OBJECTIVE: To investigate the effect of mild hypothermia on neurological function in rats with spinal cord injury (SCI) based on the adenosine monophosphate activated protein kinase (AMPK)/Nod-like receptor protein 3 (NLRP3) pathway. METHODS: Fifty 7-8 weeks old SPF male Sprague Dawley rats were used to establish rat model of SCI by Allen's method. Among them, 48 successfully modeled rats were randomly divided into SCI group, mild hypothermia group (SCI+mild hypothermia treatment), and Compound C group (SCI+mild hypothermia+intraperitoneal injection of 20 mg/kg AMPK/NLRP3 pathway inhibitor Compound C), with 16 rats in each group. Another 16 normal rats with laminectomy were selected as sham-operation group. Basso-Beattie-Bresnahan (BBB) score was used to evaluate the motor ability of rats at 1, 3, 7, 14 days after treatment. After 14 days, the rats were sacrificed, and the spinal cord histopathological morphology was observed by HE staining, the neuronal apoptosis in spinal cord tissue was detected by TUNEL assay, and the serum levels of interleukin 2 (IL-2), IL-6, transforming growth factor β ₁ (TGF-β ₁), malondialdehyde (MDA), and superoxide dismutase (SOD) were detected by ELISA. The expressions of AMPK/NLRP3 pathway proteins in spinal cord tissue, including B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and cleaved-Caspase-9 were detected by Western blot. RESULTS: At 1 day after treatment, the rats in SCI group, mild hypothermia group, and Compound C group did not recover their motor ability. With the prolongation of time, the motor function of rats in each group gradually recovered. Among them, the BBB score of SCI group was significantly lower than that of sham-operation group and mild hypothermia group ( P<0.05), and the BBB score of Compound C group was significantly lower than that of mild hypothermia group ( P<0.05). Compared with the sham-operation group, the SCI group displayed obvious pathological changes in the spinal cord tissue, with disordered tissue architecture, inflammatory infiltration, and blurred interstitial boundaries. The neuronal apoptosis rate, Bax/Bcl-2 ratio, cleaved Caspase-9 expression, NLRP3 protein expression, serum IL-2, IL-6, and MDA levels were elevated, whereas serum TGF-β ₁, SOD levels, and spinal cord phosphorylation AMPK/AMPK protein expression significantly decreased ( P<0.05). Compared with the SCI group, the above phenomena significantly improved in the mild hypothermia group ( P<0.05), while the Compound C group showed the opposite trend of change compared to the mild hypothermia group ( P<0.05). CONCLUSION Mild hypothermia can attenuate neurological dysfunction after SCI in rats, potentially by activating the AMPK/NLRP3 pathway.
Animals ; Spinal Cord Injuries/physiopathology* ; Rats, Sprague-Dawley ; Male ; Rats ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; AMP-Activated Protein Kinases/metabolism* ; Hypothermia, Induced ; Signal Transduction ; Spinal Cord/pathology* ; Apoptosis ; Interleukin-6/metabolism* ; Disease Models, Animal ; bcl-2-Associated X Protein/metabolism* ; Superoxide Dismutase/metabolism* ; Proto-Oncogene Proteins c-bcl-2/metabolism* ; Caspase 9/metabolism*

PURPOSE: To investigate the protective effect of sub-hypothermic mechanical perfusion combined with membrane lung oxygenation on ischemic hypoxic injury of yorkshire brain tissue caused by traumatic blood loss. METHODS: This article performed a random controlled trial. Brain tissue of 7 yorkshire was selected and divided into the sub-low temperature anterograde machine perfusion group (n = 4) and the blank control group (n = 3) using the random number table method. A yorkshire model of brain tissue injury induced by traumatic blood loss was established. Firstly, the perfusion temperature and blood oxygen saturation were monitored in real-time during the perfusion process. The number of red blood cells, hemoglobin content, NA⁺, K⁺, and Ca²⁺ ions concentrations and pH of the perfusate were detected. Following perfusion, we specifically examined the parietal lobe to assess its water content. The prefrontal cortex and hippocampus were then dissected for histological evaluation, allowing us to investigate potential regional differences in tissue injury. The blank control group was sampled directly before perfusion. All statistical analyses and graphs were performed using GraphPad Prism 8.0 Student t-test. All tests were two-sided, and p value of less than 0.05 was considered to indicate statistical significance. RESULTS: The contents of red blood cells and hemoglobin during perfusion were maintained at normal levels but more red blood cells were destroyed 3 h after the perfusion. The blood oxygen saturation of the perfusion group was maintained at 95% - 98%. NA⁺ and K⁺ concentrations were normal most of the time during perfusion but increased significantly at about 4 h. The Ca²⁺ concentration remained within the normal range at each period. Glucose levels were slightly higher than the baseline level. The pH of the perfusion solution was slightly lower at the beginning of perfusion, and then gradually increased to the normal level. The water content of brain tissue in the sub-low and docile perfusion group was 78.95% ± 0.39%, which was significantly higher than that in the control group (75.27% ± 0.55%, t = 10.49, p < 0.001), and the difference was statistically significant. Compared with the blank control group, the structure and morphology of pyramidal neurons in the prefrontal cortex and CA1 region of the hippocampal gyrus were similar, and their integrity was better. The structural integrity of granulosa neurons was destroyed and cell edema increased in the perfusion group compared with the blank control group. Immunofluorescence staining for glail fibrillary acidic protein and Iba1, markers of glial cells, revealed well-preserved cell structures in the perfusion group. While there were indications of abnormal cellular activity, the analysis showed no significant difference in axon thickness or integrity compared to the 1-h blank control group. CONCLUSIONS Mild hypothermic machine perfusion can improve ischemia and hypoxia injury of yorkshire brain tissue caused by traumatic blood loss and delay the necrosis and apoptosis of yorkshire brain tissue by continuous oxygen supply, maintaining ion homeostasis and reducing tissue metabolism level.
Animals ; Perfusion/methods* ; Disease Models, Animal ; Brain Injuries/etiology* ; Swine ; Male ; Hypothermia, Induced/methods*

At present, research on the efficacy of local physical cooling devices is mainly based on clinical observation, but there is relatively little research on evaluating the effectiveness of local cold therapy cooling and the penetration depth. This study is based on the research of the structure and morphology of local muscle tissue in the human body, as well as the heat transfer characteristics and mechanisms of the human body. A simulation phantom of human muscle tissue under temperature cycling was created, and the differences in evaluating the effectiveness of local cold therapy between the human body and the simulation phantom were compared. This provides a new evaluation method for evaluating the cooling effectiveness of local physical cooling equipment.
Humans ; Phantoms, Imaging ; Hypothermia, Induced/methods*

OBJECTIVES: To develop risk prediction models for postoperative hypothermia after transurethral holmium laser enucleation of the prostate (HoLEP) using machine learning algorithms. METHODS: We retrospectively analyzed the clinical data of 403 patients from our center (283 patients in the training set and 120in the internal validation set) and 120 patients from Weifang People's Hospital (as the external validation set). The risk prediction models were built using logistic regression, decision tree and support vector machine (SVM), and model performance was evaluated in terms of accuracy, recall, precision, F1 score and AUC. RESULTS: Operation duration, prostate weight, intraoperative irrigation volume, and being underweight were identified as the predictors of postoperative hypothermia following HoLEP. Among the 3 algorithms, SVM showed the best precision rate and accuracy in all the 3 data sets and the best area under the ROC (AUC) in the training set and validation set, followed by logistic regression, which had a similar AUC in the two data sets. SVM outperformed logistic regression and decision tree models in the validation set in precision, accuracy, recall, F1 score, and AUC, and performed well in the external validation set with better precision rate and accuracy than logistic regression and decision tree models but slightly lower recall rate, F1 index, and AUC value than the decision tree model. SVM outperformed logistic regression and decision tree models in precision, accuracy, F1 score, and AUC in the training set, but had slightly lower recall rate than the decision tree. CONCLUSIONS Among the 3 models, SVM has the best performance and generalizability for predicting post-HoLEP hypothermia risk to provide support for clinical decisions.
Humans ; Male ; Retrospective Studies ; Machine Learning ; Transurethral Resection of Prostate/adverse effects* ; Hypothermia/etiology* ; Prostatic Hyperplasia/surgery* ; Algorithms ; Lasers, Solid-State ; Risk Assessment ; Postoperative Complications ; Decision Trees ; Logistic Models ; Aged ; Middle Aged ; Support Vector Machine

OBJECTIVES: To investigate the relationship between hypothermia duration and postoperative complications in patients undergoing gynecological surgery. METHODS: Patients who underwent elective gynecological surgery at our hospital were consecutively enrolled between October 2020 and January 2022. Core temperature was continuously monitored intraoperatively, and early postoperative complications were collected. By adjusting the logistic regression model for potential confounding factors, the association of postoperative complications with the duration of hypothermia, the lowest body temperature below 36°‍C, and the hypothermia upon admission to postanesthesia care unit (PACU) or intensive care unit (ICU) were analyzed. Additionally, the potential inflection point in the relationship between the duration of hypothermia and the risk of postoperative complications was explored by using cumulative probability scatter plots and moving average sequences. RESULTS: The study included 370 patients, with 193 (52.2%) experiencing hypothermia and 177 (47.8%) not. Among them, 92 (24.9%) developed complications. The duration of hypothermia (adjusted odds ratio [OR] for each one-minute increase: 1.003; 95% confidence interval [CI]: 1.000-1.006, P=0.047) and hypothermia upon admission to PACU or ICU (adjusted OR: 1.980; 95% CI: 1.135-3.454, P=0.016) were associated with early postoperative complications. Notably, the cumulative incidence of postoperative complications tended to rise as the duration of hypothermia increased, with a potential inflection point observed at 120 minutes. CONCLUSIONS In gynecological surgery, the duration of hypothermia as well as hypothermia upon admission to PACU or ICU are associated with postoperative complications. Minimizing the duration of hypothermia may be clinically beneficial.
Humans ; Female ; Hypothermia/epidemiology* ; Postoperative Complications/etiology* ; Gynecologic Surgical Procedures/adverse effects* ; Prospective Studies ; Middle Aged ; Adult ; Intensive Care Units ; Time Factors ; Aged

OBJECTIVES: Postoperative hypothermia is a common clinical complication with a high incidence rate, potentially adversely affecting postoperative recovery. Transurethral holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure for benign prostatic hyperplasia (BPH). Offering advantages such as minimal bleeding, broad indications, and rapid postoperative recovery. However, research on risk factors for postoperative hypothermia following HoLEP remains limited, and predictive models for guiding clinical practice are lacking. This study aims to develop a predictive model for assessing the risk of postoperative hypothermia in HoLEP patients and to identify relevant risk factors. METHODS: Clinical data from patients who underwent HoLEP at affiliated Hospital of Shandong Second Medical University were retrospectively collected. Patients were categorized into a hypothermia group and a non-hypothermia group based on whether postoperative hypothermia occurred. Preoperative, intraoperative, and postoperative indicators were compared between the 2 groups. Least absolute shrinkage and selection operator (LASSO) regression combined with logistic regression analysis was used to analyze clinical data. A predictive model for assessing the risk of postoperative hypothermia after HoLEP was constructed and internally validated using bootstrap resampling. RESULTS: A total of 403 patients were included in the analysis, among whom 85 patients developed postoperative hypothermia, with an incidence rate of 21.1%. Logistic regression analysis identified operative duration (OR=1.009, 95% CI 1.003 to 1.015), underweight status (OR=9.881, 95% CI 4.038 to 24.910), and prostate weight (OR=1.021, 95% CI 1.012 to 1.030) as independent risk factors for postoperative hypothermia, and these variables were incorporated into the nomogram model. Internal validation showed strong discriminative ability of the nomogram, with an area under the receiver operating characteristic curve (AUC) of 0.755 (95% CI 0.686 to 0.820) and a C-index of 0.832 (95% CI 0.787 to 0.865). The calibration curve demonstrated good consistency between predicted and observed outcomes. Decision curve analysis showed that the nomogram provided greater clinical utility when the risk threshold for postoperative hypothermia was between 8% and 97%. CONCLUSIONS This study developed a nomogram model for predicting the risk of postoperative hypothermia in HoLEP patients, providing clinicians with a simple and effective predictive tool for individualized risk assessment and preoperative decision-making.
Humans ; Male ; Nomograms ; Prostatic Hyperplasia/surgery* ; Lasers, Solid-State/adverse effects* ; Risk Factors ; Retrospective Studies ; Transurethral Resection of Prostate/methods* ; Postoperative Complications/epidemiology* ; Hypothermia/epidemiology* ; Middle Aged ; Aged

To evaluate the effectiveness of intervention plans developed by the evidence base multi-discipline critical strategies (EBPCS) on temperature and clinical outcomes in very preterm infants (VPIs) born at<32 weeks. Clinical data were collected from VPIs born in the delivery room/operating room of Chengdu Women's and Children's Central Hospital from May 1, 2021, to May 31, 2022, who required immediate temperature management and were transferred to the neonatal intensive care unit (NICU) of the hospital. The study population was randomly divided into a control group and an intervention group based on the random number table method, with 108 cases in each group. The control group implemented the conventional temperature management recommended by domestic guidelines, while the intervention group adopted EBPCS interventions compared to the control group. The differences in body temperature and clinical outcomes between the two groups were compared after the implementation of different temperature management strategies. A total of 216 VPIs were included. The intervention group had a lower incidence of hypothermia (30.55% vs. 87.03%, P<0.001), higher mean body temperature admitted to the NICU [(36.56±0.31) ℃ vs. (35.77±0.53) ℃, P<0.001], a lower dose of pulmonary surfactant [(115.94±36.96) mg/kg vs. (151.41±54.68) mg/kg, P=0.014], shorter duration of mechanical ventilation [(5.77±1.26) days vs. (14.19±4.63) days, P=0.006], and lower incidence of intraventricular haemorrhage (12.04% vs. 23.15%, P=0.032). The implementation of temperature intervention strategies developed by the EBPCS for VPIs after birth could prevent and reduce the incidence of hypothermia and improve clinical outcomes.
Child ; Female ; Humans ; Infant ; Infant, Newborn ; Fever ; Hypothermia/prevention & control* ; Infant, Premature ; Infant, Very Low Birth Weight ; Temperature

To evaluate the effectiveness of intervention plans developed by the evidence base multi-discipline critical strategies (EBPCS) on temperature and clinical outcomes in very preterm infants (VPIs) born at<32 weeks. Clinical data were collected from VPIs born in the delivery room/operating room of Chengdu Women's and Children's Central Hospital from May 1, 2021, to May 31, 2022, who required immediate temperature management and were transferred to the neonatal intensive care unit (NICU) of the hospital. The study population was randomly divided into a control group and an intervention group based on the random number table method, with 108 cases in each group. The control group implemented the conventional temperature management recommended by domestic guidelines, while the intervention group adopted EBPCS interventions compared to the control group. The differences in body temperature and clinical outcomes between the two groups were compared after the implementation of different temperature management strategies. A total of 216 VPIs were included. The intervention group had a lower incidence of hypothermia (30.55% vs. 87.03%, P<0.001), higher mean body temperature admitted to the NICU [(36.56±0.31) ℃ vs. (35.77±0.53) ℃, P<0.001], a lower dose of pulmonary surfactant [(115.94±36.96) mg/kg vs. (151.41±54.68) mg/kg, P=0.014], shorter duration of mechanical ventilation [(5.77±1.26) days vs. (14.19±4.63) days, P=0.006], and lower incidence of intraventricular haemorrhage (12.04% vs. 23.15%, P=0.032). The implementation of temperature intervention strategies developed by the EBPCS for VPIs after birth could prevent and reduce the incidence of hypothermia and improve clinical outcomes.
Child ; Female ; Humans ; Infant ; Infant, Newborn ; Fever ; Hypothermia/prevention & control* ; Infant, Premature ; Infant, Very Low Birth Weight ; Temperature

Compared with conventional cardiopulmonary resuscitation (CCPR), extracorporeal cardiopulmonary resuscitation (ECPR) can improve the survival rate of patients with cardiac arrest, and reduce the risk of reperfusion injury. However, it is still difficult to avoid the risk of secondary brain damage. Low temperature management has good neuroprotective potential for ECPR patients, which minimizes brain damage. However, unlike CCPR, ECPR has no clear prognostic indicator. The relationship between ECPR combined with hypothermia management-related treatment measure and neurological prognosis is not clear. This article reviews the effect of ECPR combined with different therapeutic hypothermia on brain protection and provides a reference for the prevention and treatment of neurological injury in patients with ECPR.
Humans ; Brain ; Cardiopulmonary Resuscitation ; Brain Injuries ; Hypothermia, Induced ; Heart Arrest

Targeted temperature management (TTM) has been partially applied in patients with restoration of spontaneous circulation (ROSC) after cardiac arrest (CA). In the 2020 American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines, TTM is used as advanced life support after ROSC for the treatment of patients with CPR. TTM has a protective effect on cardiac function after CA, but the specific mechanism of its protective effect on cardiac function remains unclear. In this paper, the basic experimental progress, clinical trial progress and development prospect of TTM on the protective mechanism of cardiac function after CA are reviewed.
United States ; Humans ; Cardiopulmonary Resuscitation/methods* ; Temperature ; Heart Arrest/therapy* ; Hypothermia, Induced/methods* ; Body Temperature