Dry heat, moist heat and body fat: are heating modalities really effective in people who are overweight?

Surface heating modalities are commonly used in physical therapy and physical medicine for increasing circulation, especially in deep tissues, to promote healing. However, recent evidence seems to indicate that in people who are overweight, heat transfer is impaired by the subcutaneous fat layer. The present investigation was conducted on 10 subjects aged 22-54 years, whose body mass index averaged 25.8+/-4.6. Subcutaneous fat above the quadriceps muscle varied from 0.51 to 0.86 cm of thickness. Three heating modalities were examined: the application of dry heat with a commercial chemical heat pack, hydrocollator heat packs (providing a type of moist heat), and a whirlpool, where conductive heat loss through water contact would be very high. The temperature of the skin and the temperature in the muscle (25 mm below the skin surface) were assessed by thermocouples. The results of the experiments showed that for heating modalities that are maintained in skin contact for long periods of time, such as dry heat packs (in place for 6 hours), subcutaneous fat did not impair the change in deep muscle temperature. In contrast, when rapid heat modalities were used, such as the hydrocollator and the whirlpool (15 minutes of sustained skin contact), the transfer of heat from the skin to deep muscle was significantly impaired in people with thicker subcutaneous fat layers. We observed that the greater the impairment in heat transfer to muscle from skin covered by body fat, the warmer the skin temperature increase during the modality.

Does skin moisture influence the blood flow response to local heat? A re-evaluation of the Pennes model.

Pennes first described a model of heat transfer through the limb based only on calories delivered from a heat source, calories produced by metabolism and skin blood flow. The purpose of this study was to determine the effect of a moist versus a dry heat source on the skin in eliciting a blood flow response to add data to this model. Ten subjects were examined, both male and female, with a mean age of 32.5 +/- 11.6 years, mean height of 172.8 +/- 12.3 cm, and mean weight of 77.6 +/- 19.5 kg. Skin temperature was measured by a thermocouple placed on the skin and skin blood flow measured by a laser Doppler flow meter. The results of the experiments using a dry heat pack (commercially available chemical 42 degrees C cell dry heat source), moist hydrocollator pack (72.8 degrees C) separated from the skin by eight layers of towels, and whirlpool at 40 degrees C, showed that moist heat caused a significantly higher skin blood flow (about 500% greater) than dry heat (p < 0.01). Most of the greater increase in skin blood flow with moist heat was due to the greater rate of rise of skin temperature with moist versus dry heat while some of the increase in blood flow was due to the moisture itself. This could either be related to the greater heat flux across the skin with moist air or due to changing the ionic environment around skin thermo receptors by keeping the skin moist during heating. Skin thermo receptors are believed to be temperature sensitive calcium gated channels in endothelial cells which couple calcium influx to a release of nitric oxide. If true, reducing moisture in the skin might have the effect of altering ionic flux through these receptors. A correct model of skin heat flux should therefore take heat moisture content into consideration.

The transfer of current through skin and muscle during electrical stimulation with sine, square, Russian and interferential waveforms.

Electrical stimulation is a commonly used modality for both athletic training and physical therapy. However, there are limited objective data available to determine the waveform which provides the maximum muscle strength as well as minimizing pain. In the present investigation, two groups of subjects were examined. Group 1 was composed of six males and four females and group 2 was composed of three male and three female subjects. The first series of experiments investigated muscle strength with stimulation at currents of 20, 40 and 60 milliamps using sine, square, Russian and interferential waveforms evaluating strength production and pain as outcomes. The second phase of experiments compared the effect of the different waveforms on current dispersion in surface versus deep muscle electrodes with these same waveforms. The results of the experiments showed that sine wave stimulation produced significantly greater muscle strength and significantly less pain than square wave, Russian or interferential stimulation at that same current. The most painful stimulation was square wave. Strength production was greatest with sine wave and least with Russian and interferential. An explanation of these findings may be the filtering effect of the fat layer separating skin from muscle. The highly conductive muscle and skin dermal layers would form the plates of a capacitor separated by the subcutaneous fat layer providing an RC filter. This filtering effect, while allowing sine wave stimulation to pass to the muscle, reduced power transfer in square wave, Russian and interferential stimulation is observed.

Anticonvulsants containing the N-(3-aryl-2-propenoyl) amido pharmacophore.

A series of 1-(3-aryl-2-propenoyl)-4-oxopiperidines (1) as well as some related semicarbazones (2) and thiosemicarbazones (3) were prepared in order to determine whether the relative locations of aryl rings and amidic groups would lead to novel anticonvulsant agents. Initially the compounds were administered intraperitoneally to mice and examined in the maximal electroshock (MES), subcutaneous pentylenetetrazole (scPTZ) and neurotoxicity (NT) screens. The biodata revealed that anticonvulsant properties were displayed by most of the compounds in series (1), in half of the semicarbazones (2) while protection was absent by members of series (3). Molecular modeling was utilized in order to compare the positions of a phenyl ring in relation to amidic groups in representative compounds in series (1-3) with previously reported anticonvulsant agents. Molecular simplification of 4-oxo-1-(3-phenyl-2-propenoyl)piperidine (la) led to 1-(3-phenyl-2-propenoyl)piperidine (7) and N,N-diethylcinnamamide (8) with retention of anticonvulsant properties. Both (la) and (8) afforded protection in the hippocampal kindling screen in rats. When administered orally to rats, (la) and (8) demonstrated activity in the MES screen and in the case of (8), a huge protection index was observed revealing it to be an important lead compound. The IC50 values of all of the compounds towards murine P388 cells were in excess of 50 microM while several compounds displayed cytotoxicity towards Mycobacterium tuberculosis.

Comparison of resin-dentine interface in primary and permanent teeth for three different durations of dentine etching.

Hybridization of dentine is identified as a basic bonding mechanism between resin and dentine, hence studying the micro morphology of hybrid layer may explain lower bond strength that has been observed in primary teeth. The aim of the present study was to compare the thickness and micromorphology of Hybrid layer formed in primary and permanent teeth for 3 different durations of dentine etching time (5, 10 and 15 sec) with 10% phosphoric acid as etchant. Thickness and micromorphology of hybrid layer was observed on SEM photographs obtained at 750X. Results indicated that primary teeth presented with a significantly thicker hybrid layer compared to permanent teeth at 10 sec (P<0.05) and 15 sec (P<0.01) of dentine etching. It was concluded that owing to the high reactivity of primary teeth to etchants, the etchants be applied for shorter period on primary dentine compared to permanent dentine for better performance of composite restoration in primary dentition.

Bordetella holmesii bacteraemia in an individual on haemodialysis.

A case of haemodialysis-associated bacteraemia due to Bordetella holmesii is described. Commercially available identification kits failed to identify the isolate, which was speciated using 16s rRNA gene sequencing. B. holmesii is a rare cause of bacteraemia, endocarditis and pneumonia in the immunosuppressed and may also cause a pertussis-like illness.