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Xie J, Wang L, Xu Y, Ma Y, Zhang L, Yin W, Huang Y. Exertional heat stroke-induced changes in gut microbiota cause cognitive impairment in mice. BMC Microbiol 2024; 24:134. [PMID: 38654189 DOI: 10.1186/s12866-024-03276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The incidence of exertional heat stroke (EHS) escalates during periods of elevated temperatures, potentially leading to persistent cognitive impairment postrecovery. Currently, effective prophylactic or therapeutic measures against EHS are nonexistent. METHODS The selection of days 14 and 23 postinduction for detailed examination was guided by TEM of neuronal cells and HE staining of intestinal villi and the hippocampal regions. Fecal specimens from the ileum and cecum at these designated times were analyzed for changes in gut microbiota and metabolic products. Bioinformatic analyses facilitated the identification of pivotal microbial species and metabolites. The influence of supplementing these identified microorganisms on behavioral outcomes and the expression of functional proteins within the hippocampus was subsequently assessed. RESULTS TEM analyses of neurons, coupled with HE staining of intestinal villi and the hippocampal region, indicated substantial recovery in intestinal morphology and neuronal injury on Day 14, indicating this time point for subsequent microbial and metabolomic analyses. Notably, a reduction in the Lactobacillaceae family, particularly Lactobacillus murinus, was observed. Functional annotation of 16S rDNA sequences suggested diminished lipid metabolism and glycan biosynthesis and metabolism in EHS models. Mice receiving this intervention (EHS + probiotics group) exhibited markedly reduced cognitive impairment and increased expression of BDNF/TrKB pathway molecules in the hippocampus during behavioral assessment on Day 28. CONCLUSION Probiotic supplementation, specifically with Lactobacillus spp., appears to mitigate EHS-induced cognitive impairment, potentially through the modulation of the BDNF/TrKB signaling pathway within the hippocampus, illustrating the therapeutic potential of targeting the gut-brain axis.
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Affiliation(s)
- Jiangang Xie
- Department of Interventional Vascular, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi Province, 710018, China
| | - Linxiao Wang
- College of Life Sciences, Northwest University, Xi'an, 710127, China
| | - Yunyun Xu
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, 710000, China
| | - Yuexiang Ma
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, 710000, China
| | - Lingqin Zhang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, 710000, China
| | - Wen Yin
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, 710000, China.
| | - Yang Huang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, 710000, China.
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Feng L, Yin JY, Liu YH, Zhang P, Zhao YL, Song Q, Ping P, Fu SH. N-terminal pro-brain natriuretic peptide - a significant biomarker of disease development and adverse prognosis in patients with exertional heat stroke. Mil Med Res 2024; 11:26. [PMID: 38654334 PMCID: PMC11036771 DOI: 10.1186/s40779-024-00531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China
| | - Jian-Yuan Yin
- Department of Critical Care, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China
| | - Yao-Hong Liu
- Department of Anesthesiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China
| | - Pei Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China
| | - Ya-Li Zhao
- Central Laboratory, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China.
| | - Qing Song
- Heatstroke Treatment and Research Center of Chinese PLA, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China.
| | - Ping Ping
- General Station for Drug and Instrument Supervision and Control, Joint Logistic Support Force of Chinese PLA, Beijing, 100076, China.
| | - Shi-Hui Fu
- Department of Cardiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan, China.
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, 100853, China.
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Mikacic M, Begovic TI, Jerkovic I, Batinic MM, Kovacic V. Severe rhabdomyolysis after exertional heat stroke treated with a hemoadsorber CytoSorb: lesson for the clinical nephrologist ®. J Nephrol 2024:10.1007/s40620-024-01918-7. [PMID: 38512381 DOI: 10.1007/s40620-024-01918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/28/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Marijana Mikacic
- Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, Internal Medicine Department, University of Split School of Medicine, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia
| | - Tanja Ilic Begovic
- Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, Internal Medicine Department, University of Split School of Medicine, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia
| | - Ivan Jerkovic
- Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, Internal Medicine Department, University of Split School of Medicine, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia
| | - Marina Maras Batinic
- Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, Internal Medicine Department, University of Split School of Medicine, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia
| | - Vedran Kovacic
- Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, Internal Medicine Department, University of Split School of Medicine, University Hospital of Split, Spinciceva 1, 21000, Split, Croatia.
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Wang X, Shang X, Li X, Liu S, Lai B, Ma L, Sun Y, Ma L, Ning B, Li Y, Wang Q. Phase-change material cooling blanket: A feasible cooling choice during transport after exercise-induced hyperthermia. J Therm Biol 2023; 114:103576. [PMID: 37344017 DOI: 10.1016/j.jtherbio.2023.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Exercise-induced hyperthermia preceding the onset of exertional heatstroke requires a rapid reduction in the body core temperature (Tcore) to ensure safety. In recent years, phase-change material (PCM) cooling devices have been increasingly used for rapid cooling after hyperthermia due to their superior capacity for heat absorption. OBJECTIVES This study aimed to evaluate the cooling performance and effectiveness of a PCM cooling blanket on heart rate (HR) and heart rate variability (HRV) recovery after exercise-induced hyperthermia. DESIGN Randomized cross-over. METHODS The study participants were 12 male volunteers who were engaged in professional training and completed an endurance exercise for approximately 30 min in a hot and humid environment (temperature ≈ 30 °C; relative humidity ≈ 66%). The participants underwent a 30-min cooling trial after exercise, receiving either treatment with a PCM cooling blanket (PCM group) or natural cooling (CON group). The Tcore, HR, and HRV time-domain indices were used for analysis. RESULTS The Tcore values were significantly lower in the PCM group during cooling. Reductions in the Tcore from precooling to 20 min of cooling were significantly greater in the PCM group than in the CON group. The HR in the PCM group was lower than that recorded in the CON group at 10 and 20 min of cooling. The reduction in HR during cooling from precooling was also significantly greater in the PCM group. HRV time-domain indices during cooling in the PCM group were significantly lower compared with the CON group while elevations in some HRV time-domain indices from precooling to postcooling were significantly greater in the PCM group than in the CON group. CONCLUSIONS The PCM cooling blanket had good cooling performance and the ability to hasten recovery of both HR and HRV. It may serve as a feasible cooling choice during transport after exercise-induced hyperthermia.
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Affiliation(s)
- Xin Wang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Xueyi Shang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Xin Li
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Shuyuan Liu
- Emergency Department, The Sixth Medical Center of Chinese PLA General Hospital, No.6 of Fucheng Road, Beijing, 100048, China
| | - Bin Lai
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Lizhi Ma
- Department of Medical Risk Management, The Third Medical Center of Chinese PLA General Hospital, No. 69 of Yongding Road, Beijing, 100039, China
| | - Ying Sun
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Lan Ma
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Bo Ning
- Department of Intensive Care Unit, Air Force Medical Center of China, No.30 of Fucheng Road, Beijing, 100142, China
| | - Yan Li
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Qian Wang
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China.
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Klous L, van Diemen F, Ruijs S, Gerrett N, Daanen H, de Weerd M, Veenstra B, Levels K. Efficiency of three cooling methods for hyperthermic military personnel linked to water availability. Appl Ergon 2022; 102:103700. [PMID: 35231652 DOI: 10.1016/j.apergo.2022.103700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Three feasible cooling methods for treatment of hyperthermic individuals in the military, that differed considerably in water volume needed (none to ~80 L), were evaluated. METHODS Ten male soldiers were cooled following exercise-induced hyperthermia (rectal temperature (Tre) ∼39.5 °C) using ventilation by fanning (1.7 m s-1), ventilation by fanning (1.7 m s-1) while wearing a wet t-shirt (250 mL-27 °C water) and tarp assisted cooling with oscillations (80 L of 27.2 ± 0.5 °C water; TACO). RESULTS Cooling rates were higher using TACO (0.116 ± 0.032 °C min-1) compared to ventilation (0.065 ± 0.011 °C min-1, P<0.001) and ventilation in combination with a wet t-shirt (0.074 ± 0.020 °C min-1, P=0.002). Time to cool (TTC) to Tre=38.2 °C for TACO was shorter (14 ± 4 min) compared to ventilation only (20 ± 5 min; P=0.018), but not to ventilation while wearing a wet t-shirt (18 ± 6 min; P=0.090). CONCLUSIONS TACO may be an acceptable, efficient and feasible cooling method in case of exertional heat stroke. However, in case of limited water availability, transportat should be prioritized, and cooling of any form should be implemented while waiting for and during transport.
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Affiliation(s)
- Lisa Klous
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Netherlands Organization for Applied Scientific Research (TNO), Department of Human Performance, Unit Defence, Safety and Security, Soesterberg, The Netherlands
| | - Femke van Diemen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Silke Ruijs
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Nicola Gerrett
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Gentherm Inc., Michigan, USA
| | - Hein Daanen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Marijne de Weerd
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands
| | - Bertil Veenstra
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands
| | - Koen Levels
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, the Netherlands.
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He S, Li R, Peng Y, Wang Z, Huang J, Meng H, Min J, Wang F, Ma Q. ACSL4 contributes to ferroptosis-mediated rhabdomyolysis in exertional heat stroke. J Cachexia Sarcopenia Muscle 2022; 13:1717-1730. [PMID: 35243801 PMCID: PMC9178366 DOI: 10.1002/jcsm.12953] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rhabdomyolysis (RM) is a common complication of exertional heat stroke (EHS) and constitutes a direct cause of death. However, the mechanism underlying RM following EHS remains unclear. METHODS The murine EHS model was prepared by our previous protocol. RNA sequencing is applied to identify the pathological pathways that contribute to RM following EHS. Inhibition of the acyl-CoA synthetase long-chain family member 4 (ACSL4) was achieved by RNA silencing in vitro prior to ionomycin plus heat stress exposure or pharmacological inhibitors in vivo prior to heat and exertion exposure. The histological changes, the iron accumulation, oxidized phosphatidylethanolamines species, as well as histological evaluation and levels of lipid metabolites in skeletal muscle tissues were measured. RESULTS We demonstrated that ferroptosis contributes to RM development following EHS. Ferroptosis inhibitor ferrostatin-1 administration once EHS onset significantly ameliorated the survival rate of EHS mice from 35.357% to 52.288% within 24 h after EHS (P = 0.0028 compared with control) and markedly inhibited RM development induced by EHS. By comparing gene expression of between sham heat rest (SHR) (n = 3) and EHS (n = 3) mice in the gastrocnemius (Gas) muscle tissue, we identified that Acsl4 mRNA expression is elevated in Gas muscle tissue of EHS mice (P = 0.0038 compared with SHR), so as to its protein levels (P = 0.0001 compared with SHR). Followed by increase in creatine kinase (CK) and myoglobin (MB) levels, the labile iron accumulation, decrease in glutathione peroxidase 4 (GPX4) expression, and elevation of lipid peroxidation products. From in vivo and in vitro experiments, inhibition of Acsl4 significantly improves muscle cell death caused by EHS, thereby ameliorating RM development, followed by reduction in CK and MB levels by 30-40% (P < 0.0001; n = 8-10) and 40% (P < 0.0001; n = 8-10), restoration of GPX4 expression, and decrease in lipid peroxidation products. Mechanistically, ACSL4-mediated RM seems to be Yes-associated protein (YAP) dependent via TEA domain transcription factor1/TEA domain transcription factor4. CONCLUSIONS These findings demonstrate an important role of ACSL4 in mediating ferroptosis activation in the development of RM following EHS and suggest that targeting ACSL4 may represent a novel therapeutic strategy to limit the skeletal muscle cell death and prevent RM after EHS.
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Affiliation(s)
- Sixiao He
- Department of Biopharmaceutics, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Ru Li
- Department of Biopharmaceutics, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Yanmei Peng
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ziqing Wang
- Department of Biopharmaceutics, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Junhao Huang
- Department of Biopharmaceutics, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Hongen Meng
- The Fourth Affiliated Hospital, The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Cancer Center, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, China
| | - Junxia Min
- The Fourth Affiliated Hospital, The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Cancer Center, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, China
| | - Fudi Wang
- The Fourth Affiliated Hospital, The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Cancer Center, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, China.,The First Affiliated Hospital, The Second Affiliated Hospital, Basic Medical Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, China
| | - Qiang Ma
- Department of Biopharmaceutics, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
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Li Z, McKenna Z, Fennel Z, Nava RC, Wells A, Ducharme J, Houck J, Morana K, Mermier C, Kuennen M, Magalhaes FDC, Amorim F. The combined effects of exercise-induced muscle damage and heat stress on acute kidney stress and heat strain during subsequent endurance exercise. Eur J Appl Physiol 2022; 122:1239-1248. [PMID: 35237867 DOI: 10.1007/s00421-022-04919-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study was to investigate the combined effect of downhill running and heat stress on muscle damage, as well as on heat strain and kidney stress during subsequent running in the heat. METHODS In a randomized cross-over study, ten non-heat-acclimated, physically active males completed downhill running in temperate (EIMD in Temp) and hot (EIMD in Hot) conditions followed by an exercise-heat stress (HS) test after 3-h seated rest. Blood and urine samples were collected immediately pre- and post-EIMD and HS, and 24 h post-EIMD (post-24 h). Core temperature and thermal sensation were measured to evaluate heat strain. Serum creatine kinase (CK), maximal voluntary isometric contraction of the quadriceps (MVC) and perceived muscle soreness were measured to evaluate muscle damage. Urinary neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels were measured to indicate acute kidney stress. RESULTS CK, MVC and perceived soreness were not different between conditions at any timepoints. In the EIMD in Hot condition, urinary NGAL was significantly elevated from pre- to post-HS (pre-HS: 6.56 {1.53-12.24} ng/min, post-HS: 13.72 {7.67-21.46} ng/min, p = 0.034). Such elevation of NGAL or KIM-1 was not found in the EIMD in Temp condition. CONCLUSIONS As compared with downhill running in a temperate environment, downhill running in a hot environment does not appear to aggravate muscle damage. However, elevated NGAL levels following EIMD in a hot environment suggest such exercise may increase risk of mild acute kidney injury during subsequent endurance exercise in the heat.
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Affiliation(s)
- Zidong Li
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA. .,Department of Health and Human Performance, Northwestern State University, Natchitoches, LA, USA.
| | - Zachary McKenna
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Zachary Fennel
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Roberto Carlos Nava
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA.,Research Division, Joslin Diabetes Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew Wells
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA.,Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Jeremy Ducharme
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Jonathan Houck
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA.,Department of Health and Human Performance, Roanoke College, Salem, VA, USA
| | - Kylie Morana
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Christine Mermier
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Matthew Kuennen
- Department of Exercise Science, High Point University, High Point, NC, USA
| | - Flavio de Castro Magalhaes
- Department of Physical Education, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Fabiano Amorim
- Department of Health, Exercise and Sport Sciences, University of New Mexico, Albuquerque, NM, USA
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Li P, Yang L, Liu R, Chen RL. The value of the exertional heat stroke score for the prognosis of patients with exertional heat stroke. Am J Emerg Med 2021; 50:352-355. [PMID: 34454398 DOI: 10.1016/j.ajem.2021.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the exertional heat stroke score (EHSS) system for the prognosis of exertional heat stroke (EHS) patients. METHODS Forty-two EHS patients who had been treated in our hospital between January 2017 and December 2019 were divided into two groups according to their prognosis, a survival group and a non-survival group. All the patients had received comprehensive EHS treatment after admission, and their EHSS parameters were collected within 24 h of admission, including body temperature, hepatorenal function, and coagulation function. A retrospective comparative evaluation was made of the effectiveness of the EHSS, the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) in making an EHS prognosis. RESULTS Among 42 patients, 28 patients were treated successfully and discharged from the hospital, 5 were given a poor prognosis, and 9 died, amounting to a fatality rate of 21.42%. Univariate analysis showed that within 24 h of admission, the differences were statistically significant (p < 0.05) in the comparison of the following factors: lactate concentration, platelets, prothrombin time, fibrinogen, troponin, aspartate aminotransferase, total bilirubin, urinary creatinine, acute gastrointestinal injury, temperature, and Glasgow coma score. However, no statistically significant difference in blood pH was observed between the two groups of patients (p = 0.117). The EHSS, APACHE II, and SOFA scores of the survival group were significantly lower than those of the non-survival group (p < 0.001). The area under the receiver operating characteristic curve of the EHSS, APACHE II and SOFA scores were the area under the curve (AUC) EHSS = 0.96 (0.901, 0.990), AUC Apache II = 0.895 (0.802, 0.950), and AUC SOFA = 0.884 (0.837, 0.964), respectively. Thus, the EHSS diagnostic efficacy of the survival group was significantly higher than that of the other two scores. In addition, the sensitivity and specificity of EHSS were higher than those of the APACHE II and SOFA scores. CONCLUSION The EHSS has a good diagnostic efficacy for the prognosis of EHS patients and is significantly higher than that of the APACHE II and SOFA scores. This finding provides a theoretical basis for further increasing the rescue success rate of EHS patients and improving their prognostic quality of life.
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Affiliation(s)
- Pu Li
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an 710032, Shaanxi, China
| | - Liu Yang
- Cardiovascular Medicine, Baoji High-tech Hospital, Baoji 721006, China
| | - Rui Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an 710032, Shaanxi, China
| | - Rui-Lin Chen
- Department of Pulmonary and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China.
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Hosokawa Y, Murata Y, Stearns RL, Suzuki-Yamanaka M, Kucera KL, Casa DJ. Epidemiology of sudden death in organized school sports in Japan. Inj Epidemiol 2021; 8:27. [PMID: 34247655 PMCID: PMC8273996 DOI: 10.1186/s40621-021-00326-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Nearly half of the sudden deaths documented in Japanese middle and high school occurred during school organized sport activities. However, no study to date has calculated the incidence rates of these deaths by sport. Therefore, this study aimed to describe the epidemiology of sudden death in organized school sports in Japan. Methods Data submitted to Japan Sport Council (JSC) Injury and Accident Mutual Aid Benefit System between 2005 and 2016 were retrieved from JSC website for analysis (n = 1137). Case information on fatal incidents that occurred during organized school sports in middle and high school students were extracted for analysis (n = 198). Descriptive statistics about activity type, sex, sport, cause of death, and presence of on-site trained medical personnel were calculated using frequencies and proportions. Sudden death incidence rates were expressed per 100,000 athlete-years with 95% confidence intervals (CI). Results The overall incidence rate of sports-related death was 0.38 deaths per 100,000 athlete-years (95%CI = 0.30, 0.45). Only three cases (2%) reported having trained medical personnel on-site at the time of death. Most deaths were in male student athletes (n = 149/162, 92%), with 7.5 times greater fatality rate in male compared to female student athletes (incidence rate ratio, 7.5; 95%CI = 4.43, 13.22). Baseball (n = 25/162, 15.4%), judo (n = 24/162, 14.8%), soccer/futsal (n = 20/162, 12.3%), and basketball (n = 18/162, 11.1%) accounted for 53.7% of deaths. Accounting for the number of participants in the respective sport, the three highest average incident rates of death were reported in rugby (4.59 deaths per 100,000 athlete-years, 95%CI = 2.43, 6.75), judo (3.76 deaths per 100,000 athlete-years, 95%CI = 1.58, 5.93), and baseball (0.59 deaths per 100,000 athlete-years, 95%CI = 0.38, 0.79). The top three causes of death were sudden cardiac arrest (n = 68/162, 42.0%), head trauma (n = 32/162, 19.8%), and heat related injury (n = 25/162, 15.4%). Conclusions In conclusion, the highest rates of sports-related death among Japanese student athletes were observed in the following: rugby, male athletes, and during practices. The leading cause of death was sudden cardiac arrest.
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Affiliation(s)
- Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, Japan.
| | - Yuki Murata
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Aichi, Japan
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | | | - Kristen L Kucera
- Department of Exercise and Sport Science, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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Cheng L, Liu DL, Wang MN, Yin XX, Liu Y, Liu W, Zhang QF, Ye G. [Risk factors analysis of acute kidney injury in patients with exertional heatstroke]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:29-32. [PMID: 33535336 DOI: 10.3760/cma.j.cn121094-20200114-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the risk factors of acute renal injury (AKI) in exertional heat radiation disease (EHS) . Methods: In november 2019, the clinical data of 69 EHS patients admitted from July 2015 to September 2019 were reviewed. The general data, laboratory indexes, Glasgow score (GCS) at admission, 24-hour acute physiology and chronic health score Ⅱ (APACHE Ⅱ) , exposure time rate and physical labor intensity were collected. According to the occurrence of AKI, the patients were divided into AKI group and non-AKI group, 31 and 38 in each group. The differences of general data and laboratory indexes between the two groups were compared, and the t and Mann-Whitney U test were used to compare the two groups. The enumeration data are expressed by examples and constituent ratio (%) . Independent sample χ(2) test is used for inter-group comparison, and multiple test is used for multi-sample comparison. The correlation was analyzed by linear regression. Risk factors were analyzed by Logistic regression analysis. Results: At discharge, 31 of 69 EHS patients developed AKI. Compared with the non-AKI group, the heart rate, white blood cell count, lactic acid, D-dimer and myoglobin were higher; MAP, platelet count and PH were lower in the AKI group. The difference was statistically significant (P<0.05) . APACHE Ⅱ score, core temperature, time to drop to 38.5 ℃, contact time rate, platelet count, pH, lactic acid, D-dimer and myoglobin were all correlated with creatinine (r=0.57, 0.42, 0.80, 0.78, 0.57, 0.43, 0.51, 0.55, 0.79) . APACHE Ⅱ score, time to drop to 38.5C, Lac and MYO are the risk factors of AKI in EHS patients. Multivariate Logistic regression analysis showed that the time required to drop to 38.5C was an independent risk factor for the occurrence of AKI. Conclusion: AKI is a serious complication of EHS. EHS complicated with AKI, should be identified early and effective intervention measures should be taken.
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Liu S, Xing L, Wang J, Xin T, Mao H, Zhao J, Li C, Song Q. The relationship between 24-hour indicators and mortality in patients with exertional heat stroke. Endocr Metab Immune Disord Drug Targets 2021; 22:241-246. [PMID: 33480352 DOI: 10.2174/1871530321666210122153249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exertional heat stroke (EHS) is a life-threatening illness that can lead to multiple organ damage in the early stage. OBJECTIVE This study aimed to investigate the relationship between 24-hour indicators and mortality in patients with EHS. METHODS The records of EHS patients hospitalized were collected and divided into the death group and the survival group. We then analyzed the demographic characteristics and APACHE II scores and laboratory results of the participants in the blood within the first 24 h after hospitalization, and assessed whether these candidate indicators differed between the death group and the survival group. Cox regression analysis of the survival data was performed to explore the relationship between early indicators and prognosis. RESULTS The levels of plasma PT, APTT, TT, and INR were significantly higher in the death group than in the survival group. The blood PLT count and the levels of PTA and Fb were significantly lower in the death group than in the survival group, while the levels of BU, SCr, ALT, AST, TBil, and DBil were significantly higher in the death group than in the survival group. Furthermore, the levels of Mb, LDH, TNI, and NT-proBNP were significantly higher in the death group than in the survival group, while there was no significant difference in CK levels between the two groups. CONCLUSION Patients with EHS often had multiple organ injuries in the early stage (within 24 h), while those cases in the death group were more severe.
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Affiliation(s)
- Shuyuan Liu
- Medical School of Chinese PLA, Beijing 100853. China
| | - Ling Xing
- Medical School of Chinese PLA, Beijing 100853. China
| | - Jinpeng Wang
- Department of Epidemic, the Jingzhong Medical Center, Chinese PLA General Hospital, Beijing 100120. China
| | - Tianyu Xin
- Department of Emergency, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048. China
| | - Handing Mao
- Medical School of Chinese PLA, Beijing 100853. China
| | - Jinbao Zhao
- Medical School of Chinese PLA, Beijing 100853. China
| | - Cong Li
- Medical School of Chinese PLA, Beijing 100853. China
| | - Qing Song
- Medical School of Chinese PLA, Beijing 100853. China
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Yang MM, Wang L, Zhang Y, Yuan R, Zhao Y, Hu J, Zhou FH, Kang HJ. Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis. Mil Med Res 2020; 7:40. [PMID: 32854781 PMCID: PMC7453553 DOI: 10.1186/s40779-020-00269-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heat stroke (HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke (EHS). METHODS Data were collected from a total of 170 exertional heat stroke (EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic (ROC) curve (AUC) were used to screen exertional heat stroke score (EHSS) parameters, including but not limited body temperature (T), Glasgow Coma Scale (GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified. RESULTS Through screening with a series of methods, as described above, the present study determined 12 parameters - body temperature (T), GCS, pH, lactate (Lac), platelet count (PLT), prothrombin time (PT), fibrinogen (Fib), troponin I (TnI), aspartate aminotransferase (AST), total bilirubin (TBIL), creatinine (Cr) and acute gastrointestinal injury (AGI) classification - as EHSS parameters. It is a 0-47 point system designed to reflect increasing severity of heat stroke. Low (EHSS< 20) and high scores (EHSS> 35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS > AUCSOFA > AUCAPACHE II. CONCLUSION A total of 12 parameters - T, GCS, pH, Lac, PLT, PT, Fib, TnI, AST, TBIL, Cr and gastrointestinal AGI classification - are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases.
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Affiliation(s)
- Meng-Meng Yang
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lu Wang
- Medical School of Chinese PLA, Beijing, China
| | - Yu Zhang
- Medical School of Chinese PLA, Beijing, China
| | - Rui Yuan
- Medical School of Chinese PLA, Beijing, China
| | - Yan Zhao
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jie Hu
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Fei-Hu Zhou
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hong-Jun Kang
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China.
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Ogden HB, Fallowfield JL, Child RB, Davison G, Fleming SC, Delves SK, Millyard A, Westwood CS, Layden JD. Influence of aerobic fitness on gastrointestinal barrier integrity and microbial translocation following a fixed-intensity military exertional heat stress test. Eur J Appl Physiol 2020; 120:2325-37. [PMID: 32794058 DOI: 10.1007/s00421-020-04455-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Exertional-heat stress adversely disrupts gastrointestinal (GI) barrier integrity, whereby subsequent microbial translocation (MT) can result in potentially serious health consequences. To date, the influence of aerobic fitness on GI barrier integrity and MT following exertional-heat stress is poorly characterised. METHOD Ten untrained (UT; VO2max = 45 ± 3 ml·kg-1·min-1) and ten highly trained (HT; VO2max = 64 ± 4 ml·kg-1·min-1) males completed an ecologically valid (military) 80-min fixed-intensity exertional-heat stress test (EHST). Venous blood was drawn immediately pre- and post-EHST. GI barrier integrity was assessed using the serum dual-sugar absorption test (DSAT) and plasma Intestinal Fatty-Acid Binding Protein (I-FABP). MT was assessed using plasma Bacteroides/total 16S DNA. RESULTS UT experienced greater thermoregulatory, cardiovascular and perceptual strain (p < 0.05) than HT during the EHST. Serum DSAT responses were similar between the two groups (p = 0.59), although Δ I-FABP was greater (p = 0.04) in the UT (1.14 ± 1.36 ng·ml-1) versus HT (0.20 ± 0.29 ng·ml-1) group. Bacteroides/Total 16S DNA ratio was unchanged (Δ; -0.04 ± 0.18) following the EHST in the HT group, but increased (Δ; 0.19 ± 0.25) in the UT group (p = 0.05). Weekly aerobic training hours had a weak, negative correlation with Δ I-FABP and Bacteroides/total 16S DNA responses. CONCLUSION When exercising at the same absolute workload, UT individuals are more susceptible to small intestinal epithelial injury and MT than HT individuals. These responses appear partially attributable to greater thermoregulatory, cardiovascular, and perceptual strain.
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Tripp B, Vincent HK, Bruner M, Smith MS. Comparison of wet bulb globe temperature measured on-site vs estimated and the impact on activity modification in high school football. Int J Biometeorol 2020; 64:593-600. [PMID: 31863179 DOI: 10.1007/s00484-019-01847-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/01/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
Exertional heat stroke is one of the top three causes of death in young athletes, particularly high school football players. Despite evidence that these deaths are completely avoidable with appropriate prevention and treatment, deaths still occur at an alarming rate. Wet bulb globe temperature (WBGT) is the preferred method of both the National Athletic Trainers' Association and American College of Sports Medicine to measure heat intensity. Based on the WBGT, activity modification guidelines (AMG) dictate work-to-rest ratios, activity levels and duration, protective equipment worn, and length and frequency of hydration breaks. Due to the cost of handheld WBGT monitors, smartphone apps that estimate WBGT have been considered an alternative. However, it is unclear how WBGT values estimated by these smartphone apps compare to those measured on-site using handheld WBGT monitors. We compared WBGT values estimated by a commercial smartphone app to those taken on-site at the same time and place. Thirteen athletic trainers measured WBGT in the field during high school football practices over a three-month season in North Central Florida. A paired sample t-test indicated the smartphone app significantly overestimated WBGT (29.0°C ± 4.1°C) compared to on-site measures (26.4°C ± 3.2°C) ( r =0.580; t(943)=-23.38, p <0.0001). The smartphone app-estimated values were consistently greater than on-site measures, resulting in potentially unnecessary activity modifications and cancellations if the app was used in place of on-site handheld WBGT monitors. Despite being significantly cheaper than handheld WBGT monitors, at this time, smartphone apps are not ready for widespread use to guide activity modification decisions.
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Affiliation(s)
- Brady Tripp
- University of Florida, Gainesville, FL, USA.
| | - Heather K Vincent
- Department of Orthopaedics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michelle Bruner
- University of Florida, Department of Orthopedics and Rehabilitation, Gainesville, FL, USA
| | - Michael Seth Smith
- University of Florida, Department of Orthopedics and Rehabilitation, Gainesville, FL, USA
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Mitchell KM, Cheuvront SN, King MA, Mayer TA, Leon LR, Kenefick RW. Use of the heat tolerance test to assess recovery from exertional heat stroke. Temperature (Austin) 2019; 6:106-119. [PMID: 31286022 DOI: 10.1080/23328940.2019.1574199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 01/28/2023] Open
Abstract
Exercise or work in hot environments increases susceptibility to exertional heat illnesses such as exertional heat stroke (EHS). EHS occurs when body heat gain exceeds body heat dissipation, resulting in rapid body heat storage and potentially life-threatening consequences. EHS poses a dangerous threat for athletes, agriculture workers, and military personnel, as they are often exposed to hot environmental conditions that restrict body heat loss or contribute to body heat gain. Currently, there is limited guidance on return to activity (RTA) after an episode of EHS. While examining biomarkers in the blood is thought to be beneficial for determining RTA, they are not sensitive or specific enough to be a final determining factor as organ damage may persist despite blood biomarkers returning to baseline levels. As such, additional assessment tests to more accurately determine RTA are desired. One method used for determining RTA is the heat tolerance test (HTT, 120 minutes treadmill walking; 40°C, 40% relative humidity). Unfortunately, the HTT provides even less information about EHS recovery since it offers no test sensitivity or specificity even after years of implementation. We provide an overview of the HTT and the controversy of this test with respect to assessment criteria, applicability to tasks involving high metabolic workloads, and the lack of follow-up analyses to determine its accuracy for determining recovery in order to diminish the likelihood of a second EHS occurrence.
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Affiliation(s)
- Katherine M Mitchell
- U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts
| | - Samuel N Cheuvront
- U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts
| | - Michelle A King
- U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts
| | - Thomas A Mayer
- U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts.,Oak Ridge Institute for Science and Education, Belcamp, MD, USA
| | - Lisa R Leon
- U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts
| | - Robert W Kenefick
- U.S. Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, Massachusetts
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Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O. Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke. BMC Nephrol 2016; 17:55. [PMID: 27267762 PMCID: PMC4895821 DOI: 10.1186/s12882-016-0268-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/01/2016] [Indexed: 02/04/2023] Open
Abstract
Background Exertional heat stroke (EHS) is a life-threatening illness and leads to multi-organ dysfunction including acute kidney injury (AKI). The clinical significance of abnormal electrolytes and renal outcomes in ESH patients has been poorly documented. We aim to exhibit the electrolyte abnormalities, renal outcomes and risk factors of patients with AKI receiving dialysis in EHS. Methods A retrospective cohort study in EHS patients between 2003 and 2014 were conducted. Clinical and laboratory outcomes including serum and urine electrolytes, AKI and dialysis were assessed on admission, during hospitalization and at the time of their discharge from the hospital. A logistic regression analysis was performed for risk factors of acute dialysis. Results All 66 subjects with mean age 22.1 ± 4.3 years were included. On admission, the common electrolyte disturbances were hypokalemia (71.2 %), hypophosphatemia (59.1 %), hyponatremia (53.0 %), hypocalcemia (51.5 %), and hypomagnesemia (34.9 %). Electrolytes depletion was confirmed as renal loss (potassium loss; 54.2 %, phosphate loss; 86.7 %, sodium loss; 64.7 % and magnesium loss; 83.3 %). During hospitalization ranging from 2 to 209 days, 90.9 % patients suffered from AKI with 16.7 % receiving acute dialysis, and 3 % patients died. At discharge, AKI and electrolyte abnormalities had dramatically improved. The prognosis factors for AKI receiving dialysis were identified as neurological status, renal function and serum muscle enzyme at time of admission. Conclusion The study suggests that hypoelectrolytemia and AKI are frequently observed in patients with EHS. Neurological impairment, impaired renal function, and increased serum muscle enzyme should be considered risk factors of acute dialysis.
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Affiliation(s)
- Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand.
| | - Suramanat Kongthaworn
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Panbubpa Choovichian
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
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REYNOLDS KORYA, EVANICH JOHNJ, EBERMAN LINDSEYE. Reflective Blankets Do Not Effect Cooling Rates after Running in Hot, Humid Conditions. Int J Exerc Sci 2015; 8:97-103. [PMID: 27182414 PMCID: PMC4831857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Reflective blankets (RB) are often provided at the conclusion of endurance events, even in extreme environments. The implications could be dangerous if increased core body temperature (CBT) is exacerbated by RB. To evaluate the effect of RB on cooling rate for individuals walking or sitting after intense running. Pilot, randomized control trial experimental design. Environmental chamber. Recreational runners (age=25±5y; mass=76.8±16.7kg; height=177±9cm) completed an 8km (actual mean distance=7.5±1.1km). We randomly assigned participants into one of four groups: walking with blanket (WB=5), walking without blanket (WNB=5), sitting with blanket (SB=5), or sitting without blanket (SNB=4). Participants ran on a treadmill at their own pace until volitional exhaustion, achieving the 8km distance, or experiencing CBT=40°C. Every three minutes during the running (time determined by pace) and cooling protocol (62 min in chamber), we measured CBT, HR, and Borg scale, and environmental conditions. We evaluated cooling rate, peak physiological variables, pace, and environment by condition using a Kruskal-Wallis non-parametric one-way ANOVAs. We identified similar exercise sessions (df=3; CBT χ2=0.921, p=0.82; HR χ2=7.446, p=0.06; Borg χ2= 5.732, p=0.13; pace χ2=0.747, p=0.86) and similar environmental characteristics between conditions (df=3; Wet Bulb Globe Temperature=26.18±2.78°C, χ2=1.552, p=0.67). No significant differences between conditions on cooling rate (df=3, χ2=2.301, p=0.512) were found, suggesting RBs neither cool nor heat the body, whether seated (SB=0.021±0.011deg/min; SNB=0.029±0.002deg/min) or walking (WB=0.015±0.025deg/min; WNB=0.021±0.011deg/min) in a hot, humid environment. CBT in distance runners is not altered by the use of a RB during a seated or walking cool down after a strenuous run.
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Abstract
Amphetamine (Amp) increases exercise duration. It is thought to do so by masking fatigue, but there have been very few studies looking at the effect of amphetamine on maximal oxygen consumption (VO2MAX) and running economy. Furthermore, it is unknown if amphetamine's effect on exercise duration occurs in a warm environment. We conducted separate experiments in male Sprague-Dawley rats testing the effect of amphetamine on VO2MAX (n = 12), running economy (n = 12), and exercise duration (n = 24) in a warm environment. For VO2MAX and running economy, rats were randomized to either amphetamine at 1 mg/kg (Amp-1) or 2 mg/kg (Amp-2). Animals served as their own controls in a crossover design with the administration order counter-balanced. To study the effect of amphetamine on exercise duration, we conducted run-to-exhaustion treadmill testing on rats in a 32˚C environment following administration of Amp-1, Amp-2, or Saline. Compared to control, Amp-2 increased VO2MAX (by 861 ± 184 ml/kg/hr, p = 0.005) and the time to VO2MAX (by 2.5 ± 0.8 min, p = 0.03). Amp-1 had no effect on VO2MAX but increased the time to VO2MAX (by 1.7 ± 0.5 min, p = 0.03). Neither dose improved running economy. In the warm, only rats in the Amp-1 group (+9.4 min, p = 0.02) had an increased time to exhaustion. Compared to control (41.6 ± 0.3°C), both amphetamine doses had higher temperatures at exhaustion: Amp-1 (42.0 ± 0.2°C) and Amp-2 (42.1 ± 0.2°C). Our results suggest that ergogenic effect of amphetamine occurs by masking fatigue but this effect may be offset in the warm with higher doses.
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Affiliation(s)
- Dmitry V Zaretsky
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, Indiana, USA, 46202
| | - Mary Beth Brown
- Department of Physical Therapy, Indiana University School of Health and Rehabilitation Sciences, 1140 W Michigan St, Indianapolis, Indiana, USA, 46202
| | - Maria V Zaretskaia
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, Indiana, USA, 46202
| | - Pamela J Durant
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, Indiana, USA, 46202
| | - Daniel E Rusyniak
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, Indiana, USA, 46202; Department of Pharmacology and Toxicology, Indiana University School of Medicine, 635 Barhill Drive, Indianapolis, Indiana, USA, 46202
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