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@#BACKGROUND: Heatstroke has become a common emergency event in hospitals. Procalcitonin (PCT) is used as a biomarker of infection in the emergency department (ED), but its role in rhabdomyolysis (RM) following exertional heatstroke (EHS) remains unclear. METHODS: A retrospective cohort study enrolled patients with EHS from the intensive care unit (ICU). We collected RM biomarkers, inflammation markers, critical disease scores at admission, 24 h, 48 h, and discharge, and 90-day mortality. Correlation analysis, linear regression and curve fitting were used to identify the relationship between PCT and RM. RESULTS: A total of 162 patients were recruited and divided into RM (n=56) and non-RM (n=106) groups. PCT was positively correlated with myoglobin (Mb), acute hepatic injury, disseminated intravascular coagulation (DIC), Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, with correlation coefficients of 0.214, 0.237, 0.285, 0.454, and 0.368, respectively (all P<0.05). Interestingly, the results of curve fitting revealed a nonlinear relationship between PCT and RM, and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of <4.6 ng/mL. Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases (P=0.0093). CONCLUSION: High serum PCT concentrations are associated with RM after EHS in critically ill patients. Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.
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Due to the immature development of temperature regulation in the central nervous system, children have a weakened ability to regulate heat and are susceptible to heatstroke, which can lead to organ damage. Based on the evidence evaluation criteria of the Oxford Centre for Evidence-Based Medicine, this expert consensus group evaluated the current evidence on heatstroke in children, and formed this consensus through thorough discussion with the aim of providing reference for the prevention and treatment of heatstroke in children. This consensus includes classifications, pathogenesis, prevention measures, as well as pre-hospital and in-hospital treatment plans for heatstroke in children.
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Child , Humans , Consensus , Heat Stroke/prevention & control , HospitalsABSTRACT
Abstract Objectives The authors evaluated mortality and indices of cost of care among inpatients with Atrial Fibrillation (AF) and a diagnosis of a Temperature-Related Illness (TRI). The authors also assessed trends in the prevalence of TRIs among AF hospitalizations. Methods In this cross-sectional study, the authors used discharge data from the Nationwide Inpatient Sample (NIS) collected between January 2005 and September 2015 to identify patients with a diagnosis of AF and TRI. Outcomes of interest included in-hospital mortality, invasive mechanical ventilation, hospital length of stay, and cost of hospitalization. Results A total of 37,933 encounters were included. The median age was 79 years. Males were slightly overrepresented relative to females (54.2% vs. 45.8%, respectively). Although Blacks were only 6.6% of the cohort, they represented 12.2% of the TRI cases. Compared to non-TRI-related hospitalizations, a diagnosis of a TRI was associated with an increased likelihood of invasive mechanical ventilation (16.5% vs. 4.1%, p< 0.001), longer length-of-stay (5 vs. 4 days, p <0.001), higher cost of care (10,082 vs. 8,607, in US dollars p <0.001), and increased mortality (18.6% vs. 5.1%, p <0.001). Compared to non-TRI, cold-related illness portends higher odds of mortality 4.68, 95% Confidence Interval (4.35-5.04), p <0.001, and heat-related illness was associated with less odds of mortality, but this was not statistically significant 0.77 (0.57-1.03), p= 0.88. Conclusion The occurrence of TRI among hospitalized AF patients is small but there is an increasing trend in the prevalence, which more than doubled over the decade in this study. Individuals with AF who are admitted with a TRI face significantly poorer outcomes than those admitted without a TRI including higher mortality. Cold-related illness is associated with higher odds of mortality. Further research is required to elucidate the pathogenic mechanisms underlying these findings and identify strategies to prevent TRIs in AF patients.
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With global warming and frequent heat waves, the incidence of heat-related-illness has gradually increased, and heatstroke is the most serious clinical syndrome, with high mortality and incidence of sequelae. Effective heatstroke warning aims to reduce the incidence and the harm of heatstroke by monitoring certain parameters and forecasting the possibility of suffering heat illness, however, there is no unified summary of the heatstroke early warning system at present. The occurrence of heatstroke involves two key aspects: climate environment and individual susceptibility, and individual susceptibility is manifested as the difference in heat tolerance ability. This article represents the current early warning system of heatstroke from climate environment, such as effective temperature, heat index, wet bulb globe temperature (WBGT) index, somatosensory temperature, etc., and individual susceptibility, for the reference of research and development in this field.
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Objective To explore the association between HMGB1 and coagulation disorder in severe heat stroke rats. Methods A total of 48 rats were randomized equally into 8 groups: Room temperature group (Sham), severe heatstroke (HS) re-cooling 0 h (HS-0 h), 3 h (HS-3 h), 6 h (HS-6 h), 9 h (HS-9 h), 12 h (HS-12 h), 18 h (HS-18 h), 24 h (HS-24 h) groups. Sham group rats were housed at room temperature of (25.0±0.5) ℃ and humidity of (50.0%±5.0%), while severe heatstroke group rats were kept in an incubator at a temperature of (39.5±0.2) ℃ and humidity of 60.0%±5.0%. Rats with the rectal temperature (Tr) reached 43 ℃ were defined as the onset of severe heatstroke, followed by transferring to the room temperature for natural cooling. The blood samples were collected at 0, 3, 6, 9, 12, 18 and 24 h after natural cooling. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib) were evaluated by clotting methods. HMGB1and thrombin-antithrombin (TAT) were detected by ELISA. Results A linear association between HMGB1 and PT was found (P0.05); a nonlinear association between HMGB1 and PLT was found (P0.05). Conclusions HMGB1 has a significant association with coagulation disorder in severe heat stroke rats. The mechanism needs to be further studied.
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Objective To observe the changes of NF-κB and inflammatory cytokine expression after CD200 pretreatment in severe heatstroke rats for exploring whether the molecular mechanism of CD200 inhibition of severe heat stroke inflammatory response is related to NF-κB signaling pathway. Methods Forty male Wistar rats were randomly divided into control group (n=8), severe heatstroke model group (HS group, n=16), and CD200 pretreatment group (CD200 group, n=16). The HS group and the CD200 group were injected with physiological saline and CD200 recombinant fusion protein before heat exposure to prepare a classical rat heat stroke model, and the control group was placed at room temperature of 22.0±1.0 ℃. The expression of NF-κB/ p65 mRNA in lung tissue were detected at 60 min after model establishment, and serum high mobility group protein B1 (HMGB1), tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) were detected. The pathological changes of the lungs were observed, and the survival time of severe heatstroke rats were recorded. Results CD200 pretreatment could inhibit the expression of NF-κB/p65mRNA. Compared with the control group, the expressions of NF-κB/p65 mRNA in the HS group and CD200 group were significantly increased (P<0.05), and the expression of NF-κB/p65 mRNA in CD200 group was lower than that in HS group (P<0.05). Serum HMGB1, TNF-α and IL-6 in HS group and CD200 group were significantly higher than those in the control group (P<0.05). The HMGB1, TNF-α and IL-6 in the HS group were higher than those in the CD200 group (P<0.05). The median survival time of severe heat stroke were prolonged in the CD200 group compared with the HS group (P<0.05), and the pathomorphological changes showed that inflammation and alveolar exudation were significantly reduced in the CD200 group compared with the HS group. Conclusions CD200 pretreatment can alleviate the inflammatory response in severe heatstroke rats. The possible molecular mechanism of CD200 to relieve severe heatstroke inflammatory response may be involved with NF-κB signaling pathway, which can reduce severe disease by inhibiting the activation of NF-κB and the expression of inflammatory factors.
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Objective: To investigate the effect of the monocytes/macrophages on acute lung injury in rats with severe heatstroke, by modulating the expression of triggering receptor expressed on myeloid cells-1 (TREM-1). Methods: Forty rats were randomized evenly into the control group (Con group), heatstroke group (HS group), the low dose inhibitor group (LD group) and the high dose inhibitor group (HD group). Before heatstroke induction, the rats of LD and HD groups were administrated with a 50 mg/kg and 100 mg/kg bolus of LP-17, respectively. All rats were exposed to an environment with temperature of (40 ± 2) °C and humidity of 65% ± 5% for 60 minutes to induce heatstroke. Enzyme-linked immunosorbent assay (ELISA) was utilized to quantify the concentration of tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-1β in the peripheral blood and pulmonary tissue. The expression of TREM-1 on peripheral monocytes was identified by flow cytometry. Moreover, the histological phenotypes were evaluated after HE stain and the expression of inducible nitric oxide synthase (iNOS) was analyzed by immunohistochemistry in pulmonary tissues. Furthermore, Western blotting was used to detect the protein level of TREM-1 and monocyte chemoattractant protein-1 (MCP-1). Results: Compared to HS rat, in rats pretreated with LP-17, the levels of TNF-α, IL-6 and IL-1β in peripheral blood (P<0.01) and pulmonary tissue (P<0.01) were descended; the upregulation of TREM-1 on peripheral monocytes was alleviated in (P<0.01); the histological injury (P<0.01) were reduced; the protein levels of iNOS, TREM-1 and MCP-1 (P<0.01) were down-regulated. Conclusion: The down-regulation of the TREM-1 activity on the monocytes/macrophages in the peripheral blood and lung tissue by the bolus of LP-17 benefit to ameliorate the lung injury induced by heatstroke via inhibiting inflammation, oxidative stress and chemokine.
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Objective To investigate the oncosis of skeletal muscle cells during heatstroke, and the mechanism severe heatstroke associated with rhabdomyolysis. Methods The human skeletal muscle cells (HSKMC) were divided into control group and heat shock group. The control group was incubated at 37 ℃, 5% CO2 cell incubator, while the heat shock group was exposed at 43 ℃, 5% CO2 cell incubator for 2 hours, followed by incubating at 37 ℃, 5% CO2 cell incubator. At incubation point of 0, 6, 12, and 24 hours, the CCK-8 method was used to detect cell viability; the LDH method was used to detect cytotoxicity; the transmission electron microscope was used to detect cell ultrastructure changes; Annexin -FITC/PI double staining method was used to detect double-positive cell rate; Western blotting method was used to detect porimin and caspase-3 protein expression. Results Compared with the control group, HSKMC cell viability decreased with cytotoxicity increased at 0 h after rewarming in a time-dependent manner (P0.05). Conclusion Heat stroke-induced oncosis rather than apoptosis of skeletal muscle cells.
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Abstract Purpose: To investigate the protective effect of L-carnitine on myocardial injury in rats with heatstroke. Methods: orty-eight rats were randomly divided into control, heatstroke and 25, 50 and 100 mg/kg L-carnitine groups. The last three groups were treated with 25, 50 and 100 mg/kg L-carnitine, respectively, for seven successive days. Then, except for the control group, the other four groups were transferred into the environment with ambient temperature of (39.5 ± 0.4 °C) and relative humidity of (13.5 ± 2.1%) for 2 h. The core temperature (Tc), mean arterial pressure (MAP), heart rate (HR) and serum and myocardial indexes were detected. Results: Compared with the heatstroke group, in the 100 mg/kg L-carnitine group, the Tc was significantly decreased, the MAP and HR were significantly increased, the serum creatine kinase, lactate dehydrogenase, alkaline phosphatase, aspartate aminotransferase, tumor necrosis factor α and interleukin 1β levels were significantly decreased, the myocardial superoxide dismutase and glutathione peroxidase levels were significantly increased, the myocardial malondialdehyde level was significantly decreased and the cardiomyocyte apoptosis index and myocardial caspase-3 protein expression level were remarkably decreased (p < 0.05). Conclusions: The L-carnitine pretreatment can alleviate the myocardial injury in heatstroke rats through reducing the inflammatory response, oxidative stress and cardiomyocyte apoptosis.
Subject(s)
Animals , Carnitine/pharmacology , Heat Stroke/metabolism , Heat Stroke/drug therapy , Rats , Oxidative Stress , Malondialdehyde/metabolism , Myocardium/metabolismABSTRACT
BACKGROUND: Heatstroke is one of the most serious heat-related illnesses. However, establishing public policies to prevent heatstroke remains a challenge. This study aimed to investigate the most relevant climate elements and their warning criteria to prevent outdoor heatstroke (OHS).METHODS: We investigated heatstroke patients from five major hospitals in Daegu metropolitan city, Korea, from June 1 to August 31, 2011 to 2016. We also collected the corresponding regional climate data from Korea Meteorological Administration. We analyzed the relationship between the climate elements and OHS occurrence by logistic regression.RESULTS: Of 70 patients who had heatstroke, 45 (64.3%) experienced it while outdoors. Considering all climate elements, only mean heat index (MHI) was related with OHS occurrence (p=0.019). Therefore, the higher the MHI, the higher the risk for OHS (adjusted odds ratio, 1.824; 95% confidence interval, 1.102–3.017). The most suitable cutoff point for MHI by Youden’s index was 30.0°C (sensitivity, 77.4%; specificity, 73.7%).CONCLUSION: Among the climate elements, MHI was significantly associated with OHS occurrence. The optimal MHI cutoff point for OHS prevention was 30.0°C.
Subject(s)
Humans , Climate , Heat Stroke , Hot Temperature , Incidence , Korea , Logistic Models , Meteorology , Odds Ratio , Public Policy , Sensitivity and SpecificityABSTRACT
Objective: To investigate the plasma exosome S100P levels in patients with heatstroke and evaluate its clinical diagnostic value. Methods: Thirty heatstroke patients were selected from June 2016 to June 2018 in the General Hospital of Southern Theatre Command of PLA, and 15 healthy people in the Physical Examination Center of our hospital were selected as control. The venous blood was collected, followed by plasma exosomes extraction using polyethylene glycol precipitation. The plasma exosome S100P was quantified by ELISA. The correlation analysis between plasma exosomal S100P, clinical indicators, and disease severity was performed. The receiver operating characteristic (ROC) curve was analyzed to evaluate the efficacy of plasma exosome S100P in diagnosing heatstroke. Results: The level of plasma exosomes S100P in patients with heatstroke significantly increased [healthy people vs. heatstroke patients: (195.89 ± 131.97) pg/ml vs. (1163.62 ± 747.15) pg/ml, P<0.001], and the level of plasma exosome S100P was significantly correlated with the severity of heatstroke patients [Mild heatstroke patients vs. severe heatstroke patients (553.63 ± 311.85) pg/ml vs. (1570.28 ± 672.03) pg/ml, P<0.001]. The correlation coefficients r of plasma exosome S100P with APACHE II score, SOFA score and MODS score were 0.888, 0.901, and 0.887, respectively (P<0.001). The area under the ROC curve for the diagnosis of heatstroke by plasma exosomal S100P was 0.931 (95%CI 0.857-1.000, P<0.001). The area under the ROC curve of plasma exosomal S100P for assessing the severity of heatstroke was 0.956 (95%CI 0.890-1.000, P<0.001). Conclusion: The level of plasma exosomal S100P correlates with severity of heatstroke and can be used as a potential marker for diagnosis and prognosis of heatstroke.
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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.
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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.
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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.
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Objective Via the analysis of clinical effect of combined traditional Chinese and western medicine in treating severe heatstroke (HS), to explore the rescue therapeutic measures of combined Chinese and western medicine for HS. Methods A case of HS patient admitted to the Department of Emergency Intensive Care Unit (EICU) of Shuguang Hosipital Affiliated to Shanghai University of Traditional Chinese medicine (TCM) was treated with the combination of traditional Chinese and western medicine. The physical hypothermia with ice-blanket and ice-cap and supportive therapy were immediately given to the patient after admission; then the TCM prescription Siwei Xiangru decoction plus or minus was additionally given; the ingredients of the decoction were as follows: elsholtziae 9 g, white lentil coat 15 g, poria cocos 20 g, rhizome atractylodis 15 g, tangerine peel 6 g, processed pinellia ternate 9 g, codonopsis 10 g, licorice 3 g, 1 dose, 2 times per day. The changes of HS patient's laboratory indexes, symptoms and signs were observed. Results After the combined treatment with traditional Chinese and western medicine, the respiratory rate of the patient was improved significantly, and the oxygenation was maintained at 0.99-1.00, no symptoms of fever, cough, sputum were seen. On the fourth day after treatment, the patient was transferred to local hospital, on the day of discharge, the patient had no fever or shortness of breath, urine volume and color were normal, and vital signs stable. Conclusions Effective continuous and controlled cooling is not only the main treatment measure in modern western medicine but also in TCM. Meanwhile, because 'heat must carry moisture, and heat often damage body fluid', it is necessary to observe the patient's dynamic changes of heat and damp evil. When clearing summer heat and damp evil, simultaneously, the measures of strengthening spleen and stomach, enhancing qi and nourishing fluid to prevent further consumption of the body fluid should be paid attention to.
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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 (℃): 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.
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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 ℃ 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 (℃: 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). Conclusion 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.
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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 (ORSⅢ) 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+ORSⅢ 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+ORSⅢ groups were orally given 20 mL/kg water or ORSⅢ 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 ℃ were considered as the onset of EHS. The rats in the normal control group were exposed to room temperature (25±2) ℃ 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+ORSⅢ 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+ORSⅢ 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+ORSⅢ 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+ORSⅢ group (P < 0.01). Conclusions EHS could lead to liver, intestinal barrier dysfunction and electrolyte disturbance. Pre-treatment of ORSⅢ could alleviate the intestinal dysfunction and electrolyte disorder caused by EHS in rats. It can lower the serum potassium to some extent. However, ORSⅢ failed to protect liver from EHS.
ABSTRACT
Objective @#To investigate the epidemiological characteristics of heatstroke and its correlation with meteorological factors in Shaoxing in 2017,and to provide evidence for heatstroke prevention and control.@*Methods @#The data of heatstroke cases and the daily meteorological indexes were collected from July 2017 to August 2017 in Shaoxing to describe the spatial,temporal and population distribution of heatstroke cases. The correlation between heatstroke and meteorological factors was analyzed by multivariate logistic regression model.@*Results @#A total of 759 cases of heatstroke were reported,with an average age of（53.3 ±17.9）years. There were 487 males cases（64.16%）and 272 female cases（35.84%）. There were 618 cases of mild heatstroke（81.42%）and 141 cases of severe heatstroke（18.58%）. There were six cases of death from severe heatstroke,and the mortality of severe heatstroke was 4.26%. Minimum temperature（rs=0.851,P<0.001）,maximum temperature（rs=0.726,P<0.001）and wind speed（rs=0.285,P=0.025）were positively correlated with the incidence of heatstroke,and relative humidity（rs=-0.693,P<0.001）and rainfall（rs=-0.414,P=0.001）were negatively correlated with the incidence of heatstroke. The results of logistic regression analysis showed that high daily minimum temperature was a risk factor for severe heatstroke（OR=1.854,95%CI：1.606-2.140）.@*Conclusion@# The mortality of severe heatstroke patients was high in Shaoxing,the daily minimum temperature was correlated with severe heatstroke.