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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(10): 1304-1306, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31771735

RESUMO

OBJECTIVE: Heat stroke is the most serious type of heat-related diseases, and the induced multiple organ dysfunction syndrome (MODS) is an important cause of death for heat stroke patients. The cardiovascular system is one of the important targets of heat injury. Studies have reported that heat stress can lead to myocardial inhibition, abnormal heart conduction and blood flow redistribution, thus changing the hemodynamic state, leading to obvious abnormalities in electrocardiogram, echocardiography, myocardial injury biological markers and hemodynamic indicators of patients with heat stroke. In this article, the pathophysiological and histological changes and clinical manifestations of heatstroke-induced myocardial injury are reviewed, aiming to provide references for further understanding and research of myocardial damage caused by hyperthermia.


Assuntos
Traumatismos Cardíacos , Golpe de Calor , Biomarcadores , Frequência Cardíaca , Humanos , Insuficiência de Múltiplos Órgãos
2.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 35(9): 823-827, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31750825

RESUMO

Objective To study the characteristics of the expression of aquaporin-4 (AQP4) in the brains and astrocytes of rats with thermoplegia. Methods Sixty healthy male Sprague-Dawley rats weighing (250±30) g were randomly divided into control group and model group. The quiet exposure method with high temperature (40DegreesCelsius) and high humidity (70%) was used to make a typical rat model of thermoplegia to monitor rectal temperature and record onset time every 10 minutes. When the temperature of stressed rats reached 42.5 DegreesCelsius, it was regarded as onset time of the disease. The rats in both groups were placed at 26DegreesCelsius with humidity 60% later. After 5-hour observation and their behavior evaluation, the rats were killed and their brain tissues were taken for measuring the water content of the tissues. The astrocytes of the rats were cultured at 37DegreesCelsius and 41DegreesCelsius. AQP4 mRNA and protein expression were detected by reverse-transcription PCR and Western blot analysis. Results Compared with the control group, the expression of AQP4 mRNA and protein were significantly lower in the model group than in the control group. Conclusion High temperature may lead to the destruction of blood-brain barrier and the down-regulation of AQP4 mRNA and protein expression in experimental rats, which can induce the occurrence and development of cerebral edema in experimental rats.


Assuntos
Aquaporina 4/metabolismo , Barreira Hematoencefálica , Edema Encefálico/patologia , Golpe de Calor/patologia , Animais , Astrócitos , Encéfalo/metabolismo , Temperatura Alta , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 1028-1032, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537233

RESUMO

OBJECTIVE: To explore the effects of different fluid replenishment methods on the internal environment, body thermal regulatory response and severe heatstroke of 5-km armed cross-country training soldiers. METHODS: A Special Force officers and soldiers who participated in 5-km armed cross-country training (2-3 times a week, 25-30 minutes each time for 3 weeks) during summer training from June to July in 2018 were enrolled, and they were divided into three groups according to the random number table, with 300 trainees in each group. 200 mL of drinking fluids were given to each group 15 minutes before and after each 5-km armed cross-country training: A group with boiled water, B group with purified water, and C group with beverage prepared by pharmaceutical laboratory of the 990th Hospital of PLA Joint Logistics Support Force (100 mL containing 6 g carbohydrates, 42 mg sodium, and 11 mg potassium). The venous blood was collected before and after the last training or during the onset of severe heatstroke to do the following tests: serum cardiac troponin I (cTnI, chemiluminescence), MB isoenzyme of creatine kinase (CK-MB, immunosuppressive), serum creatinine (SCr, enzymatic method), urea nitrogen (BUN, enzymatic method), alanine aminotransferase (ALT, tryptase), aspartate transaminase (AST, tryptase), and Na+, K+, Cl- (electrode method). The heart rate (HR) and core temperature (Tc, anal temperature) were monitored at the same time. The amount of sweat in training and the occurrence of severe heatstroke were also recorded. RESULTS: There was no significant difference in heart, liver, kidney function, electrolyte and body heat regulation reaction among three groups of 5-km armed cross-country trainees before training. Compared with before training, the levels of serum cTnI, CK-MB, SCr, BUN, ALT, AST, HR and Tc were significantly increased after training or during the onset of severe heatstroke in three groups, while the contents of Na+, K+, Cl- were significantly decreased, but the increase or decrease of group C was relatively smaller compared with group A and group B [cTnI (µg/L): 0.9 (0.6, 1.4) vs. 1.1 (0.7, 2.8), 1.0 (0.6, 3.3); CK-MB (U/L): 7.0 (5.0, 11.0) vs. 9.0 (6.0, 14.5), 8.0 (6.0, 15.0); SCr (µmol/L): 92.09±18.64 vs. 102.78±18.77, 103.64±20.07; BUN (mmol/L): 7 (6, 9) vs. 9 (8, 11), 10 (8, 13); ALT (U/L): 27 (22, 34) vs. 36 (30, 43), 34 (27, 43); AST (U/L): 37 (31, 48) vs. 41 (34, 50), 39 (34, 51); HR (bpm): 87.01±17.07 vs. 95.88±21.06, 96.59±22.04; Tc (centigrade): 37.73±0.81 vs. 38.03±1.05, 38.10±1.04; Na+ (mmol/L): 150.14±3.86 vs. 144.18±8.89, 144.04±9.39; K+ (mmol/L): 4.32±0.57 vs. 4.15±0.62, 4.13±0.51; Cl- (mmol/L): 100.43±3.71 vs. 98.42±4.24, 98.41±4.58; all P < 0.01]. The incidence of severe heatstroke in group C was significantly lower than that in group A and group B [1.67% (5/300) vs. 5.00% (15/300), 5.33% (16/300), χ2 = 6.424, P = 0.040]. There was no significant difference in sweating volume in groups A, B, C (g: 370.47±48.71, 370.85±50.66, 370.17±50.21, F = 0.014, P = 0.986). There was no significant difference in the above indexes between group A and group B (all P > 0.05). Bi-classification Logistic regression analysis showed that the increase of HR, Tc and excessive loss of Na+, K+, Cl- were risk factors for severe heatstroke [odds ratio (OR) was 0.848, 0.138, 1.565, 17.996 and 2.328 respectively, all P < 0.01]. CONCLUSIONS: Timely supplementation of carbohydrate, sodium and potassium ions can effectively change the internal environment and body heat regulation reaction of 5-km armed cross-country trainees, so as to reduce the occurrence of severe heatstroke. The increases of HR, Tc and excessive loss of Na+, K+, Cl- are risk factors for severe heatstroke.


Assuntos
Hidratação/métodos , Golpe de Calor , Militares , Regulação da Temperatura Corporal , Creatina Quinase Forma MB , Eletrólitos , Temperatura Alta , Humanos
4.
N Engl J Med ; 381(12): 1186, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31532980

Assuntos
Golpe de Calor , Humanos
5.
N Engl J Med ; 381(12): 1186, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31532981

Assuntos
Golpe de Calor , Humanos
6.
N Engl J Med ; 381(12): 1186-1187, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31532982

Assuntos
Golpe de Calor , Humanos
7.
N Engl J Med ; 381(12): 1187, 2019 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-31532983

Assuntos
Golpe de Calor , Humanos
8.
Artigo em Inglês | MEDLINE | ID: mdl-31527479

RESUMO

BACKGROUND: This study aims to compare the Bouchama heatstroke (B-HS) and Japanese Association for Acute Medicine heatstroke (JAAM-HS) criteria with regard to the diagnosis and prediction of mortality and neurological status of heatstroke patients. METHODS: This multicenter observational study recruited eligible patients from the emergency departments of 110 major hospitals in Japan from 1 July to 30 September, 2014. RESULTS: A total of 317 patients (median age, 65 years; interquartile range, 39-80 years) were included and divided into the B-HS, JAAM-HS, and non-HS groups, with each group consisting of 97, 302, and 15 patients, respectively. The JAAM-HS (1.0; 95% confidence interval [CI], 0.87-1.0) and B-HS (0.29; 95% CI, 0.14-0.49) criteria showed high and low sensitivity to mortality, respectively. Similarly, the JAAM-HS (1.0; 95% CI, 0.93-1.0) and B-HS (0.35; 95% CI, 0.23-0.49) criteria showed high and low sensitivity to poor neurological status, respectively. Meanwhile, the sequential organ failure assessment (SOFA) scores demonstrated good accuracy in predicting mortality among heat-related illness (HRI) patients. However, both JAAM-HS and B-HS criteria could not predict in-hospital mortality. The AUC of the SOFA score for mortality was 0.83 (day 3) among the HRI patients. The patients' neurological status was difficult to predict using the JAAM-HS and B-HS criteria. Concurrently, the total bilirubin level could relatively predict the central nervous system function at discharge. CONCLUSIONS: The JAAM-HS criteria showed high sensitivity to mortality and could include all HRI patients who died. The JAAM-HS criterion was considered a useful tool for judgement of admission at ED. Further investigations are necessary to determine the accuracy of both B-HS and JAAM-HS criteria in predicting mortality and neurological status at discharge.


Assuntos
Golpe de Calor/diagnóstico , Golpe de Calor/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bilirrubina , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Sociedades Médicas , Adulto Jovem
9.
J Strength Cond Res ; 33(10): 2616-2621, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31425459

RESUMO

Bradley, LJ, Miller, KC, Wiese, BW, and Novak, JR. Precooling's effect on American football skills. J Strength Cond Res 33(10): 2616-2621, 2019-Precooling (i.e., cooling before exercise) may reduce the risk of exertional heatstroke (EHS) in American football athletes. However, implementation of precooling by coaches or medical staff would likely be poor if it impaired performance. We investigated whether precooling impacted American football skill performance in this randomized, crossover, counterbalanced study. Twelve men (24 ± 2 years, mass = 85.5 ± 6.3 kg, height = 181.8 ± 8.1 cm) completed a familiarization day to practice each skill and then 2 testing days. On testing days (wet-bulb globe temperature = 19.3 ± 4.1° C), subjects were either precooled for 15 minutes using cold-water immersion (10.1 ± 0.3° C) or not (control). Then, they donned an American football uniform and completed several bouts of 8 different football skills. Rectal temperature (Trec) was measured before, during, and after skill testing. Precooling did not affect vertical jump, broad jump, agility, dynamic or stationary catching, or maximum throwing distance (p ≥ 0.13). Precooling impaired 40-yard dash time (precooling = 5.72 ± 0.53 seconds, control = 5.31 ± 0.34 seconds; p = 0.03, effect size = 1.2) and throwing accuracy (precooling = 4 ± 1 points, control = 7 ± 2 points; p = 0.001, effect size = 1.4). On average, Trec was 0.58 ± 0.35° C lower during skills testing after precooling and statistically differed from control from minute 10 to the end of testing (∼35 minutes; p < 0.05, effect size ≥ 1.2). Precooling may be a useful EHS prevention strategy in American football players because it lowered Trec without impacting most skills. By lowering Trec, precooling would prolong the time it would take for an athlete's Trec to become dangerous (i.e., >40.5° C). If precooling is implemented, coaches should alter practice so that throwing accuracy and speed drills occur after an athlete's Trec returns to normal (i.e., >35 minutes).


Assuntos
Desempenho Atlético/fisiologia , Futebol Americano/fisiologia , Adulto , Temperatura Corporal , Temperatura Baixa , Estudos Cross-Over , Teste de Esforço , Golpe de Calor/prevenção & controle , Temperatura Alta , Humanos , Imersão , Masculino , Distribuição Aleatória , Água , Adulto Jovem
10.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(7): 890-895, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31441416

RESUMO

OBJECTIVE: To explore the relationship between training burnout, sleep quality and heat regulation response, severe heatstroke in people performed 5-km armed cross-country training. METHODS: 600 male officers and soldiers who participated in 5-km armed cross-country training in summer from 2017 to 2018 were enrolled. All trainees participated in 5-km armed cross-country training in environment with ambient temperature > 32 centigrade and (or) humidity > 65%. They were divided into two groups according to whether severe heatstroke occurred during 5-km armed cross-country training. The age, military age, body mass index (BMI), physical fitness score, external environment (such as ambient temperature, relative humidity, wind speed, heat index), training burnout score and Pittsburgh sleep quality index scale (PSQI) score, heart rate (HR), core temperature (Tc), sweating volume and serum Na+, K+, Cl- levels were compared between the groups. The risk factors of severe heatstroke during 5-km armed cross-country training were screened by binary multivariate Logistic regression analysis. RESULTS: There were 26 cases of severe heatstroke in 600 trainees who participated in 5-km armed cross-country training, with an incidence of 4.33%. There was no significant difference in age, military age, BMI, physical fitness score and external environment of 5-km armed cross-country training between people with or without severe heatstroke. Compared with those without severe heatstroke, the dimensions of training burnout and the total average scores of training burnout of severe heatstroke personnel before 5-km armed cross-country training were increased significantly (physical and mental exhaustion score: 12.4±2.5 vs. 9.4±3.5, training alienation score: 8.8±2.8 vs. 5.8±2.3, low sense of achievement score: 8.2±2.7 vs. 5.6±2.3, total score of training burnout: 9.8±3.2 vs. 6.9±3.2, all P < 0.01), all factors except daytime dysfunction (DD) of PSQI and total PSQI score were also increased significantly [sleep quality (SQ) score: 1.0 (1.0, 2.0) vs. 1.0 (1.0, 1.0), fall asleep time (SL) score: 2.0 (1.0, 3.0) vs. 1.0 (1.0, 1.0), sleep time (SH) score: 1.0 (0.8, 2.0) vs. 1.0 (0, 1.0), sleep efficiency (SE) score: 1.0 (0, 1.0) vs. 0 (0, 0.8), sleep disorder (SD) score: 2.0 (1.0, 3.0) vs. 1.0 (0, 2.0), total PSQI score: 1.0 (1.0, 2.0) vs. 1.0 (0, 1.0), all P < 0.01], HR was increased significantly at onset (bpm: 120.00±10.57 vs. 86.49±14.91, P < 0.01), Tc was increased significantly (centigrade: 41.46±0.57 vs. 37.97±0.83, P < 0.01), serum electrolyte contents were decreased significantly [Na+ (mmol/L): 130.54±5.97 vs. 143.15±10.56, K+ (mmol/L): 3.72±0.44 vs. 4.37±0.50, Cl- (mmol/L): 97.58±4.80 vs. 102.10±2.39, all P < 0.01], and the amount of sweat during training was increased significantly (g: 395.81±16.16 vs. 371.88±40.76, P < 0.01). Binary multivariate Logistic regression analysis showed that total score of training burnout [odd ratio (OR) = 0.653, 95% confidence interval (95%CI) = 0.563-0.757], total PSQI score (OR = 0.693, 95%CI = 0.525-0.916), HR (OR = 0.871, 95%CI = 0.838-0.908), Tc (OR = 0.088, 95%CI = 0.043-0.179), sweating volume (OR = 0.988, 95%CI = 0.979-0.997), Na+ (OR = 1.112, 95%CI = 1.069-1.158), K+ (OR = 13.900, 95%CI = 5.343-36.166), Cl- (OR = 1.393, 95%CI = 1.252-1.550) were independent risk factors for severe heatstroke during 5-km armed cross-country training (all P < 0.01). CONCLUSIONS: Increase in training burnout, total PSQI score, excessive changes of body heat regulation response and excessive loss of Na+, K+, Cl- in serum are independent risk factors for severe heatstroke during 5-km armed cross-country training under the same conditions with high temperature and humidity environment.


Assuntos
Esgotamento Psicológico , Golpe de Calor , Temperatura Alta , Militares , Frequência Cardíaca , Humanos , Masculino , Sono , Estresse Fisiológico
11.
J Athl Train ; 54(9): 921-928, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31454289

RESUMO

CONTEXT: Exertional heat stroke (EHS) is a leading cause of sudden death in high school football players. Preparedness strategies can mitigate EHS incidence and severity. OBJECTIVE: To examine EHS preparedness among high school football programs and its association with regional and state preseason heat-acclimatization mandates. DESIGN: Cross-sectional study. SETTING: Preseason high school football programs, 2017. PATIENTS OR OTHER PARTICIPANTS: A total of 910 athletic trainers (ATs) working with high school football (12.7% completion rate). MAIN OUTCOME MEASURE(S): We acquired data on high school football programs' EHS preparedness strategies in the 2017 preseason via an online questionnaire, looking at (1) whether schools' state high school athletic associations mandated preseason heat-acclimatization guidelines and (2) heat safety region based on warm-season wet-bulb globe temperature, ranging from the milder region 1 to the hotter region 3. Six EHS-preparedness strategies were assessed: EHS recognition and treatment education; policy for initiating emergency medical services response; emergency response plan enactment; immersion tub filled with ice water before practice; wet-bulb globe temperature monitoring; and hydration access. Multivariable binomial regression models estimated the prevalence of reporting all 6 strategies. RESULTS: Overall, 27.5% of ATs described their schools as using all 6 EHS-preparedness strategies. The highest prevalence was in region 3 schools with state mandates (52.9%). The multivariable model demonstrated an interaction in which the combination of higher heat safety region and presence of a state mandate was associated with a higher prevalence of reporting all 6 strategies (P = .05). Controlling for AT and high school characteristics, the use of all 6 strategies was higher in region 3 schools with state mandates compared with region 1 schools without state mandates (52.9% versus 17.8%; prevalence ratio = 2.68; 95% confidence interval = 1.81, 3.95). CONCLUSIONS: Our findings suggest a greater use of EHS-preparedness strategies in environmentally warmer regions with state-level mandates for preseason heat acclimatization. Future researchers should identify factors influencing EHS preparedness, particularly in regions 1 and 2 and in states without mandates.


Assuntos
Aclimatação/fisiologia , Futebol Americano/fisiologia , Golpe de Calor , Temperatura Alta/efeitos adversos , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Estudos Transversais , Gerenciamento Clínico , Feminino , Golpe de Calor/epidemiologia , Golpe de Calor/prevenção & controle , Golpe de Calor/terapia , Humanos , Incidência , Masculino , Inquéritos e Questionários , Estados Unidos/epidemiologia
12.
Internist (Berl) ; 60(9): 1007-1008, 2019 09.
Artigo em Alemão | MEDLINE | ID: mdl-31342089
13.
J Athl Train ; 54(7): 758-764, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31343276

RESUMO

CONTEXT: Exertional heatstroke is one of the leading causes of death in American football players. Precooling (PC) with whole-body cold-water immersion (CWI) may prevent severe hyperthermia and, possibly, exertional heatstroke. However, it is unknown how much PC delays severe hyperthermia when participants wear American football uniforms during exercise in the heat. Does PC alter the effectiveness of CWI once participants become hyperthermic or affect perceptual variables during exercise? OBJECTIVES: We asked 3 questions: (1) Does PC affect how quickly participants become hyperthermic during exercise in the heat? (2) Does PC before exercise affect rectal temperature (Trec) cooling rates once participants become hyperthermic? (3) Does PC affect perceptual variables such as rating of perceived exertion (RPE), thermal sensation, and environmental symptoms questionnaire (ESQ) responses? DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twelve physically active males (age = 24 ± 4 years, height = 181.8 ± 8.4 cm, mass = 79.9 ± 10.3 kg). INTERVENTION(S): On PC days, participants completed 15 minutes of CWI (9.98°C ± 0.04°C). They donned American football uniforms and exercised in the heat (temperature = 39.1°C ± 0.3°C, relative humidity = 36% ± 2%) until Trec was 39.5°C. While wearing equipment, they then underwent CWI until Trec was 38°C. Control-day procedures were the same except for the PC intervention. MAIN OUTCOME MEASURE(S): Rectal temperature, heart rate, thermal sensation, RPE, and ESQ responses were measured throughout testing. The duration of cold-water immersion was used in conjunction with Trec to calculate cooling rates. RESULTS: Precooling allowed participants to exercise 17.6 ± 3.6 minutes longer before reaching 39.5°C (t11 = 17.0, P < .001). Precooling did not affect postexercise CWI Trec cooling rates (PC = 0.18°C/min ± 0.06°C/min, control = 0.20°C/min ± 0.09°C/min; t11 = 0.9, P = .17); ESQ responses (F2,24 = 1.3, P = .3); or RPE (F2,22 = 2.9, P = .07). Precooling temporarily lowered thermal sensation (F3,26 = 21.7, P < .001) and heart rate (F3,29 = 21.0, P < .001) during exercise. CONCLUSIONS: Because PC delayed hyperthermia without negatively affecting perceptual variables or CWI effectiveness, clinicians may consider implementing PC along with other proven strategies for preventing heat illness (eg, acclimatization).


Assuntos
Vestuário , Futebol Americano , Golpe de Calor , Adulto , Temperatura Baixa , Estudos Cross-Over , Exercício/fisiologia , Febre , Futebol Americano/fisiologia , Frequência Cardíaca/fisiologia , Golpe de Calor/fisiopatologia , Golpe de Calor/prevenção & controle , Temperatura Alta , Humanos , Masculino , Sensação Térmica/fisiologia , Estados Unidos , Água
16.
Environ Monit Assess ; 191(Suppl 2): 394, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31254102

RESUMO

Heatwaves are one of the deadliest natural disasters that occur annually with thousands of people seeking medical attention. The spatio-temporal synchronization between peaks in disease manifestation and high temperature provides important insights into the seasonal timing of the heatwave and the response it may cause with respect to emergence, severity, and duration. The objectives of this study are to examine the association between hospitalizations due to heat stroke in older adults and heat in the United States (US) and explore synchronization with respect to heatwave sequence, time of arrival, and regional climate. Three large data sets were utilized: daily hospitalization records of the US elderly between 1991 and 2006, annual demographic summaries on Medicare beneficiaries maintained by the Centers for Medicare and Medicaid Services (CMS), and nationwide daily meteorological observations. We modeled seasonal fluctuations in health outcomes, such as the timing and intensity of the seasonal peak in hospitalizations using refined harmonic GLM for eight climatically similar regions. During the 16-year study period, there were 40,019 heat-related hospitalizations (HRH) in the conterminous  US. The rates of HRH varied substantially across eight climatic regions: with the highest rate of 7.05 cases per million residents observed in areas with temperate arid summers and winters (TaTa) and the lowest rate of 0.67-in areas with cold moderately dry summers and arid winters (CdCa), where summer temperatures are about  18.3 °C and 12.1 °C, respectively. We detected 400 heatwaves defined as any day when the night time temperature is above its 90th percentile for the current and previous nights. The first seasonal heatwave in a season resulted in 4274 hospitalizations over 342 heatwave-days: 34.3% of 12,442 hospitalizations occurred in 26% of 1308 heatwave-days. The relative risks of increased HRH associated with the first and second heatwaves were 10.4 (95%CI: 8.5; 12.3) and 11.4 (95%CI: 9.6; 13.3), respectively, indicating the disproportional effects of early heatwave arrivals. The seasonal spike in heat stroke hospitalizations in regions with relatively similar annual temperatures, e.g. in areas with temperate moderately dry summers and winters (TdTa: 12.8 °C) and (TaTa: 11.1 °C) ranged between 4.5 (95%CI: 3.3; 5.5) and 11.0 (95%CI: 8.2; 14.9) cases per million residents, respectively, indicating substantial regional differences. The differences in heat-related hospitalizations and response to heatwaves are substantial among older adults residing in different climate regions of the conterminous US. The disproportionally high response to the early seasonal heatwave deserves special attention, especially in the context of prevention and decision support frameworks.


Assuntos
Clima , Calor Extremo/efeitos adversos , Golpe de Calor/etiologia , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Golpe de Calor/epidemiologia , Humanos , Masculino , Medicare/estatística & dados numéricos , Risco , Estações do Ano , Temperatura Ambiente , Estados Unidos/epidemiologia
17.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 594-597, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198146

RESUMO

OBJECTIVE: To explore the clinical characteristics and early sensitive indicators of severe heat stroke patients in order to predict the development of severe heat stroke in the early stage. METHODS: Thirty-eight patients with severe heat stroke admitted to emergency department of Beijing Daxing District People's Hospital from July 30th to August 5th in 2018 were enrolled. There were 18 patients suffered from exertional heat stroke (EHS), and 12 patients suffered from classical heat stroke (CHS), and 8 patients with heat spasm and heat exhaustion were selected as control group. The gender, age, onset time, body temperature, heart rate (HR), lactic acid (Lac), platelet (PLT), alanine aminotransferase (ALT), alanine aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (SCr), serum sodium at admission of hospital, as well as positive rate of myoglobin (MYO) and D-dimer (the positive threshold of MYO and D-dimer was 107 µg/L and 600 µg/L respectively) were recorded and compared among the groups. Receiver operating characteristic (ROC) curve was plotted to analyze the prognostic value of MYO and D-dimer on heat stroke. The outcome of all patients was followed up, and the 28-day mortality between EHS and CHS patients was compared. The patient's body temperature was measured again after 4 hours of active cooling treatment (T4 h), and the relationship between T4 h and 28-day mortality was discussed. RESULTS: The majority of severe heat stroke patients were male, especially in EHS patients. EHS patients were younger than CHS ones, and had shorter onset time, with significant differences among the groups. The body temperature and HR at admission in the EHS group and the CHS group were significantly higher than those in the control group [body temperature (centigrade): 41.34±0.67, 40.39±0.58 vs. 37.80±1.39; HR (bpm): 139.78±15.63, 113.08±17.70 vs. 92.00±15.89, all P < 0.05], PLT was significantly lowered (×109/L: 164.94±73.80, 165.78±53.49 vs. 249.50±84.22, both P < 0.05), and the positive rates of MYO and D-dimer were also significantly increased [MYO positive rate: 100.0% (18/18), 100.0% (12/12) vs. 50.0% (4/8); D-dimer positive rate: 77.8% (14/18), 100.0% (12/12) vs. 12.5% (1/8), all P < 0.05]. ROC curve analysis showed that positive MYO and D-dimer at admission had certain diagnostic value for heat stroke, the area under ROC curve (AUC) was 0.750 and 0.871, the sensitivity was 50.0% and 87.5%, and the specificity was 100% and 86.7%, respectively. The 28-day mortality of the EHS group was significantly higher than that of the CHS group [44.4% (8/18) vs. 8.3% (1/12), P < 0.05]. Furthermore, the 28-day mortality of the patients with T4 h ≥ 38 centigrade in the EHS group was significantly higher than those with T4 h < 38 centigrade [70.0% (7/10) vs. 12.5% (1/8), P < 0.05]. CONCLUSIONS: The decreased PLT and the increased D-dimer in the early stage of heat stroke indicate that the damage of coagulation mechanism is prominent in patients with heat stroke. EHS patients have the characteristics of acute onset, severe condition, rapid progression and poor prognosis, and the 28-day mortality is significantly higher than that of CHS patients. MYO and D-dimer are sensitive indicators in early stage of heat stroke patients, which can be used as reference for early diagnosis of heat stroke.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Golpe de Calor/diagnóstico , Mioglobina/sangue , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Golpe de Calor/sangue , Humanos , Masculino , Valor Preditivo dos Testes , Índice de Gravidade de Doença
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 598-602, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198147

RESUMO

OBJECTIVE: To observe the damage of various organs of rats with exertional heatstroke (EHS), and to investigate the protective effect of oral rehydration salts III (ORS III) on multi-organ function in rats with EHS. METHODS: Fifty-one male Sprague-Dawley (SD) rats were randomly divided into four groups by random digit table: normal control group (n = 13), EHS group (n = 13), EHS+water group (n = 12), and EHS+ORS III group (n = 13). All rats in the EHS groups received adaptive training for 7 days before the experiment. On the 8th day, the rats of EHS+water and EHS+ORS III groups were orally given 20 mL/kg water or ORS III 30 minutes before the experiment. No pretreatment was performed in the EHS group. EHS model was reproduced by forcing rats to run under hot environment. The rats which refused to exercise and which core temperature > 40.5 centigrade were considered as the onset of EHS. The rats in the normal control group were exposed to room temperature (25±2) centigrade and humidity (50±5)% without any treatment. Six hours later, blood of inferior vena cava was collected, and the levels of serum MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (SCr), blood urea nitrogen (BUN), serum potassium, serum sodium and serum chloride were determined by automatic chemical analyzer. Serum intestinal fatty acid-binding protein (I-FABP) was determined by enzyme linked immunosorbent assay (ELISA). RESULTS: The levels of LDH, ALT, AST, BUN, serum sodium and serum chloride in the EHS group were significantly higher than those in the normal control group [LDH (U/L): 1 220±427 vs. 837±485, ALT (U/L): 138 (97, 164) vs. 37 (33, 42), AST (U/L): 409 (380, 566) vs. 86 (78, 104), BUN (mmol/L): 11.7 (9.6, 13.2) vs. 5.9 (5.5, 6.1), serum sodium (mmol/L): 148.0 (143.5, 154.5) vs. 139.0 (138.0, 140.5), serum chloride (mmol/L): 100.9±2.3 vs. 97.3±1.4, all P < 0.05], but no significant difference in CK-MB, SCr or serum potassium could be found [CK-MB (U/L): 1 280±373 vs. 1 379±480, SCr (µmol/L): 38.2±7.5 vs. 35.5±6.3, serum potassium (mmol/L): 5.5 (4.4, 6.2) vs. 4.7 (4.4, 4.9), all P > 0.05]. In the EHS+ORS III group, only serum potassium level was significantly lower than that in the EHS group [mmol/L: 4.0 (3.7, 4.4) vs. 5.5 (4.4, 6.2), P < 0.01], while no significant difference in other parameters was found between the EHS+ORS III group and the EHS group as well as the EHS+water group. Serum I-FABP level in the EHS group was significantly higher than that in the normal control group [µg/L: 36.90 (29.10, 45.00) vs. 11.39 (0.31, 20.80), P < 0.01]. Serum I-FABP level in the EHS+water and EHS+ORS III groups were notably lower than that in the EHS group [µg/L: 24.19 (20.00, 28.36), 0.31 (0.31, 5.58) vs. 36.90 (29.10, 45.00), both P < 0.01], additionally, I-FABP level was much lower in the EHS+ORS III group (P < 0.01). CONCLUSIONS: EHS could lead to liver, intestinal barrier dysfunction and electrolyte disturbance. Pre-treatment of ORS III could alleviate the intestinal dysfunction and electrolyte disorder caused by EHS in rats. It can lower the serum potassium to some extent. However, ORS III failed to protect liver from EHS.


Assuntos
Hidratação/métodos , Golpe de Calor/terapia , Intestinos/fisiologia , Sais/uso terapêutico , Animais , Golpe de Calor/fisiopatologia , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
19.
J Spec Oper Med ; 19(2): 108-116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31201762

RESUMO

Temperature increases due to climate changes and operations expected to be conducted in hot environments make heat-related injuries a major medical concern for the military. The most serious of heat-related injuries is exertional heat stroke (EHS). EHS generally occurs when health individual perform physical activity in hot environments and the balance between body heat production and heat dissipation is upset resulting in excessive body heat storage. Blood flow to the skin is increased to assist in dissipating heat while gut blood flow is considerably reduced, and this increases the permeability of the gastrointestinal mucosa. Toxic materials from gut bacteria leak through the gastrointestinal mucosa into the central circulation triggering an inflammatory response, disseminated intravascular coagulation (DIC), multiorgan failure, and vascular collapse. In addition, high heat directly damages cellular proteins resulting in cellular death. In the United States military, the overall incidence of clinically diagnosed heat stroke from 1998 to 2017 was (mean ± standard deviation) 2.7 ± 0.5 cases/10,000 Soldier-years and outpatient rates rose over this period. The cornerstone of EHS diagnosis is recognition of central nervous dysfunction (ataxia, loss of balance, convulsions, irrational behavior, unusual behavior, inappropriate comments, collapse, and loss of consciousness) and a body core temperature (obtained with a rectal thermometer) usually >40.5°C (105°F). The gold standard treatment is whole body cold water immersion. In the field where water immersion is not available it may be necessary to use ice packs or very cold, wet towels placed over as much of the body as possible before transportation of the victim to higher levels of medical care. The key to prevention of EHS and other heat-related injuries is proper heat acclimation, understanding work/rest cycles, proper hydration during activity, and assuring that physical activity is matched to the Soldiers' fitness levels. Also, certain dietary supplements (DSs) may have effects on energy expenditure, gastrointestinal function, and thermoregulation that should be considered and understood. In many cases over-motivation is a major risk factor. Commanders and trainers should be alert to any change in the Soldier's behavior. Proper attention to these factors should considerably reduce the incidence of EHS.


Assuntos
Exercício/fisiologia , Golpe de Calor , Temperatura Alta/efeitos adversos , Militares , Doenças Profissionais , Golpe de Calor/diagnóstico , Golpe de Calor/epidemiologia , Golpe de Calor/fisiopatologia , Golpe de Calor/terapia , Humanos , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/fisiopatologia , Doenças Profissionais/terapia
20.
BMC Neurol ; 19(1): 133, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215399

RESUMO

BACKGROUND: Heat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain. CASE PRESENTATION: We encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid-base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient's level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved. CONCLUSIONS: This case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.


Assuntos
Golpe de Calor/complicações , Golpe de Calor/diagnóstico por imagem , Golpe de Calor/patologia , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/etiologia , Trombose Intracraniana/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos
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