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To evaluate whether single measurements of serum estradiol (EWe analyzed baseline data from two clinical trials conducted in 2012-2017: MsFLASH 03 (178 peri-/post-menopausal women aged 40-62 years with bothersome vasomotor symptoms, mean age 54) and MsFLASH 05 (181 post-menopausal women aged 45-70 years with moderate-to-severe vulvovaginal symptoms, mean age 61).Symptom bother (hot flushes or flashes, night sweats, sweating, aching in muscles and joints, change in sexual desire, vaginal dryness during intercourse, and avoiding intimacy) in the past month was assessed using the Menopause-Specific Quality of Life questionnaire. Using logistic regression, we calculated the area under the receiver operating characteristic curve (AUC) values for EAUC values (95% confidence interval) ranged between 0.51 (0.41-0.60) and 0.62 (0.53, 0.72) for MsFLASH 03 and between 0.51 (0.42, 0.59) and 0.64 (0.53, 0.75) for MsFLASH 05. There was little evidence of associations between serum hormone levels and bother by a given menopausal symptom.These findings do not support the clinical utility of a single measurement of serum of E

Tingling dermal pain triggered by sweating impairs the lives of patients with cholinergic urticaria and generalized anhidrosis. However, dermal pain evoked by sweating stimuli has been under investigated.To clarify characteristics of tingling dermal pain on sweating, we retrospectively evaluated clinical and histopathological manifestations in 30 patients having the main problem of dermal pain on sweating, and the efficacy of treatments.Dermal pain upon sweating affected mostly young males. It accompanied eruptions upon sweating and/or hypohidrosis in 24 patients, while 6 patients had dermal pain independently of hypohidrosis or eruptions. Dermal pain appeared immediately upon exposure to sweating stimuli, and disappeared within mostly 30 or 10 min. Hypohidrosis was not necessarily generalized but localized or absent. Histological analysis revealed that dermal pain could occur even without morphological changes and inflammation of sweat glands. Hypersensitivity to sweat contents was found only in 26% of patients. Sweat histamine and increase of plasma histamine after thermal induction in patients were significantly higher than those in healthy subjects. Effectiveness of steroid pulse therapy was demonstrated for dermal pain with hypohidrosis. Medications acting on nervous systems and regular sweat-inducing activities for promoting perspiration were also effective.Short-lasting tingling dermal pain appears immediately upon exposure to sweating stimuli, regardless of developing eruptions and/or presence of hypohidrosis, but possibly in association with sweat and plasma histamine.

Introduction Compensatory sweating (CS) is a common complication after thoracoscopic sympathectomy (TS) and is mainly associated with surgical technique. Our aim was to identify potential risk-factors for CS following TS for primary focal hyperhidrosis in children. Methods A retrospective, single-center review of all bilateral TS was performed between 2017 and 2019. Hyperhidrosis disease severity scale was used for pre-operative severity assessment. Post-operative evaluations were performed after three and six months. Results More than the 36-month period, 41 patients were submitted to T2–T4 TS, and 25 were females (60.9%). Median age at surgery was 15.5 years. CS was identified at the 3rd month in 17 (41%) children with most in the dorsolumbar region (56%). By the 6th month, there was a significant reduction in CS (41 to 32%, p = 0.02). The probability of resolution of CS by 6 months is about 50% in both the dorsolumbar and abdominal regions. Neither age, gender, body mass index, family history, or concomitant illnesses seemed to influence CS (p > 0.05). Axillary hyperhidrosis appears to be associated with the development of dorsolumbar CS (p = 0.037). Conclusion Thoracoscopic sympathectomy for PFH is a safe and effective procedure, but compensatory sweating can be a common and debilitating side effect. Age, gender, and body mass index do not appear to influence CS. Axillary hyperhidrosis may be related to the development of dorsolumbar CS. Level of evidence III.

Background Botulinum neurotoxin type A has been used for the treatment of hyperhidrosis. Objective To perform a systematic review of the literature to identify evidence on the treatment approaches and outcomes associated with abobotulinumtoxinA (aboBoNT-A) treatment of hyperhidrosis. Methods EMBASE, MEDLINE, and the Cochrane Library were searched for relevant observational studies, randomized controlled trials, and nonrandomized controlled trials. There were no date or country restrictions. Bibliographies of review articles and recent congress proceedings (2017-2019) were also searched. Articles were screened using predefined eligibility criteria and relevant data were extracted. Results Of 191 unique articles identified, 23 were considered relevant (3 observational studies, 10 nonrandomized controlled trials, and 10 randomized controlled trials). These articles provided data on axillary (13), palmar (7), and forehead (1) hyperhidrosis, compensatory hyperhidrosis of the back (1), Frey syndrome (1), and diabetic gustatory sweating (1). All studies reported that aboBoNT-A reduced sweating and no serious adverse events were observed. Patient satisfaction was high and improvements to quality of life were observed after aboBoNT-A treatment. Limitations Variability in the injection technique when data were compared across studies. Conclusion This study describes a range of treatment approaches and demonstrates positive outcomes of aboBoNT-A treatment for multiple types of hyperhidrosis.

Objective To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis. Methods Forty patients with combined palmar and plantar hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). Results In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. Conclusions Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.

Background Coronary risk scores (CRS) including History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score and Emergency Department Assessment of Chest pain Score (EDACS) can help identify patients at low risk of major adverse cardiac events. In the emergency department (ED), there are wide variations in hospital admission rates among patients with chest pain. Objective This study aimed to evaluate the impact of CRS on the disposition of patients with symptoms suggestive of acute coronary syndrome in the ED. Methods This retrospective cohort study included 3660 adult patients who presented to the ED with chest pain between January and July in 2019. Study inclusion criteria were age > 18 years and a primary position International Statistical Classification of Diseases and Related Health Problems-10th revision coded diagnosis of angina pectoris (I20.0–I20.9) or chronic ischemic heart disease (I25.0–I25.9) by the treating ED physician. If the treating ED physician completed the electronic structured variables for CRS calculation to assist disposition planning, then the patient would be classified as the CRS group; otherwise, the patient was included in the control group. Results Among the 2676 patients, 746 were classified into the CRS group, whereas the other 1930 were classified into the control group. There was no significant difference in sex, age, initial vital signs, and ED length of stay between the two groups. The coronary risk factors were similar between the two groups, except for a higher incidence of smokers in the CRS group (19.6% vs. 16.1%, p = 0.031). Compared with the control group, significantly more patients were discharged (70.1% vs. 64.6%) directly from the ED, while fewer patients who were hospitalized (25.9% vs. 29.7%) or against-advise discharge (AAD) (2.6% vs. 4.0%) in the CRS group. Major adverse cardiac events and mortality at 60 days between the two groups were not significantly different. Conclusions A higher ED discharge rate of the group using CRS may indicate that ED physicians have more confidence in discharging low-risk patients based on CRS.

The objective was to compare the efficacy of three different heat acclimation protocols to improve exercise performance in the heat. Thirty four cyclists completed one of three 10-day interventions 1) 50-min cycling per day in 35 °C, 2) 50-min cycling per day wearing thermal clothing, and 3) 50-min cycling wearing thermal clothing plus 25 min hot water immersion per day. Pre- and post-intervention hemoglobin mass, intravascular volumes and core temperature were determined at rest. Heart rate, sweat rate, blood lactate concentration and core temperature were evaluated during 15-min submaximal and 30-min all-out cycling performance conducted in 35.2 ± 0.1 °C and 61 ± 1% relative humidity. There were no significant between-group differences in any of the determined variables. None of the interventions statistically altered any of the parameters investigated as part of the 15-min submaximal trial. However, following the intervention period, heat chamber, thermal clothing and thermal clothing + hot water immersion all improved 30-min all-out average power in the heat (9.5 ± 3.8%, 9.5 ± 3.6 and 9.9 ± 5.2%, respectively, p 0.001, F = 192.3). At termination of the 30-min all-out test, the increase in blood lactate concentration, rate of perceived exertion and sweat rate were not different between the three interventions. In conclusion, daily training sessions conducted either in ambient 35 °C, while wearing thermal clothing in temperate conditions or while wearing thermal clothing combined with hot water immersion are equally effective for improving exercise performance in the heat.

Cholinergic urticaria (CholU) is characterized by the occurrence of itchy wheals induced by sweating. Intradermal injections of acetylcholine (ACh) have been proposed to help with diagnosing CholU and subgrouping of patients, but controlled studies are largely missing.To compare the rates of positive ACh test results in well characterized CholU patients and controls and to identify clinical features of CholU linked to ACh reactivity.Acetylcholine was injected intradermally into 38 CholU patients and 73 matched healthy controls. Wheal and flare skin responses were assessed after 15 and 30 min and correlated with clinical features of CholU.At 15 min after intradermal injections of ACh, wheal and flare responses were significantly more frequent in CholU patients than healthy controls, wheals: 34 % vs.15% (P = 0.028); flares: 50 % vs.18 % (P0.001). Also, wheals were 37 % and flares 172 % larger and of longer duration in CholU patients than in healthy controls (both P0.01). CholU patients with ACh-induced wheals (AChIntradermal ACh testing does not allow for the identification of CholU patients due to its low sensitivity. ACh-induced wheals, in patients with CholU, is linked to sweating and longer lasting symptoms. Intradermal ACh testing is an interesting tool for mechanistic studies in CholU.

Dysautonomia has been reported in COVID-19. Sweat function testing has been proposed to assess autonomic neuropathy. Fifty Indian patients consulting for neurological symptoms participated in this observational study. The NHS questionnaire for neurological symptoms was completed and electrochemical skin conductance was measured using Sudoscan. The 26% of patients with sweat dysfunction i) were older (p = 0.001), ii) were more frequently treated at home (p = 0.008), iii) were more likely to have received antiviral treatment (p = 0.0006), and iv) more frequently reported at least one motor, sensory or autonomic symptom (p = 0.04). This preliminary study suggests that patients with COVID-19 should be screened for dysautonomia.

Objectives We investigated the thermoregulatory responses to ice slurry ingestion during low- and moderate-intensity exercises with restrictive heat loss. Design Randomised, counterbalanced, cross-over design. Methods Following a familiarisation trial, ten physically active males exercised on a motorised treadmill at low-intensity (L; 40% VO2max) or moderate-intensity (M; 70% VO2max) for 75-min, in four randomised, counterbalanced trials. Throughout the exercise bout, participants donned a raincoat to restrict heat loss. Participants ingested 2 g kg−1 body mass of ambient water (L + AMB and M + AMB trials) or ice slurry (L + ICE and M + ICE trials) at 15-min intervals during exercise in environmental conditions of Tdb, 25.1 ± 0.6 °C and RH, 63 ± 5%. Heart rate (HR), gastrointestinal temperature (Tgi), mean weighted skin temperature (Tsk), estimated sweat loss, ratings of perceived exertion (RPE) and thermal sensation (RTS) were recorded. Results Compared to L + AMB, participants completed L + ICE trials with lower ΔTgi (0.8 ± 0.3°C vs 0.6 ± 0.2 °C; p = 0.03), mean RPE (10 ± 1 vs 9 ± 1; p = 0.03) and estimated sweat loss (0.91 ± 0.2 L vs 0.78 ± 0.27 L; p = 0.04). Contrastingly, Tgi (p = 0.22), Tsk (p = 0.37), HR (p = 0.31), RPE (p = 0.38) and sweat loss (p = 0.17) were similar between M + AMB and M + ICE trials. RTS was similar during both low-intensity (4.9 ± 0.5 vs 4.7 ± 0.3; p = 0.10) and moderate-intensity exercise (5.3 ± 0.47 vs 5.0 ± 0.4; p = 0.09). Conclusions Per-cooling using ice slurry ingestion marginally reduced thermal strain during low-intensity but not during moderate-intensity exercise. Ice slurry may be an effective and practical heat mitigation strategy during low-intensity exercise such as in occupational and military settings, but a greater volume should be considered to ensure its efficacy.

Background Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (video-assisted thoracoscopic sympathectomy [VATS]) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of patients aged 40 years or older compared with those of young adult patients (19–40 years). Methods We retrospectively analyzed 2,431 HH patients who underwent bilateral VATS and divided the patients into the following groups: a group younger than 40 years old (1,760 patients) and a group 40 years and older (142 patients). Variables included quality of life before surgery, improvement in quality of life after surgery, clinical improvement in sweating, the presence of severe compensatory hyperhidrosis (CH), and general satisfaction at 1 month after surgery. Results We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the 2 groups of patients. More than 90% of the patients in this series had great clinical improvement in the main HH site, with no significant difference between the 2 groups. Severe CH occurred in 23.8% of the patients in this series, with no significant difference between the 2 groups. Conclusions Patients 40 years of age or older benefit just as much as younger patients from VATS performed to treat primary HH, presenting excellent significant surgical results.

Objective To ascertain the association between vasomotor menopausal symptoms (VSM), hot flushes and night sweats, and cardiovascular disease, coronary heart disease and cerebrovascular disease. Study design The study sample comprised 8881 women (aged 45–50 years) with available hospital separation data from the 1946-51 cohort (1996–2016) of the ongoing Australian Longitudinal Study on Women’s Health, a national prospective cohort study. Main outcome measures First fatal or non-fatal cardiovascular disease, coronary heart disease, and cerebrovascular disease events were obtained through linkage with hospital admission data, the National Death Index, and Medicare Benefits Schedule. Hot flushes and night sweats were assessed via questionnaires at each main survey. Additionally, we calculated the duration of symptoms based on whether or not women reported vasomotor menopausal symptoms in each survey. Results There were 925 cardiovascular disease, 484 coronary heart disease and 154 cerebrovascular disease events. There was no consistent evidence of any association with vasomotor menopausal symptoms, hot flushes and night sweats. We did find marginally statistically significant associations between presence of night sweats and cardiovascular disease (Hazard Ratio = 1.18, 95 % Confidence Interval: 1.01–1.38), and between the duration of vasomotor menopausal symptoms [years] and coronary heart disease (Hazard Ratioper year = 1.03, 95 % Confidence Interval: 1.00–1.05). However, given the number of associations tested, these findings could very well have arisen by chance. Conclusion In this large longitudinal study with 20 years of follow-up and clinical outcomes we did not find a convincing association between vasomotor menopausal symptoms, hot flushes, night sweats and cardiovascular disease, coronary heart disease and cerebrovascular disease.

Case Presentation A 38-year-old Jamaican man with no medical history presented with worsening right-sided weakness. He developed an ascending hemiparesis that began in the right lower extremity 3 months ago and progressed to the right upper extremity this past month. Over the past 3 months, the patient has had unintentional weight loss and an ataxic gait, and for the past month he has had night sweats. He denied headache, vision changes, numbness, tingling, cough, or chest pain. Social history was significant for 20 smoking pack-years and daily use of marijuana.

Objectives To investigate the efficacy of heat acclimation (HA) in the young (YEX) and elderly (EEX) following exercise-HA, and the elderly utilising post-exercise hot water immersion HA (EHWI). Design Cross-sectional study. Method Twenty-six participants (YEX: n = 11 aged 22 ± 2 years, EEX: n = 8 aged 68 ± 3 years, EHWI: n = 7 aged 73 ± 3 years) completed two pre-/post-tests, separated by five intervention days. YEX and EEX exercised in hot conditions to raise rectal temperature (Trec) ≥38.5 °C within 60 min, with this increase maintained for a further 60 min. EHWI completed 30 min of cycling in temperate conditions, then 30 min of HWI (40 °C), followed by 30 min seated blanket wrap. Pre- and post-testing comprised 30 min rest, followed by 30 min of cycling exercise (3.5 W·kg−1 Ḣprod), and a six-minute walk test (6MWT), all in 35 °C, 50% RH. Results The HA protocols did not elicit different mean heart rate (HR), Trec, and duration Trec ≥ 38.5 °C (p > 0.05) between YEX, EEX, and EHWI groups. Resting Trec, peak skin temperature, systolic and mean arterial pressure, perceived exertion and thermal sensation decreased, and 6MWT distance increased pre- to post-HA (p 0.05). Conclusions Irrespective of age or intervention, HA induced thermoregulatory, perceptual and exercise performance improvements. Both exercise-HA (EEX), and post-exercise HWI (EHWI) are considered viable interventions to prepare the elderly for heat stress.

Introduction Excess catecholamine stimulates heat production in brown adipose tissue (BAT). Activation of BAT can be detected in patients presenting pheochromocytoma. Case study A 58-year-old female patient sought medical advice due to 13 kg weight loss over 2 years accompanied by sweating and high blood pressure. Thoracic-abdominal-pelvic CT-scan revealed a solid 40 mm mass in the left adrenal compartment with peri-adrenal nodules and a solid 80 mm mass at the lower end of the right kidney. 18FDG-PET scan exhibited intense uptake in the supraclavicular, intercostal, mediastinal, peri-renal, mesenteric, iliac and inguinal spaces. Renal tumor with locoregional infiltration and remote metastases was initially considered. Diagnosis of pheochromocytoma was subsequently confirmed by a 10-fold increase in urinary catecholamine, metanephrine and normetanephrine levels. Left adrenalectomy confirmed the diagnosis of pheochromocytoma, with 3 lymph-node metastases in the adjacent adipose tissue surrounded by brown fat. The patient was clinically asymptomatic with normal blood pressure at 3 months post-surgery. A weight gain of 6 kg was recorded, with normalisation of catecholamines/metanephrine/normetanephrine levels. Bilateral peri-renal infiltration (including the right renal mass) disappeared on CT-scan, and TEP-18-FDG no longer showed hypermetabolism. Recurrent mediastinal metastases were diagnosed 6 months after surgery. Conclusion Brown fat activation may mislead diagnosis of pheochromocytoma, suggesting multi-metastatic extra-adrenal tumor, if clinicians are not aware of it.

Objective The main therapeutic method of treatment for local hyperhidrosis is endoscopic thoracic sympathectomy. Generally, resections of the sympathetic trunk or ganglia are performed between the second rib and sixth rib. However, this procedure can result in compensatory sweating, in which excess sweating occurs on the back, chest, and abdomen. Compensatory sweating has been regarded as a thermoregulatory response and thought to be untreatable. This study suggests that compensatory sweating is not a physiologic reaction and is indeed treatable. Methods Eight patients with severe compensatory sweating were treated by observing blood perfusion of the skin with laser speckle flowgraphy, which determines the sympathetic nerves related to the area of skin with compensatory sweating. When intraoperative monitoring with laser speckle flowgraphy indicated the position of compensatory sweating by electrical stimulation of the sympathetic ganglion, ganglionectomy was performed. Results The skin domain that each sympathetic nerve controls was able to be detected by laser speckle flowgraphy. In all patients, compensatory sweating was resolved after interruption of the ganglia or sympathetic nerves related to compensatory sweating. Conclusions Our results demonstrate that compensatory sweating is caused by denatured sympathetic nerves influenced by endoscopic thoracic sympathectomy and is not the result of a physiological response. With laser speckle flowgraphy, the sympathetic nerve related to the sweating of various parts of the body could be identified. The treatment of compensatory sweating on the back, chest, and stomach was previously considered to be difficult; however, compensatory sweating is demonstrated to be treatable with this technique.

The human eccrine sweat gland is central to the evolution of the human genus, permitting an enormous thermoregulatory sweating capacity that was essential to the human niche of high physical activity in open, hot, semi-arid environments. Despite a century of research inventorying the structure and function of eccrine glands and the physiological responses of human heat acclimation, we do not have a clear understanding of how intraspecific differences in eccrine density affect thermoregulation. Similarly, existing data does not comprehensively catalogue modern human diversity in this trait, nor do we understand the relative influences of evolutionary forces and phenotypic plasticity in shaping this diversity.

Shoe microclimate (temperature and humidity) has been suggested to contribute to perceptions of foot thermal comfort. However, limited data is available for perceptual responses in relation to shoe microclimate development both over time and within different areas of the shoe. This study evaluates perceptions of foot thermal comfort for two running shoes different in terms of air permeability in relation to temporal and spatial characteristics of shoe microclimate. The temporal characteristics of shoe microclimate development were similar for both shoes assessed. However, higher temperatures and humidity were observed for the less permeable shoe. Changes to shoe microclimate over time and differences between shoes were perceivable by the users. This study provides the most detailed assessment of shoe microclimate in relation to foot thermal comfort to date, providing relevant information for footwear design and evaluation.

A previous study of electroencephalography (EEG) changes with syncope led to a finding that some young patients develop prolonged periods of tilt-induced hypotension, but they do not lose consciousness. The present study aim was to compare patterns of hemodynamic changes, measures of duration, and sweating between these patients and patients with tilt-induced vasovagal syncope.In an observational study, qualitative changes in hemodynamic parameters were compared between patients with prolonged hypotension (n = 30) and with syncope (n = 30). To demonstrate that periods of hypotension far-exceed the typical presyncope period, several parameters were used to compare the durations of events between groups. Differences in sweating patterns were explored.Parallels in hemodynamic changes were present in both groups suggesting similar vasovagal mechanisms. Patients with prolonged hypotension had longer durations of hypotension (165 ± 44 versus 57 ± 13 s, p 0.001), diminished cardiac output (109 ± 38 versus 32 ± 9 s, p 0.001), and EEG slowing (85 ± 31 versus 9 ± 4 s, p 0.001) compared to patients with syncope. While all patients generated an increase in sweat rate, those with hypotension only developed a robust sweat response that always preceded the plateau in hypotension compared to 14 (47%) patients with syncope who developed an increase in sweating prior to syncope, p 0.001.Similarities are present among hemodynamic changes with prolonged hypotension and with tilt-induced vasovagal syncope, suggesting a possible vasovagal mechanism for prolonged hypotension. If true, understanding why some individuals develop a vasovagal response that does not culminate in rapid syncope may help to elucidate the physiologic underpinnings of the vasovagal reflex.

Heat stress is one of the most important factors that affect the performance of some Bos taurus breeds and crosses in tropical regions. The Brahman breed was developed in hot regions of the world and often has genes that confer resistance to heat stress compared to other breeds of beef cattle. The goal of this work was to evaluate the adaptive responses of Brahman bulls, based on physiological, hormonal and hair characteristics according to season. The physiological, hormonal and hair characteristics were rectal temperature (RT), respiratory rate (RR), sweating rate (SR), triiodothyronine (T3), thyroxine (T4), cortisol concentrations (CO), coat thickness (CT), hair length (HL), hair diameter (HD) and hair density (ND). These were recorded in Brahman bulls from a Cerrado biome during four seasons: spring (21 September to 20 December), summer (21 December to 17 March), autumn (18 March to 20 June) and winter (21 June to 20 September). Data was analyzed using a general linear model that included season as a fixed effect; in addition, multivariate tests and logistic regression were also used to characterize the animals within each season. The meteorological variables defined the four seasons, besides identifying climatic differences between them. Significant differences (P > 0.05) were found for most of the physiological, hormonal and hair characteristics according to season. The Brahman bulls presented particular adaptive characteristics in each season. Individually, most of the Brahman bulls presented the same adaptive reaction in each season; particular similarity occurred for the summer and autumn. This pattern is a reflection of the inter-relationships between physiological responses and hair characteristics.

As little as 2% total body mass (BM) loss from sweat has been shown to compromise physiological functioning during prolonged exercise in the heat, subsequently compromising endurance performance. Purpose: This observational study aims to describe the fluid balance and thermoregulatory responses of competitive triathletes racing at a major international competition in a cool environment. Methods: Fluid balance and thermoregulatory responses was measured in six (3 male, 3 female) national-level triathletes competing at the ITU World Triathlon Grand Finale in ambient temperatures of 19–20 °C (relative humidity (RH) ~55%). Dry, nude BM was recorded before and immediately following the race. Fluid intake was monitored throughout the race. Pre-race urine samples were measured for specific gravity (USG). Each athlete ingested a core temperature (Tc) pill 5 h prior to the event and was monitored before and after the race. Results: Three of six triathletes arrived at the race mildly dehydrated (USG 1.021,1.024,1.030). One of these athletes (1F) subsequently withdrew from the race providing no further data. Another athlete (1M) ended the race vomiting providing invalid hydration data. The four remaining competitors’ sweat loss was on average 2.15 L (range: 1.65–2.80 L), while fluid intake was 0.66 L (0.50–0.85 L). A mean loss of 3.3% (2.2–4.5%) BM was recorded. Tc increased by 2.0 °C (1.1–2.9 °C) and 4/5 athletes’ (2 M, 2 F) Tc exceeded 39 °C by race-end. Both female athletes self-reported feelings of heat-related exhaustion at the completion of the race. Conclusions: Despite cool environmental conditions, elite triathletes lost ~3.3% BM, replacing only 33% of sweat losses, and achieved a Tc > 39 °C by race-end.

Introduction The aim of the study was to evaluate the reliability of five different sweat analysis techniques which measure; whole body sweat rate [WBSR], local sweat rate [LSR] (via technical absorbent [TA] method and KuduSmart® monitor), sweat conductivity [SC] and sweat gland activation [SGA] in a female population when exercising moderately under heat stress. Methods Fourteen females (age; 26 ± 7 years, body mass; 66.5 ± 7.6 kg, height; 167.1 ± 6.4 cm) completed a preliminary threshold walking test (to determine exercise intensity) and two main trials, separated by 2 days. Main trials consisted of 30-min seated rest in the environmental chamber (35 °C, 50% relative humidity) in an upper body sauna-suit, before its removal, and walking at a moderate intensity (4 metabolic equivalents) for 30-min (speeds ranged from 4.8 to 6.5 km h−1). WBSR was measured via nude mass pre and post exercise. The TA and Tegaderm patches (for sweat sodium chloride) were placed on the back, forearm and chest for the entire 60-min, replicated for all participants for both trials. SGA was assessed following the 60-min trial and the KuduSmart® monitor was placed on the left arm for the 30-min of exercise. Results WBSR, LSR methods and SC demonstrated no difference between trials (p > 0.05), good agreement (within limits), strong correlations (r ≥ 0.88) and low typical error of measurements [TEM] ( Conclusion Sudomotor function is reliable, as demonstrated by good reliability, small TEM and strong correlations. The use of these sweat techniques is appropriate and practical in females who are exercising at moderate intensity under heat stress, and so, may aid future interventions. SGA shows larger variation and should be used with caution.

Objectives To determine if intermittent exercise-heat exposures (IHE) every fifth day sustain heat acclimation (HA) adaptations 25 days after initial HA. Design Randomized control trial. Methods Sixteen non-heat acclimatized men heat acclimated during 10–11 days of exercise in the heat (40 °C, 40% RH). A heat stress test (120 min, 45% V ˙ O2peak) before (Pre HA) and after HA (Post HA) in similar hot conditions assessed HA status. Pair-matched participants were randomized into a control group (CON; n = 7) that exercised in a temperate environment (24 °C, 21%RH) or IHE group (n = 9) that exercised in a hot environment (40 °C, 40%RH) every fifth day for 25 days following HA (+25d) with out-of-laboratory exercise intensity and duration recorded. Both groups completed +25d in the hot condition. Results Both groups heat acclimated similarly (p > 0.05) evidenced by lower heart rate (HR), thermoregulatory, physiological, and perceptual responses (perceived exertion, fatigue, thermal sensation) Pre HA vs. Post HA (p ≤ 0.05). At +25d, post-exercise HR (p = 0.01) and physiological strain index (p Conclusions Exercise-heat exposures every fifth day for 25 days and regular intense physical activity after HA sustained HR and Tre adaptations and reduced perceptual and physiological strain during exercise-heat stress ∼1 month later.

We investigated the influence of exercise intensities and regional differences in the sudomotor recruitment pattern in boys. Six prepubertal boys (age 11 ± 1 yr) cycled at light, moderate, and high exercise intensity (35%, 50%, and 65% VO2max) for 30 min in a temperate condition (28 °C, 40% relative humidity). Local sweat rate (ventilated capsule) and number of activated sweat glands (starch-iodine technique) at five body sites were assessed and sweat gland output was calculated. Responses in boys were compared with those in nine young men (23 ± 1 yr) tested under identical conditions. The forehead, chest, back, and forearm, but not thigh, sweat rate increased from light to moderate and at high intensities in boys (all p ≤ 0.005) but not from moderate to high (all p ≥ 0.071). The sweat rate on the forehead was relatively higher (p ≤ 0.045) and thigh was lower (p ≤ 0.050) than other sites in boys at moderate and high intensities. Exercise intensity-dependent sweating was associated with activating more sweat glands but not increasing glandular output in boys. The sweat rate in boys was attenuated versus men heterogeneously across body sites concurrent to low glandular outputs (all p ≤ 0.027). We conclude that exercise intensity modulates the sweat rate in boys by changing the number of activated sweat glands heterogeneously among skin sites. Age-related differences in the sudomotor pattern are evident at higher exercise intensities. Development of glandular output per gland occurring from boys to young men may play a key role in modulating sweat rate with respect to exercise intensity and regional differences.

Objective To evaluate the association between vasomotor symptoms (VMS) and non-alcoholic fatty liver disease (NAFLD) in postmenopausal women. Methods This cross-sectional study included 1793 Korean postmenopausal women aged 45–65 years who attended a routine health check at a Korean institution from January 2010 to December 2012. Their scores on the Menopause Rating Scale were used to assess VMS. Moderate to severe VMS included ratings of moderate, severe, and very severe. NAFLD was diagnosed by abdominal ultrasound among those who indicated that their ethanol intake was less than 70 g/week. Results The mean age of these participants was 54.51 ± 4.74 years and the mean duration of menopause was 5.36 ± 4.41 years. A total of 602 (33.6%) women reported mild VMS while 435 (24.3%) reported moderate to severe VMS. The prevalence of NAFLD differed significantly according to the severity of VMS (none, 31.7%; mild, 34.9%; moderate to severe, 39.1%; p = 0.037). Levels of the liver enzymes alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase were significantly higher in women with moderate to severe VMS than in those without VMS. Logistic regression analysis revealed that moderate to severe VMS were significantly associated with the risk of NAFLD (OR: 1.50, 95% CI: 1.10–2.03) after adjusting for age, years since menopause, central obesity, alcohol use, smoking, exercise, and insulin resistance. Conclusions Moderate to severe VMS are associated with NAFLD and worse liver function profiles in otherwise healthy postmenopausal women. Further longitudinal studies are needed to investigate casual relationships and underlying mechanisms.

The aim of this study was to assess the relationship between sudomotor function and microvascular perfusion in patients with type 1 diabetes (DM1).We evaluated 415 patients (206 women), with DM1, median age of 41 (IQR: 33-53) years, disease duration of 25 (IQR: 20-32) years. We assessed metabolic control of diabetes and the presence of peripheral and cardiac autonomic neuropathy. Sudomotor function was assessed using Sudoscan device by electrochemical skin conductance (ESC). Microvascular function was measured by laser-Doppler flowmetry with basal perfusion, the peak flow after occlusion (PORHpeak) and THmax which is the percentage change between basal perfusion and the peak flow during thermal hyperemia (TH). The accumulation of advanced glycation end products in the skin was assessed by skin autofluorescence (AF) measurement using AGE Reader. We subdivided patients based on the presence of diabetic peripheral neuropathy (DPN), cardiac autonomic neuropathy (CAN) and according to normal value of ESC.Patients with abnormal ESC had higher skin AF [2.5 (2.1-2.9) vs 2.1 (1.9-2.5) AU, p 0.001], lower eGFR [83 (72-96) vs 98 (86-108) ml/min/1.73 m2, p 0.001], higher basal perfusion [25 (12-81) vs 14 (7-43) PU, p 0.001], lower THmax [664 (137-1461) vs 1115 (346-1933) %, p = 0.002], higher PORHpeak [104 (59-167) vs 70 (48-135) PU, p 0.001] as compared to subjects with normal ESC results. We found negative correlation between THmax and TG level (Rs = -0.14, p 0.005), AF (Rs = -0.19, p = 0.001), vibration perception threshold - VPT (Rs = -0.24, p 0.001) and positive correlation with HDL level (Rs = 0.14, p = 0.005), Feet ESC (Rs = 0.21, p 0.001) and Hands ESC (Rs = 0.14, p = 0.004). We found positive correlation between PORHpeak and TG level (Rs = 0.14, p = 0.003), skin AF (Rs = 0.29, p 0.001), VPT (0.27, p 0.001) and negative correlation with eGFR (Rs = -0.2, p 0.001), HDL (Rs = -0.12, p = 0.01), Feet ESC (Rs = -0.27, p 0.001) and Hand ESC (Rs = -0.16, p = 0.002).Impaired microvascular reactivity is associated with sudomotor dysfunction in patients with type 1 diabetes.

To evaluate autonomic symptoms and function in Friedreich's Ataxia (FRDA).Twenty-eight FRDA patients and 24 controls underwent clinical/electrophysiological testing. We employed the Friedreich's Ataxia Rating Scale (FARS) and the Scales for Outcomes in Parkinson's Disease: Autonomic Questionnaire-SCOPA-AUT to estimate the intensity of ataxia and autonomic complaints, respectively. Cardiovagal tests and the quantitative sudomotor axonal reflex, Q-SART, were then assessed in both groups.In the patient group, there were 11 men with mean age of 31.5 ± 11.1 years. Mean SCOPA-AUT score was 15.1 ± 8.1. Minimum RR interval at rest was shorter in the FRDA group (Median 831.3 × 724.0 ms, p 0.001). The 30:15 ratio, Valsalva index, E:I ratio, low and high frequency power presented no differences between patients and controls (p 0.05). Sweat responses were significantly reduced in patients for all sites tested (forearm 0.389 × 1.309 µL; proximal leg 0.406 × 1.107 µL; distal leg 0.491 × 1.232 µL; foot 0.265 × 0.708 µL; p value 0.05). Sweat volumes correlated with FARS scores.We found abnormal sudomotor but normal heart rate variability in FRDA. Small cholinergic post-ganglionic fibers are affected in the disease.Quantification of sudomotor function might be a biomarker for FRDA.

Characterizing the physiologic changes leading up to psychogenic nonsyncopal collapse (PNSC) may help to elucidate the processes that cause paroxysmal functional neurological symptom disorders and to clinically distinguish PNSC from syncope. Thus, we aimed to characterize preictal sweat rate, heart rate, and systolic blood pressure changes among patients with tilt-induced PNSC compared to patients with tilt-induced neurally mediated syncope. The presence of increased preictal sweating was compared between groups. Heart rates and systolic blood pressures were compared from the recumbent and tilted baselines to the periods 120 s and 30 s prior to PNSC and syncope. Patients with PNSC (n = 44) were more likely than patients with syncope (n = 44) to have preictal increases in sweating, n = 31 (70.5%) versus n = 21 (47.7%), p = 0.03, although all patients with syncope eventually developed a sweat response. Comparing the recumbent baseline to the period 30 s prior to PNSC, blood pressure (112 ± 9 versus 129 ± 13 mmHg, p 0.001) and heart rate (76 ± 12 versus 119 ± 22 bpm, p 0.001) increased. Similarly, comparing the tilted baseline to the period 30 s prior to PNSC, blood pressure (118 ± 12 versus 129 ± 13 mmHg, p 0.001) and heart rate (95 ± 15 versus 119 ± 22 bpm, p 0.001) increased. Preictal blood pressure and heart rate differed significantly between patients with PNSC and patients with syncope. In conclusion, signs of autonomic arousal (increased sweating, heart rate, and blood pressure) often precede tilt-induced PNSC. Sweating prior to fainting may not be useful in distinguishing PNSC from neurally mediated syncope.

The purpose of this study was to investigate design modifications in structural firefighter turnout suits for their ability to reduce heat stress during firefighting activities. A secondary aim of this research established a benchmark for the manikin heat loss value necessary to achieve significant improvements in physiological comfort. Eight professional firefighters participated in five simulated exercise sessions wearing a control turnout suit and one of four turnout prototypes: Single Layer, Vented, Stretch, and Revolutionary. Physiological responses (internal core body temperature, skin temperature, physiological strain, heart rate, and sweat loss) were measured when wearing each turnout suit prototype. Results demonstrated a significant increase in work time and significant reductions in heat stress (core temperature, skin temperature, and physiological strain) when participants wore the Single Layer, Vented, and Revolutionary prototypes. An estimated garment heat loss value of 150 W/m2 was determined in order to achieve a significant reduction in heat stress.

We tested the hypothesis that thermal behavior during the exercise recovery compensates for elevated core temperatures despite autonomic thermoeffector withdrawal. In a thermoneutral environment, 6 females and 6 males (22 ± 1 y) cycled for 60 min (225 ± 46 W metabolic heat production), followed by 60 min passive recovery. Mean skin and core temperatures, skin blood flow, and local sweat rate were measured continually. Subjects controlled the temperature of their dorsal neck to perceived thermal comfort using a custom-made neck device. Neck device temperature provided an index of thermal behavior. Mean body temperature, calculated as the average of mean skin and core temperatures, provided an index of the stimulus for thermal behavior. To isolate the independent effect of exercise on thermal behavior during recovery, data were analyzed post-exercise the exact minute mean body temperature recovered to pre-exercise levels within a subject. Mean body temperature returned to pre-exercise levels 28 ± 20 min into recovery (Pre: 33.5 ± 0.2, Post: 33.5 ± 0.2 °C, P = 0.20), at which point, mean skin temperature had recovered (Pre: 29.6 ± 0.4, Post: 29.5 ± 0.5 °C, P = 0.20) and core temperature (Pre: 37.3 ± 0.2, Post: 37.5 ± 0.3 °C, P = 0.01) remained elevated. Post-exercise, skin blood flow (Pre: 59 ± 78, Post: 26 ± 25 PU, P = 0.10) and local sweat rate (Pre: 0.05 ± 0.25, Post: 0.13 ± 0.14 mg/cm2 min−1, P = 0.09) returned to pre-exercise levels, while neck device temperature was depressed (Pre: 27.4 ± 1.1, Post: 21.6 ± 7.4 °C, P = 0.03). These findings suggest that thermal behavior compensates for autonomic thermoeffector withdrawal in the presence of elevated core temperatures post-exercise.

Author(s): Harrington, LB; Blondon, M; Cushman, M; Kaunitz, AM; Allison, MA; Wang, L; Sullivan, S; Woods, NF; LaCroix, AZ; Heckbert, SR; McKnight, B; Rossouw, J; Smith, NL | Abstract: Essentials Vasomotor symptoms have been proposed as markers of changing cardiovascular risk. In this cohort study, we evaluated these symptoms as markers of venous thrombosis (VT) risk. We found no evidence that vasomotor symptom presence or severity were associated with VT risk. Among these postmenopausal women, vasomotor symptoms are not a useful marker of VT risk. SUMMARY:Background Vasomotor symptoms may be markers of changes in cardiovascular risk, but it is unknown whether these symptoms are associated with the risk of venous thrombosis (VT). Objective To evaluate the association of vasomotor symptom presence and severity with incident VT risk among postmenopausal women, independent of potential explanatory variables. Methods This cohort study included participants of the Women's Health Initiative (WHI) Hormone Therapy Trials (n = 24 508) and Observational Study (n = 87 783), analyzed separately. At baseline, women reported whether hot flashes or night sweats were present and, if so, their severity. Using Cox proportional hazards models, we estimated the VT risk associated with vasomotor symptom presence and severity, adjusted for potential explanatory variables: age, body mass index, smoking status, race/ethnicity, and time-varying current hormone therapy use. Results At baseline, WHI Hormone Therapy Trial participants were aged 64 years and WHI Observational Study participants were aged 63 years, on average. In the WHI Hormone Therapy Trials over a median of 8.2 years of follow-up, 522 women experienced a VT event. In the WHI Observational Study, over 7.9 years of follow-up, 1103 women experienced a VT event. In adjusted analyses, we found no evidence of an association between vasomotor symptom presence (hazard ratio [HR]adj 0.91, 95% confidence interval [CI] 0.75-1.1 in the WHI Hormone Therapy Trials; HRadj 1.1, 95% CI 0.99-1.3 in the WHI Observational Study) or severity (HRadj for severe versus mild 0.99, 95% CI 0.53-1.9 in the WHI Hormone Therapy Trials; HRadj 1.3, 95% CI 0.89-2.0) in the WHI Observational Study) and the risk of incident VT. Conclusions Although vasomotor symptoms have been associated with the risk of other cardiovascular events in published studies, our findings do not suggest that vasomotor symptoms constitute a marker of VT risk.

The regulation of body temperature is one of the most critical functions of the nervous system. Here we review our current understanding of thermoregulation in mammals. We outline the molecules and cells that measure body temperature in the periphery, the neural pathways that communicate this information to the brain, and the central circuits that coordinate the homeostatic response. We also discuss some of the key unresolved issues in this field, including the following: the role of temperature sensing in the brain, the molecular identity of the warm sensor, the central representation of the labeled line for cold, and the neural substrates of thermoregulatory behavior. We suggest that approaches for molecularly defined circuit analysis will provide new insight into these topics in the near future.

It can be difficult to differentiate multiple system atrophy (MSA) with predominant parkinsonism (MSA-P), a very disabling but rare disease, from Parkinson's disease (PD). Autonomic dysfunction, particularly cardiovascular autonomic neuropathy (CAN), is classically more pronounced in MSA. We investigated whether testing for CAN combined with sweat function assessment was helpful to differentiate patients with MSA from those with PD.In this retrospective study, 62 patients with MSA-P and 96 with PD, comparable in age, BMI and sex ratio with disease duration of 4.3±2.5 years for MSA vs. 11.5±6 years for PD (P0.0001) were tested for CAN using heart rate changes with deep breathing (HR-DB), stand test (HR-ST) and Valsalva maneuver (HR-VM) and blood pressure changes during stand test (BPs-ST and BPd-ST), Valsalva maneuver (BPs-VM-II and IV), hand grip (BPd-HG) and the total "Ewing" score tests (EwS), and for sweating function using electrochemical skin conductance for hands and feet (HESC and FESC).In MSA-P abnormal EwS, HR-DB, BP-ST and ESC were more frequent compared to PD, despite longer disease duration for PD. Using a model adjusted for sex, BMI, age, disease duration and treatment, the Odds Ratio for having MSA-P vs. PD based on EwS was 2.71, on HR-DB 2.36, on BP-ST 2.87 and on ESC 4.94 while it was 11.68 (2.17-62.79) for the combination of the three last tests.Assessment of HR-DB, BP-ST and ESC, that is, rapid and non-invasive could be helpful in combination as a first simple screening to differentiate MSA-P from PD.

Background To determine in vivo effects of CFTR modulators on mutation S945L. Methods We measured effects of CFTR modulators on CFTR-dependent sweating (‘C-sweat') in two pancreatic sufficient cystic fibrosis (CF) subjects. S1 (S945L/G542X) took ivacaftor and S2 (S945L/F508del) took ivacaftor+tezacaftor. Sweating was stimulated pharmacologically to produce sequentially both CFTR-independent (methacholine stimulated) M-sweat and C-sweat; and the ratio of these was compared. Sweat secretion was measured with two methods: real time secretory rate quantitative recording and by optically measuring the growth of sweat bubbles under oil from multiple identified glands. Results Using the quantitative recorder, we saw zero C-sweat secretion off-drug, but when on-drug the C-sweat responses for both subjects were comparable to those seen in carriers. The on-drug response was further quantified using the sweat bubble method. Each subject again showed robust C-sweat responses, with C-sweat/M-sweat ratios~half of the ratio determined for a cohort of 40 controls tested under identical conditions. Conclusion These in vivo results, consistent with prior in vitro findings, indicate that the drug treatments restore near-normal function to S945L-CFTR, and support the use of ivacaftor as a treatment for CF patients who carry this allele.

Background Postmenopausal symptomatology has not been elucidated in large, long-term human clinical trials. Our objective was to measure quality of life in postmenopausal women aged 50–70 years. Methods A Menopause-Specific Quality of Life-Intervention (MENQOL) questionnaire was completed by women enrolled in the Minnesota Green Tea Trial (n = 932) to assess vasomotor, physical, sexual, and psychosocial symptoms in the years following menopause. Responses were coded; mean overall and domain scores ranged from 1 to 8. A higher score indicated more severe symptoms. Results Mean overall MENQOL scores were highest in women aged 50–54.9 years. A pattern of reduced symptom severity with increasing age was observed overall and within each domain. Women aged 50–54.9 years had more severe night sweats and sweating than other age groups (P ≤ 0.001) and more severe hot flashes than women aged ≥ 60 years (P ≪ 0.001). No differences between age groups were seen on mean score in the Sexual domain. Compared with women aged 50.0–54.9 years (the reference group), study participants aged 60–64.9 and ≥ 65 years had lower MENQOL scores in the Psychosocial domain (P = 0.029 and P ≪ 0.001). Women aged 50–54.9 years had more severe symptoms related to negative mood than women ≥65 years (P ≤ 0.009). Compared with women aged 50–54.9 years, those in the age groups 60–64.9 and ≥ 65 years had lower scores for “poor memory” (2.98 ± 1.75 and 2.66 ± 1.68 vs. 3.43 ± 1.87, P ≪ 0.001). Women ≥ 65 years reported lower scores for “feeling tired or worn out”, “difficulty sleeping”, and “lack of energy” than all other age groups (P ≤ 0.003). Conclusion The findings of this descriptive analysis of postmenopausal women may help clinicians counsel women about expectations and treatment options to address menopause-associated symptoms and the relationship between postmenopausal symptoms and overall health.

The purpose of this study was to determine the time course for the previously reported reduction in sweat sodium ion concentration during heat acclimation. Four healthy volunteers completed 7 consecutive days of heat acclimation which included 2h of treadmill walking in a 40°C and 40% relative humidity environment. A modified constant hyperthermia protocol was used as workloads were increased each day to maintain a constant core temperature over the 7 days of heat acclimation. Forearm sweat was collected 3 times during each 2h exercise bout on days 1, 3, 5, and 7 of heat acclimation. Forearm sweat rate and sweat sodium ion concentration were determined from each sample. The results showed that there was a significant (p < 0.05) downward shift in the mean sweat rate vs. sweat sodium ion concentration relationship on days 3, 5, and 7 of heat acclimation, as compared to the pre-heat acclimation (day 1) data. Thus, at any given sweat rate, heat acclimation resulted in a significantly lower sweat sodium ion concentration. The response was very rapid and occurred following only 2 consecutive days of heat exposure (i.e., day 3 vs. day 1 data). Furthermore, the calculated sweat sodium ion concentration, at a sweat rate of 1µl/cm2/min, decreased linearly (r = - 0.50, p < 0.05) during the 7 days of heat acclimation. Such results suggest that heat acclimation rapidly improves sodium ion reabsorption from the eccrine sweat gland duct as evidenced by significant reductions in the sweat sodium ion concentration.

Introduction Facial hyperhidrosis (FH) may lead patients to a significantly impaired quality of life (QOL). Video-assisted thoracoscopic sympathectomy (VATS) is reserved for more severe cases refractory to common first-line agents. The aim of this study was to evaluate the efficacy of VATS for FH and to compare the results between patients with facial hyperhidrosis as main complaint (FHMC) and patients with facial hyperhidrosis as nonmain complaint (FHNMC). Methods This was a retrospective study based on medical chart analysis from March 2000 to January 2014: 40 patients with FHMC and 136 patients with FHNMC. Patients underwent VATS at the T2, T3, or T4 level, according to the main site of complaint. We assessed improvement in QOL, improvement in hyperhidrosis, and presence of complications and side effects, notably compensatory hyperhidrosis (CH). Results Patients with FHMC reported greater improvement in FH (97.1% versus 93.6%; P = 0.006) but had lower improvement in QOL (78.2% versus 92.7%; P = 0.024) compared to patients with FHNMC. For patients with FHNMC, any degree of improvement in FH was reported by 100%, almost 95%, and nearly 80% of the patients who underwent VATS at the T2, T3, and T4 level, respectively ( P = 0.039). Pain and CH were reported by more than 61% and 92% of the patients, respectively, with no statistical difference between both groups. Conclusions Patients with FHMC, despite the greater improvement in FH, experienced lower improvement in QOL compared to patients with FHNMC. CH was the most frequent side effect in both groups, affecting more than 92% of the patients.

This paper outlines the development of a finite element human thermoregulatory model using an anatomically and geometrically correct human body model. The finite element body model was constructed from digital Phantoms and is anatomically realistic, including 13 organs and tissues: skin, muscles, fat, bones, heart, lungs, brain, bladder, intestines, stomach, kidneys, liver, and eyes. The model simulates thermal responses through a passive and active system. The passive system describes heat balance within the body and between the skin surface and environment. The active system describes thermoregulatory mechanisms, i.e., vasodilation, vasoconstriction, sweating, and shivering heat production. This model predicts temperature distribution across the body at high spatial resolution, and provides insight into human thermoregulatory responses to non-uniform and transient environments. Predicted temperatures (i.e., core, skin, muscle and fat) at 29 sites were compared with measured values in comfort, hot, and cold conditions. The comprehensive validation shows predictions are accurate and acceptable.

Exertional heat stress presents a different acute challenge to salt balance compared to at rest. Sodium (Na+) and chloride (Cl−) losses during exercise are overwhelmingly driven by eccrine sweat glands (the “leader”), with minimal urinary excretion. Total salt losses are therefore largely influenced by thermoregulatory need, although adaptations from prior heat exposure or altered dietary intake influences sweat gland ion reabsorption, and therefore sweat Na+ ([Na+]sweat) and Cl− concentrations. The hypotheses that body Na+ and Cl− conservation, or their release from osmotically inactive stores, can occur during the timeframe of a single bout of exertional heat stress, has not been studied to date. The consequences of unreplaced Na+ and Cl− losses during exertional heat stress appear limited primarily to their interactions with water balance. However, the water volume ingested is substantially more influential than salt intake on total body water, plasma volume, osmolality, and thermoregulation during exercise. Acute salt and water loading 1–3 h prior to exercise can induce isosmotic hyperhydration in situations where this is deemed beneficial. During exercise, only scenarios of whole body [Na+]sweat > 75th centile, combined with fluid replacement >80% of losses, are likely to require significant replacement to prevent hyponatremia. Post-exercise, natriuresis resumes as the main regulator of salt losses, with the kidneys (the “follower”) working to restore salt balance incurred from any exercise-induced deficit. If such a deficit exceeds usual dietary intake, and rapid restoration of hydration status is desirable, a deliberate increase in salt intake may assist in volume restoration.

Background The teratogenic risk associated with maternal hyperthermia (i.e., core temperature ≥39.0 °C) has been a crucial motive in understanding thermoregulatory responses in pregnancy. To date, a substantial number of studies have focused on core temperature responses in a wide range of exercise intensities, duration, and ambient temperatures. Fortunately, none have reported core temperatures exceeding 39.0 °C. Nonetheless, there are limited studies that have provided substantial insight into both dry and evaporative heat loss mechanisms involved in facilitating the maintenance of core temperature (≥39.0 °C) during heat stress in pregnant women. The purpose of this scoping review was to summarize the available literature that has assessed heat loss responses in studies of human pregnancy. Methods A search strategy was developed combining the terms pregnancy, thermoregulation, and adaptation. A systematic search was performed in the following databases: PubMed, Embase, Scopus, and ProQuest. Studies eligible for inclusion included pregnant women between the ages of 18–40 years old, and at least one measurement of the following: sweating, blood flow, skin temperature, and behavioural responses. Retrieved data were categorized as evaporative (sweating), dry or behavioural heat loss responses and summarized narratively. Results Thirty-three studies were included in this review (twenty-nine measured physiological responses and four measured behavioural responses). Studies suggest that during exercise, evaporative (sweating) and dry (skin blood flow and temperature) heat loss responses increase from early to late pregnancy in addition to greater cardiac output, blood volume and reduced vascular resistance. Behavioural practices related to heat loss responses are also influenced by cultural/religious expectations, personal preferences and sociodemographics. Conclusion The findings from this review suggest that pregnancy modifies evaporative (sweating), dry and behavioural heat loss. However, future studies have an opportunity to compare heat loss measurements accounting for gestational weight gain and thermal sensation/comfort scale to associate physiological responses with perceptual responses across pregnancy.

Neuropathy is a major diabetic complication. While the mechanism of this neuropathy is not well understood, it is believed to result in part from deficient nerve regeneration. Work from our laboratory established that gp130 family of cytokines are induced in animals after axonal injury and are involved in the induction of regeneration-associated genes (RAGs) and in the conditioning lesion response. Here, we examine whether a reduction of cytokine signaling occurs in diabetes. Streptozotocin (STZ) was used to destroy pancreatic β cells, leading to chronic hyperglycemia. Mice were injected with either low doses of STZ (5×60mg/kg) or a single high dose (1×200mg/kg) and examined after three or one month, respectively. Both low and high dose STZ treatment resulted in sustained hyperglycemia and functional deficits associated with the presence of both sensory and autonomic neuropathy. Diabetic mice displayed significantly reduced intraepidermal nerve fiber density and sudomotor function. Furthermore, low and high dose diabetic mice showed significantly reduced tactile touch sensation measured with Von Frey monofilaments. To look at the regenerative and injury-induced responses in diabetic mice, neurons in both superior cervical ganglia (SCG) and the 4th and 5th lumbar dorsal root ganglia (DRG) were unilaterally axotomized. Both high and low dose diabetic mice displayed significantly less axonal regeneration in the sciatic nerve, when measured in vivo, 48h after crush injury. Significantly reduced induction of two gp130 cytokines, leukemia inhibitory factor and interleukin-6, occurred in diabetic animals in SCG 6h after injury compared to controls. Injury-induced expression of interleukin-6 was also found to be significantly reduced in the DRG at 6h after injury in low and high dose diabetic mice. These effects were accompanied by reduced phosphorylation of signal transducer and activator of transcription 3 (STAT3), a downstream effector of the gp130 signaling pathway. We also found decreased induction of several gp130-dependent RAGs, including galanin and vasoactive intestinal peptide. Together, these data suggest a novel mechanism for the decreased response of diabetic sympathetic and sensory neurons to injury.

Resumen Sabemos que el cambio climático afecta de forma considerable a la salud, si bien son muy pocos los estudios que recogen sus consecuencias a nivel renal. Se ha visto como las olas de calor aumentan la morbimortalidad cardiovascular y respiratoria, pero también el riesgo de fracaso renal agudo, así como el índice de ingresos de causa nefrológica, con la mortalidad que ello implica. Las situaciones de deshidratación repetidas en población expuesta de forma habitual a altas temperaturas parecen estar generando una nueva entidad dentro de la enfermedad renal crónica proteinúrica, cuyo mecanismo fisiopatológico se va dilucidando. Pero más allá de olas de calor y temperaturas extremas, se ha comprobado que existe una variación estacional del filtrado glomerular que pudiera facilitar el desarrollo de fracaso renal y alteraciones electrolíticas en periodos extremadamente cálidos. Entre las alteraciones del medio interno, parecen aumentar fundamentalmente las disnatremias, aunque es poca la evidencia bibliográfica al respecto. Los grupos de riesgo para presentar enfermedades asociadas al calor son ancianos, niños, enfermos crónicos, personas encamadas, discapacitados, sujetos que viven solos o con escaso contacto social y las poblaciones más desfavorecidas a nivel socioeconómico. Abstract It is well known that climate change greatly affects human health, even though there are few studies on renal outcomes. Heat waves have been found to increase cardiovascular and respiratory morbidity and mortality, as well as the risk of acute renal failure and hospitalisation due to renal diseases, with related mortality. Recurrent dehydration in people regularly exposed to high temperatures seems to be resulting in an unrecognised cause of proteinuric chronic kidney disease, the underlying pathophysiological mechanism of which is becoming better understood. However, beyond heat waves and extreme temperatures, there is a seasonal variation in glomerular filtration rate that may contribute to the onset of renal failure and electrolyte disorders during extremely hot periods. Although there are few references in the literature, serum sodium disorders seem to increase. The most vulnerable population to heat-related disease are the elderly, children, chronic patients, bedridden people, disabled people, people living alone or with little social contact, and socioeconomically disadvantaged people.

Upon heat exposure, the thermoregulatory system evokes reflex increases in sweating and skin blood flow responses to facilitate heat dissipation and maintain heat balance to prevent the continuing rise in core temperature. These heat dissipating responses are mediated primarily by autonomic and cardiovascular adjustments; which, if attenuated, may compromise thermoregulatory control. In patients with heart failure (HF), the neurohumoral and cardiovascular dysfunction that underpins this condition may potentially impair thermoregulatory responses and, consequently, place these patients at a greater risk of heat-related illness. The aim of this review is to describe thermoregulatory mechanisms and the factors that may increase the risk of heat-related illness in patients with HF. An understanding of the mechanisms responsible for impaired thermoregulatory control in HF patients is of particular importance, given the current and projected increase in frequency and intensity of heat waves, as well as the promotion of regular exercise as a therapeutic modality. Furthermore, novel therapeutic strategies that may improve thermoregulatory control in HF, and the clinical relevance of this work in this population will be discussed.

Axillary hyperhidrosis (AH) and bromhidrosis are common causes of consultation in dermatology. Currently, the most widely prescribed treatment for AH is botulinum toxin, a very effective but temporary option; it is totally ineffective in bromhidrosis. Sympathectomy is an increasingly infrequent choice of treatment due to the high incidence of compensatory hyperhidrosis. We describe the treatment of AH and bromhidrosis with a novel microwave device that can fibrose eccrine and apocrine glands, achieving possibly permanent results. The procedure should preferably be performed under tumescent anesthesia. Side effects, principally local inflammation, are transient. Clinical effectiveness and safety, supported by recently published studies, position this technique as a first-choice option both for hyperhidrosis and for bromhidrosis.

indexation en cours; Chemosensory anxiety signals effectively prime motor responses related to withdrawal behavior, such as the startle reflex, in adult humans. As the reproductive status strongly affects the response to social chemosignals, the current study examined whether chemosensory anxiety signals would augment the startle response in prepubertal children as it does in adults. Using cotton pads, axillary sweat was collected from 28 men while waiting for an important oral examination (anxiety condition), and during ergometer training (sport control condition). Using a constant-flow olfactometer, sweat samples and pure cotton samples (cotton control) were presented to 10 prepubertal girls aged 9-13years (M=11.25, SD=1.25) for 3000ms during inhalation. White noise bursts of 102dB(A) served as startle probes, and startle responses were recorded via electromyography of the orbicularis oculi muscle. The girls showed larger startle amplitudes to probes presented in the context of chemosensory anxiety signals as compared to a context of sport control sweat (p

In this experiment, hand and forearm vasomotor activity was investigated during localised, but stable heating and cooling of the face, hand and thigh, under open-loop (clamped) conditions. It was hypothesised that facial stimulation would provoke the most potent vascular changes. Nine individuals participated in two normothermic trials (mean body temperature clamp: 36.6 °C; water-perfused suit and climate chamber) and two mildly hyperthermic trials (37.9 °C). Localised heating (+5 °C) and cooling (−5 °C) stimuli were applied to equal surface areas of the face, hand and thigh (perfusion patches: 15 min), while contralateral forearm or hand blood flows (venous-occlusion plethysmography) were measured (separate trials). Thermal sensation and discomfort votes were recorded before and during each thermal stimulation. When hyperthermic, local heating induced more sensitive vascular responses, with the combined thermosensitivity of both limb segments averaging 0.011 mL·100 mL −1 ·min −1 ·mmHg −1 ·°C −1 , and 0.005 mL·100 mL −1 ·min −1 ·mmHg −1 ·°C −1 during localised cooling ( P P >0.05). Therefore, regional differences in vasomotor and sensory sensitivity appeared not to exist. When combined with previous observations of sudomotor sensitivity, it seems that, during mild heating and cooling, regional representations within the somatosensory cortex may not translate into meaningful differences in thermal sensation or the central integration of thermoafferent signals. It was concluded that inter-site variations in the cutaneous thermosensitivity of these thermolytic effectors have minimal physiological significance over the ranges investigated thus far.

It has been demonstrated that precooling with ice slurry ingestion enhances endurance exercise capacity in the heat. However, no studies have yet evaluated the optimal timing of ice slurry ingestion for precooling. This study aimed to investigate the effects of varying the timing of ice slurry ingestion for precooling on endurance exercise capacity in a warm environment. Ten active male participants completed 3 experimental cycling trials to exhaustion at 55% peak power output (PPO) after 15min of warm-up at 30% PPO at 30°C and 80% relative humidity. Three experimental conditions were set: no ice slurry ingestion (CON), pre-warm-up ice slurry ingestion (-1°C; 7.5gkg-1) (PRE), and post-warm-up ice slurry ingestion (POST). Rectal and mean skin temperatures at the beginning of exercise in the POST condition (37.1±0.2°C, 33.8±0.9°C, respectively) were lower than those in the CON (37.5±0.3°C; P