Thermal limits of survival and reproduction depend on stress duration: A case study of Drosophila suzukii

Studies of ectotherm responses to heat extremes often rely on assessing absolute critical limits for heat coma or death (CTmax), however, such single parameter metrics ignore the importance of stress exposure duration. Furthermore, population persistence may be affected at temperatures considerably below CTmax through decreased reproductive output. Here we investigate the relationship between tolerance duration and severity of heat stress across three ecologically relevant life-history traits (productivity, coma and mortality) using the global agricultural pest Drosophila suzukii. For the first time, we show that for sublethal reproductive traits, tolerance duration decreases exponentially with increasing temperature (R2 > 0.97), thereby extending the Thermal Death Time framework recently developed for mortality and coma. Using field micro-environmental temperatures, we show how thermal stress can lead to considerable reproductive loss at temperatures with limited heat mortality highlighting the importance of including limits to reproductive performance in ecological studies of heat stress vulnerability.

[Retracted] Downregulation of let‑7b promotes COL1A1 and COL1A2 expression in dermis and skin fibroblasts during heat wound repair

Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that the western blotting data shown in Figs. 4B and 5 and the H&E immunostaining data shown in Fig 1A were strikingly similar to data appearing in different form in other articles written by different authors at different research institutes that had either already been published, or were submitted for publication at around the same time.  Owing to the fact that the contentious data in the above article had already been published prior to its submission to Molecular Medicine Reports, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Molecular Medicine Reports 13: 2683-2688, 2016; DOI: 10.3892/mmr.2016.4877].

Transcriptomic approach to uncover dynamic events in the development of mid-season sunburn in apple fruit

Apples grown in high heat, high light, and low humidity environments are at risk for sun injury disorders like sunburn and associated crop losses. Understanding the physiological and molecular mechanisms underlying sunburn will support improvement of mitigation strategies and breeding for more resilient varieties. Numerous studies have highlighted key biochemical processes involved in sun injury, such as the phenylpropanoid and reactive oxygen species (ROS) pathways, demonstrating both enzyme activities and expression of related genes in response to sunburn conditions. Most previous studies have focused on at-harvest activity of a small number of genes in response to heat stress. Thus, it remains unclear how stress events earlier in the season affect physiology and gene expression. Here, we applied heat stress to mid-season apples in the field and collected tissue along a time course-24, 48, and 72 h following a heat stimulus-to investigate dynamic gene expression changes using a transcriptomic lens. We found a relatively small number of differentially expressed genes (DEGs) and enriched functional terms in response to heat treatments. Only a few of these belonged to pathways previously described to be involved in sunburn, such as the AsA-GSH pathway, while most DEGs had not yet been implicated in sunburn or heat stress in pome fruit.

Broad Scale Spatial Modelling of Wet Bulb Globe Temperature to Investigate Impact of Shade and Airflow on Heat Injury Risk and Labour Capacity in Warm to Hot Climates

While shade and air flow are recognised factors that reduce outdoor heat exposure, the level of reduction in terms of labour capacity at varying air temperature and humidity levels is poorly understood. This study investigated cooling effects on the commonly used heat index, wet bulb globe temperature (WBGT), and subsequent impact on labour capacity, for a range of air flow and shade conditions in warm to hot climates. We modelled heat exposure using a physics-based method to map WBGT for a case study region which experiences a range of heat categories with varying levels of health risks for outdoor workers. Continent-scale modelling confirmed significant spatial variability in the effect of various shade and wind speed scenarios across a range of real-world mid-summer daytime conditions. At high WBGTs, increasing shade or air flow for outdoor workers lowered heat exposure and increases labour capacity, with shade giving the greatest benefit, but cooling varied considerably depending upon underlying air temperature and humidity. Shade had the greater cooling effect; reducing incident radiation by 90% decreased WBGT by 2-6 °C depending on location. Wind had a lower cooling effect in the hottest regions, with a decreasing exponential relationship between wind speed and WBGT observed.

An Acquired Anterior Glottic Web Model by Heat Injury with a Laryngoscopic Approach in a Rabbit

Acquired anterior glottic webs (AGW) can lead to abnormally elevated phonatory pitch, dysphonia, and airway obstruction requiring urgent intervention. In this study, we construct a novel AGW rabbit model using heat injury by a laryngoscopic way. A primary study was conducted to identify the injury depth in rabbits' vocal folds (VFs) by graded heat energy, and the heat energy for the incurrence of epithelial layer, lamina propria, and muscular layer (ML) injury was 25, 30 and 35 W, respectively. Then, four different models were designed based on the depth and degree of the injury to determine the optimal procedure for AGW formation. Morphological features, vibratory capacity, and histopathologic features of the AGW were correspondingly evaluated. The procedure for conferring the heat injury to the depth of ML and the extent of anterior commissure and middle part of bilateral VFs showed the highest success rate of AGW formation (95%, 19/20). For its low cost, effectiveness, and stability for AGW formation, the heat injury rabbit model with a laryngoscopic approach may provide a new platform for testing novel anti-adhesion materials and bioengineered therapies. Impact Statement Tissue engineering based on biomaterials has been a very hot research field and may be introduced to prevent the acquired anterior glottic web (AGW) formation. However, lacking a widely recognized animal model for AGW has limited the trial of anti-adhesion materials in the larynx. In this study, we have developed a novel rabbit model for AGW formation by conferring a heat injury under a laryngoscope; this model is cheap, effective, and stable for the anti-adhesion materials and bioengineered therapies. Thus, this research would arouse crucial interest and be widely employed.

Neuromotor deficits and altered physiological responses to repeated exertional heat stroke exposures in mice

Exertional heat stroke (EHS) is a life-threatening illness that can lead to negative health outcomes. Using a "severe" preclinical mouse model of EHS, we tested the hypotheses that one EHS exposure results in altered susceptibility to a subsequent EHS and reduced neuromotor performance. Female C57BL/6 mice underwent two protocols, 2 wk apart, either an EHS trial (EHS) or a sham exercise control trial (EXC). For EHS, mice ran in a forced running wheel at 37.5°C/40% relative humidity until loss of consciousness, followed by a slow cooling protocol (2 h recovery at 37.5°C). EXC mice exercised equally but in ∼22°C. Mice were randomized into three groups: 1) EXC-EXC (two consecutive EXC, n = 6, 2) EHS-EXC (EHS followed by EXC, n = 5), and 3) EHS-EHS (repeated EHS, n = 9). Mice underwent noninvasive neuromotor and behavioral tests during recovery and isolated soleus force measurements at the end of recovery. At the first EHS, mice reached average peak core temperatures (Tc,max) of 42.4°C, (46% mortality). On the second EHS, average Tc,max was reduced by ∼0.7°C (P < 0.05; mortality 18%). After the first EHS, both EHS-EX and EHS-EHS showed significant reductions in maximum strength (24 h and 1 wk post). After the second EHS, strength, horizontal rotation, hindlimb tone, suspended hindlimb splay, trunk curl, and provoked biting continued to decline in the EHS-EHS group. In conclusion, exposure to a second EHS after 2 wk leads to increased exercise times in the heat, symptom limitation at a lower Tc,max, and greater deficits in neuromotor and behavioral function during recovery.

Evaluation of distinct modes of oxidative secondary injury generated in heat-treated cells of Escherichia coli with solid/liquid and complex/semi-synthetic media sets

AIMS

To characterize and evaluate oxidative secondary injury generated in heat-treated Escherichia coli cells during recovery cultivation either on agar or in a broth of a semi-synthetic enriched M9 (EM9) medium and a complex Luria broth (LB) medium with different types of antioxidants.

METHODS AND RESULTS

E. coli cells grown in the EM9 and LB broth were heated at 50^o C in a buffer (pH7.0). Heated cells were recovered on the same kind of agar medium as that used for growth, with or without different antioxidants. Although these antioxidants mostly protected the cells from oxidative secondary injury on the recovery media, sodium thiosulfate and sodium pyruvate were most protective on EM9 and LB agars, respectively. Determination of viability using the most probable number and growth delay analysis methods showed significant reductions in the protective effects of antioxidants in the EM9 and LB media.

CONCLUSION

Oxidative secondary injury generated in heated E. coli cells was found to be qualitatively and quantitatively diverse under cellular and environmental conditions.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results suggest that different modes of oxidation should be considered in viability determination and injured cell enumeration of heat-treated cells.

Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis

CONTEXT

Recurrent laryngeal nerve (RLN) injury is a complication of thermal thyroid nodule treatment.

OBJECTIVE

We investigated the influencing factors of RLN injury in patients who underwent thermal ablation of thyroid nodules.

METHODS

The data of 1004 patients (252 male, 752 female; median age 44 years) who underwent thermal thyroid nodule ablation were retrospectively reviewed. Patients were divided into benign cystic, benign solid, and papillary thyroid cancer (PTC) groups. The parameters related to RLN injury were analyzed, including the largest diameter, location of the nodules, and shortest distance of the nodule to thyroid capsule and tracheoesophageal groove (TEG). Univariate and multivariate analyses were performed to select risk factors for RLN injury.

RESULTS

The RLN injury rate was higher in PTC (6.3%) than in benign cystic (1.2%, P = 0.019) and solid nodules (2.9%, P = 0.018). PTC subgroup analysis showed that the RLN injury rate was higher in T1b (10.7%) and T2 (28.6%) PTC than in T1a PTC (5.0%, P < 0.05). In the PTC group, TEG distance, anterior capsule distance, median capsule distance, posterior capsule distance, and maximum nodule diameter were risk factors for RLN injury. The logistic regression fitting of the nomogram showed high prediction efficiency (C-Index 0.876). The main cause of RLN injury was insufficient medial isolating fluid (MIF). The safety thicknesses of MIF for benign cystic, benign solid, and PTC nodules were 3.1 mm, 3.7 mm, and 3.9 mm, respectively.

CONCLUSION

Several risk factors for RLN injury should be considered before thermal ablation of thyroid nodules. The RLN injury rate could be predicted with the nomogram.

Fatal pediatric hyperthermia: A forensic review

This paper examines a pediatric hyperthermia homicide in which the decedent was placed into a room with only a diaper on and left unattended overnight. There were no furnishings in the room except for a 1500-W space heater and a stroller. The following morning, emergency personnel were summoned to the residence. A caretaker said the decedent playing normally 5 min before making the 911 call. The decedent's initial rectal temperature was 42.2°C. Law enforcement asked how long the child had to be exposed to a high temperature in order to induce fatal hyperthermia in an empty bedroom. The scene was reconstructed using the child's residence and the same heater. Environmental data were gathered over a 16-h period. The thermal parameters of the room and environment were analyzed using a lumped-element thermal model. These parameters were then fed into an adapted Gagge's two-node model of human thermal regulation, which provided a time-window of exposure necessary to elicit hyperthermia, which in this case, depending on certain variables, ranged from 45 min to 4 h.

Accuracy of Algorithm to Non-Invasively Predict Core Body Temperature Using the Kenzen Wearable Device

With climate change increasing global temperatures, more workers are exposed to hotter ambient temperatures that exacerbate risk for heat injury and illness. Continuously monitoring core body temperature (T_C) can help workers avoid reaching unsafe T_C. However, continuous T_C measurements are currently cost-prohibitive or invasive for daily use. Here, we show that Kenzen's wearable device can accurately predict T_C compared to gold standard T_C measurements (rectal probe or gastrointestinal pill). Data from four different studies (n = 52 trials; 27 unique subjects; >4000 min data) were used to develop and validate Kenzen's machine learning T_C algorithm, which uses subject's real-time physiological data combined with baseline anthropometric data. We show Kenzen's T_C algorithm meets pre-established accuracy criteria compared to gold standard T_C: mean absolute error = 0.25 °C, root mean squared error = 0.30 °C, Pearson r correlation = 0.94, standard error of the measurement = 0.18 °C, and mean bias = 0.07 °C. Overall, the Kenzen T_C algorithm is accurate for a wide range of T_C, environmental temperatures (13-43 °C), light to vigorous heart rate zones, and both biological sexes. To our knowledge, this is the first study demonstrating a wearable device can accurately predict T_C in real-time, thus offering workers protection from heat injuries and illnesses.

Organ Histopathology and Hematological Changes Associated With Heat Exposure in Australian Desert Birds

An inability of the body to appropriately respond to extreme temperatures will result in pathological changes to vital organs and adverse hematological changes. Mild heat exposure of a bird to a temperature above the zone of thermoneutrality can induce subclinical heat stress, which may be a precursor to illness. The ability to identify subtle changes that may be associated with subclinical heat stress can be important in early diagnosis and treatment of heat stress in birds. Pathological changes to internal body organs, post-heat exposure, were microscopically examined in 13 budgerigars (Melopsittacus undulatus), 15 zebra finches (Taeniopygia guttata), and 8 diamond doves (Geopelia cuneata) as model species for the bird orders Psittaciformes, Passeriformes, and Columbiformes, respectively. There was mild to moderate congestion of the lungs of 28/36 birds examined, including all of the budgerigars and diamond doves. In 8/15 zebra finches no significant lung congestion was noted. Interstitial and pulmonary hemorrhage was in observed in one diamond dove. The most common hepatic pathologic change identified was micro- and macro-vesicular hepatocellular vacuolation (4/15 zebra finches, 5/13 budgerigars, and 8/8 diamond doves). There was mild to moderate congestion in the kidneys of 1/15 zebra finch, 2/ 13 budgerigars, and 4/8 diamond doves, as well as in the gastrointestinal tract of 1/15 zebra finch and 7/8 budgerigars. Budgerigars showed a decrease in hematocrit and a significant change in the numbers of heterophils and lymphocytes following heat exposure. The basophil population of cells remained relatively stable in both budgerigars and diamond doves. These findings indicate avian species differences in body organ and hematological changes following exposure to similar elevations in environmental temperatures.

Optimization of broth recovery for repair of heat-injured Salmonella enterica serovar Typhimurium and Escherichia coli O157:H7

AIMS

The purpose of this research was to determine optimum conditions for broth recovery of heat-injured Salmonella Typhimurium and Escherichia coli O157:H7.

METHODS AND RESULTS

Exposure to 55°C for 15 and 25 min, respectively, induced cellular injury to those pathogens. Comparison was made with the commonly used overlay method using selective medium for recovering sublethally injured cells of S. Typhimurium. For E. coli O157:H7, phenol red agar base with 1% sorbitol was used. After cell suspensions were heated at 55°C for selected time intervals, microbes were 10-fold diluted with brain heart infusion (BHI), tryptic soy broth (TSB) and TSB with 0·6% yeast extract (TSBYE) and incubated at 37°C for up to 3 h. At hourly intervals, diluents were plated onto selective medium for recovery. Simultaneously, diluents were plated onto tryptic soy agar (TSA) for recovery of sublethally injured cells. For overlays, diluents were plated onto TSA and overlaid with selective agar after a resuscitation interval. Broth recovery conditions for S. Typhimurium and E. coli O157:H7 were determined to be 1 h in any of the following broth media: BHI, TSB or TSBYE. When liquid resuscitation was applied to sublethally injured cells in food samples (milk), 1 h was also sufficient time for recovery.

CONCLUSIONS

The broth recovery method is a convenient alternative to conventional recovery methods.

SIGNIFICANCE AND IMPACT OF THE STUDY

Cells sublethally injured by control interventions might not grow on selective medium because they have no resistance to several selective compounds. However, injured cells can recuperate and multiply under conditions sufficient for recovery. To repair and detect heat-injured cells, the overlay method is commonly used but this method has some limitations. This study confirms the effectiveness of liquid resuscitation method on recovery of injured cells. The broth recovery can replace the overlay method due to greater convenience and timesaving.

Individualized estimation of human core body temperature using noninvasive measurements

A rising core body temperature (T_c) during strenuous physical activity is a leading indicator of heat-injury risk. Hence, a system that can estimate T_c in real time and provide early warning of an impending temperature rise may enable proactive interventions to reduce the risk of heat injuries. However, real-time field assessment of T_c requires impractical invasive technologies. To address this problem, we developed a mathematical model that describes the relationships between T_c and noninvasive measurements of an individual’s physical activity, heart rate, and skin temperature, and two environmental variables (ambient temperature and relative humidity). A Kalman filter adapts the model parameters to each individual and provides real-time personalized T_c estimates. Using data from three distinct studies, comprising 166 subjects who performed treadmill and cycle ergometer tasks under different experimental conditions, we assessed model performance via the root mean squared error (RMSE). The individualized model yielded an overall average RMSE of 0.33 (SD = 0.18)°C, allowing us to reach the same conclusions in each study as those obtained using the T_c measurements. Furthermore, for 22 unique subjects whose T_c exceeded 38.5°C, a potential lower T_c limit of clinical relevance, the average RMSE decreased to 0.25 (SD = 0.20)°C. Importantly, these results remained robust in the presence of simulated real-world operational conditions, yielding no more than 16% worse RMSEs when measurements were missing (40%) or laden with added noise. Hence, the individualized model provides a practical means to develop an early warning system for reducing heat-injury risk.

NEW & NOTEWORTHY A model that uses an individual’s noninvasive measurements and environmental variables can continually “learn” the individual’s heat-stress response by automatically adapting the model parameters on the fly to provide real-time individualized core body temperature estimates. This individualized model can replace impractical invasive sensors, serving as a practical and effective surrogate for core temperature monitoring.

Heat Stress Is More Damaging to Superior Spikelets than Inferiors of Rice (Oryza sativa L.) due to Their Different Organ Temperatures

In general, the fertility and kernel weight of inferior spikelets of rice (Oryza Sativa L.) are obviously lower than those of superior spikelets, especially under abiotic stress. However, different responses to heat stress are seemed to show between the superior and inferior spikelet, and this response is scarcely documented that the intrinsic factors remain elusive. In order to reveal the mechanism underlying, two rice plants with different heat tolerance were subjected to heat stress of 40°C at anthesis. The results indicated that a greater decrease in fertility and kernel weight was observed in superior spikelets compared to inferior spikelets. This decrease was primarily ascribed to their different organ temperatures, in which the temperature of the superior spikelets was significantly higher than that of inferior spikelets. We inferred the differences in canopy temperature, light intensity and panicle types, were the primary reasons for the temperature difference between superior and inferior spikelets. Under heat stress, the fertility and kernel weight of superior and inferior spikelets decreased as the panicle numbers per plant were reduced, which was accompanied by significantly increasing the canopy temperatures. Thus, it was suggested that the rice plant with characteristic features of an upright growth habit and loose panicles might be more susceptible to heat stress resulting from their higher canopy and spikelets temperatures.

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

OBJECTIVE

To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation.

BACKGROUND

Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport. The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs. These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes.

RECOMMENDATIONS

Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.

Application of iodinated starch powder using an atomizer spray gun - a new and effective tool to evaluate hypohidrosis

BACKGROUND

Hypohidrosis is defined as diminished sweating in response to an appropriate thermal or sympathetic stimulus. When encountered in a clinical setting, it necessitates an accurate documentation of its pattern and extent to prognosticate the risk of associated heat-related illnesses. This can be achieved by thermoregulatory sweat testing which includes a starch-iodine sweat test that can be administered via various methods.

OBJECTIVE

To describe and evaluate the effectiveness and safety of a novel method of using an atomizer spray gun in administering the starch-iodine test.

METHODS

We describe the administration of the starch-iodine test via an atomizer spray gun (Series 700 Lab Model; Mitsuba Systems, Mumbai, India). The method was utilized for the evaluation of 30 individuals who presented with symptoms of hypohidrosis.

RESULTS

Application of iodinated starch powder prepared in-house with the atomizer spray gun achieved a lightweight and homogeneous coat on our patients' skin which allowed for clear visualization of the sweating pattern in areas of anhidrosis. The sharp demarcation of the pathological regions enabled the precise calculation of the affected body surface area of impaired sweating. Unlike the starch-iodine tests using the Minor and Wada methods, neither staining of the skin nor irritation was detected in this method.

CONCLUSION

We report a novel method of using an atomizer spray gun to perform the starch-iodine test in a rapid, reproducible, effective, and safe manner suitable for use in the clinical evaluation of hypohidrosis.

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

OBJECTIVE

To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation.

BACKGROUND

Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport. The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs. These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes.

RECOMMENDATIONS

Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.

Heat-related illness in sports and exercise

Exertional heat-related illness (EHRI) is comprised of several states that afflict physically active persons when exercising during conditions of high environmental heat stress. Certain forms of EHRI may become life threatening if not treated. Exertional heat stroke (EHS), characterized by a core body temperature of >40 ° C and mental status changes, is the most severe form of EHRI. EHS must be treated immediately with rapid body cooling to reduce morbidity and mortality. Many EHRI cases are preventable by following heat acclimatization guidelines, modifying sports and exercise sessions during conditions of high environmental heat stress, maintaining adequate hydration, avoiding exertion in the heat when ill, and by educating sports medicine personnel, coaches, parents, and athletes on the early recognition and prevention of EHRI. Heat exhaustion, exercise-associated collapse, exercise-associated muscle cramps, exercise-associated hyponatremia, and exertional rhabdomyolysis are also described.

The thermal-circulatory ratio (TCR): An index to evaluate the tolerance to heat

Introduction

The common practice in the Israel Defense Force is that all exertional heat related injuries victims undergo a heat tolerance test (HTT) as a part of the “return to duty” process. The purpose of this study was to develop a quantitative, supportive physiological index for the assessment of the HTT based on the understanding that heat strain level should combine the thermal and cardiovascular strains.

Materials and methods

The HTT results of 104 individuals with a history of heat injuries were retrospectively analyzed after randomly divided into two groups (an analysis group and a validation group). Rectal temperature and heart rate were monitored continuously during the test. Using the ratio between those two variables we constructed the TCR (Thermal-Circulatory Ratio) index and defined thresholds for determining heat tolerance based on the HTT.

Results

Using a TCR value of 0.279 [°C/bpm] or less after completing the 120 min HTT can be used as a significant measure to distinguish between heat tolerance and heat intolerance individuals with sensitivity and specificity of 100% of 89%, respectively. In addition, a TCR value of 0.320 [°C/bpm] or less calculated after 60 min was found as a significant measure to determine heat tolerance with 100% sensitivity and 69% specificity. The latter threshold may assist in significantly shortening the HTT for those individuals whose TCR value matches this criterion.

Discussion and conclusion

A new index (TCR) that combines the thermal and cardiovascular responses to exercise-heat stress was found to be a valid measure, with high sensitivity and specificity, to support the distinguishing between heat tolerance and heat intolerance individuals following a HTT. Furthermore, the suggested index may enable to shorten the HTT, which will make the test more efficient.

Exertional heat stroke management strategies in United States high school football

BACKGROUND

The 5-year period of 2005-2009 saw more exertional heat stroke-related deaths in organized sports than any other 5-year period in the past 35 years. The risk of exertional heat stroke appears highest in football, particularly during the preseason.

PURPOSE

To estimate the incidence of exertional heat stroke events and assess the utilization of exertional heat stroke management strategies during the 2011 preseason in United States high school football programs.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A self-administered online questionnaire addressing the incidence of exertional heat stroke events and utilization of exertional heat stroke management strategies (eg, removing athlete's football equipment, calling Emergency Medical Services [EMS]) was completed in May to June 2012 by 1142 (18.0%) athletic trainers providing care to high school football athletes during the 2011 preseason.

RESULTS

Among all respondents, 20.3% reported treating at least 1 exertional heat stroke event. An average of 0.50 ± 1.37 preseason exertional heat stroke events were treated per program. Athletic trainers responding to exertional heat stroke reported using an average of 6.6 ± 1.8 management strategies. The most common management strategies were low-level therapeutic interventions such as removing the athlete's football equipment (98.2%) and clothing (77.8%) and moving the athlete to a shaded area (91.6%). Few athletic trainers reported active management strategies such as calling EMS (29.3%) or using a rectal thermometer to check core body temperature (0.9%). Athletic trainers in states with mandated preseason heat acclimatization guidelines reported a higher utilization of management strategies such as cooling the athlete through air conditioning (90.1% vs 65.0%, respectively; P < .001), immersion in ice water (63.0% vs 45.4%, respectively; P = .01), or fans (54.3% vs 42.0%, respectively; P = .06) and monitoring the athlete's temperature (60.5% vs 46.2%, respectively; P = .04).

CONCLUSION

Preseason exertional heat stroke events, which are likely to be fatal if untreated, were reported by one fifth of all athletic trainers in high school football programs. The standard of care is (and should be) to treat proactively; therefore, treatment is not a perfect proxy for incidence. Nevertheless, there is an urgent need for improved education and awareness of exertional heat stroke in high school football. Areas of improvement include the greatly increased use of rectal thermometers and immersion in ice water.

Virulence of Culture Filtrate from Heat-Injured and Repaired Listeria Strains: Assay on Bovine Mammary Epithelial (MAC-T) Cells

The cytotoxic effect of culture filtrates from healthy, heat-stressed, and repaired Listeria monocytogenes and L. innocua on the bovine mammary epithelial cell line MAC-T was examined. Culture filtrates were collected from Listeria spp. following treatments which included: (i) 18 h of growth of Listeria at 37°C; (ii) sublethal heat treatment at 56°C for 50 minutes; (iii) repair of the injured cells at 37°C for 7 h; (iv) growth of repaired bacterial cells at 37°C for 36 h; and (v) heat injury at 56°C for 50 min of the cell population obtained after the initial repair and growth. Strains chosen for study included two genetic mutants of L. monocytogenes : a hemolysin-negative mutant, CNL 85/162 (Hly^-) and a hemolysin-positive revertant, CNL 85/163 (Hly⁺). Culture filtrates obtained from Hly^- bacteria did not prevent adhesion of the mammary epithelial cells and slightly stimulated their growth. In contrast, culture filtrates from Hly⁺ bacteria grown for 18 h significantly reduced the ability of MAC-T cells to adhere to the cell culture dishes, prevented the growth of those cells that were attached to the dishes, and caused cell death. Supernatants from Hly⁺ and Hly^- following injury and during repair had no lethal effect on MAC-T cells. The effects of culture medium obtained after growth of the repaired Listeria cells on MAC-T cells were similar to those recorded for medium from the first 18 h growth for both strains, indicating that cells regain virulence potential once they have repaired and reinitiated growth. Culture filtrates obtained from L. monocytogenes Scott A showed results similar to those of Hly⁺, decreasing adherence and growth of MAC-T cells, while L. innocua culture filtrate had no adverse effect. The results of these experiments suggest that when injured, L. monocytogenes does not demonstrate adverse effects towards MAC-T cells. Once repair is completed and the listeria are growing, activity towards MAC-T cells is restored.

Comparison of Oxygen Scavengers for Their Ability to Enhance Resuscitation of Heat-injured Listeria monocytogenes

The recovery of heat-injured Listeria monocytogenes Scott A in Fraser broth (FB) supplemented with sodium thioglycolate, sodium pyruvate, L-(+)-cysteine hydrochloride, catalase or Oxyrase? was studied. After 3 h of incubation at 30°C, recovery was enhanced by all oxygen scavengers except sodium pyruvate. Oxyrase? (0.005 U ml^-1) promoted the highest recovery (34%) compared to recovery in control broth (19%). All oxygen scavengers enhanced the recovery of injured L. monocytogenes in FB within 6 h of incubation. After 6 h at 30°C, 49 and 55% of injured cells underwent resuscitation in FB containing 2.5 mg of sodium pyruvate ml^-1 and 400 μg of catalase ml^-1, respectively, compared to 24% resuscitation in FB not supplemented with oxygen scavengers. The percentage recovery was increased as the incubation time was extended to 6 and 24 h. Nearly all injured cells were recovered within 24 h of incubation, regardless of supplementation of FB with oxygen scavengers. Fraser broth containing 2.5 mg of sodium pyruvate ml^-1, 400 μg of catalase ml^-1 or 0.01 U of Oxyrase? ml^-1 were tested to determine the optimal incubation time and temperature for recovering heat-injured L. monocytogenes . Percentage recovery of injured cells increased with an increase in temperature from 25 to 30°C and from 30 to 35°C. The highest percentage of injured cells recovered was observed in FB containing 400 μg of catalase ml^-1 (67%) and 0.01 U of Oxyrase? ml^-1 (68%) within 6 h of incubation at 35°C. Catalase (400 μg ml^-1) and Oxyrase? (0.01 U ml^-1) in FB resulted in significantly higher recovery of injured cells from heated whole milk; however, recovery of injured cells from heated skim milk was not significantly higher. Enrichment in FB containing catalase or Oxyrase? has potential for recovering heat-injured L. monocytogenes cells within 6 h compared to 24 h required in conventional methods.