Guangzhou Women and Children’s Medical Centre, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
| | - Gen Lu
- Department of Respiration,
Guangzhou Women and Children’s Medical Centre, Guangzhou Medical University, Guangzhou 510120, Guangdong, China
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12
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Goto H, Kinoshita M, Oshima N. Heatstroke-induced acute kidney injury and the innate immune system. Front Med (Lausanne) 2023; 10:1250457. [PMID: 37614951 PMCID: PMC10442538 DOI: 10.3389/fmed.2023.1250457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/28/2023] [Indexed: 08/25/2023] Open
Abstract
Heatstroke can cause multiple organ failure and systemic inflammatory response syndrome as the body temperature rises beyond the body's ability to regulate temperature in a hot environment. Previous studies have indicated that heatstroke-induced acute kidney injury (AKI) can lead to chronic kidney disease. Therefore, there is an urgent need to elucidate the mechanism of heatstroke-induced AKI and to establish methods for its prevention and treatment. Recent reports have revealed that innate immunity, including neutrophils, macrophages, lymphocytes, and mast cells, is deeply involved in heat-induced AKI. In this review, we will discuss the roles of each immune cell in heat-induced renal injury and their potential therapeutic use.
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Affiliation(s)
- Hiroyasu Goto
- Department of Nephrology and Endocrinology, National Defense Medical College, Tokorozawa, Japan
| | - Manabu Kinoshita
- Department of Immunology and Microbiology, National Defense Medical College, Tokorozawa, Japan
| | - Naoki Oshima
- Department of Nephrology and Endocrinology, National Defense Medical College, Tokorozawa, Japan
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13
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Moran DS, DeGroot DW, Potter AW, Charkoudian N. Beating the heat: military training and operations in the era of global warming. J Appl Physiol (1985) 2023; 135:60-67. [PMID: 37199784 PMCID: PMC10281783 DOI: 10.1152/japplphysiol.00229.2023] [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: 04/13/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/19/2023] Open
Abstract
Global climate change has resulted in an increase in the number and intensity of environmental heat waves, both in areas traditionally associated with hot temperatures and in areas where heat waves did not previously occur. For military communities around the world, these changes pose progressively increasing risks of heat-related illnesses and interference with training sessions. This is a significant and persistent "noncombat threat" to both training and operational activities of military personnel. In addition to these important health and safety concerns, there are broader implications in terms of the ability of worldwide security forces to effectively do their job (particularly in areas that historically already have high ambient temperatures). In the present review, we attempt to quantify the impact of climate change on various aspects of military training and performance. We also summarize ongoing research efforts designed to minimize and/or prevent heat injuries and illness. In terms of future approaches, we propose the need to "think outside the box" for a more effective training/schedule paradigm. One approach may be to investigate potential impacts of a reversal of sleep-wake cycles during basic training during the hot months of the year, to minimize the usual increase in heat-related injuries, and to enhance the capacity for physical training and combat performance. Regardless of which approaches are taken, a central feature of successful present and future interventions will be that they are rigorously tested using integrative physiological approaches.
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Affiliation(s)
- Daniel S Moran
- School of Health Sciences, Department of Health Systems Management, Ariel University, Ariel, Israel
| | | | - Adam W Potter
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Nisha Charkoudian
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
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14
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Kruijt N, van den Bersselaar LR, Hopman MTE, Snoeck MMJ, van Rijswick M, Wiggers TGH, Jungbluth H, Bongers CCWG, Voermans NC. Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms. SPORTS MEDICINE - OPEN 2023; 9:33. [PMID: 37204519 DOI: 10.1186/s40798-023-00570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. METHODS We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients' perspective on these outcomes. RESULTS Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. CONCLUSION Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands.
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - L R van den Bersselaar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M T E Hopman
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - M M J Snoeck
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M van Rijswick
- Department of Exercise Medicine and Exercise Physiology, Royal Dutch Army, Utrecht, The Netherlands
| | - T G H Wiggers
- Department of Sports Medicine, Anna Hospital, Geldrop, The Netherlands
| | - H Jungbluth
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - C C W G Bongers
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
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15
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Rentería LI, Zheng X, Valera I, Machin DR, Garcia CK, Leon LR, Laitano O. Ovariectomy aggravates the pathophysiological response to exertional heat stroke in mice. J Appl Physiol (1985) 2023; 134:1224-1231. [PMID: 37022961 PMCID: PMC10151055 DOI: 10.1152/japplphysiol.00092.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Female mice have a greater capacity for exercising in the heat than male mice, reaching greater power output and longer times of heat exposure before succumbing to exertional heat stroke (EHS). Differences in body mass, size, or testosterone do not explain these distinct sex responses. Whether the ovaries could account for the superior exercise capacity in the heat in females remains unknown. Here, we determined the influence of ovariectomy (OVX) on exercise capacity in the heat, thermoregulation, intestinal damage, and heat shock response in a mouse EHS model. We performed bilateral OVX (n = 10) or sham (n = 8) surgeries in young adult (4 mo) female C57/BL6J mice. Upon recovery from surgeries, mice exercised on a forced wheel placed inside an environmental chamber set at 37.5 °C and 40% relative humidity until experiencing loss of consciousness (LOC). Terminal experiments were performed 3 h after LOC. OVX increased body mass by the time of EHS (sham = 3.8 ± 1.1, OVX = 8.3 ± 3.2 g, P < 0.05), resulted in shorter running distance (sham = 753 ± 189, OVX = 490 ± 87 m, P < 0.05), and shorter time to LOC (sham = 126.3 ± 21, OVX = 99.1 ± 19.8 min, P < 0.05). Histopathological assessment of the intestines revealed damage in the jejunum (sham = 0.2 ± 0.7, OVX = 2.1 ± 1.7 AU, P < 0.05) and ileum (sham = 0.3 ± 0.5, OVX = 1.8 ± 1.4 AU, P < 0.05). OVX increased mesenteric microvascular density (sham = 101 ± 25, OVX = 156 ± 66 10-2 mm/mm2, P < 0.05) and decreased concentration of circulatory heat shock protein 72 (HSP72) (sham = 26.7 ± 15.8, OVX = 10.3 ± 4.6 ng/mL, P < 0.05). No differences were observed in cytokines or chemokines between groups. Our findings indicate that OVX aggravates the pathophysiological response to EHS in mice.NEW & NOTEWORTHY Females outperform males in a mouse model of exertional heat stroke (EHS). Here, we show for the first time the impact of ovariectomy (OVX) on EHS pathophysiology. OVX resulted in a shorter exercise capacity in the heat, greater intestinal damage, and lower heat shock response following EHS.
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Affiliation(s)
- Liliana I Rentería
- College of Health and Human Sciences, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Xiangyu Zheng
- College of Health and Human Sciences, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Isela Valera
- College of Health and Human Sciences, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Daniel R Machin
- College of Health and Human Sciences, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Christian K Garcia
- College of Health and Human Sciences, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
- College of Health and Human Performance, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States
| | - Lisa R Leon
- College of Health and Human Performance, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States
| | - Orlando Laitano
- College of Health and Human Sciences, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
- College of Health and Human Performance, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States
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