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PubMed1993

Discriminant analysis of symptom pattern and serum antibody titres in humidifier related disease.

BACKGROUND: The heterogeneous patterns of symptoms among factory workers exposed to aerosols from contaminated air humidifiers were analysed to assess the association between specific symptoms and the serum IgG antibody response to the humidifier water contaminants, and to test the ability of specific symptoms to predict this antibody response. METHODS: Symptoms from 88 factory workers were surveyed by a doctor administered questionnaire and compared with their serum IgG antibody titres to humidifier water contaminants quantified by enzyme immunoassay. RESULTS: The strength of association between individual symptoms and antibody showed that fever, shivering or chills, influenza-like symptoms, or headache were individually significantly associated with the presence and higher titres of antibody. This was also true for those subjects whose symptoms were most pronounced during the first day of the working week. Within each subject's full symptom profile there were significant associations between the description of chest tightness, breathlessness, and wheeze; between headache and influenza like symptoms; between fever and shivering or chills; and between intermittent onset and general tiredness. Discriminant analysis of the full symptom profiles showed that there was maximum information content in five independent parameters, namely, the descriptions of fever, headache, and chest tightness, the timing of their onset, and the readiness to describe miscellaneous symptoms in addition to those in the questionnaire. On the basis of these criteria 72% of subjects could be classified according to their antibody state. Cluster analysis with these five independent parameters described four symptom clusters: one associated with high median antibody levels, one with low, and two with zero median levels. These were, respectively: (1) fever with headache and chest tightness; (2) either no or few symptoms; (3) chest tightness and headache with intermittent onset; (4) headache and miscellaneous symptoms with intermittent onset. CONCLUSIONS: The association between serum antibody titres and specific symptom patterns may identify different categories of disease which constitute the spectrum known as humidifier related disease, and strengthens the hypothesis that antibody may be involved in the pathogenesis of some components of the disease.

Antibodies↗
PubMed1987

Diabetes mellitus and thermoregulation.

Diabetes mellitus is accompanied by a variety of alterations in metabolic, cardiovascular, and neuronal function. This paper provides a comprehensive review of the ways in which these pathophysiological aspects of diabetes may impair thermoregulatory function. The influence of diabetic neuropathy and vasculopathy on the control of peripheral blood flow is reviewed and the additional effects of changing levels of blood glucose and insulin are discussed. Both hypoglycaemia and diabetic ketoacidosis are associated with hypothermia, but the reasons for this in ketoacidosis are not clear. Impairment of heat conservation may contribute to and could be a consequence of autonomic neuropathy. The final section of the paper describes a study of our own in which metabolic stability was maintained by infusing insulin intravenously before and during the determination of the thermoregulatory responses to acute cold stress. Under these conditions, there was impairment of reflex vasoconstriction in the limbs of diabetics with neuropathy. This failure to reduce heat loss resulted in half the diabetics with neuropathy shivering in response to moderate cooling, which in some subjects was accompanied by a fall in core temperature. Diabetics without neuropathy and nondiabetics neither shivered nor dropped core temperature.

Blood Glucose↗
PubMed1986

Stimulation of ventromedial hypothalamus induces cold defense responses in conscious rabbits.

The involvement of the ventromedial hypothalamus (VMH) in thermoregulatory responses, which include heat production and heat loss responses, was investigated by the method of electrical stimulation. Electrical stimulation of the VMH caused a rise in rectal temperature, accompanied by the enhancement of heat production: O2 consumption and shivering. In addition, a reduction in heat loss was observed, including decreases in skin temperature (Ts), respiratory rate, and body surface area resulting from a huddled posture. In this study, stimulation of the lateral hypothalamus and other regions near the VMH had no effect on thermoregulatory responses. beta-Blocker (propranolol, 1 mg/kg iv) injected 20 min before stimulation lessened O2 consumption by approximately 10% and attenuated the reduction in Ts during VMH stimulation, whereas alpha-blockade (phentolamine, 1 mg/kg iv) was ineffective. These results indicate that most of the increase in O2 consumption during VMH stimulation was due to the occurrence of shivering but that some component of it could be due to nonshivering thermogenesis. They also indicate that the VMH, either directly or by converging influences, is involved in the activation of thermoregulatory responses to cold stress.

Adrenergic beta-Antagonists↗
PubMed1988

Physiological changes during thermoregulation and fever in urethan-anesthetized rats.

Adult male Wistar rats were anesthetized with urethan (1.5 g/kg). They were unable to maintain body temperature (Tb) in a warm (32 degrees C) or cool (9 degrees C) environment or at a laboratory room temperature of 22 degrees C. Tb was allowed to fall to 35.8, 34.5, or 33.3 degrees C, and prostaglandin E1 (PGE1, 400 ng) was delivered into a lateral cerebral ventricle. An immediate feverlike rise in Tb resulted, accompanied by vigorous shivering. Animals were vasoconstricted throughout. When Tb was raised to and maintained at 38.3 or 39.5 degrees C, animals also responded with a fever; however, the magnitude of the fever diminished as the starting Tb increased. In a series of experiments in which Tb was maintained (36.8-37.4 degrees C) by means of a heating pad, PGE1 delivered into a lateral cerebral ventricle or into the anterior hypothalamus caused a dose-dependent change in Tb, which was similar in time of onset, magnitude, and duration to that observed in conscious animals. This fever was accompanied by shivering and increased O2 uptake, heart rate, arterial blood pressure, respiratory rate, and intracranial pressure during the rising phase of the fever, and vasodilation of the paws occurred during defeveresence. Animals were also able to develop a dose-dependent rise in Tb in response to purified human interleukin 1.

Alprostadil↗
PubMed1990

Stimulatory effects of cold exposure and cold acclimation on glucose uptake in rat peripheral tissues.

The effects of cold exposure on the net rates of 2-[3H]deoxy-D-glucose uptake (Ki) in rat peripheral tissues were investigated comparatively in warm- and cold-acclimated animals to determine whether cold acclimation induces regulatory alterations in glucose metabolism. Acute exposure of warm-acclimated (25 degrees C) rats to cold (48 h at 5 degrees C) markedly increased the Ki values in red and white skeletal muscles (2-5 times), in the heart (8 times), in several white adipose tissue (WAT) depots (4-20 times), and in brown adipose tissue (BAT) (110 times). After cold acclimation (3 wk at 5 degrees C), the Ki values further increased in the heart (15 times) and WAT (up to 29 times) but decreased in BAT (36 times). Remarkably, glucose uptake was still increased in muscles of cold-exposed/cold-acclimated animals (that do not shiver), demonstrating that enhanced glucose uptake may occur in muscles in the absence of shivering thermogenesis (or contractile activity). When cold-acclimated rats were returned to the warm for 18 h, the Ki values of all tissues, except WAT, returned to control levels. Cold exposure synergistically potentiated the stimulation of tissue glucose uptake induced by a maximal effective dose of insulin (0.5 U/kg iv) in warm- as well as in cold-acclimated animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Acclimatization↗
PubMed1982

Restoration of thermoregulatory response to body cooling by cooling hands and feet.

Deep body temperature fell progressively by 0.5-1.4 degrees C during 3-h immersions in 29 degrees C water. Both in unacclimatized volunteers and, to a lesser degree, in divers in cold-water training, cooling the hands and feet for 1 h in 12 degrees C water during such immersion caused sensation of cold, shivering, and rise in metabolic rate; it caused body temperature to rise in unacclimatized subjects and halted its fall in divers. Tissue conductances generally fell a little in divers but rose in unacclimatized subjects, probably because of muscle blood flow associated with the greater shivering in the latter. Soaking the skin for 4 h produced no major changes in cutaneous thermal sensation assessed in the forearm, though with seawater it sometimes reduced cold sensation and with distilled water sometimes reduced warm sensation, a little. It is concluded that uniform skin temperature of 29 degrees C often induces insufficient heat-gain reflexes to maintain body temperature and that cooling of the extremities can restore adequate thermoregulatory response.

Adult↗
PubMed1983

Hypergravic fields and parallel controllers for thermoregulation.

To test the proposal that mammals have parallel neurocontrollers for temperature regulation, Long-Evans hooded male rats were exposed to cold while in a 3-G field. When exposed to cold, these rats consumed 35% less oxygen/min at 3 G than they did when exposed to cold at 1 G. However, rats acclimated for 6 wk to 5 degrees C consumed oxygen at the same rate during cold exposure at 3 G as at 1 G. Because cold-acclimated rats generate heat primarily by nonshivering thermogenesis while rats acclimated to room temperature rely to a greater extent on shivering, the 35% decrease in oxygen consumption of cold-exposed room-temperature rats in 3-G fields may reflect an inactivation of shivering. These oxygen consumption measurements, together with measurements of core and tail temperatures of rats in 3-G fields, are consistent with the proposal that neurocontrollers for thermoregulation are arranged in parallel and can be uncoupled by hypergravic fields.

Acclimatization↗
PubMed1987

Heat debt as an index for cold adaptation in men.

Several types of cold adaptation in men have been described in the literature (metabolic, insulative, hypothermic). The aim of this study is to show that the decrease of heat debt can be considered as a new index for cold adaptation. Ten male subjects were acclimated by water immersions (temperature 10-15 degrees C, 4 immersions/wk over 2 mo). Thermoregulatory responses before and after acclimation were tested by a standard cold test in a climatic chamber for 2 h at rest [dry bulb temperature (Tdb): 10 degrees C; relative humidity (rh): 25%]. After adaptation, four thermoregulatory modifications were observed: an increase in the delay for the onset of shivering (32.7 +/- 7.99 instead of 14.1 +/- 5.25 min); a decrease of body temperature levels for the onset of shivering [rectal temperature (Tre): 37.06 +/- 0.08 instead of 37.31 +/- 0.06 degrees C; mean skin temperature (Tsk): 24.83 +/- 0.56 instead of 26.86 +/- 0.46 degrees C; mean body temperature (Tb): 33.03 +/- 0.20 instead of 34.16 +/- 0.37 degrees C); a lower level of body temperatures in thermoneutrality (Tre = 37.16 +/- 0.08 instead of 37.39 +/- 0.06 degrees C; Tsk = 31.29 +/- 0.21 instead of 32.01 +/- 0.22 degrees C; Tb = 35.92 +/- 0.08 instead of 36.22 +/- 0.05 degrees C); a decrease of heat debt calculated from the difference between heat gains and heat losses (5.66 +/- 0.08 instead of 8.33 +/- 0.38 kJ/kg). The different types of cold adaptation observed are related to the physical characteristics of the subjects (percent body fat content) and the level of physical fitness (VO2max).(ABSTRACT TRUNCATED AT 250 WORDS)

Acclimatization↗
PubMed1988

Thermoregulatory model for immersion of humans in cold water.

The mathematical models of thermoregulation of Stolwijk and Hardy, and Montgomery were used to develop a model suitable for the simulation of human physiological responses to cold-water immersion. Data were obtained from experiments where 13 healthy male volunteers were totally immersed under resting and nude conditions for 1 h in water temperatures of 20 and 28 degrees C. At these temperatures, the mean measured rectal temperature (Tre) fell by approximately 0.9 and 0.5 degrees C, respectively, yet mean measured metabolic rate (M) rose by approximately 275 and 90 W for the low body fat group (n = 7) and 195 and 45 W for the moderate body fat group (n = 6). To predict the observed Tre and M values, the present model 1) included thermal inputs for shivering from the skin independent of their inclusion with the central temperature to account for the observed initial rapid rise in M, 2) determined a thermally neutral body temperature profile such that the measured and predicted initial values of Tre and M were matched, 3) confined the initial shivering to the trunk region to avoid an overly large predicted initial rate of rectal cooling, and 4) calculated the steady-state convective heat loss by assuming a zero heat storage in the skin compartment to circumvent the acute sensitivity to the small skin-water temperature difference when using conventional methods. The last three modifications are unique to thermoregulatory modeling.

Body Temperature Regulation↗
PubMed1989

Thermoregulation during cold water immersion is unimpaired by low muscle glycogen levels.

This investigation studied the importance of muscle glycogen levels for body temperature regulation during cold stress. Physiological responses of eight euglycemic males were measured while they rested in cold (18 degrees C, stirred) water on two separate occasions. The trials followed a 3-day program of diet and exercise manipulation designed to produce either high (HMG) or low (LMG) preimmersion glycogen levels in the muscles of the legs, arms, and upper torso. Preimmersion vastus lateralis muscle glycogen concentrations were lower during the LMG trial (144 +/- 14 mmol glucose/kg dry tissue) than the HMG trial (543 +/- 53 mmol glucose/kg dry tissue). There were no significant differences between the two trials in shivering as reflected by aerobic metabolic rate or in the amount of body cooling as reflected by changes in rectal temperature during the immersions. Postimmersion muscle glycogen levels remained unchanged from preimmersion levels in both trials. Small but significant increases in plasma glucose and lactate concentration occurred during both immersions. Plasma glycerol increased during immersion in the LMG trial but not in the HMG trial. Plasma free fatty acid concentration increased during both immersion trials, but the change was apparent sooner in the LMG immersion. It was concluded that thermoregulatory responses of moderately lean and fatter individuals exposed to cold stress were not impaired by a substantial reduction in the muscle glycogen levels of several major skeletal muscle groups. Furthermore, the data suggest that, depending on the intensity of shivering, other metabolic substrates are available to enable muscle glycogen to be spared.

Adult↗
PubMed1990

Metabolic effects of exposure to hypoxia plus cold at rest and during exercise in humans.

To determine effects on metabolic responses, subjects were exposed to four environmental conditions for 90 min at rest followed by 30 min of exercise: breathing room air with an ambient temperature of 25 degrees C (NN); breathing room air with an ambient temperature of 8 degrees C (NC); hypoxia (induced by breathing 12% O2 in N2) with a neutral temperature (HN); and hypoxia in the cold (HC). Hypoxia increased heart rate (HR), systolic blood pressure (SBP), pulmonary ventilation (VE), respiratory exchange ratio (R), blood lactate, and perceived exertion during exercise while depressing rectal temperature (Tre) and O2 uptake (VO2). Cold exposure elevated SBP, diastolic blood pressure (DBP), VE, VO2, blood glucose, and blood glycerol but decreased HR, Tre, and R. Shivering and DBP were higher and Tre was lower in HC compared with NC. HR, SBP, VE, R, and lactate tended to be higher in HC compared with NC, whereas VO2 and blood glycerol tended to be depressed. These results suggest that cold exposure during hypoxia results in an increased reliance on shivering for thermogenesis at rest whereas, during exercise, heat loss is accelerated.

Adult↗
PubMed1996

Cardiovascular responses to beta-stimulation with isoproterenol in deep hypothermia.

The aim of this study was to investigate the effects of beta-stimulation in deep (25 degrees C) hypothermia. Cardiac catheterization was performed on seven anesthetized beagle dogs. They were cooled between ice bags down to 25 degrees C and received isoproterenol administered intravenously three times: at the normal body temperature (37 degrees C) before cooling, after cooling at 25 degrees C, and after rewarming at 37 degrees C. Circulatory function was measured for every 1 degree C of temperature change. Isoproterenol infusion at 37 degrees C induced cardiac acceleration, including the increases of heart rate, cardiac output, and peak first derivative of the left ventricular pressure curve. Systemic vascular and mean outflow resistances and mean aortic pressure decreased. During cooling, shivering thermogenesis continued, even down to 25 degrees C. At 25 degrees C, cardiac acceleration after isoproterenol infusion did not exist but relaxation rate increased slightly. Systemic vascular and mean outflow resistances decreased, but left ventricular end-diastolic and filling pressures increased. beta-Stimulation at normal body temperature increases shivering thermogenesis during cooling. The venous return to the left ventricle at 25 degrees C increased after isoproterenol infusion while systemic vascular resistance decreased, indicating systemic vasodilatation. This increase in preload is probably due to vasoconstriction in pulmonary vessels, which may be mediated by prejunctional beta-adrenoceptors. For cardiac inotrophy, the isoproterenol had no physiologically significant effects at 25 degrees C. After rewarming at 37 degrees C, the effects of isoproterenol were physiologically similar to the effects at the same temperature before cooling.

Adrenergic beta-Agonists↗
PubMed1997

Efficacy of forced-air and inhalation rewarming by using a human model for severe hypothermia.

We recently developed a nonshivering human model for severe hypothermia by using meperidine to inhibit shivering in mildly hypothermic subjects. This thermal model was used to evaluate warming techniques. On three occasions, eight subjects were immersed for approximately 25 min in 9 degrees C water. Meperidine (1.5 mg/kg) was injected before the subjects exited the water. Subjects were then removed, insulated, and rewarmed in an ambient temperature of -20 degrees C with either 1) spontaneous rewarming (control), 2) inhalation rewarming with saturated air at approximately 43 degrees C, or 3) forced-air warming. Additional meperidine (to a maximum cumulative dose of 2.5 mg/kg) was given to maintain shivering inhibition. The core temperature afterdrop was 30-40% less during forced-air warming (0.9 degree C) than during control (1.4 degrees C) and inhalation rewarming (1.2 degrees C) (P < 0.05). Rewarming rate was 6- to 10-fold greater during forced-air warming (2.40 degrees C/h) than during control (0.41 degree C/h) and inhalation rewarming (0.23 degree C/h) (P < 0.05). In nonshivering hypothermic subjects, forced-air warming provided a rewarming advantage, but inhalation rewarming did not.

Adult↗
PubMed2002

Effect of water temperature on cooling efficiency during hyperthermia in humans.

We evaluated the cooling rate of hyperthermic subjects, as measured by rectal temperature (T(re)), during immersion in a range of water temperatures. On 4 separate days, seven subjects (4 men, 3 women) exercised at 65% maximal oxygen consumption at an ambient temperature of 39 degrees C until T(re) increased to 40 degrees C (45.4 +/- 4.1 min). After exercise, the subjects were immersed in a circulated water bath controlled at 2, 8, 14, or 20 degrees C until T(re) returned to 37.5 degrees C. No difference in cooling rate was observed between the immersions at 8, 14, and 20 degrees C despite the differences in the skin surface-to-water temperature gradient, possibly because of the presence of shivering at 8 and 14 degrees C. Compared with the other conditions, however, the rate of cooling (0.35 +/- 0.14 degrees C/min) was significantly greater during the 2 degrees C water immersion, in which shivering was seldom observed. This rate was almost twice as much as the other conditions (P < 0.05). Our results suggest that 2 degrees C water is the most effective immersion treatment for exercise-induced hyperthermia.

Adult↗
PubMed2002

Effect of cold exposure on fuel utilization in humans: plasma glucose, muscle glycogen, and lipids.

The relative roles of circulatory glucose, muscle glycogen, and lipids in shivering thermogenesis are unclear. Using a combination of indirect calorimetry and stable isotope methodology ([U-13C]glucose ingestion), we have quantified the oxidation rates of these substrates in men acutely exposed to cold for 2 h (liquid conditioned suit perfused with 10 degrees C water). Cold exposure stimulated heat production by 2.6-fold and increased the oxidation of plasma glucose from 39.4 +/- 2.4 to 93.9 +/- 5.5 mg/min (+138%), of muscle glycogen from 126.6 +/- 7.8 to 264.2 +/- 36.9 mg glucosyl units/min (+109%), and of lipids from 46.9 +/- 3.2 to 176.5 +/- 17.3 mg/min (+376%). Despite the observed increase in plasma glucose oxidation, this fuel only supplied 10% of the energy for heat generation. The major source of carbohydrate was muscle glycogen (75% of all glucose oxidized), and lipids produced as much heat as all other fuels combined. During prolonged, low-intensity shivering, we conclude that total heat production is unequally shared among lipids (50%), muscle glycogen (30%), plasma glucose (10%), and proteins (10%). Therefore, future research should focus on lipids and muscle glycogen that provide most of the energy for heat production.

Adult↗
PubMed1992

The fate of Schwann cells transplanted in the brain during development.

Purified rat Schwann cells labeled with Hoechst 33342 fluorescent fluorochrome were transplanted into the brain of the newborn shiverer mouse. The grafted cells survived and were able to migrate through the host parenchyma. However, Schwann cell migration was restricted to the grafted hemisphere and to structures adjacent to the graft. With time, Hoechst labeled cells, present at the site of implantation or dispersed in the host parenchyma, decreased progressively in number. Instead, they concentrated along the blood vessels, meninges and ventricles. Despite the presence of Hoechst labeled Schwann cells in white matter tracks during the process of central myelination, Schwann cell myelination could not be evidenced by immunodetection of the peripheral myelin protein or by ultrastructural observation of the typical Schwann cell basement membrane surrounding peripheral myelin. A series of additional transplantations involving Schwann cells of mouse or rat origin, grafted either as cell suspensions or as nerve fragments, demonstrated that transplanted Schwann cells formed myelin around developing host axons only when included in a nerve fragment. Immunodetection of GFAP in astrocytes and type IV collagen in basement membranes as well as electron microscopy showed that reactive astrocytes invaded the grafted area after the first week of transplantation and sometimes formed basement membranes isolating partially the graft from the host parenchyma. During host myelination, astrocytes, which were present in most white matter structures, surrounded grafted cells. Occasionally, they enclosed Schwann cells in basement membranes or encircled host axons. Later, reactive astrocytes were associated with Schwann cells restricted to blood vessel and ventricular walls, and meninges. Our results suggest that in the presence of competitive developing oligodendrocytes, astrocytes are able to limit migration and prevent myelination of Schwann cells transplanted in the newborn shiverer brain. In addition, astrocytes seem to be able to expel the grafted cells and finally exclude them from the host parenchyma.

Animals↗
PubMed1992

Stage specific, (O4+GalC-) isolated oligodendrocyte progenitors produce MBP+ myelin in vivo.

O4+/A007+GalC- proligodendroblasts represent a distinct stage of development in the oligodendrocyte lineage, occurring just prior to the appearance of postmitotic GalC+ oligodendrocytes. These cells, isolated directly from postnatal rat telencephalon by an immunopanning procedure, can terminally differentiate and myelinate axons when transplanted back into an in vivo environment. Specifically, after 30 days in the brain of newborn shiverer mouse hosts, O4+GalC- oligodendrocyte progenitors produced myelin basic protein positive (MBP+) patches. These MBP+ patches, examined by both light and confocal microscopy, contained oligodendrocyte cell bodies and ensheathed host shiverer axons morphologically similar to those found in normal rat brain at an analogous age. These results suggest that isolated O4+GalC- cells can become biochemically mature oligodendrocytes with the capacity to elaborate myelin sheaths, and further define the period of development during which oligodendrocytes retain their capacity to myelinate axons when given a receptive environment.

Animals↗
PubMed1981

Drug fever due to nomifensine treatment in patients with endogenous depression.

Nomifensine was introduced as an effective antidepressant drug with few side effects. However, among our patients we have seen 2 typical cases of drug fever due to nomifensine. 2-4 weeks after start of nomifensine treatment, 75-150 mg/day, for recurrent endogenous depressions the patients developed shiverings and fever. Nomifensine was withdrawn and both became afebrile within 1 day. A provocation test with 50 mg nomifensine p.o. again resulted in shiverings and fever within 6-8 h. 1 of the patients was allergic to other drugs and suffered from asthma. During the acute episode of illness the serum concentration of alanine aminotransferase was elevated and it normalized after stopping the treatment. A liver biopsy at that time showed liver cell necrosis, and a moderate grade of steatosis and fibrosis was also present. The results indicate that nomifensine may cause drug fever. It is possible that patients with allergy and/or liver diseases in particular may be susceptible to drug fever due to nomifensine.

Aged↗