Self-reported effects of warm seasonal temperatures in persons with spinal cord injury

OBJECTIVE

Spinal cord injury (SCI) interrupts motor, sensory, and autonomic pathways, impairing mobility and increasing heat storage during warm seasonal temperatures due to compromised autonomic control of vasodilation and sweating and recognition of body temperature. Thus, persons with SCI are more vulnerable to hyperthermia and its adverse effects. However, information regarding how persons with SCI perceive warmer seasons and whether thermal discomfort during warmer seasons restricts routine activities remains anecdotal.

DESIGN

Cross-sectional, self-report surveys.

SETTING

VA Medical Center and Kessler Institute for Rehabilitation.

PARTICIPANTS

Three groups of 50 participants each: tetraplegia, paraplegia, and matched non-SCI controls.

OUTCOME MEASURES

Tetraplegia, paraplegia, and control groups responded "yes" or "no" when asked whether warm seasonal temperatures adversely affected comfort or participation in routine activities.

RESULTS

The percentage of responses differed among tetraplegia, paraplegia, and control groups when asked if they required ≥20 min to cool down once overheated (44 vs. 20 vs. 12%; X2 = 14.7, P < 0.001), whether heat-related discomfort limited their ability to go outside (62 vs. 34 vs. 32%; X2 = 11.5, P = 0.003), if they needed to use a water-mister because of the heat (70 vs. 44 vs. 42%; X2 = 9.8, P = 0.008), and if heat-related discomfort limited participation in social activities (40 vs. 20 vs. 16%; X2 = 8.7, P = 0.01).

CONCLUSION

Warmer seasonal temperatures had a greater negative impact on reported comfort and daily activities of persons with SCI than non-SCI controls. Those with tetraplegia were most adversely affected. Our findings warrant increasing awareness and identifying interventions to address the vulnerability of persons with SCI to hyperthermia.

Beyond day and night: The importance of ultradian rhythms in mouse physiology

Our circadian world shapes much of metabolic physiology. In mice ∼40% of the light and ∼80% of the dark phase time is characterized by bouts of increased energy expenditure (EE). These ultradian bouts have a higher body temperature (Tb) and thermal conductance and contain virtually all of the physical activity and awake time. Bout status is a better classifier of mouse physiology than photoperiod, with ultradian bouts superimposed on top of the circadian light/dark cycle. We suggest that the primary driver of ultradian bouts is a brain-initiated transition to a higher defended Tb of the active/awake state. Increased energy expenditure from brown adipose tissue, physical activity, and cardiac work combine to raise Tb from the lower defended Tb of the resting/sleeping state. Thus, unlike humans, much of mouse metabolic physiology is episodic with large ultradian increases in EE and Tb that correlate with the active/awake state and are poorly aligned with circadian cycling.

Head cooling wrap could suppress the elevation of core temperature after cardiac surgery during forced-air warming in a pediatric intensive care unit: a randomized clinical trial

PURPOSE

The main aim of the current trial was to explore our hypothesis that cooling head wraps lower the core temperature more effectively than ice packs on the head during forced-air warming after pediatric cardiac surgeries.

METHODS

This study was a single-center Randomized Controlled Trial. Participants were children with a weight ≤ 10 kg and hyperthermia during forced-air warming after cardiac surgeries. When the core temperature reached 37.5 °C, ice packs on the head (group C) or a cooling head wrap (group H) were used as cooling devices to decrease the core temperature. The primary outcome was the core temperature. The secondary outcomes were the foot surface temperature and heart rate. We measured all outcomes every 30 min for 240 min after the patient developed hyperthermia. We conducted two-way ANOVA as a pre-planned analysis and also the Bonferroni test as a post hoc analysis.

RESULTS

Twenty patients were randomly assigned to groups C and H. The series of core temperatures in group H were significantly lower than those in group C (p < 0.0001), and post hoc analysis showed that there was no significant difference in core temperatures at T0 between the two groups and statistically significant differences in all core temperatures at T30-240 between the two groups. There was no difference between the two groups' surface temperatures and heart rates.

CONCLUSIONS

Compared to ice packs on the head, head cooling wraps more effectively suppress core temperature elevation during forced-air warming after pediatric cardiac surgery.

Exertional heat stroke with reversible severe cerebral edema

Severe cerebral edema associated with exertional heat stroke is a major cause of death or disability. However, few studies on severe cerebral edema resulting from heat stroke have reported neuroradiological findings. Moreover, all the patients in these previous reports either died or remained severely disabled. Here, we report a case of exertional heat stroke with severe cerebral edema that probably developed or worsened due to delayed body temperature normalization. In contrast to previous reports, the patient showed complete clinical and neuroradiological recovery. This rare case suggests that severe cerebral edema could be reversed through meticulous supportive management. Moreover, it confirms the importance of rapid and effective cooling in heat stroke treatment.

Ecological constraints to match field and preferred temperatures in lizards Tropidurus catalanensis (Squamata; Tropiduridae)

We compared microhabitat and body temperatures in the field with thermal preferences of Tropidurus catalanensis to investigate if they match or diverge as demonstration respectively of suitability or poor-quality of the thermal environment. As T. catalanensis is subjected to variable thermal conditions along its distribution and may be jeopardized by the climate change, we measured its thermal preferences after exposure to milder (17 °C-27 °C) and warmer (22 °C-32 °C) thermal conditions to evaluate acclimatory responses and tolerances and vulnerabilities to warming. Field body temperatures tended to be similar to minimum preferred body temperatures, and microhabitat and body temperatures in the field were cooler in the remaining comparisons with thermal preferences [preferred (T_pref), set-point range (T_set), minimum preferred (T_{pref_min}) and maximum preferred (T_{pref_max}) body temperatures], suggesting there was a constraint to warming up in nature. The minimum preferred body temperatures may be a threshold separating proper functioning from markedly noxious impacts due to progressive impairment by the cooling. Difficulties to warm and keep suitable body temperatures may jeopardize overall ecophysiological and behavioral processes with implications for maintenance, fitness, and survival. The constraints to warm may impact T. catalanensis differently depending on its body size and its properties of heat conservation (thermal inertia). Smaller and larger T. catalanensis may respectively cool down easier and have difficulties to warm up, being jeopardized by the constraints due to the cold. The warmer preferred body temperatures coupled with the cooler microhabitats and bodies in nature complicate to anticipate how individuals will respond to climate change, but the acclimation to the warmer temperatures led six of them to death, suggesting they had limited tolerance to heat and would be vulnerable to global warming.

Thermoregulation in post-cardiac arrest patients treated with targeted temperature management

OBJECTIVE

Evaluate the relationship between heat generation during rewarming in post-cardiac arrest patients receiving targeted temperature management (TTM) as a surrogate of thermoregulatory ability and clinical outcomes.

METHODS

This is a prospective observational single-centre study conducted at an urban tertiary-care hospital. We included post-cardiac arrest adults who received TTM via surface cooling device between April 2018 and June 2019.

RESULTS

Patient heat generation was calculated by multiplying the inverse of the average machine water temperature with time to rewarm to 37 °C and standardized in two ways to account for target temperature variation: (1) divided by number of degrees between target temperature and 37 °C, and (2) limited to when patient was rewarmed from 36 °C to 37 °C. The primary outcome was poor neurologic status, defined as Cerebral Performance Category (CPC) score 3-5, and the secondary outcome was 30-day survival. Sixty-six patients were included: 45 (68%) had a CPC-score of 3-5 and 23 (35%) were alive at 30 days. Besides initial rhythm and arrest downtime, baseline characteristics were similar between outcomes. Heat generation was not associated with poor neurological outcome (CPC 3-5: 6.6 [IQR: 6.1, 7.4] versus CPC 1-2: 6.6 [IQR: 5.7, 7.6], p = 0.89) or survival at 30 days (non-survivors: 6.6 [IQR: 6.6, 7.4] vs. survivors: 6.6 [IQR: 5.7, 8.0, p = 0.78]).

CONCLUSION

Heat generation during rewarming was not associated with neurologic outcomes. However, there was a relationship between poor neurological outcome and higher median water temperatures. Time to rewarm was prolonged in patients with poor neurological outcome.

Effect of a fever in viral infections — the ‘Goldilocks’ phenomenon?

Acute infections, including those due to Coronaviridae and other viruses, often stimulate a febrile response. A mild fever appears to improve outcome; it appears to diminish viral replication by several mechanisms, including virion entry into host cells and genome transcription, and improving host defence mechanisms against the pathogen. However, a fever may also damage host cellular and tissue function and increase metabolic demands. At temperatures at the lower end of the febrile range, the benefit of the fever appears to outweigh the detrimental effects. However, at higher temperatures, the outcome worsens, suggesting that the disadvantages of fever on the host predominate. A non-infective fever is associated with a worse outcome at lower temperatures, suggesting that hyperthermia carries less benefit in the absence of infection. This review discusses the risks and benefits of a fever on the host response, focusing on the effects of a fever on viral replication and host response, and the detrimental effect on the host.

Nasal air conditioning following total inferior turbinectomy compared to inferior turbinoplasty - A computational fluid dynamics study

BACKGROUND

The aim of this study was to use computational fluid dynamics (CFD) to investigate the effects on nasal heat exchange and humidification of two different surgical techniques for reducing the inferior turbinate under different environmental conditions.

METHODS

Virtual surgery using two techniques of turbinate reduction was performed in eight nasal airway obstruction patients. Bilateral nasal airway models for each patient were compared: 1) Pre-operative 2) Post inferior turbinoplasty 3) Post total inferior turbinate resection (ITR). Two representative healthy models were included. Three different environmental conditions were investigated 1) ambient air 2) cold, dry air 3) hot, humid air. CFD modelling of airflow and conditioning was performed under steady-state, laminar, inspiratory conditions.

FINDINGS

Nasal conditioning is significantly altered following inferior turbinate reduction surgery, particularly with ITR under cold, dry inspired air (CDA). The degree of impairment is minor under the simulated range of environmental conditions (temperature = 12-40 °C; relative humidity = 13-80%). Streams of significantly colder air are found in the nasopharynx and more prevalent under CDA in ITR. These are related to high velocity flow streams, which remain cool in their centre throughout the widened inferior nasal cavity.

INTERPRETATION

Reduced air-mucosal heat exchange and moisture carrying capacity occurs under cooler temperatures in patients following inferior turbinate surgery. The clinical impact in extremely cold and dry conditions in groups with poor baseline respiratory function, respiratory illness, or endurance athletes is of special interest.

[Influence of comprehensive incubational measures on the perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting]

Objective: To explore the influence of standardized and comprehensive incubational measures on perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting. Methods: From January 2017 to November 2018, 50 patients with extensive burn who underwent escharectomy and skin grafting in the First Affiliated Hospital of Air Force Medical University and met the inclusion criteria of this study, were recruited in this retrospective cohort study. According to the incubational measures at that time, 20 patients (14 males and 6 females, aged (33.5±5.2) years) who received routine incubation during the perioperative period from January to October 2017 were set as routine incubation group, and 30 patients (23 males and 7 females, aged (35.8±1.4) years) who received standardized comprehensive incubational measures during the perioperative period from November 2017 to November 2018 were set as comprehensive incubation group. Their body temperature was controlled mainly in 4 stages: preoperative preparation and transfer from intensive care unit (ICU) to operating room, preoperative preparation in operating room, intraoperative operating room management, as well as postoperative transfer from operating room to ICU. The initial body temperature in operating room and intraoperative hypothermia duration, intraoperative blood loss, postoperative recovery time, postoperative chill, blister, and ulcer, and wound healing rate on post operation day (POD) 10 were recorded and calculated. Data were statistically analyzed with two independent samples t test and chi-square test. Results: (1) The initial body temperature in operating room of patients in comprehensive incubation group was (36.3±0.4) ℃, which was significantly higher than (35.6±0.4)℃ in routine incubation group, t=6.658, P<0.01; the intraoperative duration of hypothermia was (205±38) min, which was significantly shorter than (234±42) min in routine incubation group, t=2.564, P<0.05. (2) The intraoperative blood loss of patients in comprehensive incubation group was (323±114) mL, which was significantly less than (490±162) mL in routine incubation group, t=4.272, P<0.01; the postoperative recovery time was (36±8) min, which was significantly shorter than (49±17) min in routine incubation group, t=3.229, P<0.01. (3) The incidence of postoperative chill of patients in comprehensive incubation group was significantly lower than that in routine incubation group (χ(2)=28.626, P<0.01). The incidences of postoperative blister and ulcer of patients between the 2 groups were close. (4) On POD 10, the wound healing rate of patients in comprehensive incubation group was (78.08±0.06)%, which was significantly higher than (71.03±0.08)% in routine incubation group, t=3.694, P<0.01. Conclusions: The standardized and comprehensive incubational measures can effectively improve the initial body temperature of patients entering the operating room, shorten the intraoperative duration of hypothermia, reduce the amount of blood loss and postoperative complications, as well as shorten the postoperative recovery time, thus improve the wound healing rate.

Aquaporins, evaporative water loss and thermoregulation in heat-acclimated Mongolian gerbils (Meriones unguiculatus)

Evaporative water loss is an essential strategy to maintain stable body temperature in heat-exposed rodents. However, the thermoregulatory role and adjustment of evaporative heat loss capacity is unclear during prolonged heat exposure. Here, we studied the role of evaporative water loss in thermoregulation in Mongolian gerbils during heat acclimation. After 3 weeks of heat acclimation, gerbils exhibited a lower body temperature than the controls, and no difference in evaporative losses of water from the lung or saliva spreading compared with the controls. Heat acclimation did not alter the expression of aquaporin-1 and aquaporin-5 in the lungs and the expression of aquaporin-5 in the salivary glands. The expression of aquaporin-2 in the kidneys was kept stable, while the expression of aquaporin-1 in the kidneys was down-regulated. In addition, resting metabolic rate and non-shivering thermogenesis of heat-acclimated gerbils were reduced to 51% and 55% of the control group, respectively. Taken together, heat-acclimated Mongolian gerbils can reduce the metabolic thermogenesis without enhancing the evaporative water loss capacity for thermoregulation.

[General anesthesia for Crisponi syndrome: case report]

Crisponi syndrome is a rare and severe heritable disorder characterised by muscle contractions, trismus, apnea, feeding troubles, and unexplained high fever spikes with multiple organ failure. Here we report perioperative care for endoscopic gastrostomy of a 17 month-old female child with Crisponi syndrome. Temperature in the surgery room was strictly monitored and maintained at 19°C. The patient was exposed to both inhaled and intravenous anesthetic agents. Surgical and perioperative periods were uneventful. Episodes of fever in Crisponi syndrome arise from CRLF1 mutation, which differs from the physiological pathway underlying malignant hyperthermia.

Accuracy of the defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns

OBJECTIVE

To identify the measures of accuracy for defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns.

METHOD

Diagnostic accuracy study with cross-sectional design performed in medium and high-risk maternity units, located in Fortaleza city/Brazil. A total of 216 newborns were evaluated to identify the defining characteristics of the diagnosis under study. The measures of accuracy for defining characteristics were obtained from a latent class model with random effects for the calculation of sensitivity and specificity values.

RESULTS

The characteristics of increased respiratory rate and warm skin to the touch had higher sensitivity values (99.9%) and lower specificity (79 and 75%) and the characteristics of body temperature fluctuations above and below the normal parameters and hypertension had the highest specificity (80.4 and 100%, respectively).

CONCLUSION

The characteristic fluctuation of the body temperature above and below the normal parameters may be better to confirm the diagnosis, having presented a higher specificity value.

In vitro characterization of the thermoneutral transient receptor potential vanilloid-1 (TRPV1) inhibitor GRTE16523

The TRPV1 ion channel is a neuronal sensor that plays an important role in nociception and neuropathic as well as inflammatory pain. In clinical trials, hyperthermia and thermo-hypoaesthesia turned out as major side effects of TRPV1 antagonists, preventing successful development of such molecules as analgesics. In vitro studies demonstrated that the TRPV1 ion channel is a polymodal sensor integrating stimuli from molecular modulators with temperature, pH and transmembrane potential. Temperature dependent gating is suggested to constitute the molecular basis for its role in heat sensation and body temperature regulation. Drug discovery scientists since many years seek to obtain "thermoneutral" TRPV1 inhibitors, blocking the channels sensitivity for painful stimuli while keeping its temperature mode of activation unaffected. Aiming for a screening rational for the identification of thermoneutral TRPV1 antagonists, we broadly characterized the prototypic small molecule TRPV1 inhibitors GRT12360V and GRTE16523. In vitro, GRT12360V demonstrated pan-modality inhibition on human, cynomolgus and rodent TRPV1, whereas GRTE16523 selectively bypassed the channels temperature mode on human and cynomolgus TRPV1 and revealed partial agonism on rodent channels. Strikingly, in vivo, GRT12360V induced hyperthermia in all species tested whereas GRTE16523 proved thermoneutral in cynomolgus monkeys and induced hypothermia in rodents. Hence, working out the different in vitro to in vivo correlations of two compounds, we suggest temperature dependent voltage gating as key parameter when screening for thermoneutral TRPV1 inhibitors. We highlight a species difference of molecular TRPV1 pharmacology between primates and rodents and provide a methodological breakthrough to engineer thermoneutral TRPV1 antagonists with improved therapeutic safety.

[Effect of intraoperative warming on muscle relaxation recovery of cisatracurium in patients undergoing gastrointestinal surgery]

Objective: To investigate the effect of intraoperative warming on the postoperative relaxation recovery of cisatracurium in patients undergoing gastrointestinal surgery. Methods: Sixty ASA Ⅰ-Ⅱ patients, aged 20 to 60, undergoing elective gastrointestinal surgery in Cancer Hospital Chinese Academy of Medical Sciences from October, 2016 to March, 2019 were selected and they were randomly divided into two groups (n=30), N group and H group by random number table. N group was non-heat preserving group, and H group was heat preserving group. Tracheal intubation was induced by general anesthesia with cisatracurium 0.15 mg/kg, and the nasopharyngeal temperature were continuously monitored and recorded. Cisatracurium were infused 1-3 μg·kg(-1)·min(-1) by venous pump during operation with T1 at 1%-10% and stopped infusion 30 minutes before the end of surgery. The time when T1 recovered from 25% to 75%(muscle relaxation recovery index), and the time of T1 recovered to 25% to TOF ratios (TOFR, the ratio of the fourth muscle twitch height to T1 in TOF) recovery to 90% (full recovery time), cumulative drug use and surgery time were recorded. Results: There was no significant difference between the two groups in the cumulative drug dosage and operation time (P>0.05).The body temperature N group (35.7±0.2) ℃ was significantly lower than the H group (36.2±0.1) ℃ (t=13.940, P<0.01). The recovery index of N group (16.5±1.8) min was significantlyhigher than H group (10.5±2.1) min (t=12.094, P<0.01) and complete recovery time in N group (26.9±4.1) min was obviously longer than those in H group (15.0±2.9) (t=13.082, P<0.01). Conclusions: Patients with open gastrointestinal surgery are prone to hypothermia during surgery and heat protection is helpful to muscle relaxation recovery of cisatracurium.

Severe thermoregulatory deficiencies in mice with a deletion in the titin gene TTN

Muscular dystrophy with myositis (mdm) mice carry a deletion in the N2A region of the gene for the muscle protein titin (TTN), shiver at low frequency, fail to maintain body temperatures (T _b) at ambient temperatures (T _a) <34°C, and have reduced body mass and active muscle stiffness in vivo compared with wild-type (WT) siblings. Impaired shivering thermogenesis (ST) could be due to the mutated titin protein causing more compliant muscles. We hypothesized that non-shivering thermogenesis (NST) is impaired. To characterize the response to cold exposure, we measured T _b and metabolic rate (MR) of WT and mdm mice at four nominal temperatures: 20, 24, 29 and 34°C. Subsequently, we stimulated NST with noradrenaline. Manipulation of T _a revealed an interaction between genotype and MR: mdm mice had higher MRs at 29°C and lower MRs at 24°C compared with WT mice. NST capacity was lower in mdm mice than in WT mice. Using MR data from a previous study, we compared MR of mdm mice with MR of Perognathus longimembris, a mouse species of similar body mass. Our results indicated low MR and reduced NST of mdm mice. These were more pronounced than differences between mdm and WT mice owing to body mass effects on MR and capacity for NST. Correcting MR using Q ₁₀ showed that mdm mice had lower MRs than size-matched P. longimembris, indicating that mutated N2A titin causes severe thermoregulatory defects at all levels. Direct effects of the titin mutation lead to lower shivering frequency. Indirect effects likely lead to a lower capacity for NST and increased thermal conductance through decreased body size.

[The Effects of 30-Minutes of Pre-Warming on Core Body Temperature, Systolic Blood Pressure, Heart Rate, Postoperative Shivering, and Inflammation Response in Elderly Patients with Total Hip Replacement under Spinal Anesthesia: A Randomized Double-blind Controlled Trial]

PURPOSE

This study was designed to determine the effects of pre-warming on core body temperature (CBT) and hemodynamics from the induction of spinal anesthesia until 30 min postoperatively in surgical patients who undergo total hip replacement under spinal anesthesia. Our goal was to assess postoperative shivering and inflammatory response.

METHODS

Sixty-two surgical patients were recruited by informed notice. Data for this study were collected at a 1,300-bed university hospital in Incheon, South Korea from January 15 through November 15, 2013. Data on CBT, systemic blood pressure (SBP), and heart rate were measured from arrival in the pre-anesthesia room to 3 hours after the induction of spinal anesthesia. Shivering was measured for 30 minutes post-operatively. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured pre-operatively, and 1 and 2 days postoperatively. The 62 patients were randomly allocated to an experimental group (EG), which underwent pre-warming for 30 minutes, or a control group (CG), which did not undergo pre-warming.

RESULTS

Analysis of CBT from induction of spinal anesthesia to 3 hours after induction revealed significant interaction between group and time (F=3.85, p=.008). In addition, the incidence of shivering in the EG was lower than that in the CG (χ²=6.15, p=.013). However, analyses of SBP, heart rate, CRP, and ESR did not reveal significant interaction between time and group.

CONCLUSION

Pre-warming for 30 minutes is effective in increasing CBT 2 and 3 hours after induction of spinal anesthesia. In addition, pre-warming is effective in decreasing post-operative shivering.

Adaptive temperature regulation in the little bird in winter: predictions from a stochastic dynamic programming model

Several species of small birds are resident in boreal forests where environmental temperatures can be −20 to −30 °C, or even lower, in winter. As winter days are short, and food is scarce, winter survival is a challenge for small endothermic animals. A bird of this size will have to gain almost 10% of its lean body mass in fat every day to sustain overnight metabolism. Birds such as parids (titmice and chickadees) can use facultative hypothermia, a process in which body temperature is actively down-regulated to a specific level, to reduce heat loss and thus save energy. During cold winter nights, these birds may decrease body temperature from the normal from 42 ° down to 35 °C, or even lower in some species. However, birds are unable to move in this deep hypothermic state, making it a risky strategy if predators are around. Why, then, do small northern birds enter a potentially dangerous physiological state for a relatively small reduction in energy expenditure? We used stochastic dynamic programming to investigate this. Our model suggests that the use of nocturnal hypothermia at night is paramount in these biomes, as it would increase winter survival for a small northern bird by 58% over a winter of 100 days. Our model also explains the phenomenon known as winter fattening, and its relationship to thermoregulation, in northern birds.

Sex difference in thermal preference of adult mice does not depend on presence of the gonads

Background

The thermoneutral zone (TNZ) is a species-specific range of ambient temperature (T_a), at which mammals can maintain a constant body temperature with the lowest metabolic rate. The TNZ for an adult mouse is between 26 and 34 °C. Interestingly, female mice prefer a higher T_a than male mice although the underlying mechanism for this sex difference is unknown. Here, we tested whether gonadal hormones are dominant factors controlling temperature preference in male and female mice.

Methods

We performed a temperature preference test in which 10-week-old gonadectomized and sham-operated male and female C57BL/6J mice were allowed to choose to reside at the thermoneutral cage of 29 °C or an experimental cage of 26, 29, or 32 °C.

Results

All mice preferred a T_a higher than 26 °C, especially in the inactive phase. Choosing between 29 and 32 °C, female mice resided more at 32 °C while male mice had no preference between the temperatures. Hence, the preferred T_a for female mice was significantly higher (0.9 ± 0.2 °C) than that for male mice. However, gonadectomy did not influence the T_a preference.

Conclusions

Female mice prefer a warmer environment than male mice, a difference not affected by gonadectomy. This suggests that thermal-sensing mechanisms may be influenced by sex-specific pathways other than gonadal factors or that the thermoregulatory set point has already been determined prior to puberty.

Electronic supplementary material

The online version of this article (doi:10.1186/s13293-017-0145-7) contains supplementary material, which is available to authorized users.

Diurnal variation in the core interthreshold zone and its relation to cutaneous sensation threshold zone

BACKGROUND

The core interthreshold zone (CIZ) is defined as the range between temperatures at the onset of shivering and sweating. Its circadian or diurnal variation has not been extensively studied. The present study examined whether the CIZ is subject to a diurnal rhythm. In addition, according to the previous finding that the CIZ was proportionally correlated with peripheral interthreshold zone (PIZ), it was also examined whether cutaneous sensation threshold zone (CSZ), a determinant of the PIZ, is correlated with the CIZ.

METHODS

The CIZ and the CSZ were measured in ten Japanese men who underwent three experiments in a single day on the morning, afternoon, and evening in the 2014 experiment (so-called single-day experiment) and six Japanese men underwent the same experiments on the morning of day 1, the afternoon of day 2, and the evening of day 3 in the 2015 experiment (so-called multiple-day experiment). Air temperature was controlled at 20-24 °C. Each subject wore a suit perfused with 25 °C water at a rate of 600 cm³/min and exercised on an ergometer at 50% of their maximum work rate for 10-15 min until their rate of sweating increased. They then remained seated without exercising until their oxygen uptake increased. Rectal temperature, skin temperatures at seven sites, the sweating rate at the forehead, and oxygen uptake were continuously monitored throughout experiment. Cutaneous warm and cold sensation thresholds at three sites were measured using 1- and 2-cm² probes.

RESULTS

The results from the single-day experiment demonstrated a small change in the CIZ and core temperature prior to exercise (T _c-init) whereas those from the multiple-day experiment demonstrated continuous increase in the CIZ and T _c-init. The CSZ measured with a 1-cm² probe was inversely proportional to the average skin temperature at three sites prior to measurement (T _sk-av).

CONCLUSION

The results suggested that the CIZ may be not dependent on time of a day but T_c-init per se and may not be associated with the CSZ.

Xiyanping injection therapy for children with mild hand foot and mouth disease: a randomized controlled trial

OBJECTIVE

To evaluate the clinical effects of Xiyanping injection intervention in pediatric patients with mild hand foot and mouth disease (HFMD).

METHODS

A total of 329 patients were stratified and block-randomized for symptomatic treatment of HFMD and assigned to one of the following groups: Western Medicine (group A, n = 103), Xiyanping injection (group B, n = 109), or Xiyanping injection and symptomatic treatment using Western Medicine (group C, n = 117). During the trial, fever, rash, ulcers of the mouth were observed among participants in each group before and after treatment, and conversion rates from mild to severe HFMD were measured.

RESULTS

After 3-7 days' treatment, no significant differences in the conversion rates from mild to severe HFMD were observed among the three groups (P > 0.05). There was a significantly low number of patients with the onset time of antifebrile effect, vanished time of hand and foot rashes and cumulative time for the ulcers in the mouth vanished, among the three groups (P < 0.05, P < 0.01). The onset time of antifebrile effect of patients in groups B and C were markedly shorter compared with those in group A (P < 0.05, P < 0.01); there was no statically significant difference observed between groups B and C (P > 0.05). No significant differences were observed in the time for body temperature recovery among the three groups (P > 0.05). There were no significant differences in adverse effects among the three groups (P > 0.05).

CONCLUSION

Xiyanping injection together with use of Western Medicine is most effective for symptomatic treatment of mild HFMD. No severe adverse reactions were observed.

Effects of cooling before and during simulated match play on thermoregulatory responses of athletes with tetraplegia

OBJECTIVES

Athletes with high level spinal cord injuries (tetraplegia) are under greater thermal strain during exercise than the able-bodied. The purpose of this study was to investigate the effectiveness of pre-cooling using an ice vest and the combination of pre-cooling and cooling during play using water sprays in athletes with tetraplegia.

DESIGN

Counter-balanced, cross-over design.

METHODS

Eight wheelchair rugby players with tetraplegia completed a 60min intermittent sprint protocol (ISP) on a wheelchair ergometer in 20.2°C±0.2°C and 33.0%±3.1% relative humidity. The ISP was conducted on three occasions; no cooling (NC), pre-cooling with an ice vest (P) and pre-cooling with an ice vest and water sprays between quarters (PW). Gastrointestinal (T_gi) temperature, mean skin temperature (T_sk) and perceptual responses were measured throughout.

RESULTS

At the end of pre-cooling, the change in T_gi was not significantly different between conditions (P>0.05) but the change in T_sk was significantly greater in P and PW compared to NC (P<0.001). The change in T_gi over the ISP was significantly lower in PW and P compared to NC (P<0.05), whilst the change in T_sk was lower in PW compared to P and NC (P<0.05). Cooling had no effect on performance or perceptual responses (P>0.05).

CONCLUSIONS

Water spraying between quarters combined with pre-cooling using an ice vest lowers thermal strain to a greater degree than pre-cooling only in athletes with tetraplegia, but has no effect on simulated wheelchair rugby performance or perceptual responses.

The Extent of Myocardial Injury During Prolonged Targeted Temperature Management After Out-of-Hospital Cardiac Arrest

AIM

The aim of this study is to evaluate the extent of myocardial injury by cardiac biomarkers during prolonged targeted temperature management of 24 hours vs 48 hours after out-of-hospital cardiac arrest.

METHODS

This randomized Scandinavian multicenter study compares the extent of myocardial injury quantified by area under the curve (AUC) of cardiac biomarkers during prolonged targeted temperature management at 33°C ± 1°C of 24 hours and 48 hours, respectively. Through a period of 2.5 years, 161 comatose out-of-hospital cardiac arrest patients were randomized to targeted temperature management for 24 hours (n = 77) or 48 hours (n = 84). The AUC was calculated using both high-sensitivity cardiac troponin T (hs-cTnT_AUC) and creatine kinase-myocardial band (CK-MB_AUC) that were based upon measurements of these biomarkers every 6 hours upon admission until 96 hours after reaching target temperature.

RESULTS

The median hs-cTnT_AUC of 33,827 ng/L/h (interquartile range [IQR] 11,366-117,690) of targeted temperature management at 24 hours did not differ significantly from that of 28,973 ng/L/h (IQR 10,656-163,655) at 48 hours. In contrast, the median CK-MB_AUC of 1829 μg/L/h (IQR 800-6799) during targeted temperature management at 24 hours was significantly lower than that of 2428 μg/L/h (IQR 1163-10,906) within targeted temperature management at 48 hours, P <.05.

CONCLUSION

This study of comatose out-of-hospital cardiac arrest survivors showed no difference between the extents of myocardial injury estimated by hs-cTnT_AUC of prolonged targeted temperature management of 48 hours vs 24 hours, although the CK-MB_AUC was significantly higher during 48 hours vs 24 hours. Hence, it seems unlikely that the duration of targeted temperature management has a beneficial effect on the extent of myocardial injury after out-of-hospital cardiac arrest, and may even have a worsening effect.

Relationship between timing of cooling and outcomes in adult comatose cardiac arrest patients treated with targeted temperature management

AIM OF THE STUDY

Studies examining associations between time to target temperature and outcomes in cardiac arrest patients who underwent targeted temperature management (TTM) have shown inconsistent results. We examined these associations separately for time from restoration of spontaneous circulation to TTM initiation (pre-induction time) and time from TTM initiation to target temperature (induction time). Furthermore, we examined whether critical time thresholds exist if there is an association.

METHODS

This was a single-centre retrospective observational study including adult cardiac arrest patients treated with TTM from 2008 to 2015. We tested the associations of pre-induction time and induction time with outcomes at hospital discharge using multivariate logistic regression analysis. We then performed additional multivariate analyses, each with the significant timing variable at different binary cutoffs.

RESULTS

A total of 515 patients were analysed. At hospital discharge, 357 patients (69.3%) were alive, of whom 161 (31.3%) had a favourable neurologic outcome. In multivariate analysis, a shorter pre-induction time was independently associated with a favourable neurologic outcome (odds ratio [OR], 1.110; 95% confidence interval [CI], 1.025-1.202), whereas the induction time was not (OR, 0.954; 95% CI, 0.852-1.067). We found two pre-induction time thresholds (120 and 360min) that were associated with neurologic outcome.

CONCLUSION

We found that a shorter pre-induction time was independently associated with a favorable neurologic outcome at hospital discharge, whereas induction time was not. We also found two time thresholds at 120 and 360min, after which initiation of cooling was associated with a worse neurologic outcome.

Physiological and perceptual effects of precooling in wheelchair basketball athletes

OBJECTIVE

To investigate the physiological and perceptual effects of three precooling strategies during pre-exercise rest in athletes with a spinal cord injury (SCI).

DESIGN

Randomized, counterbalanced. Participants were precooled, then rested for 60 minutes (22.7 ± 0.2°C, 64.2 ± 2.6%RH).

SETTING

National Wheelchair Basketball Training Centre, Australia.

PARTICIPANTS

Sixteen wheelchair basketball athletes with a SCI.

INTERVENTIONS

Participants were precooled through; 1) 10 minutes of 15.8°C cold water immersion (CWI), 2) ingestion of 6.8 g/kg^-1 of slushie (S) from sports drink; 3) ingestion of 6.8 g/kg^-1 of slushie with application of iced towels to the legs, torso and back/arms (ST); or 4) ingestion of 6.8 g/kg^-1 of room temperature (22.3°C) sports drink (CON).

OUTCOME MEASURES

Core temperature (T_gi), skin temperature (T_sk), heart rate (HR), and thermal and gastrointestinal comfort.

RESULTS

Following CWI, a significant reduction in T_gi was observed compared to CON, with a greatest reduction of 1.58°C occurring 40 minutes post-cooling (95% CI [1.07, 2.10]). A significant reduction in T_gi following ST compared to CON was also observed at 20 minutes (0.56°C; [0.03, 1.09]) and 30 minutes (0.56°C; [0.04, 1.09]) post-cooling. Additionally, a significant interaction between impairment level and time was observed for T_gi and HR, demonstrating athletes with a higher level of impairment experienced a greater reduction in HR and significant decrease in rate of decline in T_gi, compared to lesser impaired athletes.

CONCLUSION

CWI and ST can effectively lower body temperature in athletes with a SCI, and may assist in tolerating warm conditions.

Perioperative hypothermia: Causes, consequences and treatment

Perioperative hypothermia, core temperature below 36.0 °C, transpires due to disruption of thermoregulation by anesthesia coupled with cold exposure to procedural surroundings and cleansing agents. Although most publications have focused on thermoregulation disruption with general anesthesia, neuraxial anesthesia may also cause significant hypothermia. The clinical consequences of perioperative hypothermia are multiple and include patient discomfort, shivering, platelet dysfunction, coagulopathy, and increased vasoconstriction associated with a higher risk of wound infection. Furthermore, postoperative cardiac events occur at a higher rate; although it is unclear whether this is due to increased oxygen consumption or norepinephrine levels. Hypothermia may also affect pharmacokinetics and prolong postoperative recovery times and hospital length of stay. In order to combat perioperative hypothermia, many prevention strategies have been examined. Active and passive cutaneous warming are likely the most common and aim to both warm and prevent heat loss; many consider active warming a standard of care for surgeries over one hour. Intravenous nutrients have also been examined to boost metabolic heat production. Additionally, pharmacologic agents that induce vasoconstriction have been studied with the goal of minimizing heat loss. Despite these multiple strategies for prevention and treatment, hypothermia continues to be a problem and a common consequence of the perioperative period. This literature review presents the most recent evidence on the disruption of temperature regulation by anesthesia and perioperative environment, the consequences of hypothermia, and the methods for hypothermia prevention and treatment.

Changes in Body Temperature in Incomplete Spinal Cord Injury by Digital Infrared Thermographic Imaging

Objective

To investigate changes in the core temperature and body surface temperature in patients with incomplete spinal cord injuries (SCI). In incomplete SCI, the temperature change is difficult to see compared with complete spinal cord injuries. The goal of this study was to better understand thermal regulation in patients with incomplete SCI.

Methods

Fifty-six SCI patients were enrolled, and the control group consisted of 20 healthy persons. The spinal cord injuries were classified according to International Standards for Neurological Classification of Spinal Cord Injury. The patients were classified into two groups: upper (neurological injury level T6 or above) and lower (neurological injury level T7 or below) SCIs. Body core temperature was measured using an oral thermometer, and body surface temperature was measured using digital infrared thermographic imaging.

Results

Twenty-nine patients had upper spinal cord injuries, 27 patients had lower SCIs, and 20 persons served as the normal healthy persons. Comparing the skin temperatures of the three groups, the temperatures at the lower abdomen, anterior thigh and anterior tibia in the patients with upper SCIs were lower than those of the normal healthy persons and the patients with lower SCIs. No significant temperature differences were observed between the normal healthy persons and the patients with lower SCIs.

Conclusion

In our study, we found thermal dysregulation in patients with incomplete SCI. In particular, body surface temperature regulation was worse in upper SCIs than in lower injuries. Moreover, cord injury severity affected body surface temperature regulation in SCI patients.

Management of the late preterm infant: not quite ready for prime time

Preterm births account for 12.5% of all births in the United States. The preterm birth rate has increased by 33% over the last 2 decades. Late and premature infants do not develop the serious and chronic conditions of the extreme premature infant. However, there is growing evidence that these infants are not as healthy as previously thought and do in fact have an increase in morbidity and mortality compared with term infants. This article summarizes the epidemiology of late preterm infants and the associated morbidities associated with their prematurity.