This study aims to construct a Nomogram for intraoperative hypothermia (IH) in elderly patients undergoing robot-assisted urological tumor resection (RAUTR) and to evaluate the effect of the model by internal and external validation. Using convenient sampling to enroll patients in a large hospital from February 2022 to July 2024 as the modeling and validation cohort. Identifying the independent risk factors for IH by univariate and multivariate logistic regression, and developing a Nomogram by the R software. The Nomogram's discrimination and accuracy were tested by receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow (H-L) test, internal validation was performed with 1000 Bootstrap resamples and calibration curves. External evaluation was conducted on a validation cohort using ROC curves and H-L tests. The modeling cohort included 420 patients, with an IH rate of 39.8%. Univariate and multivariate logistic regression showed that baseline temperature (odds ratio [OR] = 0.087), preoperative psychological score (OR = 1.114), body mass index (BMI) (OR = 0.820), and anesthesia time (OR = 1.013) were independent risk factors for IH. The ROC curve of the Nomogram had an area under the curve of 0.844 (95% confidence interval [CI]: 0.807-0.881), a maximum Youden index of 0.563, a best cutoff value of 0.383, a sensitivity of 0.772, and a specificity of 0.791. The H-L test yielded a chi-square value of 10.173 and a -value of 0.253. Internal validation with 1000 Bootstrap resamples showed a consistency coefficient of 0.844, the calibration curve fits well. A total of 120 patients were included in the validation cohort, including 45 with hypothermia (37.5%). The area under the ROC curve for the prediction of IH in the external validation cohort was 0.854 (95% CI: 0.781-0.927), and the H-L test yielded a chi-square value of 5.207 and a -value of 0.735. The IH rate is high in elderly patients undergoing RAUTR. Baseline temperature, preoperative psychological score, BMI, and anesthesia time are independent risk factors. And the Nomogram could be used to predict IH.

This study aimed to evaluate the effects of therapeutic hypothermia (TH) and the warming phase on cardiovascular hemodynamics among neonates suffering from perinatal asphyxia. The reviewed literature on hemodynamic changes among neonates undergoing TH was obtained from the following databases: PubMed, Embase, POPLINE, Cochrane Reference Libraries, Google Scholar, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Search strategies included keywords, combinations, medical subject headings, and snowball searches of related articles. The following search terms were used: brain injury, hypoxic-ischemic encephalopathy, left ventricular (LV) dysfunction, right ventricular (RV) dysfunction, and TH. We selected publications evaluating RV and LV heart function and cerebral, renal, and visceral circulation function for analysis. There were 12 prospective studies, with a total of 361 patients in the study groups and 149 patients in the control groups. There were seven retrospective studies, with a total of 1637 patients. One study was a randomized controlled trial, one was a systematic review, and one was a Cochrane review. The limitations of the review are that most of the studies are observational, making it difficult to precisely assess the causes of the observed changes, whether they are related to asphyxia, hypothermia, or other pathology. The results of the observational studies were not consistent with those of the randomized trials for ethical reasons. The hemodynamic characteristics of the cardiovascular system during TH and the rewarming phase are significantly complex. Therefore, an in-depth understanding of the pathophysiological attributes associated with these aspects is essential to provide individualized therapeutic approaches for optimizing cerebral perfusion pressure and reducing secondary injuries.

To analyze the prevalence and factors related to inadvertent intraoperative hypothermia (IOH) in adults undergoing elective robot-assisted radical cystectomy surgery (RARC) under general anesthesia. A retrospective study observed data from June 2022 to August 2023 in two large teaching hospital. Collecting core temperature and potential influencing factors through electronic medical records. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of IOH. 690 patients were included finally, with 266 (38.6) patients suffered IOH. The factors related to IOH embraced anesthesia induction time (odds ratio [OR]: 0.523; 95% confidence interval [CI]: 0.372-0.735; 0.05); age (OR: 0.984; CI: 0.970-0.970; 0.05); smoking (OR: 3.489; CI: 1.999-6.089; 0.05); intraoperative fluid volume (OR: 0.999; CI: 0.999-0.999; 0.05); surgery duration (OR: 0.996; CI: 0.994-0.998; 0.05); and baseline core temperature (OR: 1.859; CI: 1.165-2.965; 0.05). We emphasize the relatively high prevalence of IOH during elective RARC under general anesthesia and identify related factors, including lower baseline core temperature, age, longer surgery duration, surgery in the morning, larger intraoperative fluid volume, and smoking.

Core body temperature reflects core heat content, which is determined by the balance of heat production and heat loss. Studies and interventions focusing on temperature rarely measure metabolic heat production and heat loss. This study tests whether net heat balance (NHB) in humans can predict core temperature changes and secondarily whether NHB combined with skin surface temperatures (ST) can estimate core temperature. We conducted a laboratory study of healthy volunteers cooled with gel-adhesive circulating water pads with or without treatment with a drug (dexmedetomidine) to prevent shivering. We measured heat flux on the forehead, deltoid, anterior abdominal wall, and above the knee. We measured energy expenditure (W) using indirect calorimetry and core temperature (T) using deep gastrointestinal temperature. Thirteen participants (age 20-51 years; height 160-188 cm; mass 61-101 kg) participated in 21 protocol days. Mean (standard deviation [SD]) NHB ranged from +14 (26) W at baseline to -56 (25) W with drug and cooling pads. NHB predicted change in core temperature 60 minutes later (lagged regression slope: 0.33°C/100W; 95% confidence interval [CI] [0.2, 0.5]) (pseudo r = 12.81%). Forehead ST had the narrowest limits of agreement [-2.6°C, -2.4°C] for predicting core temperature with a mean bias of -2.5°C. In conclusion, NHB of -100W predicts a 0.33°C/60 minutes decrease in core temperature. Forehead temperature is the most consistent peripheral site to predict core temperature. While a cooling device increases heat loss, energy expenditure (EE) also rises with surface cooling, minimizing NHB, and core temperature change unless a drug is utilized to suppress the increase in EE.

The critical care unit at the University Hospital of Wales is a 38-bedded tertiary center. In 2023, the unit admitted 1251 unscheduled patients, of which 131 were out-of-hospital cardiac arrest (OOHCA) patients. The unit also participated in the Targeted Temperature Management 2 study and adopted the findings shortly after its publication in 2021. This gave us a unique exposure into the pitfalls associated with changing surface cooling protocols. The aim of this quality and safety initiative was to explore the causes of failure to comply with normothermic temperature targets in the OOHCA population, following a protocol change away from targeted therapeutic hypothermia. This article uses surface cooling data from OOHCA survivors. We discuss our findings from analysis of surface cooling data from 36 patients-13 pre-protocol change (targeted hypothermia) and 23 post-protocol change (targeted normothermia). Concerningly, following the change to targeted normothermia, rather than therapeutic hypothermia, the fever burden increased from an average of 2 to12 hours per patient. To address this problem, we reviewed the data and identified several causes of this failure. These failures included the failure to start the therapy at the selected trigger point, the interruption of therapy, inadequate pad sizing, and the failure to select the correct protocol. Surface cooling pitfalls are not commonly discussed in the literature, and therefore there remains a risk that units may overlook them, either when transitioning between protocols or when continuing with an ongoing surface cooling device. With evidence suggesting that pyrexia contributes to poorer outcomes, it is of vital importance that staff are aware of any potential pitfalls of surface cooling devices to mitigate unnecessary fever burden.

This study aimed to determine the effects of the thermal blanket on patients' vital signs, shivering level, chill status, and thermal comfort perception in preoperative and postoperative periods. The study was designed as a randomized controlled trial and included 44 female patients who had undergone elective gynecological surgery in a hospital in the south of Turkey. The experimental group ( = 22) was warmed using the passive warming method via a thermal blanket, and the control group ( = 22) was administered routine care via a cotton pique. The data collection tools included the "Patient Information Form," the "Patient Follow-Up Form," the "Shivering Level Diagnosis Form," and the "Thermal Comfort Perception Scale." Patients were warmed passively before (at least 10 minutes) and after surgery (at least 60 minutes) with a thermal blanket or cotton pique according to their groups. Patients' vital signs and oxygen saturation were recorded during the preoperative and postoperative periods at 15-minute intervals. The patients' shivering levels were recorded at 15-minute intervals, and chill status and thermal comfort perceptions were recorded at 30-minute intervals during the postoperative period. The data obtained in the research were analyzed using the SPSS 24.0 program. There were no statistically significant differences between the vital signs and oxygen saturation of the intervention and control groups during the first 60 minutes after surgery. The shivering level and coldness of the control group were higher in the postoperative period, but the difference between the groups was not statistically significant. There were no statistical differences between the groups in the time to reach 36.0°C ( > 0.05). Thermal comfort perception scores during the first 90 minutes were significantly higher in the intervention group ( < 0.05). The thermal blanket is not superior to the cotton pique used in standard care in maintaining body temperature, but it is effective in increasing thermal comfort perception.

Preclinical studies show that therapeutic hypothermia (TH) effectively reduces cerebral ischemic injury. In contrast, TH has not been consistently beneficial in clinical trials of stroke and cardiac arrest, perhaps from suboptimal dosing (e.g., delay, depth, and duration), among other factors. This systematic review aimed to find an optimal depth of TH from adult preclinical studies of global and focal ischemia. To study depth, without other confounds, we examined studies that compared ≥2 depths of TH versus normothermic controls. Our primary outcomes were infarct size (focal ischemia) and hippocampal cell death (global ischemia), while secondary outcomes were behavior, edema, and striatal cell death. Studies were assessed with the SYRCLE Risk of Bias tool (e.g., use of blinding) and additional indices of translational rigor (e.g., use of aged animals). Thirty studies were included from a search of the PubMed database in 2025. Many studies were rated as exhibiting a high risk of bias with low translational rigor. Overall, TH provided considerable protection on all endpoints, sometimes up to 100%, but no consistent dose-response patterns emerged, nor was an optimal depth of cooling readily evident. To explore the latter finding, specifically sampling variability, we conducted Monte Carlo simulations using the pooled standard deviation of the preclinical studies to generate three populations based upon a theoretical 5% protection per 1°C relationship (37°C vs. 32°C vs. 27°C groups run 75 times). Dose-dependent effects were statistically detectable in only 36% of comparisons, which showed comparably noisy patterns of protection. Thus, the variable dose-dependent effects in the reviewed animal studies likely arise, at least partially, from sampling error owing to using small samples from variable populations (average = 8/group in focal ischemia). Overall, these findings highlight weaknesses in the extant dose-response literature that limit our ability to precisely guide clinical trials.

Out-of-hospital cardiac arrest (OHCA) in children is a rare but catastrophic event, often resulting in significant neurological injury. Targeted temperature management (TTM), including therapeutic hypothermia (TH), has been proposed as a neuroprotective strategy. This systematic review and meta-analysis aims to evaluate the effects of different TTM strategies on survival and neurological outcomes in pediatric patients after OHCA. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Pooled outcomes were synthesized using odds ratios (OR) with 95% confidence intervals (CI), and the certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of nine studies encompassing 2107 pediatric patients were included. TH was associated with significantly higher odds of survival (OR: 1.72; 95% CI: 1.36-2.18; < 0.0001) and favorable neurological outcome (OR: 1.64; 95% CI: 1.16-2.33; = 0.006) compared to normothermia. Subgroup analysis demonstrated greater survival benefit at 12 months and improved neurological outcomes at 6-12 months. There were no statistically significant differences between groups in blood lactate levels, odds of arrhythmia, culture-proven infections, or length of hospital stay. The certainty of evidence for most outcomes was graded as low due to the predominance of nonrandomized studies and imprecision. TH as a TTM strategy following pediatric OHCA may offer survival and neurological advantage, particularly at longer-term follow-up, without a significant increase in adverse events. However, the low certainty of evidence highlights the need for further high-quality randomized trials to inform clinical practice and optimize neuroprotective care in this vulnerable population.

This investigation seeks to assess the impact of various temperature management approaches on the rates of death and organ failure among adult patients suffering from sepsis. A comprehensive search of PubMed, Embase, and CENTRAL was performed to identify randomized controlled trials (RCTs) published up to September 2024. These trials examined the impact of temperature management strategies on sepsis patients. Two independent investigators conducted literature screening, quality assessment, and data extraction. A meta-analysis was conducted using a fixed-effect model to evaluate outcome measures, including mortality and organ dysfunction. This study is registered with PROSPERO, CRD42024627677. The analysis incorporated eight RCTs, involving 1843 patients. The findings demonstrated that the management of hyperthermia markedly diminished the mortality risk among individuals suffering from sepsis (risk ratio = 0.47, 95% confidence interval [CI]: 0.37-0.59, < 0.001), exhibiting low heterogeneity ( = 39%). However, the effects of hyperthermia on organ dysfunction remained unclear (Mean Difference , 95% CI: -1.91 to 0.07, = 0.07), exhibiting low heterogeneity ( = 0%). However, these effects on organ dysfunction were based on only two studies and 215 patients, which made them prone to a type II error. Hyperthermia management strategies are effective in reducing mortality among adults with sepsis. However, their impact on organ dysfunction requires further investigation through high-quality RCTs. Despite the limitations of this study, hyperthermia strategies offer a promising approach to multidimensional intervention in sepsis. Further studies should strengthen structured subgroup analyses and mechanistic studies based on RCTs to optimize treatment strategies under various clinical scenarios.

To perform a systematic review and meta-analysis to examine the association between persistent pulmonary hypertension (PPHN) and receipt of therapeutic hypothermia (TH), compared to those who did not receive TH, among infants with moderate or severe hypoxic-ischemic encephalopathy (HIE). Systematic review and meta-analysis based on Ovid, Medline, Embase and Cochrane central searches from 01/01/2000 to 31/03/2025. We included only randomized control trials for meta-analysis and followed international guidelines for conducting systematic reviews. The primary outcome of the study was PPHN in infants undergoing TH for moderate to severe HIE. Among 185 articles identified using search strategy, 19 articles were assessed for eligibility. Eight randomized control trials (RCTs) met the inclusion criteria, and seven were included in meta-analysis. A random effects model used for the outcome of PPHN, comparing TH with NT or usual care, involving a pooled population of 1006 infants across seven studies. The relative risk of PPHN for TH versus NT was 1.13 (95% confidence interval 0.81 to 1.57). We noted risk of bias in the blinding of participants across included RCTs. We assessed nine observational studies and performed a narrative review. We noted that a considerable number of infants developed PPHN across TH and NT groups. We did not find evidence of an association between TH and PPHN in infants with moderate to severe HIE, although a considerable number of infants developed PPHN across both groups. We suggest that clinicians should be aware of the risk of PPHN to allow prompt investigation and management.

Hypoxic-ischemic encephalopathy (HIE) affects 1.3-1.7 per 1000 live births and remains a major cause of neurodevelopmental impairment (NDI). Despite therapeutic hypothermia (TH), nearly half of infants with moderate to severe HIE experience death or NDI. Identifying early prognostic indicators before TH initiation is crucial for improving management and outcomes. We conducted a retrospective case-control study of 144 infants with HIE treated with TH at Kagoshima City Hospital (2000-2022); 100 underwent developmental evaluations at 18 months. Clinical parameters, including amplitude-integrated EEG (aEEG), Thompson scores, and resuscitation details, were analyzed. Logistic regression identified predictors of adverse outcomes: death, cerebral palsy, or developmental quotient <70. Univariate analysis revealed significant predictors, including low Apgar scores, low umbilical artery pH, aEEG abnormalities, high Thompson scores, and resuscitation details. Multivariate regression identified three independent predictors: aEEG abnormalities (adjusted odds ratios [aOR] 7.1, 95% confidence interval [CI]: 1.3-38.2), Thompson score ≥12 (aOR 5.4, 95% CI: 1.5-18.7), and chest compressions (aOR 31.6, 95% CI: 4.3-231.6). We developed and derived early prognostic model from these predictors, assigning +2 points for aEEG abnormalities, +2 points for a Thompson score ≥12, and +3 points for chest compressions. A total score ≥4 achieved high sensitivity (70.4%) and specificity (90.4%), with an area under the curve of 0.87 (95% CI: 0.77-0.94). The early prognostic model may serve as an effective tool for early risk stratification in neonates with HIE before TH initiation, supporting individualized treatment decisions. This score could help identify high-risk neonates who may benefit from additional neuroprotective strategies.

This study aimed to explore the effect of the temperature chain management scheme on inadvertent perioperative hypothermia (IPH) during gynecological laparoscopic surgery. A total of 48 female adult patients who underwent elective gynecological laparoscopic surgery under general anesthesia from November 2023 to April 2024 in a teaching hospital were enrolled and randomized to receive either intraoperative prewarming fluid alone (Group C) or temperature chain management (Group T). Comparing the perioperative core and peripheral temperatures, IPH rates, shivering in postanesthesia care unit (PACU), and thermal comfort in two groups, perioperative core temperature of Group T was higher than that of Group C ( < 0.05); IPH rates and the incidence of shivering in PACU of Group T were lower than that of Group C ( < 0.05); Group T scored higher in thermal comfort than Group C when entering PACU ( < 0.05). This study reports that the use of intraoperative prewarming fluid alone does not sufficiently warm the patients. The optimal temperature management is achieved when using temperature chain management during gynecological laparoscopic surgery.

The aim of this study is to address the limited research on skin frostbite models and the gaps in pathological identification of time-series injuries in frostbitten skin, which hinder comprehensive assessment of injury severity. A deep second-degree frostbite model was developed in BALB/c nude mice, and staining identification was performed at various stages, from the onset of frostbite to the healing process. Continuous observations at multiple time points provided a more accurate and comprehensive standard for comparison in frostbite treatment experiments. A deep second-degree frostbite model was developed using BALB/c nude mice. Histopathological examination was performed with hematoxylin-eosin (HE) staining, while Masson's Trichrome (MT) staining was used to observe collagen recovery. Additionally, immunofluorescence staining was conducted to analyze epidermal cells and dermal structures. A deep second-degree frostbite model was successfully developed in BALB/c nude mice. Histopathological characteristics of mouse skin tissue were examined through HE staining at various time points. MT staining highlighted changes in the morphology and thickness of the original fibers. Immunofluorescence staining offered a detailed evaluation of the damage and recovery of appendages, including hair follicles and sweat glands. The deep second-degree frostbite model in BALB/c nude mice establishes a standard for studying skin frostbite injuries and developing related treatments.

Hypoxic-ischemic encephalopathy (HIE) is a constellation of neurological signs as a result of hypoxia, hypercapnia, metabolic acidosis, and cerebral ischemia before birth. The aim was to evaluate risk factors, clinical and laboratory findings, and morbidity and mortality in neonates diagnosed with HIE who underwent therapeutic hypothermia (TH). Between January 2015 and December 2020, neonates diagnosed with HIE were evaluated in the neonatal intensive care unit. Risk factors, sociodemographic characteristics, degree of encephalopathy, clinical and laboratory findings, results of amplitude-integrated electroencephalography (aEEG), electroencephalography (EEG), magnetic resonance imaging (MRI) including diffusion weighted imaging (DWI) and cranial ultrasound (cUS), and mortality were retrospectively recorded. Of the 81 cases, we followed up with a diagnosis of HIE. When the patients were divided into groups and evaluated according to the Sarnat & Sarnat staging system, it was observed that 22 (27.2%) of the patients had mild HIE, 49 (60.5%) of the patients had moderate HIE, and 10 (12.3%) of the patients had severe HIE. The aEEG, EEG, DWI, and renal pathology of patients with seizures were statistically significantly higher than those of patients without seizures ( = 0.004, = 0.002, = 0.014, = 0.025). MRI was performed in 66 patients within the first 7 days of life, and diffusional restriction was found in 22 of them. We found that DWI is superior to cUS in determining the severity of hypoxic injury and that renal involvement may be associated with poor neurodevelopmental outcomes. Due to the abnormal prognostic findings detected in infants with mild HIE, the existence of a standard definition of mild HIE that will determine the efficacy and reliability of therapeutic hypothermia will enable at risk infants to benefit from neuroprotective strategies.

The objective of this study was to assess the adherence to inclusion criteria for therapeutic hypothermia (TH) in neonates with hypoxic-ischemic encephalopathy (HIE) and to survey current attitudes on TH. This multicenter observational study therefore combined a retrospective analysis of the Swiss National Asphyxia and Cooling Register (2011-2023) and a prospective survey (2024) among neonatologists in the Canton of Zurich, Switzerland. A total of 456 neonates with HIE were registered in the Swiss National Asphyxia and Cooling Register in the Canton of Zurich, Switzerland, between 2011 and 2023. The rate of TH (52.6% [2011-2017] versus 52.0% [2018-2023]) as well as the incidence of off-protocol cooling remained stable over time ( = 0.614). The survey response rate was 69.5% (57/82). Difficulties with clinical grading of encephalopathy were identified. Subjectively, respondents considered themselves more generous to initiate TH. In conclusion, register data reflected good adherence to inclusion criteria for TH. The survey confirmed willingness to consider TH in milder HIE cases. However, there was no drift in clinical practice-yet?

There are many established strategies to target normothermia in the perioperative period; however, hypothermia remains a common occurrence and can have significant impacts on patient outcomes, unanticipated admissions, and postanesthesia care unit (PACU) throughput. This pilot study serves to shed light on the effectiveness of using high-flow nasal cannula (HFNC) as an alternative to a Bair Hugger (BH). This pilot study compares 10 patients warmed to normothermia with HFNC in the PACU with 15 patients warmed with traditional BH. Patients in the HFNC group reached the goal temperature of 36°C 9.1 minutes faster than the BH group. However, these findings were not statistically significant (mean time: 72.1 minutes vs 81.2; = 0.247). In addition, phase 1 recovery times were about 8 minutes longer in the HFNC group compared with the BH group but were also not statistically significant (mean time: 180.8 minutes vs 172.4; = 0.338). Based on the initial data, HFNC may play an important role in the future by making PACU rewarming more efficient and therefore having a huge impact on PACU discharge times, unanticipated hospital admissions, delayed emergence from anesthesia, and morbid cardiac events. Further large scale, randomized control studies need to be done to investigate HFNC as an alternative rewarming method for hypothermic patients in the PACU.

Intraoperative hypothermia is associated with various perioperative complications and an increased risk of mortality. This study aims to develop and validate a reliable risk model, the Intraoperative Hypothermia Risk Estimating Model (IHREM), for assessing the likelihood of intraoperative hypothermia in adult patients receiving different types of surgery and anesthesia. Data from 1815 surgical patients were collected, with 1521 used to develop the IHREM training set. Univariate logistic regression was utilized to evaluate the parameters included in the study. For the first time, parameters showing non-linear associations with the risk of intraoperative hypothermia were evaluated and then incorporated into a primary model using restricted cubic splines (RCS), based on the result of multivariate logistic regression. The final model was comprised of 12 risk factors, including body mass index (BMI), fasting time, preoperative heart rate, preoperative tympanic temperature, intravenous fluid administration volume, intraoperative irrigation volume, estimated blood loss, duration of anesthesia, surgical position, intraoperative warming, operation room temperature, and humidity. The IHREM model demonstrated satisfactory performance in the training set, exhibiting reliable discrimination, calibration, overall performance, and clinical utility. In the temporal validation set ( = 294), the c-index, calibration intercept and calibration slope, Brier score, and were determined to be 0.763 (95% CI, 0.710-0.819), 0.394 (95% CI, 0.118-0.680), 0.865 (95% CI, 0.638-1.114), 0.204 (95% CI, 0.180-0.229), and 0.236, respectively. Meanwhile, decision curve analysis and clinical impact curve showed that IHREM provides promising clinical value. In addition, RCS analysis indicated that maintaining the operation room temperature above 20°C is sufficient to prevent hypothermia while increasing or sustaining the preoperative core temperature to around 36.7-36.8°C significantly reduces the risk of hypothermia. IHREM holds promise as a valuable tool for identifying adult patients at risk of intraoperative hypothermia under various types of surgery and anesthesia, thereby supporting clinical decision-making.

Primary dysmenorrhea is a prevalent condition causing severe menstrual pain in nulliparous women, negatively impacting daily functioning and well-being. This randomized controlled trial investigated the efficacy of cryotherapy in alleviating pain and enhancing secondary outcomes such as sleep quality, quality of life, and physical activity. Fifty-eight nulliparous women were randomly assigned to a cryotherapy group or a control group. Pain intensity was measured using the Numeric Rating Scale, whereas secondary outcomes were evaluated with the Pittsburgh Sleep Quality Index, World Health Organization Quality of Life-Brief Version, and the International Physical Activity Questionnaire. Socioeconomic factors, including household income, education, and occupation, were also assessed. Cryotherapy significantly reduced pain intensity from a baseline of 7.1 ± 1.4 to 1.8 ± 1.7 ( < 0.001) compared with a modest reduction in the control group (5.9 ± 1.9-5.4 ± 2.1). Sleep quality improved more in the cryotherapy group (6.90 ± 3.0 to 5.03 ± 2.5) than in the control group (6.88 ± 3.6 to 5.68 ± 2.8). However, no statistically significant changes were observed in the quality of life or physical activity levels, likely because menstrual pain alone may not sufficiently influence these domains, which are affected by broader psychosocial and behavioral factors. These findings demonstrate that cryotherapy is a simple, cost-effective intervention for managing primary dysmenorrhea, providing substantial pain relief and modest improvements in sleep quality. Further research is recommended to evaluate its long-term benefits and potential for broader applications in menstrual health management.

Therapeutic hypothermia is a critical intervention in post-cardiac arrest care, yet the optimal cooling method remains debatable. This prospective, single-center study compared the efficacy of a novel craniocerebral hypothermia helmet with the Arctic Sun 5000 surface cooling system in post-cardiac arrest patients. Thirty-four comatose survivors of cardiac arrest were randomized to receive either craniocerebral hypothermia ( = 17) or peripheral surface cooling ( = 17). Target temperature management (32-34°C) was initiated within 30-120 minutes of return of spontaneous circulation and maintained for 36-48 hours. Craniocerebral hypothermia demonstrated significantly faster cooling initiation (32.9 ± 13.5 vs. 238 ± 25.7 minutes, < 0.001) compared with peripheral cooling, while both methods achieved similar target temperature maintenance. The craniocerebral group showed better preservation of renal function and electrolyte stability, with significantly lower increases in serum creatinine and urea levels ( < 0.001). Hospital stays were notably shorter in the craniocerebral group (13 ± 7 vs. 24.29 ± 31 days, < 0.001). While both methods achieved comparable survival rates, the craniocerebral group exhibited a lower incidence of seizures (17.6% vs. 66.6%) and improved neurological outcomes based on Cerebral Performance Category scores though not reaching statistical significance. These findings suggest that craniocerebral hypothermia offers advantages in terms of rapid cooling initiation, physiological stability, and reduced hospital stay, representing a promising alternative for targeted temperature management in post-cardiac arrest care. The enhanced practicality and comparable efficacy of this approach warrant further investigation through larger multicenter trials.

Despite growing evidence supporting the efficacy of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for accidental hypothermia (AH), few studies have assessed its real-world application. We aimed to describe the use and outcomes of VA-ECMO in AH patients using data from a multicenter registry. This retrospective study included adult AH patients from the Japanese accidental hypothermia network registry (J-Point registry) between April 2011 and March 2016. We analyzed patient characteristics, in-hospital data, VA-ECMO indications, and clinical outcomes for those who received VA-ECMO. Of the 537 patients in this registry, 22 received VA-ECMO, with a median age of 80 years. Severe AH was present in 18 patients, and 10 experienced cardiac arrest (CA) on hospital arrival. VA-ECMO was indicated for CA on hospital arrival (10 patients), CA after hospital arrival (5), hemodynamic instability (5), and severe hypothermia (1), with 1 case having an unclear indication. Rewarming was successful in 18 patients, and 9 survived. Survival was higher among those with CA on hospital arrival (5/10) compared with those who developed CA after hospital arrival (1/5). This study highlights the clinical application and outcomes of VA-ECMO for AH patients using multicenter registry data. Among the 22 patients who received VA-ECMO, 9 survived. Patients with CA on hospital arrival showed better survival compared with those who developed CA after arrival, emphasizing the importance of timely VA-ECMO initiation. Further research is warranted to refine patient selection, optimize initiation timing, and evaluate long-term outcomes.

Postcardiac arrest (PCA) syndrome is associated with high cardiovascular morbidity and mortality. Prolongation of the QT interval can lead to life-threatening ventricular arrhythmias and sudden cardiac death. Therapeutic hypothermia (TH) is widely used to improve neurological outcomes in PCA patients, but its effects on the QT interval remain a subject of investigation. This study aimed to evaluate the impact of TH on corrected QT (QTc) intervals in PCA patients. A total of 48 patients (mean age 63.2 ± 11.3 years) who survived cardiac arrest and underwent TH were included. Standard 12-lead electrocardiograms (ECGs) and serum electrolyte levels were assessed before and after TH. The QT and QTc intervals were measured using Bazett's formula, and QT dispersion (QTd) was calculated as the difference between the maximum and minimum QT intervals. Following TH, a significant increase in RR intervals was observed (480.75 ± 91.75 ms vs. 660.43 ± 97.35 ms, < 0.05). QTc intervals increased significantly from 397.13 ± 12.45 ms to 449.25 ± 21.40 ms ( < 0.05). Similarly, QTd increased from 55.48 ± 12.45 ms to 67.41 ± 13.42 ms ( < 0.05). The prolongation of the QT interval was associated with a significant decrease in serum potassium and calcium levels. In conclusion, TH leads to a significant prolongation of the QT and QTc intervals and an increase in QTd. These findings suggest that close ECG monitoring is essential in PCA patients undergoing TH, particularly in those with predisposing factors for arrhythmias.