Core temperature and sweat responses in professional women's tennis players during tournament play in the heat

Context:

Tennis is often played in hot, humid environments, intensifying the thermoregulatory strain placed on the athletes. As a safety measure, some tennis organizations allow for a 10-minute break in play between the second and third sets when environmental conditions are extreme. However, the actual effect of these breaks in reducing core temperature is unknown.

Objective:

To determine change in core temperature after a 10-minute break in play and assess fluid balance in professional female tennis players during tournament matches in the heat.

Design:

Cross-sectional study.

Setting:

A Women''s Tennis Association Tour–sanctioned outdoor tournament on hard courts under hot conditions (30.3°C ± 2.3°C).

Patients or Other Participants:

Seven professional tennis players.

Main Outcome Measure(s):

Change in core temperature after a 10-minute break in tournament play, fluid intake, and sweat losses during match play.

Results:

Core temperature was reduced from 38.92°C to 38.67°C (change of −0.25°C ± 0.20°C) when a break was taken (P  =  .02). Mean sweat rate during match play was 2.0 ± 0.5 L/h. During that time, mean fluid intake was 1.5 ± 0.5 L/h, resulting in a 1.2% ± 1.0% reduction in body mass.

Conclusions:

Female professional tennis players are subjected to high heat loads during match play in hot environments. However, a 10-minute break in play decreased core temperature in 6 of 7 players by an average of 0.25°C, indicating that the break provides practical benefits in the field. Furthermore, although mean sweat rate in this group of female tennis players was high, most athletes were still able to minimize mass loss to less than 2% of their prematch weight.     

Cytokine profile in elderly patients with sepsis

Context:

Sepsis is a serious health problem in the elderly with a high degree of mortality. There is very limited data available in elderly subjects regarding the markers for sepsis. Development of good markers will help in overall management and prediction of sepsis.

Objectives:

Serial estimation of Interleukin-6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF-α) and their correlation with mortality in sepsis in elderly patients and to determine the influence of gender on cytokine production and mortality in elderly patients with sepsis.

Settings and Design:

The prospective study was conducted at our tertiary care center from April 2007 to September 2008. Elderly Patients satisfying the Systemic Inflammatory Response Syndrome (SIRS) criteria were included.

Methods and Material:

TNF-α and IL-6 were estimated in 30 elderly patients admitted to our intensive care unit with SIRS and sepsis. The estimations were done on day 1, 3 and 7 of admission.

Statistical Analysis Used:

Student and paired ‘t’ tests, and ANOVA, which were further followed up by post-hoc ‘t’ tests with Bonferroni correction using SPSS.

Results:

Reducing levels of IL-6 levels from day 1 to 7 was found in the survivor group. TNF-α level was significantly low on day 1 in the nonsurvivor female group.

Conclusions:

Serial estimation of cytokines in elderly patients with sepsis will help in prediction of mortality. Female gender was an independent predictor of increased morality in critically ill patients with sepsis.     

Cold-Water Immersion and the Treatment of Hyperthermia: Using 38.6��C as a Safe Rectal Temperature Cooling Limit

Context:

Cold-water immersion is recommended for the immediate field treatment of exertional heat stroke. However, concerns exist over potential overcooling of hyperthermic individuals during cold-water immersion.

Objective:

To evaluate the recommendation that removing previously hyperthermic individuals from a cold-water bath at a rectal temperature (T_re) of 38.6°C would attenuate overcooling.

Design:

Controlled laboratory study.

Setting:

University research laboratory.

Patients or Other Participants:

Participants included 6 men and 4 women (age  =  22 ± 3 years, height  =  172 ± 10 cm, mass  =  67.8 ± 10.7 kg, body fat percentage  =  17.1% ± 4.5%, maximum oxygen consumption  =  59.3 ± 8.7 mL·kg⁻¹·min⁻¹).

Intervention(s):

After exercising at an ambient temperature of 40.0°C for 38.5 ± 9.4 minutes, until T_re reached 39.5°C, participants were immersed in a 2.0°C circulated water bath until T_re decreased to either 37.5°C or 38.6°C. Subsequently, participants were removed from the water bath and recovered for 20 minutes at an ambient temperature of 25°C.

Main Outcome Measure(s):

Rectal and esophageal temperatures were measured continuously during the immersion and recovery periods.

Results:

Because of the experimental design, the overall time of immersion was greater during the 37.5°C trial (16.6 ± 5.7 minutes) than the 38.6°C trial (8.8 ± 2.6 minutes) (t₉  =  −4.740, P  =  .001). During the recovery period after cold-water immersion, both rectal (F_1,9  =  50.540, P < .001) and esophageal (F_1,6  =  20.365, P  =  .007) temperatures remained greater in the 38.6°C trial than in the 37.5°C trial. This was evidenced by low points of 36.47°C ± 0.70°C and 37.19°C ± 0.71°C for rectal temperature (t₉  =  2.975, P  =  .016) and of 35.67°C ± 1.27°C and 36.72°C ± 0.95°C for esophageal temperature (t₆  =  3.963, P  =  .007) during the recovery period of the 37.5°C and 38.6°C trials, respectively.

Conclusions:

Immersion for approximately 9 minutes to a rectal temperature cooling limit of 38.6°C negated any risk associated with overcooling hyperthermic individuals when they were immersed in 2°C water.     

Cooling the neck region during exercise in the heat

Context:

Cooling the neck region can improve the ability to exercise in a hot environment. It might improve performance by dampening the perceived level of thermal strain, allowing individuals to override inhibitory signals.

Objective:

To investigate whether the enhanced ability to exercise in a hot environment observed when cooling the neck region occurs because of dampening the perceived level of thermal strain experienced and the subsequent overriding of inhibitory signals.

Design:

Crossover study.

Setting:

Walk-in environmental chamber.

Patients or Other Participants:

Eight endurance-trained, nonacclimated men (age  =  26 ± 2 years, height  =  1.79 ± 0.04 m, mass  =  77.0 ± 6.2 kg, maximal oxygen uptake [V̇O_2max]  =  56.2 ± 9.2 mL·kg⁻¹·min⁻¹) participated.

Intervention(s):

Participants completed 4 running tests at approximately 70% V̇O_2max to volitional exhaustion: 2 familiarization trials followed by 2 experimental trials (cooling collar [CC] and no collar [NC]). Trials were separated by 7 days. Familiarization and NC trials were performed without a collar and used to assess the test variability.

Main Outcome Measure(s):

Time to volitional exhaustion, heart rate, rectal temperature, neck skin temperature, rating of perceived exertion, thermal sensation, and feeling scale (pleasure/displeasure) were measured.

Results:

Time to volitional exhaustion was increased by 13.5% ± 3.8% (CC  =  43.15 ± 12.82 minutes, NC  =  38.20 ± 11.70 minutes; t₇  =  9.923, P < .001) with the CC, which reduced mean neck skin temperature throughout the test (P < .001). Participants terminated exercise at identical levels of perceived exertion, thermal sensation, and feeling scale, but the CC enabled participants to tolerate higher rectal temperatures (CC  =  39.61°C ± 0.45°C, NC  =  39.18°C ± 0.7°C; t₇  =  −3.217, P  =  .02) and heart rates (CC  =  181 ± 6 beats/min, NC  =  178 ± 9 beats/min; t₇  =  −2.664, P  =  .03) at the point of termination.

Conclusions:

Cooling the neck increased the time taken to reach volitional exhaustion by dampening the perceived levels of thermal strain.     

The Effect of Community-Managed Palliative Care Program on Quality of Life in the Elderly in Rural Tamil Nadu,India

Background:

HelpAge India has been facilitating community-managed palliative care program in the villages of Tamil Nadu, India.

Objective:

To evaluate the effect of perceived quality of life in the elderly in the project villages in rural Tamil Nadu.

Materials and Methods:

It was a community-based evaluation study. Considering the mean difference of 0.6, design effect-2, precision-5%, power 80%, and 10% non-response, a sample size of 450 elderly persons (more than 60 years) was adequate. Sample was selected by two-stage cluster sampling. Tamil version of “WHO-Quality of Life-brief questionnaire” was used. Trained interviewers made house-to-house visits and obtained information by personally interviewing the subjects.

Results:

The mean score for perceived physical quality of life in the project area was (10.47 ± 1.80 SD) high than the mean score (10.17 ± 1.82 SD) in the control area (P = 0.013) and the mean score for psychological support (10.13 ± 2.25 SD) in project area was high than the mean score (9.8 ± 2.29 SD) in control area (P = 0.043). There was no effect on domain of social relationship and environment.

Conclusions:

In the project villages, the perceived physical quality of life and psychological support among elderly persons was significantly better than the control villages.     

Core-temperature sensor ingestion timing and measurement variability

Context:

Telemetric core-temperature monitoring is becoming more widely used as a noninvasive means of monitoring core temperature during athletic events.

Objective:

To determine the effects of sensor ingestion timing on serial measures of core temperature during continuous exercise.

Design:

Crossover study.

Setting:

Outdoor dirt track at an average ambient temperature of 4.4°C ± 4.1°C and relative humidity of 74.1% ± 11.0%.

Patients or Other Participants:

Seven healthy, active participants (3 men, 4 women; age  =  27.0 ± 7.5 years, height  =  172.9 ± 6.8 cm, body mass  =  67.5 ± 6.1 kg, percentage body fat  =  12.7% ± 6.9%, peak oxygen uptake [V̇o_2peak]  =  54.4 ± 6.9 mL•kg⁻¹•min⁻¹) completed the study.

Intervention(s):

Participants completed a 45-minute exercise trial at approximately 70% V̇o_2peak. They consumed core-temperature sensors at 24 hours (P1) and 40 minutes (P2) before exercise.

Main Outcome Measure(s):

Core temperature was recorded continuously (1-minute intervals) using a wireless data logger worn by the participants. All data were analyzed using a 2-way repeated-measures analysis of variance (trial × time), Pearson product moment correlation, and Bland-Altman plot.

Results:

Fifteen comparisons were made between P1 and P2. The main effect of time indicated an increase in core temperature compared with the initial temperature. However, we did not find a main effect for trial or a trial × time interaction, indicating no differences in core temperature between the sensors (P1  =  38.3°C ± 0.2°C, P2  =  38.3°C ± 0.4°C).

Conclusions:

We found no differences in the temperature recordings between the 2 sensors. These results suggest that assumed sensor location (upper or lower gastrointestinal tract) does not appreciably alter the transmission of reliable and repeatable measures of core temperature during continuous running in the cold.     

Left atrial function for outcome prediction in severe sepsis and septic shock: An echocardiographic study

Left ventricular function and B-type natriuretic peptide (BNP) assessments are used to predict mortality in septic patients. Left atrial function has never been used to prognosticate outcome in septic patients.

Objectives:

To assess if deterioration of left atrial function in patients with severe sepsis and septic shock could predict mortality.

Methods:

We studied 30 patients with severe sepsis or septic shock with a mean age of 49.8±16.17. Echocardiographic parameters were measured on admission, Day 4, and Day 7, which comprised left ventricular ejection fraction (EF), and atrial function that is expressed as atrial ejection force (AEF). All patients were subjected to BNP assay as well. Multivariate analyses adjusted for APACHE II score was used for mortality prediction.

Results:

The underlying source for sepsis was lung in 10 patients (33%), blood in 7 patients (23.3%), abdomen in 7 patients (23.7%), and 3 patients (10%) had UTI as a cause of sepsis. Only one patient had CNS infection. In-hospital mortality was 23.3% (7 patients). Admission EF showed a significant difference between survivors and non survivors, 49.01±6.51 vs.. 56.44±6.93% (P<0.01). On the other hand, admission AEF showed insignificant changes between the same groups, 10.9±2.81 vs. 9.41±2.4 k/dynes P=0.21, while BNP was significantly higher in the non survivors, 1123±236.08 vs. 592.7±347.1 pg/ml (P<0.001). The predicatable variables for mortality was Acute Physiology and Chronic Health Evaluation II score, BNP, then EF.

Conclusion:

In septic patients, left atrial function unlike the ventricular function and BNP levels can not be used as an independent predictor of mortality.     

Risk of Hypothermia in a New Olympic Event: the 10-km Marathon Swim

INTRODUCTION:

There are no available data addressing the potential clinical risks of open-water swimming competitions.

OBJECTIVE:

Address the risks of hypothermia and hypoglycemia during a 10-km open-water swimming competition in order to alert physicians to the potential dangers of this recently-introduced Olympic event.

METHODS:

This was an observational cross-sectional study, conducted during a 10-km open-water event (water temperature 21°C). The highest ranked elite open-water swimmers in Brazil (7 men, 5 women; ages 21±7 years old) were submitted to anthropometrical measurements on the day before competition. All but one athlete took maltodextrine ad libitum during the competition. Core temperature and capillary glycemia data were obtained before and immediately after the race.

RESULTS:

Most athletes (83%) finished the race with mild to moderate hypothermia (core temperature <35°C). The body temperature drop was more pronounced in female athletes (4.2±0.7°C vs. male: 2.7±0.8°C; p=0.040). When data from the athlete who did not take maltodextrine was excluded, capillary glycemia increased among athletes (pre 86.6±8.9 mg/dL; post 105.5±26.9 mg/dL; p=0.014). Time to complete the race was inversely related to pre- competition body temperature in men (r=−0.802; p=0.030), while it was inversely correlated with the change in capillary glycemia in women (r=−0.898; p=0.038).

CONCLUSION:

Hypothermia may occur during open-water swimming events even in elite athletes competing in relatively warm water. Thus, core temperature must be a chief concern of any physician during an open-water swim event. Capillary glycemia may have positive effects on performance. Further studies that include more athletes in a controlled setting are warranted.     

Response of Thermocouples Interfaced to Electrothermometers When Immersed in 5 Water Bath Temperatures

Context:

Thermocouples and electrothermometers are used in therapeutic modality research. Until recently, researchers assumed that these instruments were valid and reliable.

Objective:

To examine 3 different thermocouple types in 5°C, 15°C, 18.4°C, 25°C, and 35°C water baths.

Design:

Randomized controlled trial.

Setting:

Therapeutic modality laboratory.

Intervention(s):

Eighteen thermocouple leads were inserted through the wall of a foamed polystyrene cooler. The cooler was filled with water. Six thermocouples (2 of each model) were plugged into the 6 channels of the Datalogger and 6 randomly selected channels in the 2 Iso-Thermexes. A mercury thermometer was immersed into the water and was read every 10 seconds for 4 minutes during each of 6 trials. The entire process was repeated for each of 5 water bath temperatures (5°C, 15°C, 18.4°C, 25°C, 35°C).

Main Outcome Measure(s):

Temperature and absolute temperature differences among 3 thermocouple types (IT-21, IT-18, PT-6) and 3 electrothermometers (Datalogger, Iso-Thermex calibrated from −50°C to 50°C, Iso-Thermex calibrated from −20°C to 80°C).

Results:

Validity and reliability were dependent on thermocouple type, electrothermometer, and water bath temperature (P < .001; modified Levene P < .05). Statistically, the IT-18 and PT-6 thermocouples were not reliable in each electrothermometer; however, these differences were not practically different from each other. The PT-6 thermocouples were more valid than the IT-18s, and both thermocouple types were more valid than the IT-21s, regardless of water bath temperature (P < .001).

Conclusions:

The validity and reliability of thermocouples interfaced to an electrothermometer under experimental conditions should be tested before data collection. We also recommend that investigators report the validity, the reliability, and the calculated uncertainty (validity + reliability) of their temperature measurements for therapeutic modalities research. With this information, investigators and clinicians will be better able to interpret and compare results and conclusions.     

Self-paced exercise performance in the heat after pre-exercise cold-fluid ingestion

Context:

Precooling is the pre-exercise reduction of body temperature and is an effective method of improving physiologic function and exercise performance in environmental heat. A practical and effective method of precooling suitable for application at athletic venues has not been demonstrated.

Objective:

To confirm the effectiveness of pre-exercise ingestion of cold fluid without fluid ingestion during exercise on pre-exercise core temperature and to determine whether pre-exercise ingestion of cold fluid alone without continued provision of cold fluid during exercise can improve exercise performance in the heat.

Design:

Randomized controlled clinical trial.

Setting:

Environmental chamber at an exercise physiology laboratory that was maintained at 32°C, 60% relative humidity, and 3.2 m/s facing air velocity.

Patients or Other Participants:

Seven male recreational cyclists (age = 21 ± 1.5 years, height = 1.81 ± 0.07 m, mass = 78.4 ± 9.2 kg) participated.

Intervention(s):

Participants ingested 900 mL of cold (2°C) or control (37°C) flavored water in 3 300-mL aliquots over 35 minutes of pre-exercise rest.

Main Outcome Measure(s):

Rectal temperature and thermal comfort before exercise and distance cycled, power output, pacing, rectal temperature, mean skin temperature, heart rate, blood lactate, thermal comfort, perceived exertion, and sweat loss during exercise.

Results:

During rest, a greater decrease in rectal temperature was observed with ingestion of the cold fluid (0.41 ± 0.16°C) than the control fluid (0.17 ± 0.17°C) over 35 to 5 minutes before exercise (t₆ = −3.47, P = .01). During exercise, rectal temperature was lower after ingestion of the cold fluid at 5 to 25 minutes (t₆ range, 2.53–3.38, P ≤ .05). Distance cycled was greater after ingestion of the cold fluid (19.26 ± 2.91 km) than after ingestion of the control fluid (18.72 ± 2.59 km; t₆ = −2.80, P = .03). Mean power output also was greater after ingestion of the cold fluid (275 ± 27 W) than the control fluid (261 ± 22 W; t₆ = −2.13, P = .05). No differences were observed for pacing, mean skin temperature, heart rate, blood lactate, thermal comfort, perceived exertion, and sweat loss (P > .05).

Conclusions:

We demonstrated that pre-exercise ingestion of cold fluid is a simple, effective precooling method suitable for field-based application.     

Hydration behaviors before and after an educational and prescribed hydration intervention in adolescent athletes

Context:

The effectiveness of education in modifying hydration behaviors in adolescent athletes is unclear.

Objective:

To assess the hydration status and behaviors of female athletes before and after a 1-time educational intervention and prescribed hydration intervention in a warm, humid, tropical environment.

Design:

Cohort study.

Setting:

Non–air-conditioned gymnasium in a tropical environment (indoor wet bulb globe temperature  =  24.0 ± 0.2°C).

Patient or Other Participants:

Thirty-six female adolescent elite volleyball players (age  =  14.8 ± 0.8 years, height  =  168.2 ± 8.2 cm, mass  =  60.8 ± 9.0 kg, body mass index  =  21.7 ± 2.7, body surface area  =  1.65 ± 0.14 m², body surface area to mass ratio  =  2.71 ± 0.18 m²·kg⁻¹·10⁻²) participated.

Intervention(s):

Four observational periods consisting of 3 practices per observational period separated by 48 hours. The 4 periods included a control period, educational intervention, prescribed hydration intervention (PHI), and observational follow-up (OF-U). After the control period, an educational intervention consisting of a slide presentation was provided to the participants, followed by a week of observation. In the PHI, a precalculated volume of water based on individual sweat rate was consumed every 20 minutes during each 2-hour practice. During all other periods, participants consumed their fluid of choice ad libitum. The order of the treatment periods was not randomized and was the same for all participants.

Main Outcome Measure(s):

Prepractice to postpractice changes in body mass (ΔBM), percentage of body mass lost (%BML), urine specific gravity, urine color, urine osmolality, sweat rate, and volume of fluid consumed (F_vol).

Results:

The PHI was the only period during which participants maintained body mass (ΔBM  =  0.05 ± 1.3%); F_vol consumed was greatest during this time (F_vol  =  1.3 ± 0.4 L; F_1,3  =  34.869, P ≤ .001). The ΔBM was less for the PHI (ΔBM  =  0.05 ± 0.9 kg, %BML  =  0.04 ± 1.3%) than the OF-U period (ΔBM  =  −0.7 ± 1.1 kg, %BML  =  −1.2 ± 1.9%; F_1,3  =  6.220, P  =  .01). The F_vol (1.3 ± 0.4 L) and percentage of fluid consumed (143.7 ± 110.8%) to restore sweat loss for the PHI period were higher than for any other period (F_1,3  =  34.869, P ≤ .001). None of the participants experienced serious dehydration in any of the conditions.

Conclusions:

A 1-time education session alone was not successful in changing hydration behaviors. However, prescribing individualized hydration protocols improved hydration for adolescents exercising in a warm, humid environment.     

Tibiofemoral Joint Positioning for the Valgus Stress Test

Context:

Recommendations on the positioning of the tibiofemoral joint during a valgus stress test to optimize isolation of the medial collateral ligament (MCL) from other medial joint structures vary in the literature. If a specific amount of flexion could be identified as optimally isolating the MCL, teaching and using the technique would be more consistent in clinical application.

Objective:

To determine the angle of tibiofemoral joint flexion between 0° and 20° that causes a difference in the slope of the force-strain line when measuring the resistance to a valgus force applied to the joint.

Design:

Cross-sectional study.

Setting:

University research laboratory.

Patients or Other Participants:

Twelve healthy volunteers (6 men, 6 women: age  =  26.4 ± 5.6 years, height  =  170.9 ± 8.4 cm, mass  =  75.01 ± 14.6 kg).

Intervention(s):

Using an arthrometer, we applied a valgus force, over a range of 60 N, to the tibiofemoral joint in 0°, 5°, 10°, 15°, and 20° of flexion.

Main Outcome Measure(s):

Force-strain measurements were obtained for 5 positions of tibiofemoral joint flexion.

Results:

As knee flexion angle increased, slope values decreased (F_4,44  =  17.6, P < .001). The slope at full extension was not different from that at 5° of flexion, but it was different from the slopes at angles greater than 10° of flexion. Similarly, the slope at 5° of flexion was not different from that at 10° of flexion, but it was different from the slopes at 15° and 20° of flexion. Further, the slope at 10° of flexion was not different from that at 15° or 20° of flexion. Finally, the slope at 15° of flexion was not different from that at 20° of flexion.

Conclusions:

When performing the manual valgus stress test, the clinician should fully extend the tibiofemoral joint or flex it to 5° to assess all resisting medial tibiofemoral joint structures and again at 15° to 20° of joint flexion to further assess the MCL.     

Sweat Rates, Sweat Sodium Concentrations, and Sodium Losses in 3 Groups of Professional Football Players

Context:

Sweat sodium losses have never been reported in a large cohort of American football players.

Objective:

To compare sweat rates (SwtRs), sweat sodium concentrations (SwtNa⁺), and sodium losses in 3 groups of players (backs and receivers [BK], linebackers and quarterbacks [LB/QB], and linemen [LM]) to determine if positional differences and, therefore, size differences exist.

Design:

Observational study.

Setting:

Data were collected during practices in the second week of 2 consecutive training camps. The wet bulb globe temperature was 78.5°F ± 3.5°F (25.9°C ± 1.9°C).

Patients or Other Participants:

Eighteen BK, 12 LB/QB, and 14 LM volunteered.

Intervention(s):

Sterile sweat patches were applied to the right forearm after the skin was appropriately cleaned. The patches were removed during practice, placed in sterile tubes, centrifuged, frozen, and later analyzed by flame photometry.

Main Outcome Measure(s):

Sweat rate, SwtNa⁺, and sodium loss. We calculated SwtR by change in mass adjusted for urine produced and fluids consumed divided by practice time in hours.

Results:

Other than age, physical characteristics were different among groups (P < .001). The SwtR was different among groups (F_2,41  =  7.3, P  =  .002). It was lower in BK (1.42 ± 0.45 L/h) than in LB/QB (1.98 ± 0.49 L/h) (P < .05) and LM (2.16 ± 0.75 L/h) (P < .01), but we found no differences between SwtRs for LB/QB and LM. The SwtNa⁺ was not different among groups (BK  =  50 ± 16 mEq/L, LB/QB  =  48.2 ± 23 mEq/L, and LM  =  52.8 ± 25 mEq/L) and ranged from 15 to 99 mEq/L. Sweat sodium losses ranged from 642 mg/h to 6.7 g/h, and findings for group comparisons approached significance (P  =  .06). On days when players practiced 4.5 hours, calculated sodium losses ranged from 2.3 to 30 g/d.

Conclusions:

The BK sweated at lower rates than did the midsized LB/QB and large LM, but LB/QB sweated similarly to LM. Sweat sodium concentration and daily sodium losses ranged considerably. Heavy, salty sweaters require increased dietary consumption of sodium during preseason.     

Temperature Increases in the Human Achilles Tendon During Ultrasound Treatments With Commercial Ultrasound Gel and Full-Thickness and Half-Thickness Gel Pads

Context:

Although originally manufactured for use in diagnostic imaging of internal structures, 2-cm-thick gel pads are also used as conducting media for therapeutic ultrasound over areas with bony prominences. Research on the ability of these pads to conduct enough energy to adequately heat tissues has provided mixed results. However, this research has mainly been performed on the triceps surae muscle, an area over which gel pads are not typically used. We wondered how much heating might be produced if a thinner pad was used over a tendon.

Objective:

To compare temperature rises in the human Achilles tendon during ultrasound treatments using ultrasound gel, a 2-cm-thick pad, and a 1-cm-thick pad.

Design:

Cross-sectional study.

Setting:

University therapeutic modality laboratory.

Patients or Other Participants:

Forty-eight healthy volunteers (24 women, 24 men).

Intervention(s):

We inserted a rigid thermocouple 1 cm deep into the Achilles tendon. Ultrasound was delivered at the following settings: 3 MHz, continuous, 1 W/cm², 10 minutes.

Main Outcome Measure(s):

Temperature was recorded every 30 seconds for 10 minutes.

Results:

Temperature increased the most in the ultrasound gel group (increase  =  13.3°C, peak  =  42°C). The 1-cm-thick pad resulted in higher tendon temperature (increase  =  9.3°C, peak  =  37.8°C) than the 2-cm-thick pad (increase  =  6.5°C, peak  =  4.8°C). The 1-cm pad produced approximately 30% more heating than the 2-cm pad (SE  =  0.72, P < .03).

Conclusions:

The thinner pad transmitted ultrasound more efficiently than the thicker pad. Thus, a gel pad of less than 1-cm thickness might be useful for superficial areas, such as the hands and ankles.     

Study of Nurses�� Knowledge about Palliative Care: A Quantitative Cross-sectional Survey

Context:

Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care.

Aims:

The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT).

Settings and Design:

Cross-sectional survey of 363 nurses in a multispecialty hospital.

Materials and Methods:

The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate ‘correct’, ‘incorrect’, or ‘unsure.’ The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items).

Statistical Analysis Used:

Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearson''s co-efficient using SPSS version 16.0 for Windows.

Results:

The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05).

Conclusions:

Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT.     

Comparison of rectal and aural core body temperature thermometry in hyperthermic, exercising individuals: a meta-analysis

Objective:

To compare mean differences in core body temperature (T_core) as assessed via rectal thermometry (T_re) and aural thermometry (T_au) in hyperthermic exercising individuals.

Data Sources:

PubMed, Ovid MEDLINE, SPORTDiscus, CINAHL, and Cochrane Library in English from the earliest entry points to August 2009 using the search terms aural, core body temperature, core temperature, exercise, rectal, temperature, thermistor, thermometer, thermometry, and tympanic.

Study Selection:

Original research articles that met these criteria were included: (1) concurrent measurement of T_re and T_au in participants during exercise, (2) minimum mean temperature that reached 38°C by at least 1 technique during or after exercise, and (3) report of means, standard deviations, and sample sizes.

Data Extraction:

Nine articles were included, and 3 independent reviewers scored these articles using the Physiotherapy Evidence Database (PEDro) scale (mean  =  5.1 ± 0.4). Data were divided into time periods pre-exercise, during exercise (30 to 180 minutes), and postexercise, as well as T_re ranges <37.99°C, 38.00°C to 38.99°C, and >39.00°C. Means and standard deviations for both measurement techniques were provided at all time intervals reported. Meta-analysis was performed to determine pooled and weighted mean differences between T_re and T_au.

Data Synthesis:

The T_re was conclusively higher than the T_au pre-exercise (mean difference [MD]  =  0.27°C, 95% confidence interval [CI]  =  0.15°C, 0.39°C), during exercise (MD  =  0.96°C, 95% CI  =  0.84°C, 1.08°C), and postexercise (MD  =  0.71°C, 95% CI  =  0.65°C, 0.78°C). As T_re measures increased, the magnitude of difference between the techniques also increased with an MD of 0.59°C (95% CI  =  0.53°C, 0.65°C) when T_re was <38°C; 0.79°C (95% CI  =  0.72°C, 0.86°C) when T_re was between 38.0°C and 38.99°C; and 1.72°C (95% CI  =  1.54°, 1.91°C) when T_re was >39.0°C.

Conclusions:

The T_re was consistently greater than T_au when T_core was measured in hyperthermic individuals before, during, and postexercise. As T_core increased, T_au appeared to underestimate T_core as determined by T_re. Clinicians should be aware of this critical difference in temperature magnitude between these measurement techniques when assessing T_core in hyperthermic individuals during or postexercise.     

Normative and Critical Criteria for Iliotibial Band and Iliopsoas Muscle Flexibility

Context:

The Ober and Thomas tests are subjective and involve a “negative” or “positive” assessment, making them difficult to apply within the paradigm of evidence-based medicine. No authors have combined the subjective clinical assessment with an objective measurement for these special tests.

Objective:

To compare the subjective assessment of iliotibial band and iliopsoas flexibility with the objective measurement of a digital inclinometer, to establish normative values, and to provide an evidence-based critical criterion for determining tissue tightness.

Design:

Cross-sectional study.

Setting:

Clinical research laboratory.

Patients or Other Participants:

Three hundred recreational athletes (125 men, 175 women; 250 in injured group, 50 in control group).

Main Outcome Measure(s):

Iliotibial band and iliopsoas muscle flexibility were determined subjectively using the modified Ober and Thomas tests, respectively. Using a digital inclinometer, we objectively measured limb position. Interrater reliability for the subjective assessment was compared between 2 clinicians for a random sample of 100 injured participants, who were classified subjectively as either negative or positive for iliotibial band and iliopsoas tightness. Percentage of agreement indicated interrater reliability for the subjective assessment.

Results:

For iliotibial band flexibility, the average inclinometer angle was −24.59° ± 7.27°. A total of 432 limbs were subjectively assessed as negative (−27.13° ± 5.53°) and 168 as positive (−16.29° ± 6.87°). For iliopsoas flexibility, the average inclinometer angle was −10.60° ± 9.61°. A total of 392 limbs were subjectively assessed as negative (−15.51° ± 5.82°) and 208 as positive (0.34° ± 7.00°). The critical criteria for iliotibial band and iliopsoas flexibility were determined to be −23.16° and −9.69°, respectively. Between-clinicians agreement was very good, ranging from 95.0% to 97.6% for the Thomas and Ober tests, respectively.

Conclusions:

Subjective assessments and instrumented measurements were combined to establish normative values and critical criterions for tissue flexibility for the modified Ober and Thomas tests.     

Effectiveness of early start of direct hemoperfusion with polymyxin B-immobilized fiber columns judging from stabilization in circulatory dynamics in surgical treatment patients

Background:

Septic shock remains a major cause of multiple organ failure and is associated with a high mortality rate. In 1994, direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX; Toray Industries Inc., Tokyo Japan) was developed in Japan and has since been used for the treatment of septic shock arising from endotoxemia.

Materials and Method:

We treated 36 patients with septic shock using direct hemoperfusion with PMX. The patients were analyzed in two groups based on whether they had undergone surgery prior to DHP-PMX treatment (surgical group: surgical treatment before DHP-PMX, medical group: no surgical treatment). In surgical group, DHP-PMX was started within three hours after the surgical treatment. Various factors were measured before and after DHP-PMX.

Results:

The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27.4 ± 8.8, and the mean sepsis-related organ failure assessment (SOFA) score was 11.8 ± 4.9 before DHP-PMX. The SOFA score was significantly higher (P = 0.0091) and the PaO2/FiO2 ratio (P/F ratio) was significantly lower (P = 0.0037) in medical group than in surgical group prior to DHP-PMX. A chi-square test showed that the survival rate in surgical group was significantly better than in medical group (P = 0.0027). The survival rate of surgical group (84.2%) was judged to be very good because the predicated survival rate based on the APACHE II score (25.0) was only 46.5%. On the other hand, the survival rate of medical group (35.3%) was almost equal to that predicted by the APACHE II score (30.6; predicted survival rate, 27.4%).

Conclusion:

The results of this study suggest the utility of early DHP-PMX in surgical group.     

Acute effect of phosphodiesterase type 5 inhibitor on serum oxidative status and prolidase activities in men with erectile dysfunction

OBJECTIVES:

To investigate the acute effect of phosphodiesterase type 5 (PDE5) inhibitor on erectile dysfunction by evaluating serum oxidative status and prolidase activity.

METHODS:

Serum samples of 36 patients with erectile dysfunction and 30 control cases were analyzed for total antioxidant status, total oxidant status, and prolidase activity, before and after the administration of tadalafil citrate.

RESULTS:

Before and after tadalafil citrate administration, serum total antioxidant status, total oxidant status, and prolidase were 1.1±0.0 vs. 1.6±0.0 µmol H₂O₂ Eq/L, 10.3±1.1 vs. 6.9±1.2 µmol H₂O₂ Eq/L, and 236.4±19.5 vs. 228.2±19.2 U/L, respectively (p<0.0001 for all).

CONCLUSIONS:

Evaluation of serum oxidative status and prolidase activity confirmed the beneficial acute effects of PDE5 inhibitor in patients with erectile dysfunction.