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Ueta H, Kodera S, Sugimoto S, Hirata A. Projection of future heat-related morbidity in three metropolitan prefectures of Japan based on large ensemble simulations of climate change under 2 °C global warming scenarios. ENVIRONMENTAL RESEARCH 2024; 247:118202. [PMID: 38224937 DOI: 10.1016/j.envres.2024.118202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/17/2024]
Abstract
Recently, global warming has become a prominent topic, including its impacts on human health. The number of heat illness cases requiring ambulance transport has been strongly linked to increasing temperature and the frequency of heat waves. Thus, a potential increase in the number of cases in the future is a concern for medical resource management. In this study, we estimated the number of heat illness cases in three prefectures of Japan under 2 °C global warming scenarios, approximately corresponding to the 2040s. Based on the population composition, a regression model was used to estimate the number of heat illness cases with an input parameter of time-dependent meteorological ambient temperature or computed thermophysiological response of test subjects in large-scale computation. We generated 504 weather patterns using 2 °C global warming scenarios. The large-scale computational results show that daily amount of sweating increased twice and the core temperature increased by maximum 0.168 °C, suggesting significant heat strain. According to the regression model, the estimated number of heat illness cases in the 2040s of the three prefectures was 1.90 (95%CI: 1.35-2.38) times higher than that in the 2010s. These computational results suggest the need to manage ambulance services and medical resource allocation, including intervention for public awareness of heat illnesses. This issue will be important in other aging societies in near future.
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Affiliation(s)
- Haruto Ueta
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan
| | - Sachiko Kodera
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan; Center of Biomedical Physics and Information Technology, Nagoya Institute of Technology, Nagoya, 466-8555, Japan
| | - Shiori Sugimoto
- Japan Agency for Marine-Earth Science and Technology, Yokohama, 236-0001, Japan
| | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, 466-8555, Japan; Center of Biomedical Physics and Information Technology, Nagoya Institute of Technology, Nagoya, 466-8555, Japan.
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2
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Lei TH, Lan L, Wang F. Indoor thermal comfort research using human participants: Guidelines and a checklist for experimental design. J Therm Biol 2023; 113:103506. [PMID: 37055124 DOI: 10.1016/j.jtherbio.2023.103506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
Thermal comfort dictates our alliesthesia and behavioural responses in indoor environments with the primary aim of maintaining the thermal homeostasis of our human body. The recent advances in neurophysiology research have suggested that thermal comfort is a physiological response that is regulated by the deviations of both skin and core temperatures. Therefore, when conducting thermal comfort using indoor occupants in an indoor environment, proper experimental design and standardisation should be followed. However, there is no published source that provides an educational guideline on how to properly implement the thermal comfort experiment in an indoor environment using indoor occupants (normal occupational activities and during sleep in a home-based setting). Therefore, the primary purpose of this work is to illustrate how to conduct indoor thermal comfort related experiments using human trials in both normal occupational activities and during sleep in a home-based setting. Furthermore, we hope that the information presented in this article will result in better experimental design when conducting the experiment on thermal comfort using indoor occupants (occupational and home-based environments). Due to this reason, special emphasis will be focused on the experimental design, selection of participants and experimental standardisation. The key summary of this article is that thermal comfort related to indoor occupants in an indoor environment should perform priori sample analysis and follow the proper experimental design and standardisation as outlined in this article.
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Takada A, Kodera S, Suzuki K, Nemoto M, Egawa R, Takizawa H, Hirata A. Estimation of the number of heat illness patients in eight metropolitan prefectures of Japan: Correlation with ambient temperature and computed thermophysiological responses. Front Public Health 2023; 11:1061135. [PMID: 36875384 PMCID: PMC9982159 DOI: 10.3389/fpubh.2023.1061135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
The number of patients with heat illness transported by ambulance has been gradually increasing due to global warming. In intense heat waves, it is crucial to accurately estimate the number of cases with heat illness for management of medical resources. Ambient temperature is an essential factor with respect to the number of patients with heat illness, although thermophysiological response is a more relevant factor with respect to causing symptoms. In this study, we computed daily maximum core temperature increase and daily total amount of sweating in a test subject using a large-scale, integrated computational method considering the time course of actual ambient conditions as input. The correlation between the number of transported people and their thermophysiological temperature is evaluated in addition to conventional ambient temperature. With the exception of one prefecture, which features a different Köppen climate classification, the number of transported people in the remaining prefectures, with a Köppen climate classification of Cfa, are well estimated using either ambient temperature or computed core temperature increase and daily amount of sweating. For estimation using ambient temperature, an additional two parameters were needed to obtain comparable accuracy. Even using ambient temperature, the number of transported people can be estimated if the parameters are carefully chosen. This finding is practically useful for the management of ambulance allocation on hot days as well as public enlightenment.
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Affiliation(s)
- Akito Takada
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Sachiko Kodera
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Koji Suzuki
- Architecture, Design, Civil Engineering, and Industrial Management Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Mio Nemoto
- Department of Environment Systems, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Ryusuke Egawa
- School of Engineering, Tokyo Denki University, Tokyo, Japan.,Cyberscience Center, Tohoku University, Sendai, Japan
| | | | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
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Abstract
Background Physiological heat adaptations can be induced following various protocols that use either artificially controlled (i.e. acclimation) or naturally occurring (i.e. acclimatisation) environments. During the summer months in seasonal climates, adequate exposure to outdoor environmental heat stress should lead to transient seasonal heat acclimatisation. Objectives The aim of the systematic review was to assess the available literature and characterise seasonal heat acclimatisation during the summer months and identify key factors that influence the magnitude of adaptation. Eligibility Criteria English language, full-text articles that assessed seasonal heat acclimatisation on the same sample of healthy adults a minimum of 3 months apart were included. Data Sources Studies were identified using first- and second-order search terms in the databases MEDLINE, SPORTDiscus, CINAHL Plus with Full Text, Scopus and Cochrane, with the last search taking place on 15 July 2021. Risk of Bias Studies were independently assessed by two authors for the risk of bias using a modified version of the McMaster critical review form. Data Extraction Data for the following outcome variables were extracted: participant age, sex, body mass, height, body fat percentage, maximal oxygen uptake, time spent exercising outdoors (i.e. intensity, duration, environmental conditions), heat response test (i.e. protocol, time between tests), core temperature, skin temperature, heart rate, whole-body sweat loss, whole-body and local sweat rate, sweat sodium concentration, skin blood flow and plasma volume changes. Results Twenty-nine studies were included in this systematic review, including 561 participants across eight countries with a mean summer daytime wet-bulb globe temperature (WBGT) of 24.9 °C (range: 19.5–29.8 °C). Two studies reported a reduction in resting core temperature (0.16 °C; p < 0.05), 11 reported an increased sweat rate (range: 0.03–0.53 L·h−1; p < 0.05), two observed a reduced heart rate during a heat response test (range: 3–8 beats·min−1; p < 0.05), and six noted a reduced sweat sodium concentration (range: − 22 to − 59%; p < 0.05) following summer. The adaptations were associated with a mean summer WBGT of 25.2 °C (range: 19.6–28.7 °C). Limitations The available studies primarily focussed on healthy male adults and demonstrated large differences in the reporting of factors that influence the development of seasonal heat acclimatisation, namely, exposure time and duration, exercise task and environmental conditions. Conclusions Seasonal heat acclimatisation is induced across various climates in healthy adults. The magnitude of adaptation is dependent on a combination of environmental and physical activity characteristics. Providing environmental conditions are conducive to adaptation, the duration and intensity of outdoor physical activity, along with the timing of exposures, can influence seasonal heat acclimatisation. Future research should ensure the documentation of these factors to allow for a better characterisation of seasonal heat acclimatisation. PROSPERO Registration CRD42020201883. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-022-01677-0.
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Anderson V, Leung ACW, Mehdipoor H, Jänicke B, Milošević D, Oliveira A, Manavvi S, Kabano P, Dzyuban Y, Aguilar R, Agan PN, Kunda JJ, Garcia-Chapeton G, de França Carvalho Fonsêca V, Nascimento ST, Zurita-Milla R. Technological opportunities for sensing of the health effects of weather and climate change: a state-of-the-art-review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:779-803. [PMID: 33427946 DOI: 10.1007/s00484-020-02063-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
Sensing and measuring meteorological and physiological parameters of humans, animals, and plants are necessary to understand the complex interactions that occur between atmospheric processes and the health of the living organisms. Advanced sensing technologies have provided both meteorological and biological data across increasingly vast spatial, spectral, temporal, and thematic scales. Information and communication technologies have reduced barriers to data dissemination, enabling the circulation of information across different jurisdictions and disciplines. Due to the advancement and rapid dissemination of these technologies, a review of the opportunities for sensing the health effects of weather and climate change is necessary. This paper provides such an overview by focusing on existing and emerging technologies and their opportunities and challenges for studying the health effects of weather and climate change on humans, animals, and plants.
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Affiliation(s)
- Vidya Anderson
- Climate Lab, Department of Physical & Environmental Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada.
| | - Andrew C W Leung
- Climate Lab, Department of Physical & Environmental Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada.
- Data & Services Section, Atmospheric Monitoring and Data Services, Meteorological Services of Canada, Environment and Climate Change Canada, Toronto, Canada.
| | - Hamed Mehdipoor
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, PO Box 217, 7500 AE, Enschede, the Netherlands.
| | | | - Dragan Milošević
- Climatology and Hydrology Research Centre, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 3, Novi Sad, 21000, Serbia
| | - Ana Oliveira
- IN+ Center for Innovation, Technology and Policy Research, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal
| | - S Manavvi
- Department of Architecture and Planning, Indian Institute of Technology, Roorkee, Uttarakhand, India
| | - Peter Kabano
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, PO Box 217, 7500 AE, Enschede, the Netherlands
- Department of Geography, School of Environment, Education & Development, The University of Manchester, Oxford Road, Manchester, UK
| | - Yuliya Dzyuban
- Office of Core Curriculum, Singapore Management University, Administration Building, 81 Victoria Street, Singapore, 188065, Singapore
| | - Rosa Aguilar
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, PO Box 217, 7500 AE, Enschede, the Netherlands
| | - Peter Nkashi Agan
- Department of General Studies, Faculty of Humanities, Management and Social Sciences, Federal University Wukari, P.M.B 1020, Wukari, Taraba State, Nigeria
| | - Jonah Joshua Kunda
- School of Geography, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Gustavo Garcia-Chapeton
- División de Ciencia y Tecnología, Centro Universitario de Occidente - CUNOC, Universidad de San Carlos de Guatemala - USAC, Calle Rodolfo Robles 29-99 zona 1, Quetzaltenango, Guatemala
| | - Vinicius de França Carvalho Fonsêca
- Brain Function Research Group, School of Physiology, 2193, University of the Witwatersrand, Johannesburg, South Africa
- Innovation Group of Biometeorology, Behavior and Animal Welfare (INOBIO-MANERA), Universidade Federal da Paraíba, Areia, 58397 000, Brazil
| | - Sheila Tavares Nascimento
- Faculty of Agronomy and Veterinary Medicine, University of Brasília, Asa Norte, Brasília, DF, 70910-970, Brazil
| | - Raul Zurita-Milla
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, PO Box 217, 7500 AE, Enschede, the Netherlands
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Lei TH, Fujiwara M, Gerrett N, Amano T, Mündel T, Inoue Y, Okushima D, Nishiyasu T, Kondo N. The effect of seasonal acclimatization on whole body heat loss response during exercise in a hot humid environment with different air velocity. J Appl Physiol (1985) 2021; 131:520-531. [PMID: 34043472 DOI: 10.1152/japplphysiol.00837.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Seasonal acclimatization from winter to summer is known to enhance thermoeffector responses in hot-dry environments during exercise whereas its impact on sweat evaporation and core temperature (Tcore) responses in hot-humid environments remains unknown. We, therefore, sought to determine whether seasonal acclimatization is able to modulate whole body sweat rate (WBSR), evaporated sweat rate, sweating efficiency, and thermoregulatory function during cycling exercise in a hot-humid environment (32°C, 75% RH). We also determined whether the increase in air velocity could enhance evaporated sweat rate and sweating efficiency before and after seasonal acclimatization. Twelve males cycled for 1 h at 40% V̇o2max in winter (preacclimatization) and repeated the trial again in summer (after acclimatization). For the last 20 min of cycling at a steady-state of Tcore, air velocity increased from 0.2 (0.04) m/s to 1.1 (0.02) m/s by using an electric fan located in front of the participant. Seasonal acclimatization enhanced WBSR, unevaporated sweat rate, local sweat rate and mean skin temperature compared with preacclimatization state (all P < 0.05) whereas sweating efficiency was lower (P < 0.01) until 55 min of exercise. Tcore and evaporated sweat rate were unaltered by acclimatization status (all P > 0.70). In conclusion, seasonal acclimatization enhances thermoeffector responses but does not attenuate Tcore during exercise in a hot-humid environment. Furthermore, increasing air velocity enhances evaporated sweat rate and sweating efficiency irrespective of acclimated state. NEW & NOTEWORTHY Seasonal acclimatization to humid heat enhances eccrine sweat gland function and thus results in a higher local and whole body sweat rate but does not attenuate Tcore during exercise in a hot-humid environment. Sweating efficiency is lower after seasonal acclimatization to humid heat compared with preacclimatization with and without the increase of air velocity. However, having a lower sweating efficiency does not mitigate the Tcore response during exercise in a hot-humid environment.
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Affiliation(s)
- Tze-Huan Lei
- College of Physical Education, Hubei Normal University, Huangshi, People's Republic of China.,Laboratory for Applied Human Physiology, Graduate School of Human Development and Environment, Kobe University, Kobe, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masashi Fujiwara
- Laboratory for Applied Human Physiology, Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Nicola Gerrett
- Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tatsuro Amano
- Faculty of Education, Niigata University, Niigata, Japan
| | - Toby Mündel
- School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Yoshimitsu Inoue
- Faculty of Human Sciences, Osaka International University, Moriguchi, Japan
| | - Dai Okushima
- Faculty of Human Sciences, Osaka International University, Moriguchi, Japan
| | - Takeshi Nishiyasu
- Institute of Health and Sports Science, University of Tsukuba, Tsukuba, Japan
| | - Narihiko Kondo
- Laboratory for Applied Human Physiology, Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
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Iida T, Nakamura M, Inazawa M, Munetsugu T, Nishida M, Fujimoto T, Sasaki Y, Ohshima Y, Nakazato Y, Namiki T, Yokozeki H. Prognosis after steroid pulse therapy and seasonal effect in acquired idiopathic generalized anhidrosis. J Dermatol 2021; 48:271-278. [PMID: 33146891 PMCID: PMC7984388 DOI: 10.1111/1346-8138.15666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
Acquired idiopathic generalized anhidrosis is a rare disease with unknown etiology. Sudden loss of sweating function adversely affects young patients' quality of life. Although systemic corticosteroid therapy is the most frequently reported treatment for the disease, its effectiveness is controversial because of the risk of recurrence. To assist clinical decision-making regarding whether to use steroids, we investigated the treatment responsiveness and recurrence rates in patients undergoing steroid pulse therapy and explored factors affecting these rates. We retrospectively collected data of 124 patients who received steroid pulse therapy to calculate the rate of responsiveness to the therapy. We also conducted a time-to-event analysis in a cohort of 57 patients who responded to steroid pulse therapy to estimate the recurrence rate after the therapy. As a result, the response and recurrence rates were 73% and 48%, respectively. Recurrence occurred within 1 year in most patients. The overall effectiveness of steroid pulse therapy was estimated to be 57% considering the recurrence rate. A delay from onset to treatment and younger age appeared to be negative factors for effectiveness. Moreover, we found a significant seasonal effect on both treatment and recurrence: autumn was the worst season for acquired idiopathic generalized anhidrosis in Japan. Our study revealed that steroid pulse therapy can be expected to be effective in half of treated patients. We recommend starting the therapy promptly after the diagnosis; however, it is also worth considering the season for treatment planning.
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Affiliation(s)
- Tadatsune Iida
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Michiko Nakamura
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Minako Inazawa
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Takichi Munetsugu
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Makiko Nishida
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Tomoko Fujimoto
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Yoshiyuki Sasaki
- Department of Maxillofacial SurgeryGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Yuichiro Ohshima
- Department of DermatologyAichi Medical University School of MedicineNagakuteJapan
| | | | - Takeshi Namiki
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Hiroo Yokozeki
- Department of DermatologyGraduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
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8
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Zhang L, Zhang X, Du L, Zhang C, Li H. Cholinergic- rather than adrenergic-induced sweating play a role in developing and developed rat eccrine sweat glands. Exp Anim 2020; 70:218-224. [PMID: 33298631 PMCID: PMC8150243 DOI: 10.1538/expanim.20-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Both cholinergic and adrenergic stimulation can induce sweat secretion in human eccrine sweat glands, but whether cholinergic and adrenergic stimulation play same roles in rat eccrine sweat glands is still controversial. To explore the innervations, and adrenergic- and cholinergic-induced secretory response in developing and developed rat eccrine sweat glands, rat hind footpads from embryonic day (E) 15.5-20.5, postanal day (P) 1-14, P21 and adult were fixed, embedded, sectioned and subjected to immunofluorescence staining for general fiber marker protein gene product 9.5 (PGP 9.5), adrenergic fiber marker tyrosine hydroxylase (TH) and cholinergic fiber marker vasoactive intestinal peptide (VIP), and cholinergic- and adrenergic-induced sweat secretion was detected at P1-P21 and adult rats by starch-iodine test. The results showed that eccrine sweat gland placodes of SD rats were first appeared at E19.5, and the expression of PGP 9.5 was detected surrounding the sweat gland placodes at E19.5, TH at P7, and VIP at P11. Pilocarpine-induced sweat secretion was first detected at P16 in hind footpads by starch-iodine test. There was no measurable sweating when stimulated by alpha- or beta-adrenergic agonists at all the examined time points. We conclude that rat eccrine sweat glands, just as human eccrine sweat glands, co-express adrenergic and cholinergic fibers, but different from human eccrine sweat glands, cholinergic- rather than adrenergic-induced sweating plays a role in the developing and developed rat eccrine sweat glands.
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Affiliation(s)
- Lei Zhang
- Mental Health Center, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
| | - Xiang Zhang
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
| | - Lijie Du
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
| | - Cuiping Zhang
- Research Center for Tissue Repair and Regeneration affiliated to the Medical Innovation Research Department and Fourth Medical Center of PLA General Hospital, Beijing 100048, P.R. China
| | - Haihong Li
- Department of Wound Repair and Dermatologic Surgery, Taihe Hospital, Hubei University of Medicine, 32 South Renmin Road, Shiyan 442000, Hubei Province, P.R. China
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9
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Notley SR, Meade RD, Akerman AP, Poirier MP, Boulay P, Sigal RJ, Flouris AD, Kenny GP. Evidence for age‐related differences in heat acclimatisation responsiveness. Exp Physiol 2020; 105:1491-1499. [DOI: 10.1113/ep088728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Sean R. Notley
- Human and Environmental Physiology Research UnitSchool of Human KineticsFaculty of Health SciencesUniversity of Ottawa Ottawa Canada
| | - Robert D. Meade
- Human and Environmental Physiology Research UnitSchool of Human KineticsFaculty of Health SciencesUniversity of Ottawa Ottawa Canada
| | - Ashley P. Akerman
- Human and Environmental Physiology Research UnitSchool of Human KineticsFaculty of Health SciencesUniversity of Ottawa Ottawa Canada
| | - Martin P. Poirier
- Human and Environmental Physiology Research UnitSchool of Human KineticsFaculty of Health SciencesUniversity of Ottawa Ottawa Canada
| | - Pierre Boulay
- Faculté des sciences de l'activité physiqueUniversité de Sherbrooke Sherbrooke Canada
| | - Ronald J. Sigal
- Human and Environmental Physiology Research UnitSchool of Human KineticsFaculty of Health SciencesUniversity of Ottawa Ottawa Canada
- Departments of MedicineCardiac Sciences and Community Health Sciences Faculties of Medicine and KinesiologyUniversity of Calgary Calgary Canada
- Clinical Epidemiology ProgramOttawa Hospital Research Institute Ottawa Canada
| | - Andreas D. Flouris
- FAME LaboratoryDepartment of Exercise ScienceUniversity of Thessaly Trikala Greece
| | - Glen P. Kenny
- Human and Environmental Physiology Research UnitSchool of Human KineticsFaculty of Health SciencesUniversity of Ottawa Ottawa Canada
- Clinical Epidemiology ProgramOttawa Hospital Research Institute Ottawa Canada
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10
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Lin CY, Hou CY, Tsai CM, Chang H. Muscle type from which satellite cells are derived plays a role in their damage response. CHINESE J PHYSIOL 2020; 63:113-121. [PMID: 32594064 DOI: 10.4103/cjp.cjp_98_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of this study was to evaluate the response of satellite cells to muscular atrophies which possess different pathological characteristics and which were induced by distinct damages. Right lower limbs of rats were exposed to denervation or disuse and later its tibialis anterior (TA) or soleus (SOL) muscles were analyzed. After confirming their functional impairments indicated by common but distinct pathological and electrophysiological characteristics, the quantitative polymerase chain reaction analysis of Pax7 and Pax3 expressions and the number of Pax7+ve and Pax3+ve cells were analyzed sequentially at day 0, day 7, and day 14. TA muscles of both denervation- and disuse-induced atrophy models showed persisted low level of Pax7 expression from day 7 (0.91 ± 0.23 and 0.31 ± 0.07, P = 0.06, n = 6) through day 14 (1.09 ± 0.15 and 0.4 ± 0.09 [P < 0.05]). On the other hand, significant elevations were observed in Pax3 expression in both atrophy models (2.73 ± 0.46 and 2.75 ± 0.26 [P < 0.05]) at day 7. Similar to TA muscle, resembled pattern of Pax7 and Pax3 expression changes were observed between the SOL muscles of denervation- and disused-atrophy models. These trends were further confirmed by the changes in Pax7+ve and Pax3+ve cell numbers of TA and SOL muscles in both atrophy models. Despite the distinct pathological findings, similar patterns in the changes of Pax3 and Pax7 expressions and the changes of Pax7+ve and Pax3+ve cell numbers were observed between the denervation- and disuse-induced atrophy models and this commonality was admitted among the muscle type. Therefore, we claim that the muscle regeneration orchestrated by satellite cells was governed by the muscle type in which satellite cells reside.
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Affiliation(s)
- Chuang-Yu Lin
- Department of Clinical Application, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - Chun-Yin Hou
- Department of Family Medicine, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Chung-Min Tsai
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University; Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
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11
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Barry H, Chaseling GK, Moreault S, Sauvageau C, Behzadi P, Gravel H, Ravanelli N, Gagnon D. Improved neural control of body temperature following heat acclimation in humans. J Physiol 2020; 598:1223-1234. [PMID: 32011734 DOI: 10.1113/jp279266] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/21/2020] [Indexed: 12/30/2022] Open
Abstract
KEY POINTS With the advent of more frequent extreme heat events, adaptability to hot environments will be crucial for the survival of many species, including humans. However, the mechanisms that mediate human heat adaptation have remained elusive. We tested the hypothesis that heat acclimation improves the neural control of body temperature. Skin sympathetic nerve activity, comprising the efferent neural signal that activates heat loss thermoeffectors, was measured in healthy adults exposed to passive heat stress before and after a 7 day heat acclimation protocol. Heat acclimation reduced the activation threshold for skin sympathetic nerve activity, leading to an earlier activation of cutaneous vasodilatation and sweat production. These findings demonstrate that heat acclimation improves the neural control of body temperature in humans. ABSTRACT Heat acclimation improves autonomic temperature regulation in humans. However, the mechanisms that mediate human heat adaptation remain poorly understood. The present study tested the hypothesis that heat acclimation improves the neural control of body temperature. Body temperatures, skin sympathetic nerve activity, cutaneous vasodilatation, and sweat production were measured in 14 healthy adults (nine men and five women, aged 27 ± 5 years) during passive heat stress performed before and after a 7 day heat acclimation protocol. Heat acclimation increased whole-body sweat rate [+0.54 L h-1 (0.32, 0.75), P < 0.01] and reduced resting core temperature [-0.29°C (-0.40, -0.18), P < 0.01]. During passive heat stress, the change in mean body temperature required to activate skin sympathetic nerve activity was reduced [-0.21°C (-0.34, -0.08), P < 0.01] following heat acclimation. The earlier activation of skin sympathetic nerve activity resulted in lower activation thresholds for cutaneous vasodilatation [-0.18°C (-0.35, -0.01), P = 0.04] and local sweat rate [-0.13°C (-0.24, -0.01), P = 0.03]. These results demonstrate that heat acclimation leads to an earlier activation of the neural efferent outflow that activates the heat loss thermoeffectors of cutaneous vasodilatation and sweating.
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Affiliation(s)
- Hadiatou Barry
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Georgia K Chaseling
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Samuel Moreault
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Claudia Sauvageau
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Parya Behzadi
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Hugo Gravel
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nicholas Ravanelli
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Daniel Gagnon
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Canada, Montréal, QC, Canada.,Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Park TH, Lee JB, Lee HJ, Yun B. Sex-related differences in sudomotor function in healthy early twenties focused on activated sweat gland density. CHINESE J PHYSIOL 2020; 63:1-6. [PMID: 32056980 DOI: 10.4103/cjp.cjp_46_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study was to quantitatively assess the difference in sudomotor function between healthy males and females in their early twenties by measuring skin surface area and activated sweat gland density (ASGD). The quantitative sudomotor axon reflex test (QSART), a method for evaluating autonomic nervous system activity, was used for quantification. In QSART, the sweat glands are activated directly or indirectly by the subcutaneous application of neurotransmitters, such as acetylcholine, through iontophoresis. This series of mechanisms is called the sudomotor axon reflex. After recording age, height, weight, and several measurements of the forearm, QSART was performed on 101 healthy controls aged 21-26 years to measure ASGD. The mean temperature and humidity on the measurement days were 11.4°C and 58.1% on May 3, 2018, and 14.7°C and 70.3% on May 10, 2018. The result of independent sample t-test showed higher ASGD in women (P < 0.05). The body surface area and the surface area of the forearms were higher in men (P < 0.001), but the number of activated sweat glands was not significantly different according to sex. The activated sweat gland counts of the body and forearms were analyzed through linear regression by age for males and females. Except for the activated sweat gland count of the male body, the analysis showed a tendency to decrease with increasing age but was not statistically significant in any case (P > 0.05). Showing insufficient coefficient of determination (R2), multiple regression analyses with sex and ages did not correct this insignificance between age and activated sweat gland count.
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Affiliation(s)
- Tae-Hwan Park
- College of Medicine, Soonchunhyang University, 366-1 Ssangyong-dong, Cheonan 31151, Republic of Korea
| | - Jeong-Beom Lee
- Department of Physiology, College of Medicine, Soonchunhyang University, 366-1 Ssangyong-dong, Cheonan 31151, Republic of Korea
| | - Hye-Jin Lee
- Department of Physiology, College of Medicine, Soonchunhyang University, 366-1 Ssangyong-dong, Cheonan 31151, Republic of Korea
| | - Bahda Yun
- College of Arts and Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
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Ravanelli N, Coombs G, Imbeault P, Jay O. Thermoregulatory adaptations with progressive heat acclimation are predominantly evident in uncompensable, but not compensable, conditions. J Appl Physiol (1985) 2019; 127:1095-1106. [PMID: 31414952 DOI: 10.1152/japplphysiol.00220.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study assessed whether, notwithstanding lower resting absolute core temperatures, alterations in time-dependent changes in thermoregulatory responses following partial and complete heat acclimation (HA) are only evident during uncompensable heat stress. Eight untrained individuals underwent 8 wk of aerobic training (i.e., partial HA) followed by 6 days of HA in 38°C/65% relative humidity (RH) (i.e., complete HA). On separate days, esophageal temperature (Tes), arm (LSRarm), and back (LSRback) sweat rate, and whole body sweat rate (WBSR) were measured during a 45-min compensable (37°C/30% RH) and 60-min uncompensable (37°C/60% RH) heat stress trial pre-training (PRE-TRN), post-training (POST-TRN), and post-heat acclimation (POST-HA). For compensable heat stress trials, resting Tes was lower POST-TRN (36.74 ± 0.27°C, P = 0.05) and POST-HA (36.60 ± 0.27°C, P = 0.001) compared with PRE-TRN (36.99 ± 0.19°C); however, ΔTes was similar in all trials (PRE-TRN:0.40 ± 0.23°C; POST-TRN:0.42 ± 0.20°C; POST-HA:0.43 ± 0.12°C, P = 0.97). While LSRback was unaltered by HA (P = 0.94), end-exercise LSRarm was higher POST-TRN (0.70 ± 0.14 mg·cm-2·min-1, P < 0.001) and POST-HA (0.75 ± 0.16 mg·cm-2·min-1, P < 0.001) compared with PRE-TRN (0.61 ± 0.15 mg·cm-2·min-1). Despite matched evaporative heat balance requirements, steady-state WBSR (31st-45th min) was greater POST-TRN (12.7 ± 1.0 g/min, P = 0.02) and POST-HA (12.9 ± 0.8 g/min, P = 0.004), compared with PRE-TRN (11.7 ± 0.9 g/min). For uncompensable heat stress trials, resting Tes was lower POST-TRN (36.77 ± 0.22°C, P = 0.05) and POST-HA (36.62 ± 0.15°C, P = 0.03) compared with PRE-TRN (36.86 ± 0.24°C). But ΔTes was smaller POST-TRN (0.77 ± 0.19°C, P = 0.05) and POST-HA (0.75 ± 0.15°C, P = 0.04) compared with PRE-TRN (1.10 ± 0.32°C). LSRback and LSRarm increased with HA (P < 0.007), supporting the greater WBSR with HA (POST-TRN:14.4 ± 2.4 g/min, P < 0.001; POST-HA:16.8 ± 2.8 g/min, P < 0.001) compared with PRE-TRN (12.7 ± 3.2 g/min). In conclusion, the thermal benefits of HA are primarily evident when conditions challenge the physiological capacity to dissipate heat.NEW & NOTEWORTHY We demonstrate that neither partial nor complete heat acclimation alters the change in core temperature during compensable heat stress compared with an unacclimated state, despite a marginally greater whole body sweat rate. However, the greater local and whole body sweat rate with partial and complete heat acclimation reduced the rise in core temperature during 60 min of uncompensable heat stress compared with an unacclimated state, suggesting the improvements in heat dissipation associated with heat acclimation are best observed when the upper physiological limits for evaporative heat loss are challenged.
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Affiliation(s)
- Nicholas Ravanelli
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Département de Pharmacologie et Physiologie, Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute Research Centre, Université de Montréal, Montreal, Quebec, Canada.,Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Geoff Coombs
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Heart, Lung and Vascular Health, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Pascal Imbeault
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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RAVANELLI NICHOLAS, COOMBS GEOFFB, IMBEAULT PASCAL, JAY OLLIE. Maximum Skin Wettedness after Aerobic Training with and without Heat Acclimation. Med Sci Sports Exerc 2018; 50:299-307. [DOI: 10.1249/mss.0000000000001439] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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MacNeill AL, Bradley MT. Temperature effects on polygraph detection of concealed information. Psychophysiology 2015; 53:143-50. [PMID: 26435532 DOI: 10.1111/psyp.12557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/07/2015] [Indexed: 11/26/2022]
Abstract
Thermoregulatory influences on electrodermal and cardiovascular activity may interfere with the detection of concealed information using a polygraph. This possibility was assessed by means of a mock terrorism scenario. Seventy-two participants were assigned to either a guilty or an innocent role. They were given a polygraph test at one of three ambient temperatures: 10°C, 22°C, or 34°C. Among guilty participants, electrodermal and cardiovascular measures were least effective at 10°C. Electrodermal results were optimal at 22°C, whereas cardiovascular results were optimal at 34°C. Among innocent participants, the effectiveness of these same measures was not affected by ambient temperature. Temperature had no significant impact on respiration results within the guilty or the innocent groups. Taken together, these findings have implications for those who use polygraphs in uncontrolled testing environments.
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Affiliation(s)
- A Luke MacNeill
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
| | - M T Bradley
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
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16
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Lee JB, Kim TW, Min YK, Yang HM. Seasonal Acclimatization in Summer versus Winter to Changes in the Sweating Response during Passive Heating in Korean Young Adult Men. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2015; 19:9-14. [PMID: 25605991 PMCID: PMC4297766 DOI: 10.4196/kjpp.2015.19.1.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 12/14/2022]
Abstract
We investigated the sweating response during passive heating (partial submersion up to the umbilical line in 42±0.5℃ water, 30 min) after summer and winter seasonal acclimatization (SA). Testing was performed in July during the summer, 2011 [summer-SA; temp, 25.6±1.8℃; relative humidity (RH), 82.1±8.2%] and in January during the winter, 2012 (winter-SA; temp, -2.7±2.9℃; RH, 65.0±13.1%) in Cheonan (126°52'N, 33.38'E), Republic of Korea. All experiments were carried out in an automated climatic chamber (temp, 25.0±0.5℃: RH, 60.0±3.0%). Fifteen healthy men (age, 23.4±2.5 years; height, 175.0±5.9 cm; weight, 65.3±6.1 kg) participated in the study. Local sweat onset time was delayed during winter-SA compared to that after summer-SA (p< 0.001). Local sweat volume, whole body sweat volume, and evaporative loss volume decreased significantly after winter-SA compared to those after summer-SA (p<0.001). Changes in basal metabolic rate increased significantly after winter-SA (p< 0.001), and tympanic temperature and mean body temperature were significantly lower after summer-SA (p<0.05). In conclusion, central sudomotor acitivity becomes sensitive to summer-SA and blunt to winter-SA in Rebubic of Korea. These results suggest that the body adjusts its temperature by economically controlling the sweating rate but does not lower the thermal dissipation rate through a more effective evaporation scheme after summer-SA than that after winter-SA.
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Affiliation(s)
- Jeong-Beom Lee
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan 331-946, Korea
| | - Tae-Wook Kim
- Department of Health Care, Graduate School, Soonchunhyang University, Asan 336-745, Korea
| | - Young-Ki Min
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan 331-946, Korea
| | - Hun-Mo Yang
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan 331-946, Korea
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17
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Lee JB, Lee IH, Shin YO, Min YK, Yang HM. Age- and sex-related differences in sudomotor function evaluated by the quantitative sudomotor axon reflex test (QSART) in healthy humans. Clin Exp Pharmacol Physiol 2014; 41:392-9. [DOI: 10.1111/1440-1681.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/03/2014] [Accepted: 03/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Jeong Beom Lee
- Department of Physiology; College of Medicine; Soonchunhyang University; Cheonan Korea
| | - In Ho Lee
- Department of Physiology; College of Medicine; Soonchunhyang University; Cheonan Korea
| | - Young Oh Shin
- Department of Healthcare; Global Graduate School; Soonchunhyang University; Asan Korea
| | - Young Ki Min
- Department of Physiology; College of Medicine; Soonchunhyang University; Cheonan Korea
| | - Hun Mo Yang
- Department of Physiology; College of Medicine; Soonchunhyang University; Cheonan Korea
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18
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Abdoli-Eramaki M, Damecour C, Christenson J, Stevenson J. The effect of perspiration on the sEMG amplitude and power spectrum. J Electromyogr Kinesiol 2012; 22:908-13. [DOI: 10.1016/j.jelekin.2012.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 04/16/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022] Open
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Bechara FG, Georgas D, Sand M, Stücker M, Othlinghaus N, Altmeyer P, Gambichler T. Effects of a long-pulsed 800-nm diode laser on axillary hyperhidrosis: a randomized controlled half-side comparison study. Dermatol Surg 2012; 38:736-40. [PMID: 22273498 DOI: 10.1111/j.1524-4725.2012.02339.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Generally, axillary hyperhidrosis (AH) is treated with antiperspirant agents, botulinum toxin, or local surgery. The effect of laser treatment on sweat secretion in patients with AH has not been investigated. OBJECTIVE To evaluate the effect of diode laser epilation on the sweat rate of patients with AH. MATERIALS AND METHODS We performed a randomized half-side controlled trial. Twenty-one patients were treated with 5 cycles of an 800-nm diode laser. Sweat rates were documented using gravimetry and a visual analogue scale. Histologic examination was performed in all patients before and after treatment. RESULTS A significant reduction in sweat rate was observed on the laser-treated (median 89 mg/min, range 42-208 mg/min vs 48 mg/min, range 17-119 mg/min; p < .001) and the untreated contralateral (median 78 mg/min, range 25-220 mg/min vs median 65 mg/min, range 24-399 mg/min; p = .04) sides, although no significant difference was found between the treated and untreated sides (p = .10). CONCLUSION Although we observed a significant decrease in sweat rate on laser-treated sites, laser epilation was not able to reduce the sweat rate significantly more than on the untreated contralateral side. These results probably indicate a placebo effect rather than a direct therapeutic effect of laser epilation.
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Affiliation(s)
- Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany.
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