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Introduction Compensatory sweating (CS) is a common complication after thoracoscopic sympathectomy (TS) and is mainly associated with surgical technique. Our aim was to identify potential risk-factors for CS following TS for primary focal hyperhidrosis in children. Methods A retrospective, single-center review of all bilateral TS was performed between 2017 and 2019. Hyperhidrosis disease severity scale was used for pre-operative severity assessment. Post-operative evaluations were performed after three and six months. Results More than the 36-month period, 41 patients were submitted to T2–T4 TS, and 25 were females (60.9%). Median age at surgery was 15.5 years. CS was identified at the 3rd month in 17 (41%) children with most in the dorsolumbar region (56%). By the 6th month, there was a significant reduction in CS (41 to 32%, p = 0.02). The probability of resolution of CS by 6 months is about 50% in both the dorsolumbar and abdominal regions. Neither age, gender, body mass index, family history, or concomitant illnesses seemed to influence CS (p > 0.05). Axillary hyperhidrosis appears to be associated with the development of dorsolumbar CS (p = 0.037). Conclusion Thoracoscopic sympathectomy for PFH is a safe and effective procedure, but compensatory sweating can be a common and debilitating side effect. Age, gender, and body mass index do not appear to influence CS. Axillary hyperhidrosis may be related to the development of dorsolumbar CS. Level of evidence III.

Background Botulinum neurotoxin type A has been used for the treatment of hyperhidrosis. Objective To perform a systematic review of the literature to identify evidence on the treatment approaches and outcomes associated with abobotulinumtoxinA (aboBoNT-A) treatment of hyperhidrosis. Methods EMBASE, MEDLINE, and the Cochrane Library were searched for relevant observational studies, randomized controlled trials, and nonrandomized controlled trials. There were no date or country restrictions. Bibliographies of review articles and recent congress proceedings (2017-2019) were also searched. Articles were screened using predefined eligibility criteria and relevant data were extracted. Results Of 191 unique articles identified, 23 were considered relevant (3 observational studies, 10 nonrandomized controlled trials, and 10 randomized controlled trials). These articles provided data on axillary (13), palmar (7), and forehead (1) hyperhidrosis, compensatory hyperhidrosis of the back (1), Frey syndrome (1), and diabetic gustatory sweating (1). All studies reported that aboBoNT-A reduced sweating and no serious adverse events were observed. Patient satisfaction was high and improvements to quality of life were observed after aboBoNT-A treatment. Limitations Variability in the injection technique when data were compared across studies. Conclusion This study describes a range of treatment approaches and demonstrates positive outcomes of aboBoNT-A treatment for multiple types of hyperhidrosis.

Objective To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis. Methods Forty patients with combined palmar and plantar hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). Results In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. Conclusions Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.

Background Coronary risk scores (CRS) including History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score and Emergency Department Assessment of Chest pain Score (EDACS) can help identify patients at low risk of major adverse cardiac events. In the emergency department (ED), there are wide variations in hospital admission rates among patients with chest pain. Objective This study aimed to evaluate the impact of CRS on the disposition of patients with symptoms suggestive of acute coronary syndrome in the ED. Methods This retrospective cohort study included 3660 adult patients who presented to the ED with chest pain between January and July in 2019. Study inclusion criteria were age > 18 years and a primary position International Statistical Classification of Diseases and Related Health Problems-10th revision coded diagnosis of angina pectoris (I20.0–I20.9) or chronic ischemic heart disease (I25.0–I25.9) by the treating ED physician. If the treating ED physician completed the electronic structured variables for CRS calculation to assist disposition planning, then the patient would be classified as the CRS group; otherwise, the patient was included in the control group. Results Among the 2676 patients, 746 were classified into the CRS group, whereas the other 1930 were classified into the control group. There was no significant difference in sex, age, initial vital signs, and ED length of stay between the two groups. The coronary risk factors were similar between the two groups, except for a higher incidence of smokers in the CRS group (19.6% vs. 16.1%, p = 0.031). Compared with the control group, significantly more patients were discharged (70.1% vs. 64.6%) directly from the ED, while fewer patients who were hospitalized (25.9% vs. 29.7%) or against-advise discharge (AAD) (2.6% vs. 4.0%) in the CRS group. Major adverse cardiac events and mortality at 60 days between the two groups were not significantly different. Conclusions A higher ED discharge rate of the group using CRS may indicate that ED physicians have more confidence in discharging low-risk patients based on CRS.

BACKGROUND Persons with an amputation may have an increased heat strain due to reduced surface area. However, there is limited evidence on the thermoregulatory responses in persons with lower-limb amputation (LLA). Although a previous study reported no difference in their rectal temperatures (Tres) in a hot environment, suggesting compensatory sweating of the intact limb, we examined the thermoregulatory responses of such persons in a hot and humid environment. OBJECTIVE To compare the thermoregulatory responses-through changes in Tre, sweat, and oxygen uptake (O2)-between persons with LLA and able-bodied (AB) individuals, in hot and humid environments. STUDY DESIGN A nonrandomized control trial. METHODS Nine AB men (AB group) and nine persons with LLA group performed the arm ergometer exercise at 60% peak power output intensity for 60 min in a hot and humid environment, and they were tested before and after performing. The O2, Tre and skin temperature, and total body sweating, and local sweating during exercise were measured and compared between the groups. RESULTS The changes in O2 and Tre after the endurance exercise did not differ between the groups (ΔTre: AB group, 1.1°C ± 0.5°C; LLA group, 1.2°C ±0.3 °C; P = 0.65), whereas the amount of local sweating of the chest (group effect, P < 0.01 by two-way analysis of variance [group × time], the group effect size was medium, η2 = 0.10) and dehydration rate (AB group, 1.5% ± 0.5%; LLA group, 2.1% ± 0.5%; P = 0.03) were higher in the LLA than in the AB group. CONCLUSIONS We compared the thermoregulatory responses of persons with LLA with those of AB individuals in hot and humid environments. Core body temperatures of persons with LLAs during endurance exercise were not different from those of AB men even in hot and humid environments. We found compensatory increases in the sweat rate of the chest and increased dehydration rate in persons with LLA. More sweat potentially means that athletes with LLA need to drink more fulids.

The purpose of this study was to examine the effect of heat acclimation (HA) on thirst levels, sweat rate, and percentage of body mass loss (%BML), and changes in fluid intake factors throughout HA induction. Twenty-eight male endurance athletes (mean ± SD; age, 35 ± 12 years; body mass, 73.0 ± 8.9 kg; maximal oxygen consumption, 57.4 ± 6.8 ml·kg−1·min−1) completed 60 min of exercise in a euhydrated state at 58.9 ± 2.3% velocity of maximal oxygen consumption in the heat (ambient temperature, 35.0 ± 1.3 °C; relative humidity, 48.0 ± 1.3%) prior to and following HA where thirst levels, sweat rate, and %BML were measured. Then, participants performed 5 days of HA while held at hyperthermia (38.50–39.75 °C) for 60 min with fluid provided ad libitum. Sweat volume, %BML, thirst levels, and fluid intake were measured for each session. Thirst levels were significantly lower following HA (pre, 4 ± 1; post, 3 ± 1, p p = .039) and %BML (pre, 2.66 ± 0.53%; post, 2.98 ± 0.83%, p = .049) were significantly greater following HA. During HA, thirst levels decreased (Day 1, 4 ± 1; Day 2, 3 ± 2; Day 3, 3 ± 2; Day 4, 3 ± 1; Day 5, 3 ± 1; p p = .010) and fluid intake (Day 1, 1.20 ± 0.45 L; Day 2, 1.52 ± 0.58 L; Day 3, 1.69 ± 0.63 L; Day 4, 1.65 ± 0.58 L; Day 5, 1.74 ± 0.51 L; p

Purpose To determine sweating responses of pre-pubertal children during intermittent exercise in a warm environment and create whole-body maps of regional sweat rate (RSRs) distribution across the body. Methods Thirteen pre-pubertal children; six girls and seven boys (8.1 ± 0.8 years) took part. Sweat was collected using the technical absorbent method in the last 5 min of a 30-min intermittent exercise protocol performed at 30 ℃, 40% relative humidity and 2 m·s−1 frontal wind. Results Mean gross sweat loss (GSL) was 126 ± 47 g·m−2·h−1 and metabolic heat production was 278 ± 50 W·m2. The lower anterior torso area had the lowest RSR with a median (IQR) sweat rate (SR) of 40 (32) g·m−2·h−1. The highest was the forehead with a median SR of 255 (163) g·m−2·h−1. Normalised sweat maps (the ratio of each region’s SR to the mean SR for all measured pad regions) showed girls displayed lower ratio values at the anterior and posterior torso, and higher ratios at the hands, feet and forehead compared to boys. Absolute SRs were similar at hands and feet, but girls sweated less in most other areas, even after correction for metabolic rate. Conclusion Pre-pubertal children have different RSRs across the body, also showing sex differences in sweat distribution. Distributions differ from adults. Hands and feet RSR remain stable, but SR across other body areas increase with maturation. These data can increase specificity of models of human thermoregulation, improve the measurement accuracy of child-sized thermal manikins, and aid companies during product design and communication.

BACKGROUND Axillary hyperhidrosis characterized by excessive sweating in the axillary regions is a frustrating chronic autonomic disorder leading to social embarrassment, impaired quality of life and usually associated with palmoplantar hyperhidrosis. Identifying the condition and its cause is central to the management. AIM The aim of this article is to discuss treatment options for axillary hyperhidrosis. METHODS Comprehensive literature search using PubMed and Google Scholar was performed to review relevant published articles related to diagnosis and treatment of axillary hyperhidrosis. RESULTS Treatment modalities for axillary hyperhydrosis vary from topical and systemic agents to injectables, newer devices and surgical measures. None except for physical measures using devices or surgery, which destroys the sweat glands to remove them, is possibly permanent and most are associated with attendant side effects. CONCLUSION Several treatments including medical and surgical option are available for the treatment of axillary hyperhydrosis. Patient education is important component of its management. Individualized approach of management is necessary for optimal outcome of treatment.

Human thermoregulatory control is often evaluated through the relationship between thermoeffector output and core or mean body temperature. In addition to providing a general indication of whether a variable of interest alters thermoregulatory control, this relationship is often used to determine how this alteration may occur. This latter interpretation relies upon two parameters of the thermoeffector output-body temperature relationship: the onset threshold and thermosensitivity. Traditionally, changes in the onset threshold and thermosensitivity are interpreted as “central” or “peripheral” modulation of thermoregulatory control, respectively. This mini-review revisits the origins of the thermoeffector output-body temperature relationship and its use to interpret “central” or “peripheral” modulation of thermoregulatory control. Against this background, we discuss the strengths and weaknesses of this approach and highlight that “central” thermoregulatory control reflects the neural control of body temperature whereas “peripheral” thermoregulatory control reflects properties specific to the thermoeffector organs. We highlight studies that employed more direct approaches to investigate the neural control of body temperature and peripheral properties of thermoeffector organs. We conclude by encouraging future investigations interested in studying thermoregulatory control to more directly investigate the component of the thermoeffector loop under investigation. heat; human; skin blood flow; sweat; thermoregulatory

The objective was to compare the efficacy of three different heat acclimation protocols to improve exercise performance in the heat. Thirty four cyclists completed one of three 10-day interventions 1) 50-min cycling per day in 35 °C, 2) 50-min cycling per day wearing thermal clothing, and 3) 50-min cycling wearing thermal clothing plus 25 min hot water immersion per day. Pre- and post-intervention hemoglobin mass, intravascular volumes and core temperature were determined at rest. Heart rate, sweat rate, blood lactate concentration and core temperature were evaluated during 15-min submaximal and 30-min all-out cycling performance conducted in 35.2 ± 0.1 °C and 61 ± 1% relative humidity. There were no significant between-group differences in any of the determined variables. None of the interventions statistically altered any of the parameters investigated as part of the 15-min submaximal trial. However, following the intervention period, heat chamber, thermal clothing and thermal clothing + hot water immersion all improved 30-min all-out average power in the heat (9.5 ± 3.8%, 9.5 ± 3.6 and 9.9 ± 5.2%, respectively, p 0.001, F = 192.3). At termination of the 30-min all-out test, the increase in blood lactate concentration, rate of perceived exertion and sweat rate were not different between the three interventions. In conclusion, daily training sessions conducted either in ambient 35 °C, while wearing thermal clothing in temperate conditions or while wearing thermal clothing combined with hot water immersion are equally effective for improving exercise performance in the heat.

Objective To explore the relationship between wearing protective masks and goggles and skin injuries in medical staff during the COVID-19 pandemic. Methods Researchers conducted a cross-sectional, multicenter online survey. Respondents voluntarily completed the questionnaire on their smartphones. Ordinal and multinomial logistic regressions were used to identify factors related to skin injuries. Results In total, 1,611 respondents wore protective masks combined with goggles in 145 hospitals in China; 1,281 skin injuries were reported (overall prevalence, 79.5%). Multiple concomitant skin injuries (68.5%) and injuries in four anatomic locations (24.0%) were the most common, followed by injuries in three (22.8%), two (21.7%), and one location (11.0%). Multinomial logistic regression indicated that sweating increased the risk of injuries in one to four anatomic locations (95% confidence interval for odds ratio 16.23-60.02 for one location and 38.22-239.04 for four locations), and wearing an N95 mask combined with goggles and a daily use longer than 4 hours increased the risk of injuries in four locations (95% confidence interval for odds ratio 1.18-5.31 and 1.14-3.93, respectively). Conclusions The prevalence of skin injuries among medical staff wearing protective masks combined with goggles was very high. These were mainly device-related pressure injuries, moisture-associated skin damage, and skin tears. The combination of various factors resulted in skin injuries at multiple sites. Preventing and managing sweating should be a focus for medical staff who wear protective masks combined with goggles for more than 4 hours.

Cholinergic urticaria (CholU) is characterized by the occurrence of itchy wheals induced by sweating. Intradermal injections of acetylcholine (ACh) have been proposed to help with diagnosing CholU and subgrouping of patients, but controlled studies are largely missing.To compare the rates of positive ACh test results in well characterized CholU patients and controls and to identify clinical features of CholU linked to ACh reactivity.Acetylcholine was injected intradermally into 38 CholU patients and 73 matched healthy controls. Wheal and flare skin responses were assessed after 15 and 30 min and correlated with clinical features of CholU.At 15 min after intradermal injections of ACh, wheal and flare responses were significantly more frequent in CholU patients than healthy controls, wheals: 34 % vs.15% (P = 0.028); flares: 50 % vs.18 % (P0.001). Also, wheals were 37 % and flares 172 % larger and of longer duration in CholU patients than in healthy controls (both P0.01). CholU patients with ACh-induced wheals (AChIntradermal ACh testing does not allow for the identification of CholU patients due to its low sensitivity. ACh-induced wheals, in patients with CholU, is linked to sweating and longer lasting symptoms. Intradermal ACh testing is an interesting tool for mechanistic studies in CholU.

Sweating during exercise is regulated by objective parameters, body weight, and endothelial function, among other factors. However, the relationship between vascular arterial stiffness and sweat volume in young adults remains unclear. This study aimed to identify hemodynamic parameters before exercise that can predict sweat volume during exercise, and post-exercise parameters that can be predicted by the sweat volume. Eighty-nine young healthy subjects (aged 21.9 ± 1.7 years, 51 males) were recruited to each perform a 3-km run on a treadmill. Demographic and anthropometric data were collected and hemodynamic data were obtained, including heart rate, blood pressure and pulse wave analysis using non-invasive tonometry. Sweat volume was defined as pre-exercise body weight minus post-exercise body weight. Post-exercise hemodynamic parameters were also collected. Sweat volume was significantly associated with gender, body surface area (BSA) (b = 0.288, p = 0.010), peripheral systolic blood pressure (SBP), peripheral and central pulse pressure (PP), and was inversely associated with augmentation index at an HR of 75 beats/min (AIx@HR75) (b = -0.005, p = 0.019) and ejection duration. While BSA appeared to predict central PP (B = 19.271, p ≤ 0.001), central PP plus AIx@HR75 further predicted sweat volume (B = 0.008, p = 0.025; B = -0.009, p = 0.003 respectively). Sweat volume was associated with peripheral SBP change (B = -17.560, p = 0.031). Sweat volume during a 3-km run appears to be influenced by hemodynamic parameters, including vascular arterial stiffness and central pulse pressure. Results of the present study suggest that vascular arterial stiffness likely regulates sweat volume during exercise.

This study aimed to evaluate the effect of head pre-cooling on the 5-km time trial performance of amateur runners in the heat. In a counterbalanced design, fifteen male amateur runners (22.6 ± 3.5 y; VO2 max in heat 42.3 ± 4.4 mLO2 /kg/min) completed two 5-km time trials performed in the heat (35 °C, 50% relative humidity). In one trial (HCOOL), participants underwent 20 min of head cooling in a temperate environment (23 °C, 70% relative humidity) prior to exercise. In another trial (CON), exercise was preceded by 20 min of rest under the same temperature conditions. Exercise time was shorter in HCOOL (25 min and 36 s ± 3 min) compared to CON (27 min ± 3 min; p= 0.02). Rectal temperature was reduced during the pre-exercise intervention in HCOOL (p< 0.001), but not in CON (p= 0.55). Relative changes in rectal temperature and mean head temperature were lower throughout HCOOL when compared with CON condition (p= 0.005 and p= 0.022, respectively). Mean skin temperature, heart rate and rating of perceived exertion did not differ between HCOOL and CON conditions throughout exercise (p= 0.20, p= 0.52 and 0.31, respectively). Thermal comfort was lower in HCOOL condition in pre-exercise (p= 0.014) with no differences observed throughout exercise (p= 0.61). 5-km running performance in a hot environment was improved after a 20-min head cooling intervention, suggesting that this method may be practical as pre-cooling strategy and easily administered to both professional and amateur runners alike.

New findings What is the central question of this study? Do sex and menstrual cycle modulate sweating during isometric handgrip exercise and muscle metaboreceptor stimulation? What is the main finding and its importance? Sex modulates sweating during isometric handgrip exercise, as indicated by the lower sweat output per gland in women than in men, but not during muscle metaboreceptor stimulation. Sweat output per gland during isometric handgrip exercise and muscle metaboreceptor stimulation were lower in the mid-luteal phase than in the early follicular phase in women. Cholinergic sweat gland sensitivity might explain, in part, the individual variation of the response. Our results provide new insights regarding sex- and menstrual cycle-related modulation of the sweating response. Abstract We investigated whether sex and menstrual cycle could modulate sweating during isometric handgrip (IH) exercise and muscle metaboreceptor stimulation. Twelve young, healthy women in the early follicular (EF) and mid-luteal (ML) phases and 14 men underwent two experimental sessions consisting of a 1.5 min IH exercise at 25 and 50% of maximal voluntary contraction (MVC) in a hot environment (35°C, relative humidity 50%) followed by 2 min forearm occlusion to stimulate muscle metaboreceptors. Sweat rates, the number of activated sweat glands and the sweat output per gland (SGO) on the forearm and chest were assessed. Pilocarpine-induced sweating was also assessed via transdermal iontophoresis to compare the responses with those of IH exercise and muscle metaboreceptor stimulation, based on correlation analysis. Sweat rates on the forearm and chest during IH exercise and muscle metaboreceptor stimulation did not differ between men and women in either menstrual cycle phase (all P ≥ 0.144). However, women in both phases showed lower SGO on the forearm and/or chest compared with men during IH exercise at 50% of MVC, with no differences in muscle metaboreceptor stimulation. Women in the ML phase had a lower forearm sweat rate during IH exercise at 50% of MVC (P = 0.015) and SGO during exercise and muscle metaboreceptor stimulation (main effect, both P ≤ 0.003) compared with those in the EF phase. Overall, sweat rate and SGO during IH exercise and muscle metaboreceptor stimulation were correlated with pilocarpine-induced responses (all P ≤ 0.064, r ≥ 0.303). We showed that sex and menstrual cycle modulate sudomotor activity during IH exercise and/or muscle metaboreceptor stimulation. Cholinergic sweat gland sensitivity might explain, in part, the individual variation of the response.

Background Paroxysmal localized hyperhidrosis is a rare disorder of the central autonomic nervous system. No association between paroxysmal hyperhidrosis and severe headache has been previously described in literature. Case description: A 65-year-old woman with idiopathic paroxysmal localized hyperhidrosis combined with severe holocranial headache attacks is described in this case report. Extensive diagnostic testing by means of laboratory examinations, 24-hour urinalyses, chest X-ray, abdominal ultrasound and computed tomography scans, and brain and spinal cord magnetic resonance imaging could not identify an underlying disorder. A diagnosis of idiopathic paroxysmal localized hyperhidrosis was made, and the patient was successfully treated with clonidine 0.075 mg three times a day, without any side effects. Conclusion Paroxysmal localized hyperhidrosis is a rare central autonomic nervous system disorder that can occur in combination with severe headache. Both the headache and paroxysmal hyperhidrosis complaints were treated effectively with clonidine in the patient described in this case-report.

Background Sensitive skin is related to environmental factors. Objectives We aimed to investigate the roles of poorly known associated and triggering factors on sensitive skin in a large global population. Methods A survey was administrated to a representative sample of the adult population aged 18-75 years in five different countries (Brazil, China, France Russia, and the United States). All participants answered a web-based questionnaire on sociodemographic characteristics, sensitive skin and environmental factors. Results Among the 10 743 included individuals (5285 men and 5458 women), 48.2% declared that they had sensitive skin. The group with sensitive skin reported significant increases in fatigue, dust or sweating and to a lesser extent food or tobacco consumption. The members of this group also declared that they experienced more sleep disorders than individuals without sensitive skin. Sensitive skin was very frequent in pregnant women, women with painful menstruations or women using contraceptive pills. Conclusions This large cohort study identified new factors, including female hormonal status, fatigue, sleep disorders and food, associated with sensitive skin. These associations suggest that sensitive skin is not restricted to an epidermal disorder but may be included in a larger context. The identified factors are potential upstream drivers of neurogenic inflammation in sensitive skin.

Dysautonomia has been reported in COVID-19. Sweat function testing has been proposed to assess autonomic neuropathy. Fifty Indian patients consulting for neurological symptoms participated in this observational study. The NHS questionnaire for neurological symptoms was completed and electrochemical skin conductance was measured using Sudoscan. The 26% of patients with sweat dysfunction i) were older (p = 0.001), ii) were more frequently treated at home (p = 0.008), iii) were more likely to have received antiviral treatment (p = 0.0006), and iv) more frequently reported at least one motor, sensory or autonomic symptom (p = 0.04). This preliminary study suggests that patients with COVID-19 should be screened for dysautonomia.

Background Primary Focal Hyperhidrosis (PFH) has a detrimental effect on Quality of Life. Repetitive, non-curative symptomatic strategies dominate current treatment of PFH, in spite of the availability of an effective and permanent curative treatment like Endoscopic Thoracic Sympathectomy (ETS). Current surgical optimization may allow for a re-established position of sympathetic modulation in this treatment algorithm. We sought to evaluate the safety, effectiveness, and long-term results of a Bilateral One-stage Single-port Sympathicotomy (BOSS) procedure in PFH patients and to identify subgroups benefitting most. Methods Prospective analysis of 163 patients, 35 (21.5%) underwent Rib-3 (R3) BOSS for palmar PFH, 58 (35.6%) R3-R5 BOSS for axillary PFH and 70 (42.9%) R3-R5 BOSS for combined palmar/axillary PFH. Effectiveness was measured using Skindex-29 and the Hyperhidrosis Disease Severity Scale (HDSS). Results Overall Skindex-29-rating (46.5 ± 14.8 preoperatively vs 20.1 ± 20.6 postoperatively, p p p = 0.004) and in terms of severe compensatory hyperhidrosis, a frequently reported side-effect (17.1% vs 32.8% respectively, p Conclusions BOSS is safe, effective, and offers a long-term curative solution in the treatment of PFH. Especially in the palmar PFH subgroup, R3 BOSS treatment results compare favorably to the treatment results of non-curative alternatives published in the current literature. Therefore, R3 BOSS should be offered to all patients with severe PFH, reporting insufficient benefit of treatment options such as oral and/or local agents.

The body naturally and continuously secretes sweat for thermoregulation during sedentary and routine activities at rates that can reflect underlying health conditions, including nerve damage, autonomic and metabolic disorders, and chronic stress. However, low secretion rates and evaporation pose challenges for collecting resting thermoregulatory sweat for non-invasive analysis of body physiology. Here we present wearable patches for continuous sweat monitoring at rest, using microfluidics to combat evaporation and enable selective monitoring of secretion rate. We integrate hydrophilic fillers for rapid sweat uptake into the sensing channel, reducing required sweat accumulation time towards real-time measurement. Along with sweat rate sensors, we integrate electrochemical sensors for pH, Cl−, and levodopa monitoring. We demonstrate patch functionality for dynamic sweat analysis related to routine activities, stress events, hypoglycemia-induced sweating, and Parkinson’s disease. By enabling sweat analysis compatible with sedentary, routine, and daily activities, these patches enable continuous, autonomous monitoring of body physiology at rest.

As persons living with HIV live longer, it is important to understand the symptoms experienced by menopausal women living with HIV (WLWH). This study used best-worst scaling (BWS) to determine the menopausal symptoms that are most burdensome for Cambodian WLWH. Participants were asked to rate a list of menopausal symptoms in terms of the most and least burdensome in their lives via BWS. The final analysis included 183 participants, 67 of whom were premenopausal, 47 perimenopausal, and 69 postmenopausal women. Physical and mental exhaustion (mean best-worst score = 319) was rated as the most burdensome symptom, and hot flushes and sweating were the least burdensome (mean best-worst score = -181). The BWS provides information on priorities for the distribution of health care resources. Understanding how Cambodian WLWH prioritize burdensome menopausal symptoms is crucial for choosing the most contextually sensitive method to provide health care services and interventions.

Context Psidium guajava L. (Myrtaceae) leaf contains a wide variety of bioactive compounds that contribute valuable effects on human well-being. Objective This study investigates the influence of guava leaf extract-menthol toner on thermoregulation, including perspiration, skin temperature, and recovery heart rate. Materials and methods This randomised, placebo-controlled clinical trial assessed the effects of the guava leaf extract-menthol toner and placebo with a 1-week washout period. Sixty-four participants were enrolled. The participants exercised on a treadmill until a 75% heart rate reserve was achieved for 5 min, followed by a 5 min post-exercise rest period. The skin temperature and heart rate were then measured before 5 mL of the testing product was sprayed to specific areas of the body, left it for 30 sec before wiped off. Post-exercise perspiration and skin temperatures were collected by sweat patches and measured by the Skin-thermometer ST500, respectively. A 20 min heart rate monitoring period started 10 min after the exercise and measured every 2 min intervals. Results Use of the toner significantly reduced post-exercise perspiration to approximately half of the baseline and placebo use values (p 0.05). Skin temperature was also unaffected (p > 0.05). Discussion and Conclusion Guava leaf extract-menthol toner reduced perspiration by astringent effects but did not influence heat dissipation and did not affect cardiovascular mechanism compared to the controls. Additional cleaning with guava leaf extract-menthol toner could offer better hygiene after a workout.

Contains fulltext : 238775.pdf (Publisher’s version ) (Open Access) A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances, and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat by examining the benefits of heat acclimation, cooling strategies, and hyperhydration. Finally, contemporary controversies are summarized and future research directions are provided.

Objectives We investigated the thermoregulatory responses to ice slurry ingestion during low- and moderate-intensity exercises with restrictive heat loss. Design Randomised, counterbalanced, cross-over design. Methods Following a familiarisation trial, ten physically active males exercised on a motorised treadmill at low-intensity (L; 40% VO2max) or moderate-intensity (M; 70% VO2max) for 75-min, in four randomised, counterbalanced trials. Throughout the exercise bout, participants donned a raincoat to restrict heat loss. Participants ingested 2 g kg−1 body mass of ambient water (L + AMB and M + AMB trials) or ice slurry (L + ICE and M + ICE trials) at 15-min intervals during exercise in environmental conditions of Tdb, 25.1 ± 0.6 °C and RH, 63 ± 5%. Heart rate (HR), gastrointestinal temperature (Tgi), mean weighted skin temperature (Tsk), estimated sweat loss, ratings of perceived exertion (RPE) and thermal sensation (RTS) were recorded. Results Compared to L + AMB, participants completed L + ICE trials with lower ΔTgi (0.8 ± 0.3°C vs 0.6 ± 0.2 °C; p = 0.03), mean RPE (10 ± 1 vs 9 ± 1; p = 0.03) and estimated sweat loss (0.91 ± 0.2 L vs 0.78 ± 0.27 L; p = 0.04). Contrastingly, Tgi (p = 0.22), Tsk (p = 0.37), HR (p = 0.31), RPE (p = 0.38) and sweat loss (p = 0.17) were similar between M + AMB and M + ICE trials. RTS was similar during both low-intensity (4.9 ± 0.5 vs 4.7 ± 0.3; p = 0.10) and moderate-intensity exercise (5.3 ± 0.47 vs 5.0 ± 0.4; p = 0.09). Conclusions Per-cooling using ice slurry ingestion marginally reduced thermal strain during low-intensity but not during moderate-intensity exercise. Ice slurry may be an effective and practical heat mitigation strategy during low-intensity exercise such as in occupational and military settings, but a greater volume should be considered to ensure its efficacy.

New strategies for early diagnosis and careful follow-up of systemic sclerosis are urgently needed. We unconventionally used a video capillaroscopy system to measure the amount of sweating on finger pads, and investigated its clinical significance. Thirty-three Japanese patients who were diagnosed with typical or pre-clinical stage patients of systemic sclerosis were included in this study. Five healthy subjects were also included. Among twenty-one patients with typical systemic sclerosis that fulfilled ACR/EULAR 2013 classification criteria, seven had increased sweating levels. On the other hand, among twelve pre-clinical stage patients that did not fulfill the classification criteria, no patient showed increase in finger sweating. We found that there was statistically significant difference. The ratio of diffuse cutaneous systemic sclerosis was also found to be significantly higher in subjects with increased amounts of sweating than in subjects with normal levels. Furthermore, the positivity of topoisomerase I antibody was statistically higher in patients with increased sweating levels than in those without. These results indicated that measurement of finger sweating levels may be a useful tool for early diagnosis and clarification of pathogenesis in this disease.

The ventilated capsule technique is widely used to measure time-dependent changes in sweating in humans. However, evaluations of its reliability (consistency) have been restricted to the forearm, despite extensive regional heterogeneity in the sweating response. Given the importance of such information for experimental design, statistical analysis and interpretation, we determined the reliability of local sweat rate at nine sites during whole-body passive (resting) heating. On three separate occasions, a water-perfused suit was used to increase and clamp oesophageal temperature 0.6, 1.2 and 1.8°C above baseline in 14 young men [24 (SD 5) years of age], while sweat rate was measured at the forehead, chest, abdomen, biceps, forearm, hand, quadriceps, calf and foot using ventilated capsules (3.8 cm2 ). Absolute and relative reliability were determined via the coefficient of variation (CV) and intraclass correlation coefficient (ICC), respectively. At low heat strain (0.6°C), almost all sites had acceptable relative reliability (ICC ≥ 0.70) and moderate absolute reliability (CV < 25%). At moderate heat strain (1.2°C), only the abdomen, hand, quadriceps and foot had acceptable relative reliability, whereas the forehead, abdomen, forearm, hand and quadriceps had moderate absolute reliability. At high heat strain (1.8°C), relative reliability was acceptable at the abdomen, quadriceps, calf and foot, whereas the chest, abdomen, forearm, hand, quadriceps, calf and foot had moderate absolute reliability. Our findings indicate that the measurement site and level of heat strain impact the consistency of local sweat rate measured via the ventilated capsule technique, and we demonstrate the possible implications for research design and data interpretation.

A night vision device (NVD) equipped on a ballistic helmet violates the locational stability of a helmet, and sweating remaining inside a helmet can also reduce helmet stability. This study aimed to investigate the combined effect of sweating and mounting a NVD on helmet stability. Nine healthy males participated in the experiments which consisted of military simulated tasks and 20 min walking. Subjective evaluations containing helmet stability and comfort along with physiological measurements such as microclimate inside a helmet and sweating rate were obtained. Local sweat rate on the forehead was predicted by sweat rate on the upper back and forearm. The results showed that (1) mounting a NVD did not significantly influence on helmet stability per se before onset of sweating, however, (2) when it is combined with sweating, helmet stability reduced 50% during shooting in a prone position (P r = 0.762, P ρ = 0.701, P

Context Research focusing on improving hydration status and knowledge in female indoor-sport athletes is limited. Investigators have demonstrated that hydration education is an optimal tool for improving the hydration status of athletes. Objective To assess the hydration status and fluid intake of collegiate female indoor-sport athletes before and after a 1-time educational intervention. Design Controlled laboratory study. Setting Collegiate women's volleyball and basketball practices. Patients or Other Participants A total of 25 female collegiate volleyball and basketball athletes (age = 21 ± 1 years, height = 173.5 ± 8.7 cm, weight = 72.1 ± 10.0 kg) were assessed during 6 days of practices. Intervention(s) Participants' hydration status and habits were monitored for 3 practice days before they underwent a hydration educational intervention. Postintervention, participants were observed for 3 more practice days. Main Outcome Measure(s) Change in body mass, fluid consumed, urine specific gravity (Usg), urine color (Ucol), and sweat rate were recorded for 6 practice days. Participants completed a hydration-knowledge questionnaire before and after the intervention. Results Three-day mean Usg and Ucol were considered euhydrated prepractice (Usg = 1.015 ± 0.006, Ucol = 4 ± 1) and remained euhydrated postpractice (Usg = 1.019 ± 0.005, Ucol = 5 ± 2) during the preintervention period. Decreased prepractice Ucol (P < .01) and increased hydration knowledge (P < .01) were present postintervention. Basketball athletes had greater body mass losses from prepractice to postpractice than did volleyball athletes (P < .001). Overall increases were evident when we compared prepractice and postpractice measures of Usg and Ucol in the preintervention (P < .001 and P = .001, respectively) and postintervention (P = .001 and P < .001) period, respectively. No correlation was found between hydration knowledge and physiological indices of hydration and fluid intake. Conclusions Overall, female collegiate indoor-sport athletes were hydrated and knowledgeable on hydration. However, our variable findings indicated that further research on these athletes is needed; clinically, attention should be given to the individual needs of each athlete. More examination will demonstrate whether a 1-time educational intervention may be an effective tool for improving hydration status in this population.

Optical coherence tomography (OCT) is a high-resolution tomographic imaging technique that uses optical interference. OCT has enabled the non-invasive three-dimensional analysis of individual acrosyringia in the stratum corneum in human skin. However, no report on the measurement of sweating by OCT using clinical data from humans has been published to date. Twenty patients with hyperhidrosis and twenty healthy subjects were included in this study. Imaging of acrosyringia in the stratum corneum using OCT and measurement of the sweat rate using the ventilated capsule method were performed simultaneously. The hand grip exercise of the right hand was used as a load to induce sweating, and the left fingertip was measured before and after the exercise load. Five acrosyringia were extracted from each OCT image, and their volumes were calculated. The mean volume of each acrosyringium was divided by the thickness of the stratum corneum to calculate the mean cross-sectional area of the acrosyringium. Furthermore, the number of sweat droplets on the skin surface was measured. The mean cross-sectional area of acrosyringia after the load increased both in patients with hyperhidrosis and in healthy subjects (P < 0.001). The mean cross-sectional area of acrosyringia of patients with hyperhidrosis was larger than that of healthy subjects (P < 0.001). The mean cross-sectional area of acrosyringia and the sweat rate showed a positive correlation before and after the load (r = 0.88 to 0.91). The number of droplets also increased after the load (P < 0.001), and the number of droplets in patients with hyperhidrosis was higher than in healthy subjects (P < 0.001). Our study has shown that acrosyringia in the stratum corneum increase in proportion to the sweat rate. OCT is a rigorous and valuable method that can measure and quantify sweating in the body without being an invasive procedure.

This study aimed to find the associations between vasomotor symptoms (VMS) and metabolic syndrome (MetS) in Chinese middle-aged women in a cross-sectional study.A total of 675 participants were recruited from an urban Chinese community. MetS was defined by the 2009 criteria of the Joint Interim Statement. VMS including hot flashes and sweats, blood pressure, weight, height, waist circumference (WC), serum glucose, triglycerides, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), estradiol, and follicle-stimulating hormone (FSH) were collected.The presence of hot flashes was independently associated with the risk of MetS after adjusting for age, menopausal status, FSHWomen with hot flashes had a higher risk of MetS. Both hot flashes and sweats were related to a higher amount of central fat indicated by WC and higher triglycerides, but were not related to blood pressure, glucose, and HDL in Chinese women.

While human eccrine sweat glands respond to adrenergic agonists, there remains a paucity of information on the factors modulating this response. Thus, we assessed the relative contribution of α- and β-adrenergic sweating during a heat exposure and as a function of individual factors of sex and training status. α- and β-adrenergic sweating was assessed in forty-eight healthy young men (n = 35) and women (n = 13) including endurance-trained (n = 12) and untrained men (n = 12) under non-heat exposure (temperate, 25°C; n = 17) and heat exposure (hot, 35°C; n = 48) conditions using transdermal iontophoresis of phenylephrine (α-adrenergic agonist) and salbutamol (β-adrenergic agonist) on the ventral forearm, respectively. Adrenergic sweating was also measured after iontophoretic administration of atropine (muscarinic receptor antagonist) or saline (control) to evaluate how changes in muscarinic receptor activity modulate the adrenergic response to a heat exposure (n = 12). α- and β-adrenergic sweating was augmented in hot compared with temperate conditions (both P ≤ .014), albeit the relative increase was greater in β (~5.4-fold)- as compared to α (~1.5-fold)-adrenergic-mediated sweating response. However, both α- and β-adrenergic sweating was abolished by atropinization (P = .001). Endurance-trained men showed an augmentation in α- (P = .043) but not β (P = .960)-adrenergic sweating as compared to untrained men. Finally, a greater α- and β-adrenergic sweating response (both P ≤ .001) was measured in habitually active men than in women. We show that heat exposure augments α-and β-adrenergic sweating differently via mechanisms associated with altered muscarinic receptor activity. Sex and training status modulate this response.

Purpose Given the pressing impact of global warming and its detrimental effect on the health of older populations, understanding age-related changes in thermoregulatory function is essential. Age differences in regional sweat distribution have been observed previously, but given the typically small measurement areas assessed, the development of whole body sweat maps for older individuals is required. Therefore, this study investigated age-related differences in regional sweat distribution in a hot environment (32 °C/50%RH) in young and older adults, using a body mapping approach. Methods Technical absorbent pads were applied to the skin of 14 young (age 24 ± 2 years) and 14 older (68 ± 5 years) males to measure regional sweat rate (RSR) at rest (30 min) and during exercise (30 min), at a fixed heat production (200 W m−2). Gastrointestinal (Tgi) and skin temperature (Tsk), heart rate, thermal sensation, and thermal comfort were also measured. Results Whole body sweat maps showed that despite equal heat production, healthy older males had significantly lower gross sweat loss (GSL) than the young and significantly lower RSR at almost all body regions at rest and at the hands, legs, ankles, and feet during exercise. The lower sweat loss in the older group coincided with a greater increase in Tgi and a consistently higher Tsk at the legs, despite subjectively feeling slightly cooler than younger individuals. Conclusion These findings support the evidence of age-related deterioration in both autonomic and subjective responses in the heat and highlight the lower extremities as the most affected body region.

Context During the menopausal transition, there is a greater likelihood of the prevalence of various bothersome symptoms, including vasomotor symptoms (VMS) and mood symptoms. Objective To investigate the association among bothersome VMS and symptoms of anxiety and depression in Chinese women during perimenopause and early in menopause. Design, Patients, Setting, and Interventions This study included 430 midlife Chinese women who had experienced natural menopause and were followed up for 10 years. A structured questionnaire was provided annually, comprising the VMS Bother Score (range 1-8) from the Menopause-Specific Quality of Life questionnaire, the Hospital Anxiety and Depression Scale, and other physical and behavioral factors. Results Among the 430 women evaluated, 78.8% had experienced VMS during long-term follow-up. The overall level of VMS bother score was relatively low (1.92 ± 1.32). Both anxiety and depressive symptoms were significantly associated with VMS bother. After adjusting for potential covariates, the association between anxiety or depression symptoms and VMS bother remained highly significant. Menopausal stage, body mass index, general health, follicle-stimulating hormone, and estradiol were independent contributors to VMS. In time-lagged (1-year) models, VMS bother scores significantly predicted the risk of symptoms of both anxiety and depression the following year. In contrast, anxiety symptoms, rather than depressive symptoms, could predict VMS bother the following year. Conclusion The prevalence of VMS in our cohort was higher than has been previously reported; however, the overall level of bother was relatively low. This study demonstrated a strong relationship between VMS bother and mood symptoms in Chinese women progressing from perimenopause through natural menopause.

ContextApproximately 70% of women report experiencing vasomotor symptoms (VMS, hot flashes and/or night sweats). The etiology of VMS is not clearly understood but may include genetic factors.Evidence AcquisitionWe searched PubMed and Embase in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. We included studies on associations between genetic variation and VMS. We excluded studies focused on medication interventions or prevention or treatment of breast cancer.Evidence SynthesisOf 202 unique citations, 18 citations met the inclusion criteria. Study sample sizes ranged from 51 to 17 695. Eleven of the 18 studies had fewer than 500 participants; 2 studies had 1000 or more. Overall, statistically significant associations with VMS were found for variants in 14 of the 26 genes assessed in candidate gene studies. The cytochrome P450 family 1 subfamily A member 1 (CYP1B1) gene was the focus of the largest number (n = 7) of studies, but strength and statistical significance of associations of CYP1B1 variants with VMS were inconsistent. A genome-wide association study reported statistically significant associations between 14 single-nucleotide variants in the tachykinin receptor 3 gene and VMS. Heterogeneity across trials regarding VMS measurement methods and effect measures precluded quantitative meta-analysis; there were few studies of each specific genetic variant.ConclusionsGenetic variants are associated with VMS. The associations are not limited to variations in sex-steroid metabolism genes. However, studies were few and future studies are needed to confirm and extend these findings.

The purpose of this study was to assess the heat strain experienced by children during unstructured physical activity outdoors in a temperate continental summer climate. Eighteen children (7 girls, 12.1 ± 1.7 years) performed up to 4 h of outdoor free-play (duration: 218 ± 33 min; air temperature of 24.5 ± 3.9°C and relative humidity of 66.2 ± 9.2%). Urine specific gravity (USG) was measured pre- and post-free-play, while body core temperature (Tco, ingestible pill) and heart rate (HR) were measured continuously. Physiological strain index (PSI) was calculated from Tco and HR (scale: 0 (none) to 10 (very high)). Activity levels were categorized as rest, light, moderate, and vigorous based on the metabolic equivalent of task, estimated from video analysis. Most children were euhydrated pre (78%, USG ≤ 1.020), but not post-free-play (28%, USG ≤ 1.020). Mean and peak Tco, HR, and PSI responses were 37.8 ± 0.3°C and 38.4 ± 0.3°C, 133 ± 14 bpm and 180 ± 12 bpm, and 4.7 ± 1.1 (low) and 7.4 ± 1.0 (high), respectively. All children reached peak Tco≥38.0°C, with seven ≥38.5°C, and the highest at 38.9°C. The children spent 58 ± 15% of free-play engaged in moderate-to-vigorous intensity physical activity. During free-play, all of the children performed moderate-to-vigorous intensity physical activity, which was associated with pronounced elevations in heat strain.

A 14-year-old boy with a history of atrial tachycardia presented to the emergency department with acute right foot weakness. One month prior to presentation, he had a self-resolving diarrheal illness and bacterial pneumonia treated with antibiotics. Two weeks later, he endorsed a dull headache, increased irritability, and neck pain. One week prior to presentation, he developed intermittent urinary retention and episodes of flushing and redness of his right face. He fell 5 days prior to presentation and in the ensuing days, he complained of bilateral hip pain and paresthesias that progressively spread to involve bilateral thighs. On the day of presentation, the patient noticed weakness of his right ankle and foot. There was no history of fever. He denied joint pain, swelling, rash, or facial droop, but he did endorse mild sound sensitivity.

NEW FINDINGS What is the central question of this study? Repeated heat exposure during the summer months can enhance heat loss in humans (seasonal heat acclimatisation), but does the magnitude of that enhancement differ between young and older adults when assessed during passive heat exposure? What is the main finding and its importance? While seasonal heat acclimatisation enhanced evaporative heat loss (i.e. sweating) in both young and older adults, those improvements led to a greater reduction in body heat storage in older adults. These outcomes indicate that heat acclimatisation may confer greater thermoregulatory benefits with increasing age. ABSTRACT Repeated heat exposure throughout summer can enhance heat loss in humans (seasonal heat acclimatisation), although the effect of ageing on those improvements remains unclear. We therefore sought to assess thermoregulatory function in young and older adults during environmental heat exposure prior to and following seasonal heat acclimatisation, hypothesizing that the magnitude of adaptation would be greater in older relative to young adults. To achieve this, 14 young (19-27 years) and 10 older adults (55-72 years), who resided in a temperate humid-continental climate, completed a 3 h resting heat exposure (44°C, ∼30% relative humidity) in the winter-spring months as part of a larger investigation (pre-acclimatisation), before being re-evaluated using the same heat stress test following the summer months (post-acclimatisation). Whole-body dry and evaporative heat exchange, and metabolic rate were measured throughout using direct and indirect calorimetry (respectively), and used to quantify body heat storage (metabolic rate + dry heat gain - evaporative heat loss). Evaporative heat loss increased in both groups following acclimatisation, but those improvements led to a decrease in body heat storage in older (mean difference (95% CI); 213 (295, 131) kJ; P

During play, ice hockey goaltenders routinely dehydrate through sweating and lose ≥2% body mass, which may impair thermoregulation and performance. Purpose: This randomized, crossover study examined the effects of mild dehydration on goaltender on-ice thermoregulation, heart rate, fatigue, and performance. Methods: Eleven goaltenders played a 70-minute scrimmage followed by a shootout and drills to analyze reaction time and movements. On ice, they either consumed no fluid (NF) and lost 2.4% (0.3%) body mass or maintained body mass with water (WAT) or a carbohydrate–electrolyte solution (CES). Save percentage, rating of perceived exertion, heart rate, and core temperature were recorded throughout, and a postskate questionnaire assessed perceived fatigue. Results: Relative to NF, intake of both fluids decreased heart rate (interaction: P = .03), core temperature (peak NF = 39.0°C [0.1°C], WAT = 38.6°C [0.1°C], and CES = 38.5°C [0.1°C]; P = .005), and rating of perceived exertion in the scrimmage (post hoc: P P P P P P P = .02). Shootout save percentage was similar between conditions (P = .37). Conclusions: Mild dehydration increased physiological strain and fatigue and decreased ice hockey goaltender performance versus maintaining hydration. Also, maintaining hydration with a CES versus WAT may further reduce perceived fatigue and positively affect movements.

In order to inform the Athlete Biological Passport (ABP), this study determined whether the elevation in hemoglobin (Hb) following intracellular or extracellular dehydration would trigger an atypical passport finding (ATPF). Seven male and three female volunteers (age: 23 ± 4 y; height: 170 ± 8 cm; body mass: 78 ± 12 kg) were carefully euhydrated (EUH) to determine baseline Hb levels. Volunteers then completed both an exercise-induced sweating dehydration (SW) protocol and a diuretic-induced dehydration (DI) protocol. Dehydration was assessed via body mass changes and Hb was measured via a bench-top automated hematology analyzer. Using the ABP module, the expected baseline range for each individual was determined using EUH trials, and the impact of each dehydration protocol was then assessed in comparison with these thresholds. Volunteers lost on average 3.1% and 3.7% body mass in the SW and DI trials, respectively. While only one subject exceeded the upper threshold following DI dehydration, six additional subjects demonstrated highly unusual ABP profiles; this was not the case for SW. Sweating is not a feasible explanation for elevated Hb during ABP testing; however, recent illness such as secretory diarrhea, which is mimicked by diuretic administration, may be capable of producing elevated Hb in athletes' biological passports.

Background Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (video-assisted thoracoscopic sympathectomy [VATS]) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of patients aged 40 years or older compared with those of young adult patients (19–40 years). Methods We retrospectively analyzed 2,431 HH patients who underwent bilateral VATS and divided the patients into the following groups: a group younger than 40 years old (1,760 patients) and a group 40 years and older (142 patients). Variables included quality of life before surgery, improvement in quality of life after surgery, clinical improvement in sweating, the presence of severe compensatory hyperhidrosis (CH), and general satisfaction at 1 month after surgery. Results We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the 2 groups of patients. More than 90% of the patients in this series had great clinical improvement in the main HH site, with no significant difference between the 2 groups. Severe CH occurred in 23.8% of the patients in this series, with no significant difference between the 2 groups. Conclusions Patients 40 years of age or older benefit just as much as younger patients from VATS performed to treat primary HH, presenting excellent significant surgical results.

Objective: Vasomotor symptoms (hot flashes, night sweats) are common during the menopausal transition. Pharmacotherapy is effective but is associated with health risks for some women. There is an increasing demand for non-pharmacological interventions. The CBT-Meno protocol is a psychological intervention targeting a range of common menopausal symptoms. We compared the impact of CBT-Meno vs. waitlist on objective and subjective measures of vasomotor symptoms and on the relationship between vasomotor symptoms and sleep difficulties.Materials: The participants were 36 perimenopausal or postmenopausal women with co-occurring depressive symptoms who participated in the CBT-Meno trial (clinicaltrials.gov NCT02480192). Subjective measures included the Hot Flash Related Daily Interference Scale, the Greene Climacteric Scale, and the Pittsburgh Sleep Quality Inventory. Objective (physiological) and 'in-the-moment' measures of vasomotor symptoms were assessed with sternal skin conductance.Results: Greater improvements in vasomotor 'bothersomeness' and 'interference' were observed in the CBT-Meno condition compared to the waitlist condition. No between-group differences were observed in vasomotor frequency (subjectively or objectively recorded) or severity ratings. Sleep disturbance was unrelated to objectively measured vasomotor symptom frequency.Conclusion: The CBT-Meno trial improved subjective but not objective (physiological) measures of vasomotor symptoms. Self-reported sleep difficulties were unrelated to subjective or objective vasomotor symptoms.

Purpose When performing endoscopic thoracic sympathectomy (ETS) in palmar hyperhidrosis patients, a device can be used to measure sweat volume pre- and postoperatively in order to assess indications and treatment effects. In this study, we measured changes in the dynamics of sweating in hyperhidrosis patients pre- and postoperatively and compared the values with those in healthy subjects without hyperhidrosis. Methods The patient group comprised 25 persons with palmar hyperhidrosis who were scheduled for ETS. The dynamics of sweating was measured at 1 day prior to surgery and at 2 days postoperatively, in 18 patients at > 1 year postoperatively in another palmar hyperhidrosis group, and in 20 healthy subjects without hyperhidrosis. A device for measuring local sweat volume was applied at the thenar eminence of both palms. Indicators established were basal sweat rate (BSR; mg/min/cm2), peak sweat rate (PSR; mg/min/cm2) during mental stress (sympathetic sweating response), sweat volume (SV), and sweat time (ST; s). Results After surgery, all of the indicators were significantly reduced in hyperhidrosis patients and there was very little response to mental stress. The subgroup of these patients assessed at > 1 year after ETS showed a trend of increased BSR similar to that of healthy subjects. These changes did not correlate with the extent of the removal surgery. Preoperatively, hyperhidrosis patients had significantly greater BSR, PSR, and SV and longer ST than healthy subjects. Conclusion All of the sweating parameters were increased in palmar hyperhidrosis patients prior to surgery. Immediately after ETS, all these parameters were significantly reduced. At > 1 year after ETS, the BSR had increased to a level similar to that of the healthy volunteers, although PSR did not respond to mental stress.

Objective To ascertain the association between vasomotor menopausal symptoms (VSM), hot flushes and night sweats, and cardiovascular disease, coronary heart disease and cerebrovascular disease. Study design The study sample comprised 8881 women (aged 45–50 years) with available hospital separation data from the 1946-51 cohort (1996–2016) of the ongoing Australian Longitudinal Study on Women’s Health, a national prospective cohort study. Main outcome measures First fatal or non-fatal cardiovascular disease, coronary heart disease, and cerebrovascular disease events were obtained through linkage with hospital admission data, the National Death Index, and Medicare Benefits Schedule. Hot flushes and night sweats were assessed via questionnaires at each main survey. Additionally, we calculated the duration of symptoms based on whether or not women reported vasomotor menopausal symptoms in each survey. Results There were 925 cardiovascular disease, 484 coronary heart disease and 154 cerebrovascular disease events. There was no consistent evidence of any association with vasomotor menopausal symptoms, hot flushes and night sweats. We did find marginally statistically significant associations between presence of night sweats and cardiovascular disease (Hazard Ratio = 1.18, 95 % Confidence Interval: 1.01–1.38), and between the duration of vasomotor menopausal symptoms [years] and coronary heart disease (Hazard Ratioper year = 1.03, 95 % Confidence Interval: 1.00–1.05). However, given the number of associations tested, these findings could very well have arisen by chance. Conclusion In this large longitudinal study with 20 years of follow-up and clinical outcomes we did not find a convincing association between vasomotor menopausal symptoms, hot flushes, night sweats and cardiovascular disease, coronary heart disease and cerebrovascular disease.

Background In 2007, the FDA added requirements for sunscreens to be labeled "re-apply at least every 2 hours" based on very limited data. This study used hybrid diffuse reflectance spectroscopy (HDRS) to evaluate the persistence of protection by 80 minutes water-resistant sunscreen formulation with and without re-application, and with and without sweat-inducing activity over 6 hours. Methods Sunscreens were applied to subject's foreheads and backs, and they remained at rest or exercised to induce sweating in a heated environment. Efficacy of a sun protection factor (SPF 50) very water-resistant sunscreen was measured with HDRS instrumentation and ultraviolet (UV) photography to determine the sunscreen protection over time. Results The sunscreen maintained SPF 50 efficacy over 6 hours for the non-active group with a single application, and for 2 hours for the active group, dropping slowly to SPF 30 level after 6 hours of sweating. Re-application of sunscreen gave additive SPF, with two applications resulting in SPF >100 and three applications approximately SPF 150. UV photography was insensitive to the differences in protection detected with HDRS instrumentation. Conclusions Sunscreen efficacy is maintained over time in the absence of sweating or rub-off. After two hours of sweating, an 80 minutes water-resistant sunscreen does not need to be re-applied "at least every 2 hours."

Purpose The hallmark menopausal symptom, vasomotor symptoms (VMS), has been linked to adverse health indicators. However, the relationship between VMS and biological aging has not been tested. We examined associations between menopausal VMS and biological aging as assessed by 2 DNA methylation-based epigenetic aging indicators previously linked to poor health outcomes. Methods Participants were members of the Women’s Health Initiative Observational Study integrative genomics substudy (N = 1206) who had both ovaries and were not taking hormone therapy. Relationships between VMS at enrollment (presence, severity) or VMS timing groups (no VMS: not at menopause onset nor at study enrollment; early VMS: at menopause onset but not at enrollment; persistent VMS: at menopause onset and study enrollment; and late VMS: at enrollment but not at menopause onset) and epigenetic clock indicators predictive of physical aging and early death (DNAm PhenoAge, DNAm GrimAge) were tested in linear regression models adjusting for age, race/ethnicity, hysterectomy, education, body mass index, smoking, and, in additional models, sleep disturbance. Results Women were on average 65 years of age at enrollment. Severe hot flashes at enrollment were associated with higher DNAm PhenoAge [relative to no hot flashes: B (SE) = 2.79 (1.27), P = 0.028, multivariable]. Further, late-occurring VMS were associated with both higher DNAm PhenoAge [B (SE) = 2.15 (0.84), P = 0.011] and DNAm GrimAge [B (SE) = 1.09 (0.42), P = 0.010, multivariable] relative to no VMS. Main Conclusions Among postmenopausal women, severe or late-occurring VMS were associated with accelerated epigenetic age, controlling for chronological age. Postmenopausal women with severe or late-occurring VMS may have greater underlying epigenetic aging.

Evaporative cooling is the critical heat dissipation mechanism for working individuals wearing thermal protective clothing in hot environments. However, until now, there is no knowledge on garment size design for evaporative cooling optimization, especially when the human body is in movements. In this study, to understand the dynamic effect of garment size on evaporative cooling, we performed experiments on a sweating thermal manikin with seven garment sizes and three walking speeds. The evaporative cooling of global and local manikin body with this wide range garment sizes was present. Results demonstrated that the effect of garment size on evaporative cooling depended on the walking speed. At lower walking speeds, the global evaporative cooling tended to decrease with greater garment size, while at higher walking speeds, the global evaporative cooling tended to increase with greater garment size. Similarly, according to effects of garment size on local evaporative cooling, body segments could be divided into three categories for evaporative cooling optimization. Further, we analyzed factors which influenced the positive effect of walking speed on the evaporative cooling. Results showed that, for most cases, the increase of evaporative cooling caused by walking showed positive linear relationship with the garment size. Further increase of walking speed led to a greater increase rate of evaporative heat loss for body segments with the small air gap. This study provides insights into clothing local characteristics of evaporative cooling with different garment sizes under dynamic conditions and may help clothing design to optimize the evaporative cooling of working individuals in hot environments.

Background OFF periods impair quality of life in Parkinson's disease but the nature and degree of this impact is largely unquantified. Optimal treatment relies on assessing the experience and impact of these periods on patients and their carepartners. Objectives To understand the experience and impact of OFF periods on their lives. Methods Informed by qualitative interviews we designed questionnaires and surveyed neurologists, people with Parkinson's disease and carepartners. Results 50 general neurologists, 50 movement disorder neurologists, 442 patients (median disease duration 5 years) and 97 carepartners were included. The most common OFF symptoms reported by patients and carepartners were stiffness, slowness of movement and changes in gait. Non-motor symptoms were less common. A higher proportion of carepartners reported each symptom. A minority of neurologists recognized pain, sweating and anxiety as possible symptoms of OFF periods. The three OFF symptoms most frequently designated as having great impact by people with Parkinson's disease were changes in gait, slowness and stiffness. In contrast, cognitive impairment was most frequently rated as having great impact on carepartners. OFF periods were reported to impact many aspects of the lives of both patients and carepartners. Conclusions In people with Parkinson's disease of under 10 years duration, motor symptoms of OFF periods predominate in impact, however cognitive impairment has great impact on carepartners. Education is needed for neurologists regarding the non-motor aspects of OFF. The importance of involving carepartners in the assessment regarding OFF periods is supported by the higher frequency of symptom reporting by carepartners, and the significant impact on their lives.

Background In people living with limb loss, addressing the resulting functional deficit with prostheses increases the risk for secondary conditions such as pressure sores, impaired blood perfusion, and injuries from accidental falls. Any of those occurrences can render the prosthesis temporarily useless, making it challenging for users to engage in many activities of daily life, including work, exercise, and social participation. Many of the described issues originate at the interface between residual limb and prosthetic socket, where the objectives of sufficient weight distribution and suspension are conflicting with the necessity to facilitate heat exchange and limit contact pressure and friction. Recently, prosthesis liners that contain phase-change material have become commercially available, holding the promise that the micro climate at the interface between the residual limb skin and the prosthetic socket can be regulated to reduce the users’ tendency to sweat. Preliminary studies on these liners indicate that the socket temperatures inside the socket stayed lower and rose slower than in conventional liners. However, the clinical relevance of those findings remains unclear. The purpose of this study is to investigate whether longer (6+ months) periods of use of phase-change material based temperature-control liners have clinically meaningful effects. Methods The protocol is a double-blind longitudinal cross-over research design. A sample of trans-tibial prosthesis users are wearing their regular gel or silicone liners for six months and phase-change material liners for another six months in a randomized sequence. Their prostheses is equipped with activity monitors to detect days when they could not wear their prosthesis. In six-week intervals, individuals’ activity, physical performance, and overall prosthesis assessment is recorded using standardized methods. Discussion Expected results will inform prescription and reimbursement practice of phase-change material-based prosthesis liners and will help improve and economize prosthetic fitting for people with limb loss. The design and duration of the protocol, including randomization, blinding, and within-subject comparison, will generate scientific evidence of a comparably high level. Inclusion of a comparably large sample and different climates, e.g. across all four seasons, will make findings applicable to a large number of prosthesis users. Trial registration Clinicaltrials.gov, NCT03428815. Registered on 12 February 2018.

This study examined the effectiveness of a field-type liquid cooling vest (LCV) worn underneath an impermeable protective suit on heat strain during walking. Eight men walked for 60 min at a moderate speed (3.0 km/h) wearing the suit in a warm environment (33°C, 60% relative humidity) without (control, CON) or with the LCV. A smaller increase in rectal temperature was recorded in participants in the LCV than in the CON condition (37.6 ± 0.1°C vs. 37.9 ± 0.1°C, p