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Fredrick FC, Meda AKR, Singh B, Jain R. Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines. Acute Crit Care 2024; 39:331-340. [PMID: 39266268 PMCID: PMC11392695 DOI: 10.4266/acc.2024.00647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/30/2024] [Indexed: 09/14/2024] Open
Abstract
Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive care syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due to its complex, multiple-cause pathophysiology and varied presentations. CIRCI, characterized by adrenal insufficiency during critical illness, presents in up to 30% of ICU patients and may manifest as an exaggerated inflammatory response. Factors such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue corticosteroid resistance, and drug-induced suppression contribute to CIRCI. Diagnosis is a complex process, relying on a comprehensive assessment including clinical presentation, laboratory findings, and dynamic stimulatory testing. Treatment involves intensive medical care and exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored to patient presentation and etiology. Understanding the pathophysiology and treatment of CIRCI is vital for clinicians managing critically ill patients and striving to improve outcomes. This research paper aims to explore the latest developments in the pathophysiology and management of CIRCI.
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Affiliation(s)
| | | | - Bhupinder Singh
- Department of Critical Care, Fortis Escorts Hospital, Amritsar, India
| | - Rohit Jain
- Avalon University School of Medicine, Willemstad, Curacao, India
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Mella VSA, Cooper CE, Karr M, Krockenberger A, Madani G, Webb EB, Krockenberger MB. Hot climate, hot koalas: the role of weather, behaviour and disease on thermoregulation. CONSERVATION PHYSIOLOGY 2024; 12:coae032. [PMID: 38803425 PMCID: PMC11129715 DOI: 10.1093/conphys/coae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/08/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
Thermoregulation is critical for endotherms living in hot, dry conditions, and maintaining optimal core body temperature (Tb) in a changing climate is an increasingly challenging task for mammals. Koalas (Phascolarctos cinereus) have evolved physiological and behavioural strategies to maintain homeostasis and regulate their Tb but are thought to be vulnerable to prolonged heat. We investigated how weather, behaviour and disease influence Tb for wild, free-living koalas during summer in north-west New South Wales. We matched Tb with daily behavioural observations in an ageing population where chlamydial disease is prevalent. Each individual koala had similar Tb rhythms (average Tb = 36.4 ± 0.05°C), but male koalas had higher Tb amplitude and more pronounced daily rhythm than females. Disease disrupted the 24-hr circadian pattern of Tb. Koala Tb increased with ambient temperature (Ta). On the hottest day of the study (maximum Ta = 40.8°C), we recorded the highest (Tb = 40.8°C) but also the lowest (Tb = 32.4°C) Tb ever documented for wild koalas, suggesting that they are more heterothermic than previously recognized. This requires individuals to predict days of extreme Ta from overnight and early morning conditions, adjusting Tb regulation accordingly, and it has never been reported before for koalas. The large diel amplitude and low minimum Tb observed suggest that koalas at our study site are energetically and nutritionally compromised, likely due to their age. Behaviour (i.e. tree hugging and drinking water) was not effective in moderating Tb. These results indicate that Ta and koala Tb are strongly interconnected and reinforce the importance of climate projections for predicting the future persistence of koalas throughout their current distribution. Global climate models forecast that dry, hot weather will continue to escalate and drought events will increase in frequency, duration and severity. This is likely to push koalas and other arboreal folivores towards their thermal limit.
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Affiliation(s)
- Valentina S A Mella
- Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales 2006, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Christine E Cooper
- School of Molecular and Life Sciences, Curtin University, Perth, Western Australia 6102, Australia
| | - Madeline Karr
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Andrew Krockenberger
- Division of Research and Innovation, James Cook University, Cairns, Queensland 4878, Australia
| | - George Madani
- School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Elliot B Webb
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales 2006, Australia
- Department of Planning and Environment, Science, Economics and Insights Division, Parramatta, New South Wales 2150, Australia
| | - Mark B Krockenberger
- Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales 2006, Australia
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Birlie TA, Amare AT, Agegn SB, Yirga GK, Bantie B, Nega TD, Eshetie Y, Woelile TA, Asmare G, Belay AT, Tasew SF. Treatment seeking delay and associated factors in adult heart failure patients admitted to Debre Tabor comprehensive specialized hospital, North West, Ethiopia. Heliyon 2024; 10:e23348. [PMID: 38187228 PMCID: PMC10767366 DOI: 10.1016/j.heliyon.2023.e23348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives This study was aimed at assessing the magnitude of treatment-seeking delay in adult heart failure patients and identifying factors that contribute to it. Design An institution-based cross-sectional study with a consecutive sampling technique was conducted at Debre Tabor Comprehensive Specialized Hospital from February 1 to November 1, 2021. Setting The study was conducted in the medical ward of the hospital. Participants A total of 187 patients aged 18 and above admitted with a diagnosis of heart failure, and able to provide information were included. Results The median delay time of adult heart failure patients admitted to the hospital was 15 days. The mean length of delay was also calculated to be 25.02 days. Urban residents and those who live at a ten or less-kilometer distance from healthcare facilities were found to be less likely to delay seeking care. Presenting with shortness of breath or paroxysmal nocturnal dyspnea, perceiving the cause to be heart-related, and getting positive responses from significant others were also associated with a relatively short delay time. Conclusion Treatment-seeking delay was found to be a major problematic issue in heart failure patients. Therefore, patients, patient families, and the community at large must be taught about the symptoms of heart failure and the need for timely care.
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Affiliation(s)
- Tekalign Amera Birlie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Setegn Bayabil Agegn
- Department of Statistics, Faculty of Natural and Computational Science, Debre Tabor University, Ethiopia
| | - Gebrie Kassaw Yirga
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Tadila Dires Nega
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Yeshambaw Eshetie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
| | - Tamiru Alene Woelile
- Department of Pediatrics and Child Health Nursing, Injibara University, Ethiopia
| | - Getachew Asmare
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Ethiopia
| | - Alebachew Taye Belay
- Department of Statistics, Faculty of Natural and Computational Science, Debre Tabor University, Ethiopia
| | - Sheganew Fetene Tasew
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre-Tabor University, Ethiopia
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Brooks TG, Lahens NF, Grant GR, Sheline YI, FitzGerald GA, Skarke C. Diurnal rhythms of wrist temperature are associated with future disease risk in the UK Biobank. Nat Commun 2023; 14:5172. [PMID: 37620332 PMCID: PMC10449859 DOI: 10.1038/s41467-023-40977-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
Many chronic disease symptomatologies involve desynchronized sleep-wake cycles, indicative of disrupted biorhythms. This can be interrogated using body temperature rhythms, which have circadian as well as sleep-wake behavior/environmental evoked components. Here, we investigated the association of wrist temperature amplitudes with a future onset of disease in the UK Biobank one year after actigraphy. Among 425 disease conditions (range n = 200-6728) compared to controls (range n = 62,107-91,134), a total of 73 (17%) disease phenotypes were significantly associated with decreased amplitudes of wrist temperature (Benjamini-Hochberg FDR q < 0.05) and 26 (6.1%) PheCODEs passed a more stringent significance level (Bonferroni-correction α < 0.05). A two-standard deviation (1.8° Celsius) lower wrist temperature amplitude corresponded to hazard ratios of 1.91 (1.58-2.31 95% CI) for NAFLD, 1.69 (1.53-1.88) for type 2 diabetes, 1.25 (1.14-1.37) for renal failure, 1.23 (1.17-1.3) for hypertension, and 1.22 (1.11-1.33) for pneumonia (phenome-wide atlas available at http://bioinf.itmat.upenn.edu/biorhythm_atlas/ ). This work suggests peripheral thermoregulation as a digital biomarker.
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Affiliation(s)
- Thomas G Brooks
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Nicholas F Lahens
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gregory R Grant
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yvette I Sheline
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Garret A FitzGerald
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Baum L, Johns M, Poikela M, Möller R, Ananthasubramaniam B, Prasser F. Data integration and analysis for circadian medicine. Acta Physiol (Oxf) 2023; 237:e13951. [PMID: 36790321 DOI: 10.1111/apha.13951] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/04/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Data integration, data sharing, and standardized analyses are important enablers for data-driven medical research. Circadian medicine is an emerging field with a particularly high need for coordinated and systematic collaboration between researchers from different disciplines. Datasets in circadian medicine are multimodal, ranging from molecular circadian profiles and clinical parameters to physiological measurements and data obtained from (wearable) sensors or reported by patients. Uniquely, data spanning both the time dimension and the spatial dimension (across tissues) are needed to obtain a holistic view of the circadian system. The study of human rhythms in the context of circadian medicine has to confront the heterogeneity of clock properties within and across subjects and our inability to repeatedly obtain relevant biosamples from one subject. This requires informatics solutions for integrating and visualizing relevant data types at various temporal resolutions ranging from milliseconds and seconds to minutes and several hours. Associated challenges range from a lack of standards that can be used to represent all required data in a common interoperable form, to challenges related to data storage, to the need to perform transformations for integrated visualizations, and to privacy issues. The downstream analysis of circadian rhythms requires specialized approaches for the identification, characterization, and discrimination of rhythms. We conclude that circadian medicine research provides an ideal environment for developing innovative methods to address challenges related to the collection, integration, visualization, and analysis of multimodal multidimensional biomedical data.
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Affiliation(s)
- Lena Baum
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Johns
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maija Poikela
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Möller
- Institute of Information Systems, University of Lübeck, Lübeck, Germany
| | | | - Fabian Prasser
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
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Skarke C, Brooks T, Lahens N, Grant G, Sheline Y, FitzGerald G. Diurnal rhythmicity of wearable device-measured wrist temperature predicts future disease incidence in the UK Biobank. RESEARCH SQUARE 2023:rs.3.rs-2535978. [PMID: 36824952 PMCID: PMC9949244 DOI: 10.21203/rs.3.rs-2535978/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Many chronic disease symptomatologies involve desynchronized sleep-wake cycles, indicative of disrupted biorhythms. This can be interrogated using body temperature rhythms, which are well-established biomarkers for circadian clock function. Here, we investigated the association of wrist temperature amplitudes with a future onset of disease in the UK Biobank one year after actigraphy. Among 425 disease conditions (range n = 200-6,728) compared to controls (range n = 62,107 - 91,134), a total of 73 (36.5%) disease phenotypes were significantly associated with decreased amplitudes of wrist temperature (Benjamini-Hochberg FDR q < 0.05) and 26 (13%) PheCODEs passed a more stringent significance level (Bonferroni-correction α < 0.05). Here, for example, a two-standard deviation (1.8° Celsius) lower wrist temperature amplitude corresponded to hazard ratios of 1.91 (1.58-2.31 95% CI) for NAFLD, 1.69 (1.53-1.88) for type 2 diabetes, 1.25 (1.14-1.37) for renal failure, 1.23 (1.17-1.3) for hypertension, and 1.22 (1.11-1.33) for pneumonia. A comprehensive phenome-wide atlas of the identified mappings has been made available at http://bioinf.itmat.upenn.edu/biorhythm_atlas/. These findings strongly suggest peripheral thermoregulation as a digital biomarker.
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Affiliation(s)
| | | | | | - Gregory Grant
- Institute of Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania; Department of Genetics, University of Pennsylvania Perelman School of Medicine
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Yang Z, Xie X, Zhang X, Li L, Bai R, Long H, Ma Y, Hui Z, Qi Y, Chen J. Circadian rhythms of vital signs are associated with in-hospital mortality in critically ill patients: A retrospective observational study. Chronobiol Int 2023; 40:262-271. [PMID: 36597185 DOI: 10.1080/07420528.2022.2163656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Vital signs have been widely used to assess the disease severity of patients, but there is still a lack of research on their circadian rhythms. The objective is to explore the circadian rhythms of vital signs in critically ill patients and establish an in-hospital mortality prediction model. Study patients from the recorded eICU Collaborative Research Database were included in the present analyses. The circadian rhythms of vital signs are analyzed in critically ill patients using the cosinor method. Logistic regression was used to screen independent predictors and establish a prediction model for in-hospital mortality by multivariate logistic regression analysis and to show in the nomogram. Internal validation is used to evaluate the prediction model by bootstrapping with 1000 resamples. A total of 29,448 patients were included in the current analyses. The Mesor, Amplitude, and Peak time of vital signs, such as heart rate (HR), temperature, respiration rate (RR), pulse oximetry-derived oxygen saturation (SpO2), and blood pressure (BP), were significant differences between survivors and non-survivors . Logistic regression analysis showed that Mesor, Amplitude, and Peak time of HR, RR, and SpO2 were independent predictors for in-hospital mortality in critically ill patients. The area under the curve (AUC) and c-index of the prediction model for the Medical intensive care unit (MICU) and Surgical intensive care unit (SICU) were 0.807 and 0.801, respectively. The Hosmer-Lemeshow test P-values were 0.076 and 0.085, respectively, demonstrating a good fit for the prediction model. The calibration curve and decision curve analysis (DCA) also demonstrated its accuracy and applicability. Internal validation assesses the consistency of the results. There were significant differences in the circadian rhythms of vital signs between survivors and non-survivors in critically ill patients. The prediction model established by the Mesor, Amplitude, and Peak time of HR, RR, and SpO2 combined with the Acute Physiology and Chronic Health Evaluation (APACHE) IV score has good predictive performance for in-hospital mortality and may eventually support clinical decision-making.Abbreviations: ICU: Intensive care unit; MICU: Medical intensive care unit; SICU: Surgical intensive care unit; HR: Heart rate; RR: Respiration rate; SpO2: Pulse oximetry-derived oxygen saturation; BP: Blood pressure; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; APACHE: Acute Physiology and Chronic Health Evaluation; bpm: beats per min; BMI: Body mass index; OR: Odd ratio; CI: Confidential interval; IQR: Interquartile range; SD: Standard deviation; ROC: Receiver operating characteristic; AUC: area under the curve; DCA: Decision curve analysis; IRB: Institutional review board.
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Affiliation(s)
- Zhengning Yang
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Xiaoxia Xie
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Xu Zhang
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Lan Li
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Ruoxue Bai
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Hui Long
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Yanna Ma
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Zhenliang Hui
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Yujie Qi
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Jun Chen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
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Chen XQ, Jiang XM, Zheng QX, Wang HW, Xue H, Pan YQ, Liao YP, Gao XX. Prevalence and risk factors of sub-health and circadian rhythm disorder of cortisol, melatonin, and temperature among Chinese midwives. Front Public Health 2023; 11:1142995. [PMID: 36875391 PMCID: PMC9975388 DOI: 10.3389/fpubh.2023.1142995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study aimed to explore the influencing factors of sub-health and circadian rhythm disorder among midwives and whether circadian rhythm disorder was associated with sub-health. Methods A multi-center cross-sectional study was conducted among 91 Chinese midwives from six hospitals through cluster sampling. Data were collected by demographic questionnaire, Sub-Health Measurement Scale version 1.0, and circadian rhythm detection. Minnesota single and population mean cosine methods were used to analyze the rhythm of cortisol, melatonin, and temperature. Binary logistic regression, nomograph model, and forest plot were performed to identify variables associated with midwives' sub-health. Results There were 65 midwives with sub-health and 61, 78, and 48 midwives with non-validation of circadian rhythms of cortisol, melatonin, and temperature among 91 midwives, respectively. Midwives' sub-health was significantly related to age, duration of exercise, weekly working hours, job satisfaction, cortisol rhythm, and melatonin rhythm. Based on these six factors, the nomogram was presented with significant predictive performance for sub-health. Furthermore, cortisol rhythm was significantly associated with physical, mental, and social sub-health, whereas melatonin rhythm was significantly correlated with physical sub-health. Conclusion Sub-health and circadian rhythm disorder were generally common among midwives. Nurse administrators are supposed to pay attention and take measures to prevent sub-health and circadian rhythm disorder among midwives.
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Affiliation(s)
- Xiao-Qian Chen
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.,Fujian Obstetrics and Gynecology Hospital, Fuzhou, Fujian, China
| | - Xiu-Min Jiang
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Qing-Xiang Zheng
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.,Fujian Obstetrics and Gynecology Hospital, Fuzhou, Fujian, China
| | - Hai-Wei Wang
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Heng Xue
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China
| | - Yu-Qing Pan
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yan-Ping Liao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiao-Xia Gao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
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Grant AD, Wilbrecht L, Kriegsfeld LJ. Adolescent Development of Biological Rhythms in Female Rats: Estradiol Dependence and Effects of Combined Contraceptives. Front Physiol 2021; 12:752363. [PMID: 35615288 PMCID: PMC9126190 DOI: 10.3389/fphys.2021.752363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/11/2021] [Indexed: 01/23/2023] Open
Abstract
Adolescence is a period of continuous development, including the maturation of endogenous rhythms across systems and timescales. Although, these dynamic changes are well-recognized, their continuous structure and hormonal dependence have not been systematically characterized. Given the well-established link between core body temperature (CBT) and reproductive hormones in adults, we hypothesized that high-resolution CBT can be applied to passively monitor pubertal development and disruption with high fidelity. To examine this possibility, we used signal processing to investigate the trajectory of CBT rhythms at the within-day (ultradian), daily (circadian), and ovulatory timescales, their dependence on estradiol (E2), and the effects of hormonal contraceptives. Puberty onset was marked by a rise in fecal estradiol (fE2), followed by an elevation in CBT and circadian power. This time period marked the commencement of 4-day rhythmicity in fE2, CBT, and ultradian power marking the onset of the estrous cycle. The rise in circadian amplitude was accelerated by E2 treatment, indicating a role for this hormone in rhythmic development. Contraceptive administration in later adolescence reduced CBT and circadian power and resulted in disruption to 4-day cycles that persisted after discontinuation. Our data reveal with precise temporal resolution how biological rhythms change across adolescence and demonstrate a role for E2 in the emergence and preservation of multiscale rhythmicity. These findings also demonstrate how hormones delivered exogenously in a non-rhythmic pattern can disrupt rhythmic development. These data lay the groundwork for a future in which temperature metrics provide an inexpensive, convenient method for monitoring pubertal maturation and support the development of hormone therapies that better mimic and support human chronobiology.
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Affiliation(s)
- Azure D. Grant
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Linda Wilbrecht
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Lance J. Kriegsfeld
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, United States
- Graduate Group in Endocrinology, University of California, Berkeley, Berkeley, CA, United States
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10
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A Tangled Threesome: Circadian Rhythm, Body Temperature Variations, and the Immune System. BIOLOGY 2021; 10:biology10010065. [PMID: 33477463 PMCID: PMC7829919 DOI: 10.3390/biology10010065] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/14/2022]
Abstract
Simple Summary In mammals, including humans, the body temperature displays a circadian rhythm and is maintained within a narrow range to facilitate the optimal functioning of physiological processes. Body temperature increases during the daytime and decreases during the nighttime thus influencing the expression of the molecular clock and the clock-control genes such as immune genes. An increase in body temperature (daytime, or fever) also prepares the organism to fight aggression by promoting the activation, function, and delivery of immune cells. Many factors may affect body temperature level and rhythm, including environment, age, hormones, or treatment. The disruption of the body temperature is associated with many kinds of diseases and their severity, thus supporting the assumed association between body temperature rhythm and immune functions. Recent studies using complex analysis suggest that circadian rhythm may change in all aspects (level, period, amplitude) and may be predictive of good or poor outcomes. The monitoring of body temperature is an easy tool to predict outcomes and maybe guide future studies in chronotherapy. Abstract The circadian rhythm of the body temperature (CRBT) is a marker of the central biological clock that results from multiple complex biological processes. In mammals, including humans, the body temperature displays a strict circadian rhythm and has to be maintained within a narrow range to allow optimal physiological functions. There is nowadays growing evidence on the role of the temperature circadian rhythm on the expression of the molecular clock. The CRBT likely participates in the phase coordination of circadian timekeepers in peripheral tissues, thus guaranteeing the proper functioning of the immune system. The disruption of the CRBT, such as fever, has been repeatedly described in diseases and likely reflects a physiological process to activate the molecular clock and trigger the immune response. On the other hand, temperature circadian disruption has also been described as associated with disease severity and thus may mirror or contribute to immune dysfunction. The present review aims to characterize the potential implication of the temperature circadian rhythm on the immune response, from molecular pathways to diseases. The origin of CRBT and physiological changes in body temperature will be mentioned. We further review the immune biological effects of temperature rhythmicity in hosts, vectors, and pathogens. Finally, we discuss the relationship between circadian disruption of the body temperature and diseases and highlight the emerging evidence that CRBT monitoring would be an easy tool to predict outcomes and guide future studies in chronotherapy.
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Cuesta-Frau D, Dakappa PH, Mahabala C, Gupta AR. Fever Time Series Analysis Using Slope Entropy. Application to Early Unobtrusive Differential Diagnosis. ENTROPY (BASEL, SWITZERLAND) 2020; 22:E1034. [PMID: 33286803 PMCID: PMC7597093 DOI: 10.3390/e22091034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022]
Abstract
Fever is a readily measurable physiological response that has been used in medicine for centuries. However, the information provided has been greatly limited by a plain thresholding approach, overlooking the additional information provided by temporal variations and temperature values below such threshold that are also representative of the subject status. In this paper, we propose to utilize continuous body temperature time series of patients that developed a fever, in order to apply a method capable of diagnosing the specific underlying fever cause only by means of a pattern relative frequency analysis. This analysis was based on a recently proposed measure, Slope Entropy, applied to a variety of records coming from dengue and malaria patients, among other fever diseases. After an input parameter customization, a classification analysis of malaria and dengue records took place, quantified by the Matthews Correlation Coefficient. This classification yielded a high accuracy, with more than 90% of the records correctly labelled in some cases, demonstrating the feasibility of the approach proposed. This approach, after further studies, or combined with more measures such as Sample Entropy, is certainly very promising in becoming an early diagnosis tool based solely on body temperature temporal patterns, which is of great interest in the current Covid-19 pandemic scenario.
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Affiliation(s)
- David Cuesta-Frau
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi Campus, 03801 Alcoi, Spain
| | | | - Chakrapani Mahabala
- Department of Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 575001, India; (C.M.); (A.R.G.)
| | - Arjun R. Gupta
- Department of Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 575001, India; (C.M.); (A.R.G.)
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12
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Coiffard B, Diallo AB, Culver A, Antonini F, Hammad E, Leone M, Mege JL. Exacerbation of circadian rhythms of core body temperature and sepsis in trauma patients. J Crit Care 2020; 60:23-26. [PMID: 32731102 DOI: 10.1016/j.jcrc.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to describe by mathematical modeling an accurate course of core body temperature (CBT) in severe trauma patients and its relation to sepsis. METHODS In a cohort of severe trauma, the CBT measurements were collected for 24 h on day 2 after admission and rhythmicity assessed by Fourier transform and Cosinor analysis to describe circadian features (frequency and amplitude). CBT was compared between patients who developed sepsis or not during the early ICU stay. RESULTS 33 patients were included in this analysis. 24 patients (73%) had a predominant rhythm of 24 h (period). The main period was lower in the 9 remaining patients (6 of 12 h, 1 of 8 h, and 2 of 6 h). Other significant frequencies of oscillation (second and third frequencies) were found, which showed an association of several well-marked rhythms. Patients with sepsis (n = 12) had a significantly higher level of CBT, but also more intense rhythms and higher amplitudes of CBT. CONCLUSION Trauma patients exhibit complex temperature circadian rhythms. Early exacerbation of the temperature rhythmicity (in frequency and amplitude) is associated with the development of sepsis. This observation accentuates the concept of circadian disruption and sepsis in ICU patients.
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Affiliation(s)
- Benjamin Coiffard
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France; Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive - Réanimation, Marseille, France.
| | - Aissatou B Diallo
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Aurélien Culver
- Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - François Antonini
- Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Emmanuelle Hammad
- Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Marc Leone
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France; Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Jean-Louis Mege
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
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13
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Diallo AB, Coiffard B, Leone M, Mezouar S, Mege JL. For Whom the Clock Ticks: Clinical Chronobiology for Infectious Diseases. Front Immunol 2020; 11:1457. [PMID: 32733482 PMCID: PMC7363845 DOI: 10.3389/fimmu.2020.01457] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
The host defense against pathogens varies among individuals. Among the factors influencing host response, those associated with circadian disruptions are emerging. These latter depend on molecular clocks, which control the two partners of host defense: microbes and immune system. There is some evidence that infections are closely related to circadian rhythms in terms of susceptibility, clinical presentation and severity. In this review, we overview what is known about circadian rhythms in infectious diseases and update the knowledge about circadian rhythms in immune system, pathogens and vectors. This heuristic approach opens a new fascinating field of time-based personalized treatment of infected patients.
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Affiliation(s)
- Aïssatou Bailo Diallo
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Benjamin Coiffard
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Aix-Marseille Univ, AP-HM, Hôpital Nord, Médecine Intensive-Réanimation, Marseille, France
| | - Marc Leone
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Aix-Marseille Univ, AP-HM, CHU Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Soraya Mezouar
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,AP-HM, UF Immunologie, Marseille, France
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