In vivo thermal conductivity of the human forearm tissues

Variations of skin thermal diffusivity on different skin regions

BACKGROUND AND OBJECTIVE

Skin thermal diffusivity plays a crucial role in various applications, including laser therapy and cryogenic skin cooling.This study investigates the correlation between skin thermal diffusivity and two important skin parameters, melanin content and erythema, in a cohort of 102 participants.

METHODS

An in-house developed device based on transient temperature measurement was used to assess thermal diffusivity at different body locations. Melanin content and erythema were measured using a colorimeter. Statistical analysis was performed to examine potential correlations.

RESULTS

The results showed that the measured thermal diffusivity values were consistent with previous reports, with variations observed among subjects. No significant correlation was found between thermal diffusivity and melanin content or erythema. This suggests that other factors, such as skin hydration or epidermis thickness, may have a more dominant influence on skin thermal properties.

CONLCUSION

This research provides valuable insights into the complex interplay between skin thermal properties and physiological parameters, with potential implications for cosmetic and clinical dermatology applications.

A 3-D virtual human model for simulating heat and cold stress

In this study, we extended our previously developed anatomically detailed three-dimensional (3-D) thermoregulatory virtual human model for predicting heat stress to allow for predictions of heat and cold stress in one unified model. Starting with the modified Pennes bioheat transfer equation to estimate the spatiotemporal temperature distribution within the body as the underlying modeling structure, we developed a new formulation to characterize the spatial variation of blood temperature between body elements and within the limbs. We also implemented the means to represent heat generated from shivering and skin blood flow that apply to air exposure and water immersion. Then, we performed simulations and validated the model predictions with experimental data from nine studies, representing a wide range of heat- and cold-stress conditions in air and water and physical activities. We observed excellent agreement between model predictions and measured data, with average root mean squared errors of 0.2°C for core temperature, 0.9°C for mean skin temperature, and 27 W for heat from shivering. We found that a spatially varying blood temperature profile within the limbs was crucial to accurately predict core body temperature changes during very cold exposures. Our 3-D thermoregulatory virtual human model consistently predicted the body's thermal state accurately for each of the simulated hot and cold environmental conditions and exertional heat stress. As such, it serves as a reliable tool to assess whole body, localized tissue, and, potentially, organ-specific injury risks, helping develop injury prevention and mitigation strategies in a systematic and expeditious manner.NEW & NOTEWORTHY This work provides a new, unified modeling framework to accurately predict the human body's thermal response to both heat and cold stress caused by environmental conditions and exertional physical activity in one mathematical model. We show that this 3-D anatomically detailed model accurately predicts the spatiotemporal temperature distribution in the body under extreme conditions for exposures to air and water and could be used to help design medical interventions and countermeasures to prevent injuries.

Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention

INTRODUCTION

Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation.

METHODS

Ten cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented.

RESULTS

The medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process.

DISCUSSION

A detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique.

Advances in thermal physiology of diving marine mammals: The dual role of peripheral perfusion

The ability to maintain a high core body temperature is a defining characteristic of all mammals, yet their diverse habitats present disparate thermal challenges that have led to specialized adaptations. Marine mammals inhabit a highly conductive environment. Their thermoregulatory capabilities far exceed our own despite having limited avenues of heat transfer. Additionally, marine mammals must balance their thermoregulatory demands with those associated with diving (i.e. oxygen conservation), both of which rely on cardiovascular adjustments. This review presents the progress and novel efforts in investigating marine mammal thermoregulation, with a particular focus on the role of peripheral perfusion. Early studies in marine mammal thermal physiology were primarily performed in the laboratory and provided foundational knowledge through in vivo experiments and ex vivo measurements. However, the ecological relevance of these findings remains unknown because comparable efforts on free-ranging animals have been limited. We demonstrate the utility of biologgers for studying their thermal adaptations in the context in which they evolved. Our preliminary results from freely diving northern elephant seals (Mirounga angustirostris) reveal blubber's dynamic nature and the complex interaction between thermoregulation and the dive response due to the dual role of peripheral perfusion. Further exploring the potential use of biologgers for measuring physiological variables relevant to thermal physiology in other marine mammal species will enhance our understanding of the relative importance of morphology, physiology, and behavior for thermoregulation and overall homeostasis.

Physiological costs of undocumented human migration across the southern United States border

[Figure: see text].

Physiological interactions with personal-protective clothing, physically demanding work and global warming: An Asia-Pacific perspective

The Asia-Pacific contains over half of the world's population, 21 countries have a Gross Domestic Product <25% of the world's largest economy, many countries have tropical climates and all suffer the impact of global warming. That 'perfect storm' exacerbates the risk of occupational heat illness, yet first responders must perform physically demanding work wearing personal-protective clothing and equipment. Unfortunately, the Eurocentric emphasis of past research has sometimes reduced its applicability to other ethnic groups. To redress that imbalance, relevant contemporary research has been reviewed, to which has been added information applicable to people of Asian, Melanesian and Polynesian ancestry. An epidemiological triad is used to identify the causal agents and host factors of work intolerance within hot-humid climates, commencing with the size dependency of resting metabolism and heat production accompanying load carriage, followed by a progression from the impact of single-layered clothing through to encapsulating ensembles. A morphological hypothesis is presented to account for inter-individual differences in heat production and heat loss, which seems to explain apparent ethnic- and gender-related differences in thermoregulation, at least within thermally compensable states. The mechanisms underlying work intolerance, cardiovascular insufficiency and heat illness are reviewed, along with epidemiological data from the Asia-Pacific. Finally, evidence-based preventative and treatment strategies are presented and updated concerning moisture-management fabrics and barriers, dehydration, pre- and post-exercise cooling, and heat adaptation. An extensive reference list is provided, with >25 recommendations enabling physiologists, occupational health specialists, policy makers, purchasing officers and manufacturers to rapidly extract interpretative outcomes pertinent to the Asia-Pacific.

In vivo skin thermophysical property testing technology using flexible thermosensor-based 3ω method

Thermophysical properties of human skin surface and subsurface can reflect the hydration state of the skin and the blood flow rate in the near surface microvessels, which reveals important physiological information related to dermatology and overall health status of human body. Although a few techniques have been developed to measure these signs, complicated devices are required and the subjects need to be completely fixed during the test period. Here, a flexible thermosensor-based 3ω technology was used to monitor thermal conductivity of human skins at different states. Through the analysis of these characteristics, the corresponding physiological state can be established, which can provide a new detection method for the evaluation or prediction of human health status.

Animal thermoregulation: a review of insulation, physiology and behaviour relevant to temperature control in buildings

Birds and mammals have evolved many thermal adaptations that are relevant to the bioinspired design of temperature control systems and energy management in buildings. Similar to many buildings, endothermic animals generate internal metabolic heat, are well insulated, regulate their temperature within set limits, modify microclimate and adjust thermal exchange with their environment. We review the major components of animal thermoregulation in endothermic birds and mammals that are pertinent to building engineering, in a world where climate is changing and reduction in energy use is needed. In animals, adjustment of insulation together with physiological and behavioural responses to changing environmental conditions fine-tune spatial and temporal regulation of body temperature, while also minimizing energy expenditure. These biological adaptations are characteristically flexible, allowing animals to alter their body temperatures to hourly, daily, or annual demands for energy. They exemplify how buildings could become more thermally reactive to meteorological fluctuations, capitalising on dynamic thermal materials and system properties. Based on this synthesis, we suggest that heat transfer modelling could be used to simulate these flexible biomimetic features and assess their success in reducing energy costs while maintaining thermal comfort for given building types.

Lost at sea: the medicine, physiology and psychology of prolonged immersion

In most countries, immersion represents the second most common cause of accidental death in children and the third in adults. Between 2010 and 2013, 561 deaths worldwide involving recreational divers were recorded by the Divers Alert Network. Consequently, there is no room for complacency when diving. Being lost at sea is a diver's worst nightmare. In 2006, a diver was lost at sea off the coast of New Zealand for 75 hours. It is unprecedented that, after such a long time immersed in temperate (16-17°C) waters, he was found and survived. His case is presented and utilised to illustrate the many physiological and psychological factors involved in prolonged immersion and what might determine survival under such circumstances. We also briefly review options for enhancing diver location at sea and a few issues related to search and rescue operations are discussed.

Cold Stress Effects on Exposure Tolerance and Exercise Performance

Cold weather can have deleterious effects on health, tolerance, and performance. This paper will review the physiological responses and external factors that impact cold tolerance and physical performance. Tolerance is defined as the ability to withstand cold stress with minimal changes in physiological strain. Physiological and pathophysiological responses to short-term (cold shock) and long-term cold water and air exposure are presented. Factors (habituation, anthropometry, sex, race, and fitness) that influence cold tolerance are also reviewed. The impact of cold exposure on physical performance, especially aerobic performance, has not been thoroughly studied. The few studies that have been done suggest that aerobic performance is degraded in cold environments. Potential physiological mechanisms (decreases in deep body and muscle temperature, cardiovascular, and metabolism) are discussed. Likewise, strength and power are also degraded during cold exposure, primarily through a decline in muscle temperature. The review also discusses the concept of thermoregulatory fatigue, a reduction in the thermal effector responses of shivering and vasoconstriction, as a result of multistressor factors, including exhaustive exercise.

Thermal transport characteristics of human skin measured in vivo using ultrathin conformal arrays of thermal sensors and actuators

Measurements of the thermal transport properties of the skin can reveal changes in physical and chemical states of relevance to dermatological health, skin structure and activity, thermoregulation and other aspects of human physiology. Existing methods for in vivo evaluations demand complex systems for laser heating and infrared thermography, or they require rigid, invasive probes; neither can apply to arbitrary regions of the body, offers modes for rapid spatial mapping, or enables continuous monitoring outside of laboratory settings. Here we describe human clinical studies using mechanically soft arrays of thermal actuators and sensors that laminate onto the skin to provide rapid, quantitative in vivo determination of both the thermal conductivity and thermal diffusivity, in a completely non-invasive manner. Comprehensive analysis of measurements on six different body locations of each of twenty-five human subjects reveal systematic variations and directional anisotropies in the characteristics, with correlations to the thicknesses of the epidermis (EP) and stratum corneum (SC) determined by optical coherence tomography, and to the water content assessed by electrical impedance based measurements. Multivariate statistical analysis establishes four distinct locations across the body that exhibit different physical properties: heel, cheek, palm, and wrist/volar forearm/dorsal forearm. The data also demonstrate that thermal transport correlates negatively with SC and EP thickness and positively with water content, with a strength of correlation that varies from region to region, e.g., stronger in the palmar than in the follicular regions.

Coronary stent as a tubular flow heater in magnetic resonance imaging

Background

A coronary stent is an artificial metallic tube, inserted into a blocked coronary artery to keep it open. In magnetic resonance imaging (MRI), a stented person is irradiated by the radio-frequency electromagnetic pulses, which induce eddy currents in the stent that produce Joule (resistive) heating. The stent in the vessel is acting like a tubular flow heater that increases the temperature of the vessel wall and the blood that flows through it, representing a potential hazard for the stented patient.

Methods

Heating of a metallic coronary stent in MRI was studied theoretically and experimentally. An analytical theoretical model of the stent as a tubular flow heater, based on the thermodynamic law of heat conduction, was developed. The model enables to calculate the time-dependent stent’s temperature during the MRI examination, the increase of the blood temperature passing through the stent and the distribution of the temperature in the vessel wall surrounding the stent. The model was tested experimentally by performing laboratory magnetic resonance heating experiments on a non-inserted stainless-steel coronary stent in the absence of blood flow through it. The model was then used to predict the temperature increase of the stainless-steel coronary stent embedded in a coronary artery in the presence of blood flow under realistic MRI conditions.

Results

The increase of the stent’s temperature and the blood temperature were found minute, of the order of several tenths of a degree, because the blood flow efficiently cools the stent due to a much larger heat capacity of the blood as compared to the heat capacity of the stent. However, should the stent in the vessel become partially re-occluded due to the restenosis problem, where the blood flow through the stent is reduced, the stent’s temperature may become dangerously high.

Conclusions

In the normal situation of a fully open (unoccluded) stent, the increase of the stent temperature and the blood temperature exiting the stent were found minute, of less than 1°C, so that the blood flow efficiently cools the stent. However, should the problem of restenosis occur, where the blood flow through the stent is reduced, there is a risk of hazardous heating.

Beyond the classic thermoneutral zone: Including thermal comfort

The thermoneutral zone is defined as the range of ambient temperatures where the body can maintain its core temperature solely through regulating dry heat loss, i.e., skin blood flow. A living body can only maintain its core temperature when heat production and heat loss are balanced. That means that heat transport from body core to skin must equal heat transport from skin to the environment. This study focuses on what combinations of core and skin temperature satisfy the biophysical requirements of being in the thermoneutral zone for humans. Moreover, consequences are considered of changes in insulation and adding restrictions such as thermal comfort (i.e. driver for thermal behavior). A biophysical model was developed that calculates heat transport within a body, taking into account metabolic heat production, tissue insulation, and heat distribution by blood flow and equates that to heat loss to the environment, considering skin temperature, ambient temperature and other physical parameters. The biophysical analysis shows that the steady-state ambient temperature range associated with the thermoneutral zone does not guarantee that the body is in thermal balance at basal metabolic rate per se. Instead, depending on the combination of core temperature, mean skin temperature and ambient temperature, the body may require significant increases in heat production or heat loss to maintain stable core temperature. Therefore, the definition of the thermoneutral zone might need to be reformulated. Furthermore, after adding restrictions on skin temperature for thermal comfort, the ambient temperature range associated with thermal comfort is smaller than the thermoneutral zone. This, assuming animals seek thermal comfort, suggests that thermal behavior may be initiated already before the boundaries of the thermoneutral zone are reached.

Measurement of the thermal conductivity of carbon nanotube--tissue phantom composites with the hot wire probe method

Developing combinatorial treatments involving laser irradiation and nanoparticles require an understanding of the effect of nanoparticle inclusion on tissue thermal properties, such as thermal conductivity. This information will permit a more accurate prediction of temperature distribution and tumor response following therapy, as well as provide additional information to aid in the selection of the appropriate type and concentration of nanoparticles. This study measured the thermal conductivity of tissue representative phantoms containing varying types and concentrations of carbon nanotubes (CNTs). Multi-walled carbon nanotubes (MWNTs, length of 900-1200 nm and diameter of 40-60 nm), single-walled carbon nanotubes (SWNTs, length of 900-1200 nm and diameter <2 nm), and a novel embodiment of SWNTs referred to as single-walled carbon nanohorns (SWNHs, length of 25-50 nm and diameter of 3-5 nm) of varying concentrations (0.1, 0.5, and 1.0 mg/mL) were uniformly dispersed in sodium alginate tissue representative phantoms. The thermal conductivity of phantoms containing CNTs was measured using a hot wire probe method. Increasing CNT concentration from 0 to 1.0 mg/mL caused the thermal conductivity of phantoms containing SWNTs, SWNHs, and MWNTs to increase by 24, 30, and 66%, respectively. For identical CNT concentrations, phantoms containing MWNTs possessed the highest thermal conductivity.

Lumped parameter thermal model for the study of vascular reactivity in the fingertip

Vascular reactivity (VR) denotes changes in volumetric blood flow in response to arterial occlusion. Current techniques to study VR rely on monitoring blood flow parameters and serve to predict the risk of future cardiovascular complications. Because tissue temperature is directly impacted by blood flow, a simplified thermal model was developed to study the alterations in fingertip temperature during arterial occlusion and subsequent reperfusion (hyperemia). This work shows that fingertip temperature variation during VR test can be used as a cost-effective alternative to blood perfusion monitoring. The model developed introduces a function to approximate the temporal alterations in blood volume during VR tests. Parametric studies are performed to analyze the effects of blood perfusion alterations, as well as any environmental contribution to fingertip temperature. Experiments were performed on eight healthy volunteers to study the thermal effect of 3 min of arterial occlusion and subsequent reperfusion (hyperemia). Fingertip temperature and heat flux were measured at the occluded and control fingers, and the finger blood perfusion was determined using venous occlusion plethysmography (VOP). The model was able to phenomenologically reproduce the experimental measurements. Significant variability was observed in the starting fingertip temperature and heat flux measurements among subjects. Difficulty in achieving thermal equilibration was observed, which indicates the important effect of initial temperature and thermal trend (i.e., vasoconstriction, vasodilatation, and oscillations).

Seasonal patterns of heat loss in wild bottlenose dolphins (Tursiops truncatus)

This study investigated patterns of heat loss in bottlenose dolphins (Tursiops truncatus) resident to Sarasota Bay, FL, USA, where water temperatures vary seasonally from 11 to 33 degrees C. Simultaneous measurements of heat flux (HF) and skin surface temperature were collected at the body wall and appendages of dolphins during health-monitoring events in summer (June 2002-2004) and winter (February 2003-2005). Integument thickness was measured and whole body conductance (W/m(2) degrees C) was estimated using HF and colonic temperature measurements. Across seasons, HF values were similar at the appendages, but their distribution differed significantly at the flipper and fluke. In summer, these appendages displayed uniformly high values, while in winter they most frequently displayed very low HF values with a few high HF values. In winter, blubber thickness was significantly greater and estimated conductance significantly lower, than in summer. These results suggest that dolphins attempt to conserve heat in winter. In winter, though, HF values across the body wall were similar to (flank) or greater than (caudal keel) summer values. It is likely that higher winter HF values are due to the steep temperature gradient between the body core and colder winter water, which may limit the dolphin's ability to decrease heat loss across the body wall.

New circulating-water devices warm more quickly than forced-air in volunteers

BACKGROUND

Newer circulating-water systems supply more heat than forced-air, mainly because the heat capacity of water is much greater than for that of dry warm air and, in part, because they provide posterior as well as anterior heating. Several heating systems are available, but three major ones have yet to be compared directly. We therefore compared two circulating-water systems with a forced-air system during simulation of upper abdominal or chest surgery in volunteers.

METHODS

Seven healthy volunteers participated on three separate study days. Each day, they were anesthetized and cooled to a core temperature near 34 degrees C, which was maintained for 45-60 min. They were then rewarmed with one of three warming systems until distal esophageal core temperature reached 36 degrees C or anesthesia had lasted 8 h. The warming systems were 1) energy transfer pads (two split torso pads and two universal pads; Kimberly Clark, Roswell, GA); 2) circulating-water garment (Allon MTRE 3365 for cardiac surgery, Akiva, Israel); and 3) lower body forced-air warming (Bair Hugger #525, #750 blower, Eden Prairie, MN). Data are presented as mean +/- sd; P < 0.05 was statistically significant.

RESULTS

The rate of increase of core temperature from 34 degrees C to 36 degrees C was 1.2 degrees C +/- 0.2 degrees C/h with the Kimberly Clark system, 0.9 degrees C +/- 0.2 degrees C/h with the Allon system, and 0.6 degrees C +/- 0.1 degrees C/h with the Bair Hugger (P = 0.002).

CONCLUSIONS

The warming rate with the Kimberly Clark system was 25% faster than with the Allon system and twice as fast as with the Bair Hugger. Both circulating-water systems thus warmed hypothermic volunteers in significantly less time than the forced-air system.

Self-rescue swimming in cold water: the latest advice

According to the 2006 Canadian Red Cross Drowning Report, 2007 persons died of cold-water immersion in Canada between 1991 and 2000. These statistics indicate that prevention of cold-water immersion fatalities is a significant public health issue for Canadians. What should a person do after accidental immersion in cold water? For a long time, aquatic safety organizations and government agencies stated that swimming should not be attempted, even when a personal flotation device (PFD) is worn. The objective of the present paper is to present the recent scientific evidence making swimming a viable option for self-rescue during accidental cold-water immersion. Early studies in the 1960s and 1970s led to a general conclusion that "people are better off if they float still in lifejackets or hang on to wreckage and do not swim about to try to keep warm". Recent evidence from the literature shows that the initial factors identified as being responsible for swimming failure can be either easily overcome or are not likely the primary contributors to swimming failure. Studies over the last decade reported that swimming failure might primarily be related not to general hypothermia, but rather to muscle fatigue of the arms as a consequence of arm cooling. This is based on the general observation that swimming failure developed earlier than did systemic hypothermia, and can be related to low temperature of the arm muscles following swimming in cold water. All of the above studies conducted in water between 10 and 14 degrees C indicate that people can swim in cold water for a distance ranging between about 800 and 1500 m before being incapacitated by the cold. The average swimming duration for the studies was about 47 min before incapacitation, regardless of the swimming ability of the subjects. Recent evidence shows that people have a very accurate idea about how long it will take them to achieve a given swimming goal despite a 3-fold overestimation of the absolute distance to swim. The subjects were quite astute at deciding their swimming strategy early in the immersion with 86% success, but after about 30 min of swimming or passive cooling, their decision-making ability became impaired. It would therefore seem wise to make one's accidental immersion survival plan early during the immersion, directly after cessation of the cold shock responses. Additional recommendations for self-rescue are provided based on recent scientific evidence.

American College of Sports Medicine position stand: prevention of cold injuries during exercise

It is the position of the American College of Sports Medicine that exercise can be performed safely in most cold-weather environments without incurring cold-weather injuries. The key to prevention is use of a comprehensive risk management strategy that: a) identifies/assesses the cold hazard; b) identifies/assesses contributing factors for cold-weather injuries; c) develops controls to mitigate cold stress/strain; d) implements controls into formal plans; and e) utilizes administrative oversight to ensure controls are enforced or modified. The American College of Sports Medicine recommends that: 1) coaches/athletes/medical personnel know the signs/symptoms and risk factors for hypothermia, frostbite, and non-freezing cold injuries, identify individuals susceptible to cold injuries, and have the latest up-to-date information about current and future weather conditions before conducting training sessions or competitions; 2) cold-weather clothing be chosen based on each individual's requirements and that standardized clothing ensembles not be mandated for entire groups; 3) the wind-chill temperature index be used to estimate the relative risk of frostbite and that heightened surveillance of exercisers be used at wind-chill temperatures below -27 degrees C (-18 degrees F); and 4) individuals with asthma and cardiovascular disease can exercise in cold environments, but should be monitored closely.

Responses to mild cold stress are predicted by different individual characteristics in young and older subjects

Older individuals' ability to maintain core temperature during cold stress is impaired; however, the relative importance of individual characteristics that influence this response are unknown. The purpose of this study was to determine the relative influence of individual characteristics on core temperature and tissue insulation (I(t)) during mild cold stress. Forty-two young (23 +/- 1 yr, range 18-30 yr) and 46 older (71 +/- 1 yr, range 65-89 yr) subjects, varying widely in muscularity, adiposity, and body size, underwent a transient cooling protocol during which esophageal temperature (T(es)) was measured continuously and I(t) was calculated using standard equations. Multiple-regression analyses were performed to determine predictors of T(es) and I(t), and standardized regression coefficients were analyzed to determine the relative influence of each predictor. Candidate predictors included age, sex, weight, body surface area, body surface area-to-mass ratio, sum of skinfolds, percent fat, appendicular skeletal muscle mass, and thyroid hormone concentrations (triiodothyronine, thyronine). The sum of skinfolds explained 67% (P < 0.01) of the T(es) variance in young subjects vs. 2% (P = 0.30) in older subjects. Conversely, appendicular skeletal muscle mass explained a greater portion of the variance in older subjects for both T(es) (older: 28%, P < 0.01; young: 8%, not significant) and I(t) (older: 46%, P < 0.01; young: 17%, P < 0.01). The T(es) residual variance was considerably larger in older subjects (59-72% vs. 14-42% in young subjects), possibly due to varying rates of physiological aging. These results suggest that the relative influence of individual characteristics changes with aging.

Effects of a thermal-insulating mouse pad on temperature of forearm and hand during computer tasks

This laboratory experiment studied the effects of a thermal-insulating mouse pad on arm temperature and comfort during computer work. Fourteen subjects performed two 20-min computer tasks (a mouse task and a combined task alternating keyboard and mouse use), under three conditions, namely with: 1) a thermal-insulating pad; 2) a placebo pad; 3) no pad (desktop). The temperatures of the forearm, wrist, hand and fingers were measured with four thermocouples. Comfort and discomfort were determined by two visual analogue scales. No arm temperature differences were found between the experimental conditions after performing the combination task in any location. After the mouse task, however, arm temperature decreased significantly less with the thermal-insulating mouse pad than with the placebo pad. The thermal-insulating pad was rated as more comfortable and less uncomfortable than a regular desktop during mouse tasks. A large size is recommended for the thermal-insulating pad.

What is known about temperature and complaints in the upper extremity? A systematic review in the VDU work environment

Upper extremity musculoskeletal complaints and disorders are frequently reported among visual display units (VDU) workers. These complaints include cold forearms, hands or fingers.

OBJECTIVE

The aim of this systematic review was to gain an insight into the relationship between objective and subjective temperature decrease and musculoskeletal disorders (MSDs) in the upper extremity in a VDU work environment by (internal or external) cooling of the arm and hand. Two questions were formulated: (1) Is a VDU work environment (temperature between 15 and 25 degrees C) associated with temperature decrease of the arm, hand or fingers in healthy subjects? (2) Is there a difference in arm, hand and finger temperature between patients with upper extremity MSDs and healthy subjects in a VDU work environment?

METHODS

Through a systematic literature search in six databases between 1989 and October 2005, 327 articles were retrieved and 17 included.

RESULTS

Forearm, hand and finger temperature significantly decreases when the ambient temperature (between 15 and 25 degrees C) decreases. The skin temperature in the hand that uses a computer mouse is lower than the other hand in the same ambient temperature. At baseline, no objective temperature differences are found between patient groups and controls, whereas in patients with cold hand complaints, lower skin temperatures are found compared to controls. The association between temperature (changes) in the forearm, hand or fingers during VDU work, and MSDs in the upper extremity is not clear.

CONCLUSION

There is no consistent evidence available for the association between upper extremity MSDs and temperature changes in forearm, hand or fingers in an office work environment.

Local heating of human skin by millimeter waves: Effect of blood flow

We investigated the influence of blood perfusion on local heating of the forearm and middle finger skin following 42.25 GHz exposure with an open ended waveguide (WG) and with a YAV mm wave therapeutic device. Both sources had bell-shaped distributions of the incident power density (IPD) with peak intensities of 208 and 55 mW/cm(2), respectively. Blood perfusion was changed in two ways: by blood flow occlusion and by externally applied vasodilator (nonivamide/nicoboxil) cream to the skin. For thermal modeling, we used the bioheat transfer equation (BHTE) and the hybrid bioheat equation (HBHE) which combines the BHTE and the scalar effective thermal conductivity equation (ETCE). Under normal conditions with the 208 mW/cm(2) exposure, the cutaneous temperature elevation (DeltaT) in the finger (2.5 +/- 0.3 degrees C) having higher blood flow was notably smaller than the cutaneous DeltaT in the forearm (4.7 +/- 0.4 degrees C). However, heating of the forearm and finger skin with blood flow occluded was the same, indicating that the thermal conductivity of tissue in the absence of blood flow at both locations was also the same. The BHTE accurately predicted local hyperthermia in the forearm only at low blood flow. The HBHE made accurate predictions at both low and high perfusion rates. The relationship between blood flow and the effective thermal conductivity (k(eff)) was found to be linear. The heat dissipating effect of higher perfusion was mostly due to an apparent increase in k(eff). It was shown that mm wave exposure could result in steady state heating of tissue layers located much deeper than the penetration depth (0.56 mm). The surface DeltaT and heat penetration into tissue increased with enlarging the irradiating beam area and with increasing exposure duration. Thus, mm waves at sufficient intensities could thermally affect thermo-sensitive structures located in the skin and underlying tissue.

Diffuse Electrical Injury: A Study of 89 Subjects Reporting Long-Term Symptomatology That is Remote to the Theoretical Current Pathway

Historically, tissue damage from electrical contact was thought to arise from resistive heating of tissues along the current pathway. The modern view has accepted that tissue damage can result from cellular rupture (electroporation) induced by the presence of an electric field. There remain electrical injuries that defy explanation by either theory. In rare electrical contacts, diffuse symptomatology arises that is neither proportionate to the electrical contact nor does it occur along the theoretical linear pathway of the current from entry point to exit point. Disproportionate, remote electrical injury is most notable when the contact voltage is low (120 and 240 V). Symptoms occur, absent diagnostic evidence, that defy explanation as organic injury. A Web-based interactive survey was used to locate and query individuals suffering from rarely occurring responses to electrical contact. The results of the study suggest that there is a common symptomatology that is neither linked to voltage nor loss of consciousness at the time of contact.

Effect of water temperature on cooling efficiency during hyperthermia in humans

We evaluated the cooling rate of hyperthermic subjects, as measured by rectal temperature (T(re)), during immersion in a range of water temperatures. On 4 separate days, seven subjects (4 men, 3 women) exercised at 65% maximal oxygen consumption at an ambient temperature of 39 degrees C until T(re) increased to 40 degrees C (45.4 +/- 4.1 min). After exercise, the subjects were immersed in a circulated water bath controlled at 2, 8, 14, or 20 degrees C until T(re) returned to 37.5 degrees C. No difference in cooling rate was observed between the immersions at 8, 14, and 20 degrees C despite the differences in the skin surface-to-water temperature gradient, possibly because of the presence of shivering at 8 and 14 degrees C. Compared with the other conditions, however, the rate of cooling (0.35 +/- 0.14 degrees C/min) was significantly greater during the 2 degrees C water immersion, in which shivering was seldom observed. This rate was almost twice as much as the other conditions (P < 0.05). Our results suggest that 2 degrees C water is the most effective immersion treatment for exercise-induced hyperthermia.

Ultra-sound imaging for precision implantation of a multi sensor temperature probe in skeletal muscle tissue

A technique for implanting multi sensor temperature probes in muscle tissue was developed to optimize the accuracy of the tissue temperature measurements and the internal localization of the probe. Real time ultra-sound imaging was used to (a) determine the best perpendicular insertion tract, (b) guide the insertion of the probe in order to avoid major blood vessels, and (c) verify the insertion point relative to discernable anatomic reference structures such as arteries and bone.

Insufficiency in a new temporal-artery thermometer for adult and pediatric patients

SensorTouch is a new noninvasive temperature monitor and consists of an infrared scanner that detects the highest temperature on the skin of the forehead, presumably over the temporal artery. The device estimates core temperature (T(core)). We tested the hypothesis that the SensorTouch is sufficiently precise and accurate for routine clinical use. We studied adults (n = 15) and children (n = 16) who developed mild fever, a core temperature of at least 37.8 degrees C, after cardiopulmonary bypass. Temperature was recorded at 15-min intervals throughout recovery with the SensorTouch thermometer and from the pulmonary artery (adults) or bladder (children). Pulmonary artery (T(core)) and SensorTouch (T(st)) temperatures correlated poorly in adults: T(core) = 0.7. T(st) + 13, r(2) = 0.3. Infrared and pulmonary artery temperatures differed by 1.3 +/- 0.6 degrees C; 89% of the adult temperatures thus differed by more than 0.5 degrees C. Bladder and infrared temperatures correlated somewhat better in pediatric patients: T(core) = 0.9. T(st) + 12, r(2) = 0.6. Infrared and bladder temperatures in children differed by only 0.3 degrees C, but the SD of the difference was 0.5 degrees C. Thus, 31% of the values in the infants and children differed by more than 0.5 degrees C.

IMPLICATIONS

We evaluated a noninvasive infrared forehead thermometer (SensorTouch) in adult and pediatric cardiac patients. Accuracy was poor in the adults and suboptimal in infants and children.

Non-invasive temperature imaging of muscles with magnetic resonance imaging using spin-echo sequences

The application of spin-echo magnetic resonance imaging sequences on non-invasive temperature imaging for temperature mapping of human limbs is investigated. In an in vitro experiment performed on a meat sample, the equilibrium magnetisation P and the spin-lattice relaxation time T1 are calculated from the values for the repetition time TR and the signal intensities obtained by a spin-echo sequence at different tissue temperatures as measured by a fibre-optic probe. T1 is linearly correlated to the tissue temperature, and P is linearly correlated to the reciprocal value of the absolute temperature. Both effects, taken together, lead to a non-linear dependency of the signal intensity on temperature. Therefore a TR leading to maximum temperature dependency of the signal intensity is calculated and used in the further experiments. In the in vivo experiments, the lower legs of two volunteers are cooled from outside. Images are acquired with a spin-echo sequence (1.5 T, TR = 1200 ms, TE = 10 ms). A rise in signal intensity in the muscle with falling skin temperature is observed, particularly in more peripheral muscle layers. This study shows that spin-echo sequences can be used to monitor temperature changes and temperature differences in living muscle tissue.

The effect of postural changes on body temperatures and heat balance

Early studies have demonstrated that rectal temperature (T(re)) decreases and mean skin temperature (Tsk) increases in subjects changing their posture from standing to supine, and vice versa. Such changes have important implications insofar as thermal stress experiments are conducted and interpreted. However, the extent of these changes between steady-state conditions is not known. In addition, it is not known whether thermal balance is also affected by postural changes. To examine these questions, 11 healthy males were exposed to a thermoneutral air environment (28.2-28.5 degrees C and 40% relative humidity) in various postures at rest. Body temperatures, heat losses, and metabolic rate were measured. Subjects wore shorts only and began in an upright posture (standing or sitting at an inclination of 7.5 degrees) on a customized tilt-table. They were tilted twice, once into a supine position and then back to the original upright position. Each tilt occurred after steady state was satisfied based on the subject's circadian variation of T(re) determined previously in a 4.25 h control supine trial. Times to supine steady state following the first tilt were [mean(SE)] 92.6 (6.4) and 116.6 (5.1) min for the standing and sitting trials, respectively. Times to upright steady state following the second tilt were 107.9 (11.4) and 124.1 (9.0) min. Mean steady-state T(re) and Tsk were 36.87 (0.07) and 34.04 (0.14), 37.47 (0.09) and 33.48 (0.14), and 37.26 (0.05) and 33.49 (0.10) degrees C for supine, standing, and sitting, respectively. Thermal balance was attained in all steady-state conditions, and allowing for a decrease in the weighting factor of T(re) for mean body temperature in the upright postures, it also appears that thermal balance was preserved between changes in posture. These results are consistent with no perceived changes by the subjects in their thermal comfort and skin wetness.

The etiology and management of inadvertent perioperative hypothermia

Mild perioperative hypothermia is a frequent complication of anesthesia and surgery. Core temperature should be monitored during general anesthesia and during regional anesthesia for large operations. Reliable sites of core temperature monitoring include the tympanic membrane, nasopharynx, esophagus, bladder, rectum, and pulmonary artery. The skin surface is not an acceptable site for monitoring core temperature. Anesthetic-induced vasodilation initially rapidly decreases core temperature secondary to an internal redistribution of heat rather than an increased heat loss to the environment. Both general and regional anesthetics impair thermoregulation, increasing the interthreshold range; that is, the range of core temperatures over which no autonomic response to cold or warmth occurs. Preinduction skin surface warming is the only means to prevent this initial redistribution hypothermia. Forced-air warming is the most effective method of rewarming hypothermic patients intraoperatively.

Morphometric influences on intraoperative core temperature changes

Intraoperative core hypothermia develops in three characteristic phases: 1) core-to-peripheral redistribution of body heat that is most prominent during the first hour after induction of anesthesia; 2) subsequent slow linear decrease in core temperature resulting largely from heat loss exceeding metabolic heat production; and 3) core temperature plateau resulting when thermoregulatory vasoconstriction decreases cutaneous heat loss and constrains metabolic heat to the core thermal compartment. Accordingly, we tested the hypotheses that: 1) core cooling does not depend on body fat (BF) or the ratio of weight-to-surface area (Wt/SA) during the initial redistribution phase; 2) the core cooling phase; 2) the core cooling rate is a function of the Wt/SA ratio during the second phase; and 3) the rate of core cooling during the plateau phase (after vasoconstriction) will be determined by the percentage of BF. In 40 patients undergoing elective colon surgery, the amount of redistribution hypothermia was inversely proportional to the percentage of BF (delta TC = 0.034.BF-2.2, r2 = 0.63) and the Wt/SA ratio (delta TC = 0.052.Wt/SA-3.35, r2 = 0.66). The core cooled linearly during the second phase, and the cooling rate was inversely proportional to the Wt/SA ratio (rate = 0.035.(Wt/SA)-2.2, r2 = 0.29). Thermoregulatory vasoconstriction was effective in virtually all patients independent of their morphology, and produced a four-fold reduction in the core cooling rate. These results indicate that patient morphometric characteristics substantially influence intraoperative core temperature changes, and that the effect depends on the hypothermia phase.

Effects of acclimatization to cold baths on men's responses to whole-body cooling in air

The purpose of this study was to investigate the thermoregulatory mechanisms underlying artificial acclimatization to cold and to compare them with those of naturally acclimatized men. Six white men were cooled, nude, in air at 10 degrees C for 2 h before and after they had been acclimatized by ten daily cold (15 degrees C) baths of 30-60 min followed by rapid rewarming in hot (38-42 degrees C) water, and again 4 months later after acclimatization had decayed. Six control subjects also underwent the same tests, providing an opportunity to discriminate between changes caused by the immersions and those caused by extraneous influences. Acclimatization significantly reduced heat production and heat loss (P < 0.05) but did not change heat debt. The reduced heat production was accompanied by reductions in shivering (P < 0.10) and in cold-induced muscle tenseness; no evidence of nonshivering thermogenesis or active brown fat was found. These findings are attributed to increased tissue insulation, mediated by an enhanced vascular response to cold that did not involve the cutaneous circulation and was probably located in skeletal muscle. Thermal sensation and discomfort did not change, although perceived strain tended to increase (P = 0.08). Acclimatization was accompanied by, but was unrelated to, slower cooling of the finger and toe. The main conclusions, and many specific findings, agree with those of two previous studies made by the same techniques in naturally acclimatized men wintering in Antarctica. Other significant findings included changes--in particular reduced thermoneutral rectal temperature and a delayed onset of shivering--that are commonly regarded as evidence of acclimatization but were in fact unrelated to it as they also occurred in the control group. They are attributed to extraneous influences, in particular the relaxation of heightened arousal ('first-time effects') found in the baseline tests.

Simultaneous temperature and regional blood volume measurements in human muscle using an MRI fast diffusion technique

The thermal dependence of the translational diffusion coefficient and of the regional blood volume was investigated in vivo by using a special MR pulsed gradient technique with reduced sensitivity to bulk tissue motion. Measurements were done at 0.5 T, using a small gradient insert. The diffusion coefficient of muscle water was calibrated against thermocouple-measured temperature in vitro, both with the muscle fibers parallel and perpendicular to the diffusion gradient. The maximum muscle temperature variation obtained by percutaneous conduction was -8.8 +/- 1.6 degrees C under cooling and +3.7 +/- 1.6 degrees C under heating, from basal state. Simultaneously the fractional regional blood volume decreased by a factor of 3.5 under cooling and increased by a factor of 2.7 under heating. Due to the interdependence of microcirculation and tissue temperature, this technique may be used to follow heat production or deposition in living tissue (muscle exercise, electromagnetic irradiation, etc.).

Thermal responses of men and women during cold-water immersion: influence of exercise intensity

The influence of exercise intensity on thermoregulation was studied in 8 men and 8 women volunteers during three levels of arm-leg exercise (level I: 700 ml oxygen (O2).min-1; level II: 1250 ml O2.min-1; level III: 1700 ml O2.min-1) for 1 h in water at 20 and 28 degrees C (Tw). For the men in Tw 28 degrees C the rectal temperature (Tre) fell 0.79 degree C (P less than 0.05) during immersion in both rest and level-I exercise. With level-II exercise a drop in Tre of 0.54 degree C (P less than 0.05) was noted, while at level-III exercise Tre did not change from the pre-immersion value. At Tw of 20 degrees C, Tre fell throughout immersion with no significant difference in final Tre observed between rest and any exercise level. For the women at rest at Tw 28 degrees C, Tre fell 0.80 degree C (P less than 0.05) below the pre-immersion value. With the two more intense levels of exercise Tre did not decrease during immersion. In Tw 20 degrees C, the women maintained higher Tre (P less than 0.05) during level-II and level-III exercise compared to rest and exercise at level I. The Tre responses were related to changes in tissue insulation (I(t)) between rest and exercise with the largest reductions in I(t) noted between rest and level-I exercise across Tw and gender. For mean and women of similar percentage body fat, decreases in Tre were greater for the women at rest and level-I exercise in Tw 20 degrees C (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Forearm temperature profile during the transient phase of thermal stress

The transient temperature response of the resting human forearm immersed in water at temperatures (Tw) ranging from 15 to 36 degrees C was investigated. Tissue temperature (Tt) was continuously monitored by a calibrated multicouple probe during the 3-h immersions. Tt was measured every 5 mm, from the longitudinal axis of the forearm to the skin surface. Skin temperature, rectal temperature, and blood flow (Q) were also measured during the immersions. The maximum rate of change of the forearm mean tissue temperature (Tt, max) occurred during the first 5 min of the immersion. Tt, max was linearly dependent on Tw (P less than 0.001), with mean values (SEM) ranging from -0.8 (0.1) degrees C.min-1 at 15 degrees C to 0.2 (0.1) degrees C.min-1 at 36 degrees C. The maximum rate of change of compartment mean temperature was dependent (P less than 0.001) on the radial distance from the longitudinal axis of the forearm. The half-time for thermal steady state of the forearm mean tissue temperature was linearly dependent on Tw between 30 and 36 degrees C (P less than 0.01), with mean values (SEM) ranging from 15.6 (0.6) min at 30 degrees C to 9.7 (1.2) min at 36 degrees C and not different between 15 and 30 degrees C, averaging 16.2 (0.6) min. There was a significant linear relationship between the half-time for thermal steady-state of the compartment mean temperature and the radial distance from the longitudinal axis of the forearm for each value of Tw tested (P less than 0.001). The data of the present study suggest that the forearm Q is an important determinant of the transient thermal response of the forearm tissue during thermal stress.