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Effects of i.v. amino acids on human splanchnic and whole body oxygen consumption, blood flow, and blood temperatures.

The thermic effect of amino acid administration was examined in healthy subjects. Pulmonary and splanchnic oxygen uptake, cardiac output, splanchnic blood flow, and blood temperatures were measured in eight healthy men before and during 2.5 h of intravenous infusion of 600 kJ of a mixture of 19 amino acids. Indirect calorimetry and catheter techniques were used, including thermometry in arterial and a hepatic venous blood. During the infusion, pulmonary oxygen uptake rose progressively from a basal value of 269 +/- 6 to 321 +/- 8 ml/min after 2.5 h. The splanchnic oxygen consumption increased from a basal level of 64 +/- 4 to a peak value of 91 +/- 7 ml/min after 2 h of infusion. The 2.5 h average splanchnic proportion of the amino acid-induced whole body thermogenesis was 51 +/- 11%. Cardiac output increased from 6.2 +/- 0.3 in the basal state to 7.3 +/- 0.4 l/min, whereas the splanchnic blood flow remained unchanged during the infusion period. The arteriohepatic venous oxygen difference increased from 51 +/- 4 in the basal state to 65 +/- 5 ml/l after 2 h of amino acid infusion. The blood temperature rose by approximately 0.25 degrees C during the amino acid infusion, reflecting an increased heat accumulation in the body. It is concluded that the splanchnic tissues account for approximately one-half of the amino acid-induced whole body thermogenesis, that amino acid infusion augments blood flow in the extrasplanchnic but not in the splanchnic tissues, and stimulates the accumulation of heat in the body most likely via a resetting of the central thermosensors.

Adult↗

Thermoregulatory responses to lipopolysaccharide in the mouse: dependence on the dose and ambient temperature.

Most published studies of thermoregulatory responses of mice to LPS involved a stressful injection of LPS, were run at a poorly controlled and often subneutral ambient temperature (T(a)), and paid little attention to the dependence of the response on the LPS dose. These pitfalls have been overcome in the present study. Male C57BL/6 mice implanted with jugular vein catheters were kept in an environmental chamber at a tightly controlled T(a). The relationship between the T(a)s used and the thermoneutral zone of the mice was verified by measuring tail skin temperature, either by infrared thermography or thermocouple thermometry. Escherichia coli LPS in a wide dose range (10(0)-10(4) microg/kg) was administered through an extension of the jugular catheter from outside the chamber. The responses observed were dose dependent. At a neutral T(a), low (just suprathreshold) doses of LPS (10(0)-10(1) microg/kg) caused a monophasic fever. To a slightly higher dose (10(1.5) microg/kg), the mice responded with a biphasic fever. To even higher doses (10(1.75)-10(4) microg/kg), they responded with a polyphasic fever, of which three distinct phases were identified. The dose dependence and dynamics of LPS fever in the mouse appeared to be remarkably similar to those seen in the rat. However, the thermoregulatory response of mice to LPS in a subthermoneutral environment is remarkably different from that of rats. Although very high doses of LPS (10(4) microg/kg) did cause a late (latency, approximately 3 h) hypothermic response in mice, the typical early (latency, 10-30 min) hypothermic response seen in rats did not occur. The present investigation identifies experimental conditions to study LPS-induced mono-, bi-, and polyphasic fevers and late hypothermia in mice and provides detailed characteristics of these responses.

Animals↗

Transient receptor potential ion channels as participants in thermosensation and thermoregulation.

Living organisms must evaluate changes in environmental and internal temperatures to mount appropriate physiological and behavioral responses conducive to survival. Classical physiology has provided a wealth of information regarding the specialization of thermosensory functions among subclasses of peripheral sensory neurons and intrinsically thermosensitive neurons within the hypothalamus. However, until recently, the molecular mechanisms by which these cells carry out thermometry have remained poorly understood. The demonstration that certain ion channels of the transient receptor potential (TRP) family can be activated by increases or decreases in ambient temperature, along with the recognition of their heterogeneous expression patterns and heterogeneous temperature sensitivities, has led investigators to evaluate these proteins as candidate endogenous thermosensors. Much of this work has involved one specific channel, TRP vanilloid 1 (TRPV1), which is both a receptor for capsaicin and related pungent vanilloid compounds and a "heat receptor," capable of directly depolarizing neurons in response to temperatures >42 degrees C. Evidence for a contribution of TRPV1 to peripheral thermosensation has come from pharmacological, physiological, and genetic approaches. In contrast, although capsaicin-sensitive mechanisms clearly influence core body temperature regulation, the specific contribution of TRPV1 to this process remains a matter of debate. Besides TRPV1, at least six additional thermally sensitive TRP channels have been identified in mammals, and many of these also appear to participate in thermosensation. Moreover, the identification of invertebrate TRP channels, whose genetic ablation alters thermally driven behaviors, makes it clear that thermosensation represents an evolutionarily conserved role of this ion channel family.

Animals↗

Energy expended during oxygen deficit period of submaximal exercise in man.

Aerobic (MR) and anaerobic (Man) metabolism was determined during the transition from mild (50 W external work) to heavier exercise (50% VO2max) in six subjects. The overall exercise efficiency was calculated during the oxygen deficit period and during steady-state exercise. MR was obtained by indirect calorimetry and Man by solving the heat balance equation: MR + Man - S = (R + C + E) + W, where radiative, convective, and evaporative heat losses (R + C + E) were measured by direct calorimetry, work output (W) by ergometry, and heat storage (S) by thermometry. (MR + Man) during the oxygen deficit period was found to be lower than MR during steady state. In the 1st min of exercise, mean mixed work efficiency (aerobic + anaerobic) was 33%, which was greater than aerobic efficiency (26.6%) during steady state. The mean anaerobic efficiency efficiency was 41%. This difference reflects the fact that the energy released by splitting of preformed high-energy bonds (i.e., creatine phosphate) is less than the energy released when high-energy bonds expended during mechanical work are continuously regenerated through oxidative phosphorylation. The reported measurements of overall energy metabolism in man provide means for estimating in vivo the coupling efficiency of physical work (i.e., 41%) as well as the efficiency with which energy released by substrate oxidations is recovered in the form of high-energy bonds (i.e., phosphorylation efficiency = 64%).

Aerobiosis↗

Effects of ventilation and pleural effusion on measurements of airway thermal volume and blood flow in dog lungs.

We studied the effects of ventilation and pleural effusion on measurements of airway thermal volume (ATV) and pulmonary blood flow (PBF) by using the airway gas thermometry method of V. B. Serikov, M. S. Rumm, K. Kambara, M. I. Bootomo, A. R. Osmack, and N. C. Staub (J. Appl. Physiol. 72: 944-953, 1992) in 39 anesthetized dogs with or without lung edema or pleural effusion. To examine the differential effects of increased-pressure and increased-permeability lung edema on accuracy and sensitivity of ATV and PBF, two models of lung edema were induced by intravenous infusion of a Dextran 70 solution and alloxan monohydrate, respectively. Dogs were hyperventilated for 3 min by using a wide range of minute ventilation (VE) to produce two steady-state conditions of airway temperature. Higher levels of VE increased an estimated amount of ATV. The ATV produced by hyperventilation at VE values of 559, 158, and 72 ml.min-1.kg-1 was consistent with the gravimetric total lung mass, the blood-free wet lung weight, and the extravascular lung water volume, respectively. The coefficient of lung thermal conductivity, a practical index of the rate of heat conduction through tissue from lung vessels, was related to the ratio of the decrease in expired air temperature to VE, and estimated PBF was consistent with the thermodilution cardiac output. Pleural effusion had little effect on measurements of ATV and PBF. However, ATV and PBF showed increased variation in dogs with dextran-induced lung edema.

Air Pressure↗

Continuous measurement of tympanic temperature with a new infrared method using an optical fiber.

The purpose of this study was to investigate the utility of an infrared tympanic thermometry by using an optical fiber for measuring tympanic temperature (Tty). In the head cooling and facial fanning tests during normothermia, right Tty measured by this method (infrared-Tty) and esophageal temperature (Tes) were not affected by decreased temple and forehead skin temperatures, suggesting that the infrared sensor in this system measured the infrared radiation from the tympanic membrane selectively. Eight male subjects took part in passive-heat-stress and progressive-exercise tests. No significant differences among infrared-Tty, the left Tty measured by thermistor (contact-Tty), and Tes were observed at rest or at the end of each experiment, and there was no significant difference in the increase in these core temperatures from rest to the end. Furthermore, there were no significant differences in the core temperature threshold at the onset of sweating and slope (the relationship of sweating rate vs. infrared-Tty and vs. contact-Tty). These results suggest that this method makes it possible to measure Tty accurately, continuously, and more safely.

Adult↗

Relationship between body heat content and finger temperature during cold exposure.

The purpose of the present experiment was to examine the relationship between rate of body heat storage (S), change in body heat content (DeltaH(b)), extremity temperatures, and finger dexterity. S, DeltaH(b), finger skin temperature (T(fing)), toe skin temperature, finger dexterity, and rectal temperature were measured during active torso heating while the subjects sat in a chair and were exposed to -25 degrees C air. S and DeltaH(b) were measured using partitional calorimetry, rather than thermometry, which was used in the majority of previous studies. Eight men were exposed to four conditions in which the clothing covering the body or the level of torso heating was modified. After 3 h, T(fing) was 34.9 +/- 0.4, 31.2 +/- 1.2, 18.3 +/- 3.1, and 12.1 +/- 0.5 degrees C for the four conditions, whereas finger dexterity decreased by 0, 0, 26, and 39%, respectively. In contrast to some past studies, extremity comfort can be maintained, despite S that is slightly negative. This study also found a direct linear relationship between DeltaH(b) and T(fing) and toe skin temperature at a negative DeltaH(b). In addition, DeltaH(b) was a better indicator of the relative changes in extremity temperatures and finger dexterity over time than S.

Adult↗

Noninvasive magnetic resonance thermography of recurrent rectal carcinoma in a 1.5 Tesla hybrid system.

To implement noninvasive thermometry, we installed a hybrid system consisting of a radiofrequency multiantenna applicator (SIGMA-Eye) for deep hyperthermia (BSD-2000/3D) integrated into the gantry of a 1.5 Tesla magnetic resonance (MR) tomograph Symphony. This system can record MR data during radiofrequency heating and is suitable for application and evaluation of methods for MR thermography. In 15 patients with preirradiated pelvic rectal recurrences, we acquired phase data sets (25 slices) every 10 to 15 minutes over the treatment time (60-90 minutes) using gradient echo sequences (echo time = 20 ms), transformed the phase differences to MR temperatures, and fused the color-coded MR-temperature distributions with anatomic T1-weighted MR data sets. We could generate one complete series of MR data sets per patient with satisfactory quality for further analysis. In fat, muscle, water bolus, prostate, bladder, and tumor, we delineated regions of interest (ROI), used the fat ROI for drift correction by transforming these regions to a phase shift zero, and evaluated the MR-temperature frequency distributions. Mean MR temperatures (T(MR)), maximum T(MR), full width half maximum (FWHM), and other descriptors of tumors and normal tissues were noninvasively derived and their dependencies outlined. In 8 of 15 patients, direct temperature measurements in reference points were available. We correlated the tumor MR temperatures with direct measurements, clinical response, and tumor features (volume and location), and found reasonable trends and correlations. Therefore, the mean T(MR) of the tumor might be useful as a variable to evaluate the quality and effectivity of heat treatments, and consequently as optimization variable. Feasibility of noninvasive MR thermography for regional hyperthermia has been shown and should be further investigated.

Antineoplastic Combined Chemotherapy Protocols↗

Variability in the measurement of corneal temperature using a noncontact infrared thermometer.

PURPOSE: To assess the variability of corneal temperature and the reproducibility of its measurement by means of a noncontact infrared thermometer in healthy subjects. METHODS: The THI-500 noncontact infrared thermometer (Tasco Japan, Osaka, Japan) was used for the measurement of corneal temperature. The reproducibility of corneal temperature measurements was assessed for 5 consecutive temperature readings obtained within 45 min or within 5 days. In addition, the interocular difference in corneal temperature and the diurnal temperature changes of the cornea were assessed. For each experiment, 10 healthy subjects were recruited. RESULTS: The reliability of 5 consecutive corneal temperature measurements obtained within 45 min and within 5 days was 97.92 and 85.35%, respectively. Interocular differences in corneal temperature were not statistically significant (p = 0.70). Average corneal temperature varied significantly during the day (p < 0.0001), with lower corneal temperature readings during the morning hours compared to those obtained during the afternoon. CONCLUSION: The assessment of corneal temperature by means of noncontact infrared thermometry is highly reproducible. Corneal temperature varies throughout the day, and this variation is independent of variations in environmental temperature.

Adult↗

[Demonstration of the effective of acupuncture on the autonomic nervous system by examination of the microcirculation].

This study served to compare the effect of needling at true acupuncture points with that of needling at non-acupuncture points. Various parameters were used to quantify the results such as measurement of the peripheral blood circulation in finger tips and the nasal mucous membrane, measurement of the skin temperature at various sites of the body by means of infrared thermography or contact thermometry, testing of skin conductance, or recording of heart frequency and respiration. These are all indicators of the functional state of the autonomic nervous system. This model experiment was performed on healthy volunteers and showed identical, transient, quick reflex responses of the sympathetic nervous system after true acupuncture as well as after needling at non-acupuncture points. These reactions are related to pain and do not allow to draw any conclusions on the specificity of the points that were needled. The aim of this project was not to make a statement about the therapeutic efficacy of acupuncture. It was meant to be a model allowing the study of some basic regulatory mechanisms which are fundamental for most treatments in complementary medicine.

Acupuncture Points↗

Iridium-192 brachytherapy in combination with interstitial microwave-induced hyperthermia for malignant glioma.

A phase I clinical trial assessing the feasibility and safety of hyperthermia in combination with 192Ir brachytherapy (60 Gy) for the treatment of malignant glioma now includes 14 patients. Hyperthermia (42-43 degrees C at tumor margin for 60 min) has been induced using stereotactically implanted afterloading catheters and a microwave (915 or 2,450 MHz) antenna array. Thermometry recorded along each catheter confirms the general ability of the technique to heat such volumes, but thermal heterogeneities are documented. Transient or permanent worsening of previous neurologic deficit, seen in 7 patients, has been the most common morbidity.

Adult↗

Microwave catheter ablation of myocardium in vitro. Assessment of the characteristics of tissue heating and injury.

BACKGROUND: Radiofrequency (RF) catheter ablation lesion size has been limited by the small volume of tissue directly heated by the RF electrode. Microwave (MW) energy has been proposed as an alternative energy source to generate larger lesions because of its increased volume of direct tissue heating. To further characterize MW ablation of myocardium, we studied the temperature-versus-distance profiles during MW ablation in an in vitro model of perfused and superfused porcine right ventricular free wall. METHODS AND RESULTS: Radial tissue temperatures in 19 isolated porcine right ventricles were measured and recorded with four fluoroptic thermometry probes placed within the myocardium at 2.5-mm radial increments from the catheter. The MW antenna catheters used were monopolar and helical-coil antennas resonating at 915 and 2450 MHz. Durations of energy delivery for a 915-MHz MW monopolar antenna (60 to 600 seconds) and a 4-mm-tip RF electrode (60 and 300 seconds) were varied to compare time courses of lesion formation. For each lesion, the temperature at the lesion border zone (the isotherm of irreversible tissue injury) was determined. Similar lesion size and temperature profiles were observed for 915- versus 2450-MHz MW antennas and monopolar versus helical-coil MW antennas. Lesion depth for the 915-MHz monopolar antenna increased monoexponentially with a half-time of 170 seconds. The isotherms for all MW antenna designs were not significantly different. The mean isotherm of irreversible tissue injury for MW lesions was not significantly different from the mean isotherm for RF lesions (54.4 degrees C versus 53.6 degrees C, respectively). CONCLUSIONS: Microwave ablation has the potential to directly heat a greater volume of tissue than RF ablation but only with efficient MW antennas. The primary mechanism of tissue injury for both MW and RF ablation appears to be thermal.

Animals↗

Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group.

BACKGROUND AND PURPOSE: Recent animal studies showed that mild resuscitative hypothermia improves neurological outcome when applied after cardiac arrest. In a 3-year randomized, prospective, multicenter clinical trial, we hypothesized that mild resuscitative cerebral hypothermia (32 degrees C to 34 degrees C core temperature) would improve neurological outcome after cardiac arrest. METHODS: We lowered patients' temperature after admission to the emergency department and continued cooling for at least 24 hours after arrest in conjunction with advanced cardiac life support. The cooling technique chosen was external head and total body cooling with a cooling device in conjunction with a blanket and a mattress. Infrared tympanic thermometry was monitored before a central pulmonary artery thermistor probe was inserted. RESULTS: In 27 patients (age 58 [interquartile range [IQR] 52 to 64] years; 7 women; estimated "no-flow" duration 6 [IQR 1 to 11] minutes and "low-flow" duration 15 [IQR 9 to 23] minutes; admitted to the emergency department 36 [IQR 24 to 43] minutes after return of spontaneous circulation), we could initiate cooling within 62 (IQR 41 to 75) minutes and achieve a pulmonary artery temperature of 33+/-1 degrees C 287 (IQR 42 to 401) minutes after cardiac arrest. During 24 hours of mild resuscitative hypothermia, no major complications occurred. Passive rewarming >35 degrees C was accomplished within 7 hours. CONCLUSIONS: Mild resuscitative hypothermia in patients is feasible and safe. A clinical multicenter trial might prove that mild hypothermia is a useful method of cerebral resuscitation after global ischemic states.

Brain↗

Impaired thermoregulation in Raynaud's phenomenon.

UNLABELLED: In an attempt to examine the role of the thermoregulatory apparatus in the etiology of Raynaud's phenomenon (RP), the authors exposed 15 women with RP and 12 controls to central body cooling and central body warming. Subjects were placed in an environmental chamber at 25 degrees C. Their right hand was placed in an annex of the chamber, which was insulated from the main chamber and maintained at a constant temperature of 25 degrees C throughout the experiment. Blood flow was measured in the digits of the right hand by venous occlusion strain gauge plethysmography and skin thermometry. Body temperature was measured with an oral thermometer. The temperature of the chamber was then increased to 35 degrees C and then reduced to 13 degrees C for twenty-five minutes with measurements repeated. Following this period patients were rewarmed in an ambient temperature of 35 degrees C for twenty minutes. RESULTS: subjects with RP had significantly lower blood flow at all stages of the test; moreover, their digital rewarming response following central cooling was considerably prolonged when compared with controls. Body temperature was lower and dropped significantly more in the RP group following the cold challenge. The authors conclude that subjects with RP have an impaired thermoregulatory mechanism. This may partially explain cold sensitivity.

Adult↗

Temporal artery temperature measurements in healthy infants, children, and adolescents.

A noninvasive temporal artery thermometer that uses arterial heat balance technology has been compared to rectal and ear thermometry and is available in the marketplace. This study was undertaken to establish mean temperatures and temperatures 2 standard deviations above the mean for healthy infants, children, and adolescents. Temperatures were measured in healthy patients 0 to 18 years of age using a noninvasive temporal artery thermometer. Temperatures were measured in 2,346 patients. Mean temperatures and temperatures 2 standard deviations above the mean were: 37.1 degrees C (38.1 degrees C) for 383 infants 0 to 2 months; 36.9 degrees C (37.9 degrees C) for 860 children 3 to 47 months; 36.8 degrees C (37.8 degrees C) for 680 children 4 to 9 years; and 36.7 degrees C (37.8 degrees C) for 423 adolescents 10 to 18 years. There were no significant differences in temperatures in white compared to African-American children, children with or without perspiration on their forehead, or between measurements taken on the left compared to the right side of the forehead. This study provides information about temporal artery temperatures in healthy infants and children that can serve as a basis for interpreting temperature measurements in ill children when the same instrument is used.

Adolescent↗

Comparison of pulmonary artery, rectal, and tympanic membrane temperatures in adult intensive care unit patients.

Tympanic thermometry using infrared thermography technology offers a noninvasive, rapid temperature measurement tool which may be useful for selected intensive care unit (ICU) patients. Multiple comparisons of pulmonary artery catheter (PAC), rectal (R), and tympanic membrane (TM) temperatures were performed in nine adult ICU patients using PAC temperatures as the gold standard. The correlation between R (r = 0.93) and PAC was significantly better than TM (r = 0.74) temperatures. However, PAC (37.2 +/- 0.06 degrees C; mean +/- SEM) and TM (37.1 +/- 0.08 degrees C) temperatures were not significantly different, whereas R (37.6 +/- 0.07 degrees C) was significantly warmer than both (P less than .05). Differences between either R (+0.4 degrees C) or TM (-0.1 degrees C) and PAC temperatures were consistent over selected ranges between 35 degrees C and 40 degrees C. The performance of TM and R was similar in the ability to predict PAC temperatures.

Adult↗

Comparison of a tympanic thermometer to rectal and oral thermometers in a pediatric emergency department.

We performed a clinical trial of a new tympanic thermometer to test its accuracy in a pediatric emergency department. Tympanic temperature was compared to oral or rectal glass and electronic temperature, depending on the developmental age of the child. Results were controlled for age of the child, cooperation, quantity of cerumen, and the presence or absence of otitis media. Our results suggest good correlation of tympanic with oral and rectal glass thermometry except in infants less than three months of age. Sensitivity and specificity, respectively, were 80% and 93% for detecting fever of 38 degrees C and 80% and 95% for detecting fever of 38.5 degrees C.

Adolescent↗

Estimation of body sites temperatures from tympanic measurements.

For many years, measurement of body temperature in routine medical practice was limited to oral, rectal and axillary sites. Recent introduction of infrared non-contact thermometers for the auditory canal requires the establishing of temperature relationships between the ear and more traditional thermometry sites. Since an auditory canal is exposed to the environment, the infrared readings from it are influenced by ambient temperature. A linear model of thermal gradients in the vicinity of an ear canal allows us to find simple formulas connecting temperatures taken from the ear with those from traditional core sites like bladder or pulmonary artery, in addition to rectal and oral. The formulas contain environment coupling coefficients. Their values have been found experimentally by measuring body temperatures from subjects in a walk-in environmental chamber and from multiple clinical studies. The derived coefficients are used in the Thermoscan PRO-1 Instant Thermometer to calculate core, oral and rectal equivalent temperatures.

Adult↗