Burns are a significant cause of morbidity and mortality in children, ranking third among the causes of injury-related deaths. Maintaining body temperature in burn patients is challenging, with the literature reporting an incidence of hypothermia up to 60%. This study aimed to determine the incidence and independent risk factors of intraoperative hypothermia in pediatric burn surgery. This retrospective observational cohort study included pediatric burn patients who underwent surgery in the pediatric surgery operating room between January 2016 and December 2019, comprising 396 procedures. Hypothermia was defined as a decrease in body temperature to below 36°C. The patients were divided into two groups: Group I (body temperature below 36°C) and Group II (body temperature ≥ 36°C). The study included patients with a median age of 30 months (1-204), and 57.3% were male. The hypothermia group exhibited a higher burn degree (25.3% vs. 10.7%, p < 0.001) and a higher percentage (10 [2-65] vs 6 [2-60], p < 0.001). Hypothermia was significantly higher in patients with flame burns than in those with scald burns (p < 0.001) and higher in the intratracheal general anesthesia group than in the laryngeal mask and mask/sedation groups (p < 0.001). Multivariable logistic regression analysis demonstrated that female gender (odds ratio [OR]: 3.358, p = 0.013), higher American Society of Anesthesiologists (ASA) score (OR: 3.440, p = 0.032), presence of a flame burn (OR: 5.685, p = 0.003), and prolonged duration of anesthesia (OR: 1.011, p = 0.022) were all independent risk factors for hypothermia. In our patient cohort, a high rate of intraoperative hypothermia (38.9%) was identified in pediatric burn patients. Female gender, higher ASA score, presence of a flame burn, and prolonged duration of anesthesia were all independent risk factors for hypothermia.
Shivering is a common complication of targeted temperature management (TTM), which could undermine its neuroprotective benefits by increasing cerebral oxygen consumption and metabolic demand. Buspirone, a 5-HT1A receptor partial agonist, is incorporated into many antishivering protocols for TTM following cardiac arrest, despite limited evidence supporting its efficacy in critically ill patients. We conducted a targeted literature review using PubMed to assess the evidence in favor of the use of buspirone in antishivering protocols during TTM. Experimental, physiological, and clinical studies were reviewed with emphasis placed on study design, patient population, and relevance to critically ill individuals undergoing TTM. Experimental studies in animals and healthy human volunteers show that buspirone can modestly lower core temperature or shivering thresholds. Two small studies (n = 8 each) in healthy male volunteers demonstrated that buspirone reduced the shivering threshold by approximately 0.7°C. A retrospective cohort study (n = 131) in post-cardiac arrest patients showed a reduction in shivering with a multidrug protocol including buspirone, but the independent contribution of buspirone could not be isolated. No randomized controlled trials have evaluated buspirone's efficacy as a standalone antishivering agent in critically ill patients. Current evidence to support the buspirone's use in antishivering protocols is limited and largely extrapolated from noncritical care settings. Given that most patients undergoing TTM already receive sedatives and analgesics with more potent antishivering effects, the incremental benefit of buspirone remains unproven. Furthermore, it adds to the already high burden of polypharmacy in ICU patients and could, in theory, increase the risk of serotonin syndrome. Randomized trials comparing protocols with and without buspirone are needed to determine its clinical utility.
Target temperature management (TTM) is a neuroprotective strategy widely used in acute brain injury. However, its real-world implementation remains highly heterogenous and the clinical implications of different temperature targets and treatment durations are not well defined. This study aimed to describe real-world TTM practices and to explore associations between TTM characteristics, coagulopathy, and in-hospital mortality in patients with acute brain injury. We retrospectively analyzed 180 patients who underwent TTM between January 2011 and December 2024 at a single tertiary medical center. Patients diagnosed with acute brain injury, including aneurysmal subarachnoid hemorrhage, traumatic brain injury (TBI), intracerebral hemorrhage, or acute infarction, were included. Clinical variables, TTM parameters, complications, comorbidities, and in-hospital outcomes were analyzed. Univariable and multivariable analyses were conducted to identify factors associated with in-hospital mortality and TTM-related coagulopathy. In-hospital mortality occurred in 78 patients (43.3%). In multivariable analysis, post-cardiac arrest state (odds ratio [OR] = 3.99, p = 0.003) and coagulopathy during TTM (OR = 5.31, p = 0.005) were significantly associated with increased in-hospital mortality. Coagulopathy occurred in 21 (11.7%) patients and was significantly associated with type of injury, which showed it was most prevalent in TBI. Prolonged duration of TTM was not associated with an increased risk of coagulopathy and was associated with lower in-hospital mortality (OR = 0.30, p < 0.001). Injury subtype demonstrated significant heterogeneity in mortality risk and was retained as a covariate in the final multivariable model. In this real-world cohort, TTM practices varied substantially across acute brain injury subtypes. Coagulopathy was associated with increased in-hospital mortality and occurred more frequently in patients with TBI. Prolonged TTM was associated with lower in-hospital mortality. However, this finding should be interpreted cautiously given the potential for survivorship bias. Mortality risk differed across injury subtypes. These findings suggest that the clinical context and underlying injury type should be considered when applying TTM in patients with acute brain injury.
Hypoxic-ischemic encephalopathy (HIE) is a critical neonatal condition for which therapeutic hypothermia (TH) remains the cornerstone of neuroprotective intervention. Clinical observations and prior studies note that electrolyte imbalances-particularly hyponatremia and hypokalemia-frequently emerge during TH. Therefore, this study explores how activation of the renin-angiotensin-aldosterone system (RAAS) may contribute to sodium (Na) and potassium (K) disturbances in asphyxiated neonates receiving TH. In this prospective study, 38 newborns with HIE treated with TH and 21 healthy term newborns were enrolled. Serum renin, aldosterone, Na, K, and urinary electrolyte levels were measured at 24, 48, and 72 hours postnatally. Receiver operating characteristic analyses assessed the diagnostic performance of renin and aldosterone. Renin and aldosterone levels were significantly elevated in the TH group compared with controls (p < 0.05). Serum sodium levels were consistently lower at all time points (p = 0.001), while potassium levels were significantly reduced at 24 and 72 hours (p < 0.05). Fractional excretion of sodium was increased at 24 hours, and potassium excretion remained elevated throughout the TH period (p < 0.05). Among the biomarkers, aldosterone demonstrated excellent diagnostic performance at 24 hours (AUC = 0.919). Activation of the RAAS is evident in asphyxiated neonates undergoing TH, with aldosterone playing a pivotal role in electrolyte disturbances. These results highlight the clinical importance of vigilant monitoring and timely correction of serum sodium and potassium levels during the hypothermia protocol.
Although evidence-based recommendations for preventing perioperative unintentional hypothermia have long been available, observational studies evaluating their implementation in hospital practice and the effectiveness of preventive interventions in at-risk patients are limited. This study aimed to determine the scope of nursing interventions for preventing perioperative unintentional hypothermia and examine the relationship between patient characteristics and these practices. This study employed a descriptive observational design. Patients undergoing elective surgery in the surgical units (orthopedics, gynecology, urology, neurosurgery, general surgery, and cardiovascular surgery) of a tertiary hospital in Turkey were observed preoperatively, intraoperatively, and on the first postoperative day. The mean age of the participants was 51.30 +/- 19.32 years; 77% were overweight or obese, 55.2% had chronic diseases, and 39.6% underwent surgeries lasting more than 2 hours. The findings indicated that the duration of surgery was a significant determinant of nurses' perioperative hypothermia prevention practices. In longer procedures, nurses' awareness of hypothermia risk increased, which was reflected in patient education, environmental temperature management, and the use of active and passive warming methods (p < 0.05). This study highlights the importance of educational programs, strengthening standard care protocols, and policy development to enhance nurses' awareness and practice in preventing perioperative unintentional hypothermia. In conclusion, effective strategies are needed to improve nursing practice and promote evidence-based interventions in this area.
Therapeutic hypothermia is widely used as a neuroprotective intervention in infants with hypoxic-ischemic encephalopathy (HIE); however, limited data exist regarding the long-term neurodevelopmental outcomes of different cooling strategies. The aim of this study is to compare the long-term neurodevelopmental and cognitive outcomes of combined hypothermia (CH) and whole-body cooling (WBC) treatments in children diagnosed with HIE with each other and with a healthy control group without an HIE diagnosis. This retrospective study included a total of 50 children diagnosed with HIE and treated with cooling therapy, who were followed in the Neonatal Intensive Care Unit of Mersin University between 2015 and 2021. Additionally, a control group was formed from healthy children of a similar age group who attended outpatient clinic checkups between these dates and whose archive records were accessible. We used the Wechsler Intelligence Scale for Children-IV (WISC-IV), the Stroop Test, and the Denver II Developmental Screening Test for neurodevelopmental assessments. Neurodevelopmental outcomes were generally found to be similar between the two groups. However, the Full Scale IQ of the CH group was found to be significantly lower compared to the control group. The groups that underwent cooling treatment showed more abnormalities in the Stroop and Denver tests compared to the control group. Although no significant difference was found between the CH and WBC methods in terms of overall results, weak outcomes in some cognitive subdomains in the CH group were noteworthy. Larger sample sizes and prospective studies are needed.
Fever after brain injury is a known contributor to poor outcomes; however, temperature-modulating devices (TMDs), such as surface and intravascular systems, face significant limitations, including delayed deployment, invasiveness, patient discomfort, skin integrity issues, frequent induction of shivering, and the need for sedation, all of which hinder timely neuroprotective therapy and confound neurological assessments. This first in-human study evaluated the safety and tolerability of an intranasal TMD, which delivers thermoelectrically temperature-regulated air via a nasal cannula to affect the core temperature. Five healthy, awake adult volunteers (median age 34 years old, 57.1% men) underwent intranasal cooling with 5°C cooled air delivered at flow rates between 15 and 58 liters per minute. The primary endpoints were safety and tolerability. The reduction in core body temperature was recorded using an esophageal temperature probe. No pharmacological agents or sedatives were administered to the patient. All participants exhibited a consistent downward trend in core body temperature, with an average reduction of 0.7°C at 30 minutes and 1.2°C at 60 minutes. Notably, no shivering or adverse events related to the intranasal TMD were reported. Cooling was well-tolerated, with esophageal probe placement being the only limiting factor for full protocol completion in some subjects. Participants remained fully conscious and communicative throughout the therapy. This intranasal TMD achieved clinically relevant core cooling without triggering shivering or requiring sedation, thereby addressing the key barriers associated with traditional TMDs. These promising early results support further investigation of this intranasal TMD in patients with acute neurological injury. Future studies should explore its performance in critical care and prehospital environments, where time-sensitive neuroprotection is most impactful.
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; p < 0.0001) and favorable neurological outcome (OR: 1.64; 95% CI: 1.16-2.33; p = 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.
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 in vivo 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 n = 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.
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; p < 0.05); age (OR: 0.984; CI: 0.970-0.970; p < 0.05); smoking (OR: 3.489; CI: 1.999-6.089; p < 0.05); intraoperative fluid volume (OR: 0.999; CI: 0.999-0.999; p < 0.05); surgery duration (OR: 0.996; CI: 0.994-0.998; p < 0.05); and baseline core temperature (OR: 1.859; CI: 1.165-2.965; p < 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 r2 = 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.
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 (n = 22) was warmed using the passive warming method via a thermal blanket, and the control group (n = 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 (p > 0.05). Thermal comfort perception scores during the first 90 minutes were significantly higher in the intervention group (p < 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.
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 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 (p < 0.05); IPH rates and the incidence of shivering in PACU of Group T were lower than that of Group C (p < 0.05); Group T scored higher in thermal comfort than Group C when entering PACU (p < 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.
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.
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.
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.
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.
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 p-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 p-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.
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 (p = 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?
