Effects of skin and mild core cooling on cognitive function in cold air in men

This study tested the effects of skin and core cooling on cognitive function in 0°C cold air. Ten males completed a randomized, repeated measures study consisting of four environmental conditions: (i) 30 min of exposure to 22°C thermoneutral air (TN), (ii) 15 min to 0°C cold air which cooled skin temperature to ~27°C (CS), (iii) 0°C cold air exposure causing mild core cooling of ∆-0.3°C from baseline (C-0.3°C) and (iv) 0°C cold air exposure causing mild core cooling of ∆-0.8°C from baseline (C-0.8°C). Cognitive function (reaction time [ms] and errors made [#]) were tested using a simple reaction test, a two-six item working memory capacity task, and vertical flanker task to assess executive function. There were no condition effects (all p > 0.05) for number of errors made on any task. There were no significant differences in reaction time relative to TN for the vertical flanker and item working memory capacity task. However, simple reaction time was slower in C-0.3°C (297 ± 33 ms) and C-0.8°C (296 ± 41 ms) compared to CS (267 ± 26 ms) but not TN (274 ± 38). Despite small changes in simple reaction time (~30 ms), executive function and working memory was maintained in 0°C cold air with up to ∆-0.8°C reduction in core temperature.

Heat Transfer Capabilities of Surface Cooling Systems for Inducing Therapeutic Hypothermia

Therapeutic hypothermia (TH) is used to treat patients with cerebral ischemia. Body surface cooling provides a simple noninvasive method to induce TH. We compared three surface cooling systems (Arctic Sun with adhesive ArcticGel pads [AS]); Blanketrol III with two nonadhesive Maxi-Therm Lite blankets [BL]); and Blanketrol III with nonadhesive Kool Kit [KK]). We hypothesized that KK would remove more heat due to its tighter fit and increased surface area. Eight subjects (four females) were cooled with each system set to 4°C outflow temperature for 120 minutes. Heat loss, skin and esophageal temperature, and metabolic heat production were measured. Skin temperature was higher with KK (p = 0.002), heat loss was lower with KK in the first hour (p = 0.014) but not after 120 minutes. Heat production increased similarly with all systems. Core temperature decrease was greater for AS (0.57°C) than BL (0.14°C; p = 0.035), but not KK (0.24°C; p = 0.1). Each system had its own benefits and limitations. Heat transfer capability is dependent on the cooling pump unit and the design of the liquid-perfused covers. Both Arctic Sun and Blanketrol III cooling/pump units had 4°C output temperatures. However, the Blanketrol III unit had a greater flow rate and therefore more cooling power. The nonadhesive BL and KK covers were easier to apply and remove compared with the adhesive AS pads. AS had an early transient advantage in heat removal, but this effect decreased over the course of cooling, thus minimizing or eliminating any advantage during longer periods of cooling that occur during clinical TH. Clinical Trial Registration number: NCT04332224.

Effects of cutaneous administration of an over-the-counter menthol cream during temperate-water immersion for exercise-induced hyperthermia in men

Introduction: Hyperthermia impairs various physiological functions and physical performance. We examined the effects of cutaneous administration with an over-the-counter (OTC) analgesic cream containing 20% methyl salicylate and 6% L-menthol during temperate-water immersion (TWI) for exercise-induced hyperthermia. Methods: In a randomized crossover design, twelve healthy males participated in both of two experiments. Firstly, participants underwent a 15-min TWI at 20°C with (CREAM) or without (CON) cutaneous application of an analgesic cream. Cutaneous vascular conductance (CVC) was measured using laser doppler flowmetry during TWI. In a subsequent experiment, same participants performed a 30-min strenuous interval exercise in a heated (35°C) environment to induce hyperthermia (~39°C), which was followed by 15 min of TWI. Results: Core body temperature, as measured by an ingestible telemetry sensor, and mean arterial pressure (MAP) were measured. CVC and %CVC (% baseline) were higher during TWI in CREAM than in CON (Condition effect: p = 0.0053 and p = 0.0010). An additional experiment revealed that core body heat loss during TWI was greater in CREAM than in CON (Cooling rate: CON 0.070 ± 0.020 vs. CREAM 0.084°C ± 0.026°C/min, p = 0.0039). A more attenuated MAP response was observed during TWI in CREAM than in CON (Condition effect: p = 0.0007). Conclusion: An OTC analgesic cream containing L-menthol and MS augmented cooling effects when cutaneously applied during TWI in exercise-induced hyperthermia. This was, at least in part, due to the counteractive vasodilatory effect of the analgesic cream. The cutaneous application of OTC analgesic cream may therefore provide a safe, accessible, and affordable means of enhancing the cooling effects of TWI.

Design and evaluation of an open-source, conformable skin-cooling system for body magnetic resonance guided focused ultrasound treatments

Purpose:

Magnetic resonance guided focused ultrasound (MRgFUS) treatment of tumors uses inter-sonication delays to allow heat to dissipate from the skin and other near-field tissues. Despite inter-sonication delays, treatment of tumors close to the skin risks skin burns. This work has designed and evaluated an open-source, conformable, skin-cooling system for body MRgFUS treatments to reduce skin burns and enable ablation closer to the skin.

Methods:

A MR-compatible skin cooling system is described that features a conformable skin-cooling pad assembly with feedback control allowing continuous flow and pressure maintenance during the procedure. System performance was evaluated with hydrophone, phantom and in vivo porcine studies. Sonications were performed 10 and 5 mm from the skin surface under both control and forced convective skin-cooling conditions. 3D MR temperature imaging was acquired in real time and the accumulated thermal dose volume was measured. Gross analysis of the skin post-sonication was further performed. Device conformability was demonstrated at several body locations.

Results:

Hydrophone studies demonstrated no beam aberration, but a 5–12% reduction of the peak pressure due to the presence of the skin-cooling pad assembly in the acoustic near field. Phantom evaluation demonstrated there is no MR temperature imaging precision reduction or any other artifacts present due to the coolant flow during MRgFUS sonication. The porcine studies demonstrated skin burns were reduced in size or eliminated when compared to the control condition.

Conclusion:

An open-source design of an MRgFUS active skin cooling system demonstrates device conformability with a reduction of skin burns while ablating superficial tissues.

Thermal behavior alleviates thermal discomfort during steady-state exercise without affecting whole body heat loss

We tested the hypothesis that thermal behavior resulting in reductions in mean skin temperature alleviates thermal discomfort and mitigates the rise in core temperature during light-intensity exercise. In a 27 ± 0°C, 48 ± 6% relative humidity environment, 12 healthy subjects (6 men, 6 women) completed 60 min of recumbent cycling. In both trials, subjects wore a water-perfused suit top continually perfusing 34 ± 0°C water. In the behavior trial, subjects maintained their upper body thermally comfortable by pressing a button to perfuse cool water (2.2 ± 0.5°C) through the top for 2 min per button press. Metabolic heat production (control: 404 ± 52 W, behavior: 397 ± 65 W; P = 0.44) was similar between trials. Mean skin temperature was reduced in the behavior trial (by -2.1 ± 1.8°C, P < 0.01) because of voluntary reductions in water-perfused top temperature (P < 0.01). Whole body (P = 0.02) and local sweat rates were lower in the behavior trial (P ≤ 0.05). Absolute core temperature was similar (P ≥ 0.30); however, the change in core temperature was greater in the behavior trial after 40 min of exercise (P ≤ 0.03). Partitional calorimetry did not reveal any differences in cumulative heat storage (control: 554 ± 229, behavior: 544 ± 283 kJ; P = 0.90). Thermal behavior alleviated whole body thermal discomfort during exercise (by -1.17 ± 0.40 arbitrary units, P < 0.01). Despite lower evaporative cooling in the behavior trial, similar heat loss was achieved by voluntarily employing convective cooling. Therefore, thermal behavior resulting in large reductions in skin temperature is effective at alleviating thermal discomfort during exercise without affecting whole body heat loss.NEW & NOTEWORTHY This study aimed to determine the effectiveness of thermal behavior in maintaining thermal comfort during exercise by allowing subjects to voluntarily cool their torso and upper limbs with 2°C water throughout a light-intensity exercise protocol. We show that voluntary cooling of the upper body alleviates thermal discomfort while maintaining heat balance through convective rather than evaporative means of heat loss.

Skin vasoconstriction as a heat conservation thermoeffector

Cold exposure stimulates heat production and conservation to protect internal temperature. Heat conservation is brought about via reductions in skin blood flow. The focus, here, is an exploration of the mechanisms, particularly in humans, leading to that cutaneous vasoconstriction. Local skin cooling has several effects: (1) reduction of tonic nitric oxide formation by inhibiting nitric oxide synthase and element(s) downstream of the enzyme, which removes tonic vasodilator effects, yielding a relative vasoconstriction; (2) translocation of intracellular alpha-2c adrenoceptors to the vascular smooth-muscle cell membrane, enhancing adrenergic vasoconstriction; (3) increased norepinephrine release from vasoconstrictor nerves; and (4) cold-induced vasodilation, seen more clearly in anastomoses-rich glabrous skin. Cold-induced vasodilation occurs in nonglabrous skin when nitric oxide synthase or sympathetic function is blocked. Reflex responses to general body cooling complement these local effects. Sympathetic excitation leads to the increased release of norepinephrine and its cotransmitter neuropeptide Y, each of which contributes significantly to the vasoconstriction. The contributions of these two transmitters vary with aging, disease and, in women, reproductive hormone status. Interaction between local and reflex mechanisms is in part through effects on baseline and in part through removal of the inhibitory effects of nitric oxide on adrenergic vasoconstriction.

Local Skin Cooling as an Aid to the Management of Patients with Breast Cancer Related Lymphedema and Fibrosis of the Arm or Breast

Based on preliminary observations that topical cooling appeared to soften lymphedematous and fibrotic tissue, our goal was to systematically and quantitatively evaluate this effect. For this purpose, topical cooling was used as part of treatment of lymphedematous and fibrotic skin of women with breast cancer related lymphedema (BCRL) and localized fibrosis. Skin tissue hardness was assessed via the force required to indent skin to 4 mm (F4.0) and 1.3 mm (F1.3) and skin water was assessed by measurements of tissue dielectric constant (TDC). Measurements were done before cooling, after cooling, and after a single treatment session in 20 women with arm involvement and in 12 women with breast involvement. Pre-cooled arm and breast skin temperatures (mean ± SD) of 32.4 ± 1.4°C and 33.8 ± 1.0°C were reduced to 23.7 ± 2.0°C and 24.7 ± 1.6°C respectively via application of cold washcloths. Cooling was associated with a significant (p<0.001) decrease in F4.0 and F1.3 at arm and breast sites. At arm sites, force reductions ranged from 24% to 28% depending on indentation depth. Although the precise mechanism linking cooling to softening is as yet not fully understood, the fact that tissue is softened carries with it many potential benefits to patient and therapist. The near immediate tissue softening is associated with less pressure on underlying nerve endings and less input to sensory nerves thereby interrupting the pain cycle resulting in rapid pain relief. The rapidly softened tissue and decreased perception of pain offers the patient hope and encouragement in their therapeutic journey to reclaiming functional use of their affected body. Further, because softer tissue becomes more pliable, myofascial lengthening, scar tissue releasing, and other aspects of treatment are easier to perform thereby reducing treatment time and effort while achieving improved functional mobility.