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This study is the first to assess the reflex control of sweating in tattooed skin. The novel findings are twofold. First, attenuated increases in sweat rate were observed in tattooed skin compared with adjacent healthy non-tattooed skin in response to a moderate increase (1.0°C) in internal temperature during a passive whole body heat stress. Second, reduced sweating in tattooed skin is likely related to functional damage to the secretory mechanisms of eccrine sweat glands, rendering it less responsive to cholinergic stimulation.

New findings What is the central question of this study? Does dietary nitrate supplementation with beetroot juice attenuate thermoregulatory and cardiovascular strain in older adults during severe heat stress? What is the main finding and its importance? A 7-day nitrate supplementation regimen lowered resting mean arterial pressure in thermoneutral conditions. During heat stress, core and mean skin temperatures, vasodilatory responses, sweat loss, heart rate and left ventricular function were unchanged, and mean arterial pressure was only transiently reduced, post-supplementation. These data suggest nitrate supplementation with beetroot juice does not mitigate thermoregulatory or cardiovascular strain in heat-stressed older individuals. Abstract This study tested the hypothesis that dietary nitrate supplementation with concentrated beetroot juice attenuates thermoregulatory and cardiovascular strain in older individuals during environmental heat stress. Nine healthy older individuals (six females, three males; aged 67 ± 5 years) were exposed to 42.5 ± 0.1°C and 34.0 ± 0.5% relative humidity conditions for 120 min before (CON) and after 7 days of dietary nitrate supplementation with concentrated beetroot juice (BRJ; 280 ml, ∼16.8 mmol of nitrate daily). Core and skin temperatures, body mass changes (indicative of whole-body sweat loss), skin blood flow and cutaneous vascular conductance, forearm blood flow and vascular conductance, heart rate, arterial blood pressures and indices of cardiac function were measured. The 7-day beetroot juice regimen increased plasma nitrate/nitrite levels from 27.4 ± 15.2 to 477.0 ± 102.5 μmol l-1 (P 0.05). Mean arterial pressure was lower in BRJ vs. CON during heat stress (treatment-by-time interaction: P = 0.02). Overall, these findings suggest that dietary nitrate supplementation with concentrated beetroot juice does not attenuate thermoregulatory or cardiovascular strain in older individuals exposed to severe ambient heat stress.

Objective: The R&D explosion for Ebola virus disease (EVD) during the 2014-2016 outbreak led to the successful development of high-quality vaccines performed by China and the U.S. This study aims to compare the R&D activities of Ebola-related medical products in two countries, as a way to present the influential factors of R&D for emerging infectious disease (EID) and to provide suggestions for timely and efficient R&D response to the COVID-19 pandemic.Methods: In this comparative study, R&D activities were analyzed in terms of research funding, scientific research outputs, R&D timeline, and government incentive and coordinated mechanisms. Quantitative analysis was performed using data retrieved from national websites, clinical trial registries and databases.Qualitative semi-structured interviews were conducted to explore perspectives of fifteen key informants from EID field, especially of those involved in Ebola product development. Findings: The funding gap between China and the U.S. was significant before 2014 and narrowed after the Ebola outbreak. Both research teams started basic studies prior to the Ebola outbreak; however, the U.S. got FDA approval for clinical trials 5 months earlier than China. The underlying gap reveals the lack of participation and support by private sectors, the stagnant transformation platform, and the inadequate government incentives in China. Conclusion: R&D pre-planning and resource deployment mechanisms are crucial for EID preparedness and response. Funding should be allocated to support diversified R&D institutions for coping with the risks. Building private and public collaboration, and strengthening government support for clinical trials may accelerate the translation of basic research.

KEY POINTS Haemorrhage is the leading cause of battlefield and civilian trauma deaths. Given that a haemorrhagic injury on the battlefield is almost always associated with pain, it is paramount that the administered pain medication does not disrupt the physiological mechanisms that are beneficial in defending against the haemorrhagic insult. Current guidelines from the US Army's Committee on Tactical Combat Casualty Care (CoTCCC) for the selection of pain medications administered to a haemorrhaging soldier are based upon limited scientific evidence, with the clear majority of supporting studies being conducted on anaesthetized animals. Specifically, the influence of low-dose ketamine, one of three analgesics employed in the pre-hospital setting by the US Army, on haemorrhagic tolerance in humans is unknown. For the first time in conscious males and females, the findings of the present study demonstrate that the administration of an analgesic dose of ketamine does not compromise tolerance to a simulated haemorrhagic insult. Increases in muscle sympathetic nerve activity during progressive lower-body negative pressure were not different between trials. Despite the lack of differences for muscle sympathetic nerve activity responses, mean blood pressure and heart rate were higher during moderate hypovolemia after ketamine vs. placebo administration. ABSTRACT Haemorrhage is the leading cause of battlefield and civilian trauma deaths. For a haemorrhaging soldier, there are several pain medications (e.g. ketamine) recommended for use in the prehospital, field setting. However, the data to support these recommendations are primarily limited to studies in animals. Therefore, it is unknown whether ketamine adversely affects physiological mechanisms responsible for maintenance of arterial blood pressure (BP) during haemorrhage in humans. In humans, ketamine has been demonstrated to raise resting BP, although it has not been studied with the concomitant central hypovolemia that occurs during haemorrhage. Thus, the present study aimed to test the hypothesis that ketamine does not impair haemorrhagic tolerance in humans. Thirty volunteers (15 females) participated in this double-blinded, randomized, placebo-controlled trial. A pre-syncopal limited progressive lower-body negative pressure (LBNP; a validated model for simulating haemorrhage) test was conducted following the administration of ketamine (20 mg) or placebo (saline). Tolerance was quantified as a cumulative stress index and compared between trials using a paired, two-tailed t test. We compared muscle sympathetic nerve activity (MSNA; microneurography), beat-to-beat BP (photoplethysmography) and heart rate (electrocardiogram) responses during the LBNP test using a mixed effects model (time [LBNP stage] × drug). Tolerance to the LBNP test was not different between trials (Ketamine: 635 ± 391 vs. Placebo: 652 ± 360 mmHg‧min, p = 0.77). Increases in MSNA burst frequency (time: P

The present study evaluated whether wearing a water-soaked t-shirt, with or without electric fan use, mitigates thermal and cardiovascular strain in older individuals exposed to hot and moderately humid conditions. Nine healthy older individuals (68 ± 4 yr; five women) completed three 120-min heat exposures (42.4 ± 0.2°C, 34.2 ± 0.9% relative humidity) on separate days while wearing a dry t-shirt (CON), a t-shirt soaked with 500 ml of tap water (WET), or a t-shirt soaked with 500 ml of tap water while facing an electric fan (2.4 ± 0.4 m/s; WET+FAN). Measurements included core and skin temperatures, evaporative mass losses, heart rate, and blood pressure. In the WET condition, elevations in core temperature were attenuated compared with DRY from 30 to 120 min and compared with WET+FAN from 30 to 90 min ( P < 0.05). Evaporative mass losses (inclusive of sweat and water losses from the shirt) were greatest in WET+FAN, followed by WET, and then DRY ( P < 0.01). Sweat losses were lowest in WET, followed by DRY, and then WET+FAN ( P < 0.01). Heart rate was lower only at 60 min in WET versus DRY ( P = 0.01). No differences in mean arterial pressure were observed ( P = 0.51). In conclusion, wearing a water-soaked t-shirt without, but not with, electric fan use is an effective heat management strategy to mitigate thermal strain and lower sweat losses in older individuals exposed to hot and moderately humid conditions. NEW & NOTEWORTHY In older individuals exposed to hot and moderately humid environments, electric fan use coupled with a water-soaked t-shirt exacerbates sweat losses without mitigating heat strain compared with a dry t-shirt. However, wearing a water-soaked t-shirt without fan use reduces sweat losses and attenuates heat strain compared with a dry t-shirt and a fan/water-soaked t-shirt combination. These findings suggest wearing a water-soaked t-shirt is an effective heat-management strategy for older individuals during heat waves when air conditioning is inaccessible.

Objective: To better understand the economic burden of patients with epilepsy receiving outpatient services in China and to analyze potential factors influencing epileptic economic burden through a cross-sectional study. Methods: Using a self-designed questionnaire, we collected information retrospectively from 754 patients with epilepsy evaluated in neurology clinics in Shanghai Municipality, Shanxi Province and Sichuan Province. Descriptive analyses were used after cost variables were presented as logarithms, and multiple linear regressions were performed to explore influencing factors. Results: Fifty percent of the investigated patients experienced an epilepsy attack before the age of 15, and 51.3% had suffered from epilepsy for more than five years. In the past year, 87.9% of patients had visited different hospitals multiple times for evaluation (40.3%) and maintenance treatment (40.7%). The total economic burden of epilepsy was US$ 1 143.2. The average direct economic burden and indirect economic burden were US$ 939.0 and US$ 110.2, respectively. Multiple linear regressions showed that patients had to bear greater economic burden if they were hospitalized, using multiple antiepileptic drugs, experiencing illness for less than 5 years, in severe seizure index or active epilepsy with drug resistance, which was statistically significant. Totally only 14.3% of patients could get reimbursement in outpatient services. Conclusions: Patients with epilepsy must present to hospitals regularly for satisfactory prognosis, which results in economic burden. Patients bear greater economic burden, especially direct medical costs, if they are newly diagnosed, experience severe seizures, or undergo multiple drug treatments that require more frequent monitoring. However, current insurance policy for outpatient services do not help reduce economic burden of patients efficiently.

Deep-sea sediments containing high concentrations of rare earth elements (REE) and yttrium (Y), termed REY-rich sediments, have attracted considerable attention and are widely distributed in the Pacific Ocean. However, the processes and mechanisms of REY enrichment in REY-rich sediments remain controversial. Here, we present our investigation of the mineralogical and geochemical characteristics of deep-sea sediments in three sediment cores from the western North Pacific Ocean. REY-rich sediments with very high total REY (ΣREY) concentrations (>3000 ppm) were discovered within the study area, which is characterized by middle REE (MREE) and heavy REE (HREE) enrichment. REY-rich sediments have unique geochemical characteristics and are different from known onshore REE ore deposits. Our results suggest that the pelagic clay sediments have higher ΣREY concentrations than the carbonate ooze sediments. Bioapatite fossil and micronodule are the main host minerals of REY in REY-rich sediments, whereas terrigenous, volcaniclastic, and calcareous materials can dilute ΣREY concentrations. The contribution of micronodule to REY enrichment in REY-rich sediments is relatively moderate compared to that of bioapatite fossil. Seawater is the main source of REY in REY-rich sediments. During diagenesis, bioapatite fossils absorb REY from seawater/porewater by substitution, whereas micronodules release REY (especially Ce) into the ambient solution. Thus, a migration of REY from micronodules to bioapatite fossils occurs. The bioapatite fossil is likely to act as the ultimate host of REY, while the micronodule acts as a temporary sink for REY. The enrichment and transformation of REY in the bioapatite fossils and micronodules mainly occur in the seawater column and the sea-sediment interface. The REY enrichment in deep-sea sediments was caused by the physical enrichment of REY-rich materials (bioapatite fossil and micronodule). The sedimentation rate, therefore, is an important controlling factor for REY enrichment. The formation of REY-rich sediments with ΣREY concentrations > 2000 ppm was likely to occur due to the additional contributions of enriched bottom currents.

Deep-sea sediments in the eastern South Pacific Ocean were recently found to contain high concentrations of rare-earth elements and yttrium (REY). To understand the genesis of REY enrichment in the sediments, we performed detailed element and isotope geochemical analyses on samples from gravity core S028GC23 recovered from the Tiki Basin in the eastern South Pacific Ocean. The REY-rich sediments in core S028GC23 are dark-brown to black zeolite clays, with REY (∑REY) contents of 1136–2213 ppm (average of 1857 ppm). The ∑REY contents in the sediments are positively correlated with P2O5 and negatively correlated with Ce anomalies. The REY-rich sediments display obvious Ce depletion and positive Y anomalies in the post-Archean Australian shale (PAAS)-normalized REY diagrams. Bioapatite fossils contain the highest REY concentrations (average of 8921 ppm) among the constituents, indicating that they are the primary hosts of REY. The REY enter through the roots and diffuse to the tops in the bioapatite fossils. Fe–Mn micronodules are divided into two different types based on Ce and Y anomalies in the PAAS-normalized REY patterns, and they have average REY concentrations of 781 ppm and 937 ppm, respectively. The phillipsite has low REY contents (average of 106 ppm) and is associated with a low sedimentation rate. REY patterns and Sr-Nd isotopic signatures show that seawater was the main ore-forming fluids during the formation of REY-rich sediments. The sedimentation rate of the sediments calculated by the 230Thex activities was 0.8 mm/Ka. The REY accumulation process can be explained by two-stage fluid-bioapatite fossil interactions and small contributions of Fe-Mn micronodules in an oxidized environment with slow sedimentation rate.

Rare earth element and ytterbium (REY)-rich deep-sea sediments are recently discovered potential undersea rare earth element (REE) resources. Here, we present the results of the mineralogical and geochemical characterization of REY-rich sediments collected from the Central Indian Ocean Basin (CIOB). These data were used to provide a jigsaw puzzle for the investigation of REY transfer during early diagenesis and to discuss the formation mechanism of REY-rich sediments. The research results show that the REY-rich sediments distributed in the CIOB mainly consist of phillipsite-bearing pelagic clay and pelagic clay, and are characterized by enrichments in middle REEs (MREEs) and heavy REEs (HREEs), negative Ce anomalies and positive Y anomalies. The REY in these sediments are mainly captured dirtcely from overlying seawater by bioapatite and micronodules at the water-sediment interface. After burial, driven by the redox reaction between organic matter and an oxidizer (free O2 and Mn and Fe oxides), the REY-rich sediments experienced weak early diagenesis, and the REY released from hydrogenetic micronodules were captured by the bioapatite.

As a potential mineral resource, the clay minerals enriched in rare earth elements including yttrium (REY) in the deep sea have been attracting great attention. However, the enrichment mechanism of REY remains unclear. To understand the geochemical characteristics and factors controlling REY enrichment in zeolite clay in the deep sea, we conducted mineral identification by XRD, major and trace element measurements by XRF and REY analyses by ICP-MS on a 1.4-m-long sediment core (GC02) located in the Central Indian Oceanic Basin (CIOB). The main findings include: (1) the core sediments in GC02 possess elevated REY contents and exhibited a strong negative Ce anomaly, an apparent MREE bulge and positive Y anomaly. These were comparable with typical REY-rich clays in the Pacific Ocean, indicating the similar REY enrichment mechanism and the presence of REY-rich clays in the CIOB; (2) in comparison with the dataset from the Wharton Basin and DSDP site 213, the higher content of REY and stronger PAAS (Post Archean Australian Shale) normalization patterns in the GC02 sediments were likely caused by the weaker impact of terrigenous materials of GC02. The CIOB was suggested to be a promising place hosting REY rich pelagic sediments.

In this study, a series of cationized starch-based flocculants (starch-3-chloro-2-hydroxypropyl triethyl ammonium chloride, St-CTA) containing various quaternary ammonium salt groups on the starch backbone were prepared using a simple etherification reaction. All of the prepared starch-based flocculants show effective performance for the flocculation of kaolin suspension, two bacterial (Escherichia coli and Staphylococcus aureus) suspensions, and two contaminant mixtures (kaolin and each bacterium) under most pH conditions. St-CTA with a high substitution degree of CTA demonstrates improved contaminant removal efficiency because of the strong cationic nature of the grafted quaternary ammonium salt groups and the charge naturalization flocculation effect. The antibacterial effects of St-CTA were also evaluated, considering that many quaternary ammonium salt compounds elicit bactericidal effects. Three-dimensional excitation-emission matrix spectra and direct cell morphological observation under scanning electron microscopy reveal that the starch-based flocculants exhibit better antibacterial effects on the Gram-negative bacterium E. coli than on the Gram-positive bacterium S. aureus. The thicker cell wall due to the presence of abundant peptidoglycan and teichoic acids of S. aureus than E. coli explains the uneasy breakage of S. aureus cell wall after being attacked by the cationized starch-based flocculants.

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS), disrupting autonomic function. The aim of this study was to test the hypothesis that individuals with MS have blunted control of thermoregulatory reflex increases in sweat rate (SR) and cutaneous vasodilation compared with controls during a passive whole body heat stress (WBH). Eighteen individuals with relapsing-remitting MS and 18 healthy controls (Con) participated in the study. Core temperature (Tcore), skin temperature, heart rate, arterial blood pressure (10-min intervals), skin blood flow (laser-Doppler flux, LDF), and SR were continuously measured during normothermic baseline (34°C water perfusing a tube-lined suit) and WBH (increased Tcore 0.8°C via 48°C water perfusing the suit). Following WBH, local heaters were warmed to 42°C, inducing peak cutaneous vasodilation at the site of LDF collection. Cutaneous vascular conductance (CVC) was calculated as the ratio of LDF to mean arterial pressure and expressed as a percentage of peak achieved during local heating. Individuals with MS had attenuated SR responses to WBH (ΔSR from baseline: Con, 0.65 ± 0.27; MS, 0.42 ± 0.17 mg·cm−2·min−1, P = 0.003), whereas Δ%CVC42C from baseline was similar between groups (Con, 42 ± 16%; MS, 38 ± 12%, P = 0.39). SR responses were blunted as a function of Tcore in MS (interaction: group × Tcore, P = 0.03), of which differences were evident at ΔTcore 0.7°C and 0.8°C ( P < 0.05). No interaction was observed in Δ%CVC42C. Taken together, the findings show MS blunts sweating responses, whereas control of the cutaneous vasculature is preserved, in response to WBH. NEW & NOTEWORTHY This study is the first to assess the reflex control of the thermoregulatory system in individuals living with multiple sclerosis (MS). The novel findings are twofold. First, attenuated increases in sweat rate in subjects with MS compared with healthy controls were observed in response to a moderate increase (0.8°C) in core temperature via passive whole body heat stress. Second, it appears the reflex control of the cutaneous vasculature is preserved in MS.

Background Multiple sclerosis (MS) is a neurological disease marked by demyelination and axonal loss. Individuals with MS experience increases in clinical signs and symptoms during heat exposure. Objective To test the hypothesis that moderate heat exposure adversely affects postural sway in individuals with MS. Methods Ten individuals with relapsing-remitting MS (50 ± 8y) and nine controls (47 ± 10y) were examined under a Thermal and a Time Control trial. Following a 30 min thermoneutral baseline (25 °C, 30% relative humidity (RH)), stand tests randomized with eyes open and closed, were performed. For Thermal, subjects were first exposed to 60 min of heating (40 °C, 30%RH) followed by 60 min of cooling (20 °C, 30%RH). For Time Control, subjects remained in a thermoneutral environment throughout. Stand tests were repeated at consistent times in both trials. Results No difference in skin and core temperatures between groups were observed for any trial (P > 0.05). During heating, postural sway was higher in MS relative to control subjects (eyes open, P = 0.03; eyes closed, P = 0.011). No differences in postural sway, regardless of eye status, were observed during the Time Control trial for either group (P > 0.05). Conclusion These data demonstrate that exposure to a moderate heating environment increases postural sway in patients with MS.

Introduction Excision of burned skin and subsequent grafting removes sweat glands and thereby impairs thermoregulation. Consequently, rehabilitation and associated exercise may be accompanied by a greater risk of hyperthermia, depending on exercise duration, intensity and environmental temperature. Current physical activity guidelines recommend adults perform at least 150 min of moderate-intensity exercise per week, which is often divided into 30-min daily sessions. This project tested the hypothesis that burn survivors could exercise for 30 min without excessive elevations in core body temperature, regardless of the total body surface area (%TBSA) burned or environmental temperature. Methods Ten subjects cycled for 60 min at 1) a moderate intensity (97±8 watts) in a thermoneutral environment (24°C, MOD_NEU), 2) a moderate intensity (100±17 watts) in a hot environment (39°C, MOD_HOT), and 3) a low intensity (65±10 watts) in a hot environment (39°C, LOW_HOT). Burn injuries were simulated by covering 0%, 20%, 40%, or 60% of the individual’s TBSA with an absorbent material that prevented sweat evaporation. Changes in gastrointestinal temperature (ΔTcore) were analyzed at 15-min increments throughout exercise. Results For the MOD_NEU trial, there were no differences in ΔTcore between the %TBSA coverage bouts at any time point during exercise. For the MOD_HOT trial, there were no differences in ΔTcore at 15 and 30 min of exercise regardless of the %TBSA coverage, while ΔTcore was appreciably elevated (P< 0.05) at 45 and 60 min of exercise for 20%+ TBSA bouts. For the MILD_HOT trial, there were no differences in ΔTcore at any time point between %TBSA bouts, with the sole exception of 60% simulated burn having a slightly greater ΔTcore (0.3±0.34°C; P< 0.05) at 60 min of exercise relative to the 0% TBSA bout. Conclusions These data indicate that individuals with up to 60% of their TBSA burned could exercise at a moderate intensity for 30 min, even in hot environmental conditions, without excessive elevations in body core temperature. Applicability of Research to Practice Individuals with significant burn injuries can benefit from exercise, without the risk of excessive hyperthermia, for up to 30 min in the heat or at least 60 min in an air conditioned space. Funding: DOD W81XWH-15-1-0647

Vast improvements in the survival rates following burn injuries has led to a greater number of patients living with a wide range of long-term impairments, activity limitations, and participation constraints. Therefore, long-term care is critical in this clinical population and necessitates appropriate rehabilitation strategies to maximize an individual's overall health. The purpose of this study was to test the hypothesis that the extent to which outcomes within the International Classification of Functioning, Disability, and Health (ICF) framework are improved following 6 months of unsupervised exercise training is influenced by the severity of a burn injury (i.e., percent body surface area injured). Outcome variables representing the dimensions of the ICF, body functions & structure, activity, and participation, were collected pre- and post- 6 months of exercise training in three groups of participants: non-injured control subjects (N = 11), subjects with moderate-level well-healed burn injuries (N = 13, 26 ± 6% body surface area burned), and subjects with high-level well-healed burn injuries (N = 20, 58 ± 15% body surface area burned). Exercise training improved lower extremity strength (changes in peak torque/kg body mass at 90 degrees/sec flexion: 30 ± 5% and extension: 36 ± 4%, p < 0.05) and functional activities (changes in sit to stand: -9 ± 4% and ascend stairs: -4 ± 1%; p < 0.05) in all groups. For outcome variables representing ICF levels of body functions & structure and activity, there were no differences at baseline or improvements made between the groups after training. That said, with the exception of the domain of functional activity (reported 17 ± 34% improvement in the high-level burn cohort, p < 0.05), no changes were revealed in the participation level of ICF indexed by health-related quality of life questionnaires. These findings support the utilization of a 6-month unsupervised exercise training program in the long-term rehabilitation of individuals with burn injuries; that is, improvements in body functions & structure and activity can be achieved with an exercise regimen regardless of the severity of burn injury.

The U.S. Army’s Standards of Medical Fitness (AR 40-501) states: “Prior burn injury (to include donor sites) involving a total body surface area of 40 percent or more does not meet the standard”. However, the standard does not account for the interactive effect of burn injury size and air temperature on exercise thermoregulation. PURPOSE: To evaluate whether the detrimental effect of a simulated burn injury on exercise thermoregulation is dependent upon air temperature. METHODS: On eight occasions, nine males cycled for 60 min at a fixed metabolic heat production (6 W·kg(−1)) in air temperatures of 40°C or 25°C with simulated burn injuries of 0% (Control), 20%, 40%, or 60% of total body surface area (TBSA). Burn injuries were simulated by covering the skin with an absorbent, vapor-impermeable material to impede evaporation from the covered areas. Core temperature was measured in the gastrointestinal tract via telemetric pill. RESULTS: In 40°C conditions, greater elevations in core temperature were observed with 40% and 60% TBSA simulated burn injuries vs. Control (P < 0.01). However, at 25°C, core temperature responses were not different vs. Control with 20%, 40%, and 60% TBSA simulated injuries (P = 0.97). The elevation in core temperature at the end of exercise was greater in the 40°C environment with 20%, 40% and 60% TBSA simulated burn injuries (P ≤ 0.04). CONCLUSION: Simulated burn injuries ≥20% TBSA exacerbate core temperature responses in hot, but not temperate, air temperatures. These findings suggest that the U.S. Army’s standard for inclusion of burned soldiers is appropriate for hot conditions, but could lead to the needless discharge of soldiers who could safely perform their duties in cooler training/operational settings.

Long-term rehabilitative strategies are important for individuals with well-healed burn injuries. Such information is particularly critical because patients are routinely surviving severe burn injuries given medical advances in the acute care setting. The purpose of this study was to test the hypothesis that a 6-mo community-based exercise training program will increase maximal aerobic capacity (V̇o2max) in subjects with prior burn injuries, with the extent of that increase influenced by the severity of the burn injury (i.e., percent body surface area burned). Maximal aerobic capacity (indirect calorimetry) and skeletal muscle oxidative enzyme activity (biopsy of the vastus lateralis muscle) were measured pre- and postexercise training in noninjured control subjects ( n = 11) and in individuals with well-healed burn injuries ( n = 13, moderate body surface area burned; n = 20, high body surface area burned). Exercise training increased V̇o2max in all groups (control: 15 ± 5%; moderate body surface area: 11 ± 3%; high body surface area: 11 ± 2%; P < 0.05), though the magnitude of this improvement did not differ between groups ( P = 0.7). Exercise training also increased the activity of the skeletal muscle oxidative enzymes citrate synthase ( P < 0.05) and cytochrome c oxidase ( P < 0.05), an effect that did not differ between groups ( P = 0.2). These data suggest that 6 mo of progressive exercise training improves V̇o2max in individuals with burn injuries and that the magnitude of body surface area burned does not lessen this adaptive response.

Impairments in sudomotor function during passive whole-body heating have been reported in multiple sclerosis (MS), a demyelinating disease of the CNS that disrupts autonomic function. However, the capability of the thermoregulatory system to control body temperature during exercise has never been assessed in MS. Thus, the aim of the present study was to test the hypothesis that thermoregulatory function is impaired in MS patients compared with healthy controls (CON) exercising at similar rates of metabolic heat production.Sweating and skin blood flow responses were compared between 12 individuals diagnosed with relapsing-remitting MS (9 females, 3 males) and 12 sex-, age-, mass-, and BSA-matched CON during a single bout of cycling exercise (rate of metabolic heat production: ∼4.5 W·kg) for 60 min in a climate-controlled room (25°C, 30% RH).Individuals with MS exhibited an attenuated increase in cumulative whole-body sweat loss after 30 min (MS, 72 ± 51 g; CON, 104 ± 37 g; P = 0.04) and 60 min (MS, 209 ± 94 g; CON, 285 ± 62 g; P = 0.02), as well as lower sweating thermosensitivity (MS, 0.49 ± 0.26 mg·cm·min·°C; CON, 0.86 ± 0.30 mg·cm·min·°C; P = 0.049). Despite evidence for thermoregulatory dysfunction, there were no differences between MS and CON in esophageal or rectal temperatures at 30- or 60-min time points (P0.05). Cutaneous vasculature responses were also not different in MS compared with CON (P0.05).Taken together, MS blunts sweating responses during exercise while cutaneous vasculature responses are preserved. Altered mechanisms of body temperature regulation in persons with MS may lead to temporary worsening of disease symptoms and limit exercise tolerance under more thermally challenging conditions.

The U.S. Army’s Standards of Medical Fitness, AR 40–501, state that “Prior burn injury (to include donor sites) involving a total body surface area of 40 percent or more does not meet the standard”. Inclusion of donor sites (sites harvested for skin grafts) in this Standard implies that thermoregulatory function is impaired within donor sites during exercise-heat stress; however, supporting evidence is currently lacking. PURPOSE: To test the hypothesis that well-healed donor and non-injured sites demonstrate similar elevations in skin blood flow and sweating during exercise-induced hyperthermia. METHODS: Twenty burn survivors (>1 year post-injury; four females) cycled for 60 min in a 39.7 ± 0.3°C and 21.1 ± 3.3% relative humidity environment at ~50% of maximal aerobic capacity. Core and mean skin temperatures were recorded throughout exercise. Skin blood flow (laser-Doppler imaging) was measured at baseline and after exercise within donor (LDF(DON)) and adjacent non-injured control (LDF(CON)) sites. At 45 min of exercise, local sweat rates (Technical Absorbents) were measured within the same donor (LSR(DON)) and non-injured (LSR(CON)) areas. RESULTS: After 60 min of exercise, core and skin temperatures reached 38.2 ± 0.4°C and 35.5 ± 1.2°C, respectively. The increase in skin blood flow from baseline to end-exercise (LDF(DON): 91.6 ± 44.5 AU; LDF(CON): 106.0 ± 61.6 AU; P = 0.17) and local sweat rates (LSR(DON): 0.46 ± 0.26 mg cm(−2) min(−1); LSR(CON): 0.53 ± 0.25 mg cm(−2) min(−1); P = 0.14) were not different between donor and non-injured control sites. CONCLUSION: Well-healed donor sites retain the ability to increase skin blood flow and sweating during exercise-heat stress, providing evidence against the inclusion of donor sites when determining whether a burn injury meets the Army’s Standards of Medical Fitness.

Long-term burn survivors have reduced aerobic capacity, placing them at increased risk for cardiovascular disease, morbidity, and mortality. However, the exact mechanism contributing to a reduced aerobic capacity remains incompletely understood, but may be related to adverse cardiovascular remodeling. Therefore, it was hypothesized that well-healed burn survivors would exhibit adverse left ventricular (LV) remodeling and impaired LV function. To test this hypothesis, 22 well-healed moderately burned individuals (age: 41 ± 14 years; BMI: 27.7 ± 5.4 kg/m(2); male/female: 12/10; extent of burn: 37 ± 12 %BSA), 11 well-healed severely burned individuals (age: 43 ± 12 years; BMI: 29.5 ± 5.8 kg/m(2); male/female: 8/3; extent of burn: 73 ± 11 %BSA), and 12 healthy, age-matched controls (age: 34 ± 9 years; BMI: 28.6 ± 5.2 kg/m(2); male/female: 5/7) were enrolled in the study. All subjects were sedentary, performing less than 30 minutes of aerobic exercise per day, 3 days per week. LV morphology and function were assessed via cardiac magnetic resonance imaging. In contrast to the hypothesis, neither the presence nor severity of burn injury adversely affected LV morphology or function, when compared with equally sedentary nonburned controls. However, of note, LV mass of all three groups was in the lowest 5th percentile compared with normative values. Finally, group differences in LV morphology were largely explained by differences in aerobic capacity. Taken together, these data suggest a prior burn injury itself does not result in pathological remodeling of the LV and support a role for aerobic exercise training to improve cardiac function.

Background The advancement in any antimalarial medicinal product including vaccines, drugs and diagnostics will have a vital influence on malaria elimination in China and on the global malaria control framework. This study aimed to identify research progress and challenges in China, hoping to better facilitate domestic elimination and for China to be more effectively involved in global malaria research and development. Methods A systematic search was conducted for research articles published from 2005 to 2014 in PubMed, CNKI and Wanfang using terms including malaria, diagnosis, drugs and vaccines. In total, 4259 articles from PubMed and 561 references from Chinese databases were included and categorized by topic. Results The literature from PubMed was clustered and seven antimalarial medicinal product research hotspots were identified; including drug resistance, diagnostic tests and vaccine antigen screening. The reports related to drugs accounted for the largest proportion in PubMed (57%) and Chinese studies (51%) while references associated with diagnostics accounted for the lowest proportion, 10% in PubMed and 14% in Chinese studies. Conclusions Despite continuous effort in malaria research and development, there exist gaps in progressive discoveries on malaria diagnostics and drugs in China. Successive focus on antimalarial medicinal products is essential to facilitate malaria control in China and worldwide.

In recent years, the use of chitosan and its derivatives as flocculants in water treatment has received considerable attention due to their many advantages, including their widespread availability, environmental friendliness, biodegradability, and prominent structural features. However, it is a significant strategy for selection and design of the high-performance materials on the basis of their structure-activity relationships. Here we describe several of the chemical modification methods commonly used to prepare chitosan-based flocculants. These methods allow convenient control and adjustment of the structures of the obtained materials to meet the different practical requirements. The influence of structural elements of the chitosan-based flocculants on their flocculation properties are emphasized in this review by examining different flocculation mechanisms and their applications in the treatment of various wastewaters containing different pollutants (insoluble suspended colloids but also dissolved matters). Above all, the chitosan-based flocculants with proper structures by precise structure control bear great application potentials in water treatment.

In this work, coscinodiscus-diatomite and melosira-diatomite have been decorated by ultrathin birnessite MnO 2 (δ-MnO 2 ) nanosheets through a one-pot hydrothermal method without using any surfactants. The δ-MnO 2 nanosheets are observed to grow vertically on the purified melosira-diatomite as well as coscinodiscus-diatomite. Moreover, the two composites exhibit high efficiency for decomposing methylene blue (MB) in the presence of H 2 O 2 . The coscinodiscus-diatmite@MnO 2 achieves a removal rate of 81.8% (2 h), and yet melosira-diatomite@MnO 2 reaches a higher degradation rate of 91.3% in 2 h. Additionally, the effects of catalyst amount, catalysis reaction temperature, preparing time have also been investigated. In principle, the diverse diatomite@MnO 2 nanostructures not only present an environmentally friendly and low cost with a good cycling stability, but also offer a simple way for the catalytic degradation of dye waste water in practical applications.

The effect of severe burn injury on vascular health is unknown. We tested the hypothesis that, compared with nonburn control subjects, vasodilator function would be reduced and that pulse-wave velocity (a measure of arterial stiffness) would be increased in individuals with prior burn injuries, the extent of which would be associated with the magnitude of body surface area having sustained a severe burn. Pulse-wave velocity and macrovascular (flow-mediated dilation) and microvascular (reactive hyperemia) dilator functions were assessed in 14 nonburned control subjects and 32 age-matched subjects with well-healed burn injuries. Fifteen subjects with burn injuries covering 17–40% of body surface area were assigned to a moderate burn injury group, and 17 subjects with burn injuries covering >40% of body surface area were assigned to a high burn injury group. Pulse-wave velocity [ P = 0.3 (central) and P = 0.3 (peripheral)] did not differ between the three groups. Macrovascular dilator function was reduced in the moderate ( P = 0.07) and high ( P < 0.05) burn injury groups compared with the control group. Likewise, peak vascular conductance during postocclusive reactive hyperemia differed from the moderate burn injury group ( P = 0.08 vs. control) and the high burn injury group ( P < 0.05 vs. control). These data suggest that vasodilator function is impaired in well-healed burn injury survivors, with the extent of impairment not dependent on the magnitude of body surface area having sustained a severe burn injury.

Multiple sclerosis (MS), a progressive neurological disease, can result in autonomic dysfunction. Impairments in the autonomic control of cardiovascular and thermoregulatory function during exercise have been observed in MS. Attenuated elevations in blood pressure during exercise in MS patients can negatively impact blood flow to skeletal muscle. Diminished sweating during exercise may impair heat dissipation likely limiting the exercise intensity that can be performed before detrimental core temperatures are reached. Further understanding the physiologic mechanisms of autonomic dysfunction during exercise in MS may lead to the development of novel therapeutic strategies targeted at improving quality of life in individuals with this disease.

Background Though many countries, including China, are moving towards malaria elimination, malaria remains a major global health threat. Due to the spread of antimalarial drug resistance and the need for innovative medical products during the elimination phase, further research and development (R&D) of innovative tools in both epidemic and elimination areas is needed. This study aims to identify the trends and gaps in malaria R&D in China, and aims to offer suggestions on how China can be more effectively involved in global malaria R&D. Methods Quantitative analysis was carried out by collecting data on Chinese malaria-related research programmes between 1985 and 2014, invention patents in China from 1985 to 2014, and articles published by Chinese researchers in PubMed and Chinese databases from 2005 to 2014. All data were screened and extracted for numerical analysis and were categorized into basic sciences, drug/drug resistance, immunology/vaccines, or diagnostics/detection for chronological and subgroup comparisons. Results The number of malaria R&D activities have shown a trend of increase during the past 30 years, however these activities have fluctuated within the past few years. During the past 10 years, R&D on drug/drug resistance accounted for the highest percentages of research programmes (32.4%), articles (55.0% in PubMed and 50.6% in Chinese databases) and patents (45.5%). However, these R&D activities were mainly related to artemisinin. R&D on immunology/vaccines has been a continuous interest for China’s public entities, but the focus remains on basic science. R&D in the area of high-efficiency diagnostics has been rarely seen or reported in China. Conclusions China has long been devoted to malaria R&D in multiple areas, including drugs, drug resistance, immunology and vaccines. R&D on diagnostics has received significantly less attention, however, it should also be an area where China can make a contribution. More focus on malaria R&D is needed, especially in the area of diagnostics, if China would like to contribute in a more significant way to global malaria control and elimination. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0222-x) contains supplementary material, which is available to authorized users.

To investigate functional and macular pigment (MP) changes in patients with early age-related macular degeneration (AMD) after multiple supplementation with lutein and zeaxanthin.112 patients with early AMD were randomly (1:1:1:1) assigned to receive 10 mg lutein, 20 mg lutein, lutein (10 mg)+zeaxanthin (10 mg), or placebo daily for 2 years. MP optical density (MPOD) was recorded at baseline, 48 weeks and 2 years. Retinal sensitivities were measured by multifocal electroretinogram for peak-to-trough amplitude (N1P1) at baseline and at 48 weeks, and in terms of microperimeter-determined mean retinal sensitivity (MRS) at 48 weeks and 2 years.Supplementation with lutein and zeaxanthin augmented MPOD significantly in active treatment groups (all p0.05). N1P1 response densities showed significant increases in ring 1 and ring 2 after 48 weeks of supplementation, while no significant changes were seen in rings 3-6. Significant increases in MRS were detected after supplementation with either 10 or 20 mg lutein, whereas no such increases were seen in the placebo arm.Supplementation with lutein and/or zeaxanthin increases MPOD, and supplemental lutein enhances retinal sensitivity, in patients with early AMD.Clinicaltrials.gov NCT10528605.

Contaminants in real water are normally complicated. Surface charges of suspended colloidal particles can be either negative or positive. In this work, a series of amphoteric starch-based grafting flocculants (3-chloro-2-hydroxypropyl trimethyl ammonium chloride modified starch-graft-poly(acrylamide-co-acrylic acid)) denoted as SCPAMPAA were successfully synthesized with different grafting ratios and used for the removal of different charged contaminants from water. Various SCPAMPAA flocculants exhibited remarkably different flocculation performance and obeyed diverse flocculation mechanisms due to the differences in their structural characteristics. Therefore, precise control of the molecular structure of flocculants is of great significance to obtain the desired flocculation performance. To provide practically operational feasibility for the preparation of a predicted flocculant, a quantitative mathematical correlation between the preparation recipe and the structural features of SCPAMPAA were derived. The final well-designed flocculant demonstrated a high flocculation performance in aspects of optimal dosage, flocculation window and pH sensitivity for the removal of both negatively and positively charged colloidal contaminants from targeted wastewater.

This study reports the synthesis of bismuth ferrite ceramics (BiFeO3, BFO) by the sol-gel method and the effect of different sintering temperatures (800 °C, 820 °C, 850 °C, 880 °C, 900 °C) on the crystal structure, morphology, dielectric properties and ferroelectric properties of the bismuth ferrite ceramics. It is observed that the bismuth ferrite phase are formed when the molar ratio of bismuth and ferric is 1.025 : 1, and the bismuth ferrite ceramics have less impurity phase at all the five sintering temperature. The morphology studies revealed that the grain of bismuth ferrite ceramics is spherical and the grain size increases with the increasing of the sintering temperature. When the bismuth ferrite ceramics with excessive bismuth sintered at 820 °C, it exhibits the higher dielectric constant and the lower dielectric loss, the remnant polarization and the coercive field are 0.35 μC/cm2 and 4.03kV/cm, respectively. The observed ferroelectricity in bismuth ferrite ceramics owes to the point defects associated with oxygen vacancy defects as well as the smaller size effect.

A crucial issue in today’s counterterrorism environment is how to assess critical infrastructure damage and develop a more appropriate design rapidly against intentional attacks, since it has become unacceptable to ignore the high impact of disruptions caused by these attacks. Degraded states vulnerability methodology (DSVM) is used to explore the vulnerability analysis and design method of critical infrastructures. After the terrorist attack, the damage status of the components at all levels of the target is quickly determined, and the probability of component level damage is simulated. Using this method to judge the functional damage condition and improve the planning and design under multi-hit. Respond quickly to the damage effect of each hit, and put forward multi-hit’s degraded states transition tables and state-effect tables. It provides the basis for rapid assessment, planning and design of critical infrastructure in modern local wars where terrorists are more intensive and frequent.