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Objective: Immersion in water during labor could reduce pain and use of epidural anesthesia during childbirth. The main objective of this study was to evaluate the influence of immersion in water during labor on the use of epidural anesthesia in a midwife care setting., Methods: We conducted a single-center retrospective study of all women who gave birth in the physiological ward of Saint-Étienne University Hospital between October 2020 and December 2022., Results: The study did not find difference between immersion group and control group concerning the use of epidural anesthesia (P=0.49). The immersion group counted more women with a duration of labor greater than 6hours than in the control group. The multivariate analysis adjusted for parity and duration of labor did not find difference between both groups [OR 0.58; 95% CI (0.30; 1.09)]., Conclusion: Even if it does not seem to modify the use of epidurals, immersion in water does not seem to increase maternal and neonatal morbidity and mortality. It represents a therapeutic alternative with reasonable cost to offer for pregnant women who wish to give birth without epidural anesthesia., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: Cold water immersion (CWI) is the most effective treatment for exertional heat stroke (EHS). However, knowledge on core temperature response during CWI treatment and the relation with patient characteristics (i.e., sex, anthropometrics) is limited. Therefore, the current study aimed to examine the core temperature response (in °C) during CWI treatment of recreational athletes participating in large running events and investigate the impact of sex and anthropometric characteristics on the cooling rate (in °C·min -1 )., Methods: This observational study includes 57 athletes ( n = 22 females; 39%) who suffered from EHS during an exercise event in the Netherlands. After admission to the medical facilities, a rectal temperature ( Trec ) probe was inserted and all clothing was removed before immersion in an ice bath (6.4 ± 1.6°C). Rectal temperature was continuously measured throughout treatment, and treatment was continued until Trec ≤ 38.9°C or based on the decision of the emergency physician., Results: Initial Trec did not differ between males (41.3 ± 0.9°C) and females (41.2 ± 0.8°C, P = 0.83). A nonlinear response to CWI was observed, with the decrease in Trec beginning after 6 min of CWI. The decrease in Trec did not differ between both sexes (p time*sex = 0.96). The cooling rate did not differ between males (0.21 ± 0.15°C·min -1 ) and females (0.19 ± 0.08°C·min -1 , P = 0.55), and was not related to body mass, body surface area and body surface area to mass ratio (all P values >0.05)., Conclusions: We demonstrated that the cooling rate during CWI did not differ between men and women suffering from EHS, and that the Trec response to CWI is nonlinear and not dependent on anthropometric characteristics. This suggests that no sex differentiation is needed in the EHS treatment guidelines and confirms the necessity to continuously monitor Trec during treatment., (Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.)

Objective: Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth., Design: Cohort study with non-inferiority design., Setting: Twenty-six UK NHS maternity services., Sample: A total of 73 229 women without antenatal or intrapartum risk factors, using intrapartum water immersion, between 1 January 2015 and 30 June 2022. The analysis excluded 12 827 (17.5%) women who received obstetric or anaesthetic interventions before birth., Methods: Non-inferiority analysis of retrospective and prospective data captured in NHS maternity and neonatal information systems., Main Outcome Measures: Maternal primary outcome: obstetric anal sphincter injury (OASI) by parity; neonatal composite primary outcome: fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48 hours of birth., Results: Rates of the primary outcomes were no higher among waterbirths compared with births out of water: rates of OASI among nulliparous women (waterbirth: 730/15 176 [4.8%] versus births out of water: 641/12 210 [5.3%]; adjusted odds ratio [aOR] 0.97, one-sided 95% CI, -∞ to 1.08); rates of OASI among parous women (waterbirth: 269/24 451 [1.1%] versus births out of water 144/8565 [1.7%]; aOR 0.64, one-sided 95% CI -∞ to 0.78) and rates of the composite adverse outcome among babies (waterbirth 263/9868 [2.7%] versus births out of water 224/5078 [4.4%]; aOR 0.65, one-sided 95% CI -∞ to 0.79)., Conclusion: Among women using water immersion during labour, remaining in the pool and giving birth in water was not associated with an increase in the incidence of adverse primary maternal or neonatal outcomes., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Introduction: We studied field rewarming using a typical winter sleeping bag versus two heated hypothermia wrap systems in a semi-realistic lab simulation., Methods: 10 participants (8 M, 2 F) were cooled to 36.1°C core temperature through 10.5-11.5°C water immersion, then performed 60 min of passive rewarming in 0°C air. The rewarming methods tested were: 1) a -9°C rated mummy-style Sleeping Bag; 2) Doctor Down Rescue Wrap; and 3) Thermal Yielding Vascular Airway Capsule (TYVAC) system; the latter two methods included vapor barriers and two heating pads. Rectal and skin temperatures, along with metabolic heat production calculated via indirect calorimetry, were measured throughout rewarming., Results: One male participant was removed from analysis due to lack of sufficient cooling. Rectal temperature decreased in the remaining participants by ∼1.1-1.2°C to 36.1°C during the initial immersion phase. Over the 60 min of rewarming, rectal temperature changes were Δ0.0 ± 0.6°C in a sleeping bag, Δ+0.2 ± 0.3°C in Doctor Down, and Δ+0.2 ± 0.3°C in TYVAC, with no significant differences across methods. Mean skin temperatures, metabolic heat production, and perceptual measures were also similar across methods with no method×time interactions., Conclusions: After 60 min of passive rewarming in cold conditions, all three rewarming methods were able to stall continued core cooling to levels at or slightly above post-immersion temperatures. With no differences in any physiological measures, it appears that all three rewarming methods are equally viable options for wilderness responders, and the choice should come down to environmetal conditions, availability, convenience, and ergonomics rather than rewarming efficacy.

Type 2 diabetes mellitus (T2DM) is characterised by endothelial dysfunction, leading to increased risk of cardiovascular disease. Emerging evidence suggest that HWI may favourably improve vascular function but data are limited in individual with T2DM. The aim was to investigate whether repeated hot water immersion (HWI) improved macrovascular, microvascular and central haemodynamic function in individuals with T2DM. Fourteen individuals completed a pre-post experimental study where participants were assessed pre- and post-8-10 × 1 h HWI sessions (40 °C water) undertaken within a 14-day period. During HWIs, body position was adjusted to clamp rectal temperature at 38.5-39.0 °C for the duration of the immersion. Stroke volume index (SVi), cardiac index (Q˙ i), resting heart rate (HR), systolic blood pressure (SBP), diastolic BP (DBP), brachial flow-mediated dilation (FMD) and cutaneous microvascular endothelial function (via transdermal iontophoresis) and plasma [nitrate] and [nitrite] (NOX; via ozone chemiluminescence) were assessed pre- and post HWI. Neither brachial FMD measures of macrovascular endothelial function (p = 0.43) or forearm microvascular function (ACh max, p = 0.63; ACh area under curve (AUC), p = 0.63; insulin max, p = 0.51; insulin AUC, p = 0.86) or NOX (p = 0.38) were changed. Q˙ i (p < 0.01), SVi (p < 0.02) and resting HR (p < 0.01) were all significantly reduced following the 10-days HWI intervention. SBP was reduced (p = 0.03), whereas DBP was unchanged (p = 0.56). HWI may represent an appropriate intervention to improve Q˙ I, SVi and BP in individuals with T2DM, but not macrovascular endothelial or cutaneous microvascular function., Competing Interests: Declaration of competing interest All authors report no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

(1) Background: The recovery method is important and decisive in the training system. This study aimed to assess the effects of various post-training recovery methods on muscle damage and strength indicators in Paralympic powerlifting athletes. (2) Methods: A crossover study was conducted involving eleven male athletes (25.4 ± 3.3 years, 70.3 ± 12.1 kg). Muscle damage was assessed using blood biochemical markers (cytokines IL-6, IL-10, and TNF-α) and isometric force indicators, including the maximum isometric force (MIF), time to MIF, and Rate of Force Development. The following assessments were performed before, immediately after, and at 24 and 48 h after the recovery protocol: (a) passive recovery (RP) or (b) cold-water immersion (CWI). (3) Results: The main results indicated that maximum isometric force (MIF) significantly improved after 48 h of CWI application ( p < 0.05; for all comparison). The analysis of biochemical markers did not yield significant differences between the recovery methods at different time points ( p > 0.05). For IL-6, there were significant differences between CWI before (2.29 ± 1.08, 95% CI 1.57-3.01) and CWI 2 h later (2 h) (4.59 ± 2.96, 95% CI 2.60-6.57; p = 0.045), and between CWI 15 min later (15 min) (4.14 ± 2.24, 95% CI 2.63-5.64) and CWI 48 h later (48 h) (2.33 ± 1.25, 95% CI 1.49-3.17; p = 0.034). There were differences between CWI 2 h (4.14 ± 2.24, 95% CI 2.63-5.64) and CWI 48 h later (2.33 ± 1.25, 95% CI 1.49-3.17; p = 0.035; F = 9.202; η 2 p = 0.479; high effect). (4) Conclusions: CWI significantly improved the post-resistance training muscle damage and strength in Paralympic powerlifting athletes.

The growing prevalence of heat stroke as a public health issue, exacerbated by climate change and increasing global temperatures, demands an immediate and strategic response to prevent weather-related morbidity and mortality. Heat stroke results from the body's inability to cope with excessive heat, leading to systemic inflammatory responses, cellular apoptosis, and potential multiorgan dysfunction or failure. However, little information explicitly outlines how to perform cold-water immersion in the emergency department (ED), including potential patient selection, how much water or ice to use, target temperatures, when to stop, and complications or challenges with the process. This narrative explores implementing a comprehensive protocol for total-body cold-water immersion developed in an ED setting, a method proven effective in rapidly reducing core body temperatures, with the goal of reducing mortality and morbidity rates associated with heat-related illnesses. The protocol involves immediate temperature assessment, followed by cold-water immersion for patients with altered mental status and core temperatures above 40 °C. Discussion about the development of the process and results from applying the protocol during the summer of 2023, including cooling rates and patient outcomes, is also included. Additionally, the article addresses challenges and lessons learned during the protocol's implementation, emphasizing the importance of multidisciplinary collaboration, staff education, and the adaptation of ED infrastructure to support this lifesaving treatment based on its use during the last 3 years. The successful resolution of the presented cases, along with the protocol's potential for widespread adoption, illustrates the critical role of cold-water immersion in enhancing ED responses to heat stroke, offering a blueprint for future research and the development of similar protocols across health care settings. This work contributes to the evolving landscape of emergency medicine and aligns with the global effort to combat the adverse health effects of climate change., (Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Ribosome biogenesis is an important regulator of skeletal muscle hypertrophy induced by repeated bouts of resistance exercise (RE). Hot-water immersion (HWI), a widely used post-exercise recovery strategy, activates the mechanistic target of rapamycin (mTOR) signaling, a key regulator of ribosome biogenesis in skeletal muscle. However, the effect of HWI on skeletal muscle ribosome biogenesis is not well understood. Here, we aimed to investigate the effects of HWI and post-exercise HWI on ribosome biogenesis using a rat RE model. Male Sprague-Dawley rats were randomly assigned to HWI and non-HWI groups. In both groups, the right leg was isometrically exercised using transcutaneous electrical stimulation, while the left leg was used as an internal non-RE control. Following RE, both limbs were immersed in hot water (41.2 ± 0.03°C) for 20 min under isoflurane anesthesia in the HWI group and the gastrocnemius muscles were sampled at 3- and 24-h post-exercise. HWI significantly increased mTOR signaling and c-Myc mRNA expression, whereas post-exercise HWI significantly increased transcription initiation factor-IA mRNA expression. However, neither HWI nor post-exercise HWI enhanced 45S pre-rRNA expression, ribosomal RNA, or ribosomal protein content. In addition, HWI tended to decrease 28S rRNA and 18S rRNA content, widely used markers of ribosome content. These results suggest that HWI as a post-exercise recovery is not effective in activating ribosome biogenesis. NEW & NOTEWORTHY Ribosome biogenesis is crucial in resistance exercise (RE)-induced skeletal muscle hypertrophy. This study examined the effects of hot-water immersion (HWI) on ribosome biogenesis after RE. HWI and post-exercise HWI increased c- Myc and transcription initiation factor-IA mRNA but did not alter ribosomal RNA transcription or ribosomal protein content. HWI tended to decrease 28S and 18S ribosomal RNA. These findings suggest that HWI, as a recovery strategy, does not effectively promote ribosome biogenesis or muscle protein synthesis.

Background: Immersion pulmonary edema (IPE) is a form of hemodynamic edema likely involving individual susceptibility., Research Question: Can assessing right ventricle (RV) systolic adaptation during immersion be a marker for IPE susceptibility?, Study Design and Methods: Twenty-eight divers participated: 15 study participants with a history of IPE (IPE group; mean ± SD age, 40.2 ± 8.2 years; two women) and 13 control participants (no IPE group; mean ± SD age, 43.1 ± 8.5 years; two women) underwent three transthoracic echocardiography studies under three different conditions: dry (participants were in the supine position on an examination table without immersion), surface immersion (participants were floating prone on the water's surface and breathing through a snorkel), and immersion and negative static lung load (divers were submerged 20 cm below the water's surface in the prone position using a specific snorkel connected to the surface for breathing). Echocardiographic measurements included tricuspid annular plane systolic excursion (TAPSE), tissue S' wave, and right ventricle global strain (RVGLS)., Results: For all divers, immersion increased RV preload. In the no IPE group, the increase in RV preload induced by immersion was accompanied by an improvement in the contractility of the RV, as evidenced by increases in TAPSE (17.08 ± 1.15 mm vs 20.89 ± 1.32 mm), S' wave (14.58 ± 2.91 cm/s vs. 16.26 ± 2.77 cm/s), and RVGLS (25.37 ± 2.79 % vs. 27.09 ± 2.89 %). Negative SLL amplified these RV adaptations. In contrast, among divers with IPE, the increase in RV preload did not coincide with an improvement in RV contractility, indicating altered adaptive responses. In the IPE group, the TAPSE values changed from 17.19 ± 1.28 mm to 21.69 ± 1.67 mm and then to 23.55 ± 0.78 mm, respectively, in the dry, surface immersion, and immersion and negative SLL conditions. The S' wave values changed from 13.42 ± 2.94 cm/s to 13.26 ± 2.96 cm/s and then to 12.49 ± 0.77 cm/s, respectively, and the RVGLS values changed from -24.09% ± 2.91% to -23.99% ± 3.38% and then to -21.96% ± 0.55%, respectively., Interpretation: Changes in RV systolic function induced by immersion (especially with the addition of negative static lung load) vary among divers based on the history of IPE. Analyzing ventricular contractility during immersion, particularly RVGLS, could help to identify individual susceptibility in divers. These findings provide insights for the development of preventive strategies., Trial Registry: Comité de Protection des Personnes; No.: 21.05.05.35821; Recherche Impliquant la Personne Humaine de type 1 (RIPH1) HPS; No.: 2021-A01225-36., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Purpose: Uncertainty exists if post-resistance exercise hydrotherapy attenuates chronic inflammatory and hormone responses. The effects of repeated post-resistance exercise water immersion on inflammatory and hormone responses in athletes were investigated., Methods: Male, academy Super Rugby players (n = 18, 19.9 ± 1.5 y, 1.85 ± 0.06 m, 98.3 ± 10.7 kg) participated in a 12-week programme divided into 3 × 4-week blocks of post-resistance exercise water immersion (either, no immersion control [CON]; cold [CWI]; or hot [HWI] water immersion), utilising a randomised cross-over pre-post design. Fasted, morning blood measures were collected prior to commencement of first intervention block, and every fourth week thereafter. Linear mixed-effects models were used to analyse main (treatment, time) and interaction effects., Results: Repeated CWI (p = 0.025, g = 0.05) and HWI (p < 0.001, g = 0.62) reduced creatine kinase (CK), compared to CON. HWI decreased (p = 0.013, g = 0.59) interleukin (IL)-1ra, compared to CON. HWI increased (p < 0.001-0.026, g = 0.06-0.17) growth factors (PDGF-BB, IGF-1), compared to CON and CWI. CWI increased (p = 0.004, g = 0.46) heat shock protein-72 (HSP-72), compared to HWI., Conclusion: Post-resistance exercise CWI or HWI resulted in trivial and moderate reductions in CK, respectively, which may be partly due to hydrostatic effects of water immersion. Post-resistance exercise HWI moderately decreased IL-1ra, which may be associated with post-resistance exercise skeletal muscle inflammation influencing chronic resistance exercise adaptive responses. Following post-resistance exercise water immersion, CWI increased HSP-72 suggesting a thermoregulatory response indicating improved adaptive inflammatory responses to temperature changes, while HWI increased growth factors (PDGF-BB, IGF-1) indicating different systematic signalling pathway activation. Our data supports the continued use of post-resistance exercise water immersion recovery strategies of any temperature during in-season competition phases for improved inflammatory adaptive responses in athletes., (© 2024. The Author(s).)

Introduction: This study was designed to evaluate the effects of multiple cold-water immersions performed daily during the preseason period on biochemical, clinical, and neuromuscular aspects of muscle damage of soccer players., Methods: This two-arm, prospectively registered, randomized controlled trial, blinded to statistician and assessors, was conducted at professional football club facilities. Twenty-three under-20 semi-professionals male soccer players were randomly allocated into cold water immersion group (bathtub with water and ice at 10 °C ± 1 °C for 10 min) or control group (rest for 10 min), every day, after training sessions during a preseason. Primary outcome was change in creatine kinase (CK) concentration, and secondary outcomes were changes in vertical jump performance, strength and perception of recovery at baseline (T0) and after protocol training (T1)., Results: Analysis of Covariance (ANCOVA) showed a statistically significant time-group interactions for CK concentration, with an average reduction of 280.39 U/L (CI95% = -519.14, -41.64; d = 0.55) in the cold-water immersion compared to the control group. No differences between groups were observed in any other measures., Conclusion: Multiple cold-water immersions at 10 °C for 10 min decreases CK concentration but does not change any clinical and neuromuscular markers of muscle damage in soccer players during a 9-day preseason., Competing Interests: Declaration of competing interest There are no known conflicts of interest associated with this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Head-out water immersion (HOWI) induces ventilatory and hemodynamic changes, which may be a result of hydrostatic pressure, augmented arterial CO 2 tension, or a combination of both. We hypothesized that the hydrostatic pressure and elevated CO 2 tension that occur during HOWI will contribute to an augmented ventilatory sensitivity to CO 2 and an attenuated cerebrovascular reactivity to CO 2 during water immersion. Twelve subjects [age: 24 ± 3 yr, body mass index (BMI): 25 ± 3 kg/m 2 ] completed HOWI, waist water immersion with CO 2 (WWI + CO 2 ), and WWI, where a rebreathing test was conducted at baseline, 10, 30, and 60 min, and postimmersion. End-tidal pressure of carbon dioxide ([Formula: see text]), minute ventilation, expired gases, blood pressure, heart rate, and middle cerebral artery blood velocity were recorded continuously. [Formula: see text] increased throughout all visits ( P ≤ 0.011), was similar during HOWI and WWI + CO 2 ( P ≥ 0.264), and was greater during WWI + CO 2 versus WWI at 10, 30, and 60 min ( P < 0.001). When HOWI vs. WWI + CO 2 were compared, the change in ventilatory sensitivity to CO 2 was different at 10 (0.59 ± 0.34 vs. 0.06 ± 0.23 L/min/mmHg; P < 0.001), 30 (0.58 ± 0.46 vs. 0.15 ± 0.25 L/min/mmHg; P < 0.001), and 60 min (0.63 ± 0.45 vs. 0.16 ± 0.34 L/min/mmHg; P < 0.001), whereas there were no differences between conditions for cerebrovascular reactivity to CO 2 ( P ≥ 0.163). When WWI + CO 2 versus WWI were compared, ventilatory sensitivity to CO 2 was not different between conditions ( P ≥ 0.642), whereas the change in cerebrovascular reactivity to CO 2 was different at 30 min (-0.56 ± 0.38 vs. -0.30 ± 0.25 cm/s/mmHg; P = 0.010). These data indicate that during HOWI, ventilatory sensitivity to CO 2 increases due to the hydrostatic pressure, whereas cerebrovascular reactivity to CO 2 decreases due to the combined effects of immersion. NEW & NOTEWORTHY Although not fully elucidated, the ventilatory and hemodynamic alterations during water immersion appear to be a result of the combined effects of immersion (i.e., elevated [Formula: see text], central hypervolemia, increased cerebral perfusion, increased work of breathing, etc.). Our findings demonstrate that an augmented ventilatory sensitivity to CO 2 during immersion may be due to the hydrostatic pressure across the chest wall, whereas an attenuated cerebrovascular reactivity to CO 2 may be due to the combined effects of immersion.

Background: People with Parkinson's Disease (PwPD) have motor symptoms that directly interfere on dry land walking performance. Despite the shallow water walking is a viable and beneficial physical intervention for PwPD, it lacks information on the comparison of the biomechanical responses of the shallow water walking by PwPD and age paired healthy individuals., Research Question: Are there differences in the spatiotemporal and angular responses of shallow water walking by older adults with and without Parkinson's disease?, Methods: In this cross-sectional study, ten older adults (9 men/1 women) with Parkinson disease (PwPD group) and ten older adults (3 men/7 women) without Parkinson's disease (Older group) walked in shallow water at self-selected comfortable speed on pool floor in the immersion depths of waist and xiphoid levels. The 2D kinematic data from the sagittal plane was collected to calculate the walking speed, stride length, stride frequency, duty factor, walk ratio, lower limb joints' range of motion and peak angular speed RESULTS: Both groups reduced similarly the walking speed with the immersion depth increase. The speed decrease was achieved by a reducing both the stride frequency and stride length only in the PwPD. The PwPD had lower contact phase than Older in the waist depth, probably due to the reduced risk of fall in water immersion and to attenuate drag force effects. The total range of joint motion was similar between groups, while the peak angular speed of ankle and knee reduced in the deeper depth in both groups., Significance: The present findings can help professionals of aquatic rehabilitation to choose the best depth for exercise programs, according to the treatment objectives. To our knowledge, this was the first study that analyzed spatiotemporal and angular variables during shallow water walking of PwPD at different depths and compared them with older people without Parkinson's disease., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Post-exercise hot (HWI) and cold (CWI) water immersion are popular strategies used by athletes in a range of sporting contexts, such as enhancing recovery or adaptation. However, prolonged heating bouts increase neuroendocrine responses that are associated with perceptions of fatigue. Fourteen endurance-trained runners performed three trials consisting of two 45-min runs at 95% lactate threshold on a treadmill separated by 6 h of recovery. Following the first run, participants completed one of HWI (30 min, 40°C), CWI (15 min, 14°C) or control (CON, 30 min rest in ambient conditions) in a randomised order. Perceived effort and recovery were measured using ratings of perceived exertion (RPE) and the Acute Recovery and Stress Scale (ARSS), whilst physiological responses including venous concentrations of a range of neuroendocrine markers, superficial femoral blood flow, heart rate and rectal temperature were measured. Exercise increased neuroendocrine responses of interleukin-6, adrenaline and noradrenaline (all P < 0.001). Additionally, perceptions of overall recovery (P < 0.001), mental performance capacity (P = 0.02), physical performance capability (P = 0.01) and emotional balance (P = 0.03) were reduced prior to the second run. However, there was no effect of condition on these variables (P > 0.05), nor RPE (P = 0.68), despite differences in rectal temperature, superficial femoral blood flow following the first run, and participants' expected recovery prior to the intervention (all P < 0.001). Therefore, athletes may engage in post-exercise hot or cold-water immersion without negatively impacting moderate-intensity training sessions performed later the same day., (© 2024 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

We report the case of a 49-year-old woman who suffered an envenomation from a greater weever during a seaside vacation along the Aegean coast in Izmir, Türkiye. Following the incident, she experienced intense pain and sought treatment at an emergency department, where she received analgesics and cold compresses. Unfortunately, this approach failed to alleviate her pain, which persisted for approximately 24 hours. On the twelfth day, with symptoms worsening and the emergence of a larger wound than the one sustained on the day of the incident, she visited the University Hospital for further care, where she received periodic wound cleaning and a six-week antibiotic treatment regimen for possible osteomyelitis after suspicious findings on her Magnetic Resonance Imaging. The standard treatment for piscine envenomation involves hot water immersion to neutralize thermolabile toxins, providing pain relief and preventing subsequent complications. The water temperature should be between 40 and 45 degrees Celsius, and the affected body part should be immersed for at least 60 minutes. This case underscores the critical nature of hot water immersion in managing envenomation, a step which, if omitted, can result in extended pain duration and the evolution of a wound requiring over five months to heal.

Objective: To assess the effectiveness of alternating hot-cold water immersion (AHCWI) in patients with acute stroke., Design: A single-blind pilot randomized controlled trial., Setting: Department of Rehabilitation Medicine of a medical center., Participants: Early stroke survivors (N=24) with moderate-to-severe arm paresis., Interventions: In addition to conventional rehabilitation, eligible patients were randomly assigned to an AHCWI group (n=12, for AHCWI) or a control group (n=12, for upper limb [UL] cycling exercises) 5 times per week for 6 weeks., Main Outcome Measures: The Fugl-Meyer Assessment motor-UL (FMA-UL) score, Motricity Index-UL (MI-UL) score, modified Motor Assessment Scale (MMAS; including its UL sections, MMAS-UL) score, Berg Balance Scale score, Barthel Index (BI), and modified Ashworth Scale score were assessed by the same uninvolved physical therapist at baseline and after 4 and 6 weeks of intervention., Results: Compared with the control group, the AHCWI group performed better, with significant group effects (P<.05), and exhibited significant improvements in FMA-UL, MI-UL, and MMAS-UL scores at 4 and 6 weeks (P<.05). Although the remaining outcomes were not significantly different, they favored the AHCWI group. Notably, a significant difference was observed in the BI at 4 weeks (P=.032). Significant changes in the muscle tone or adverse effects were not observed in either group after the intervention., Conclusions: AHCWI with stroke rehabilitation is feasible and may facilitate motor function recovery of the paretic UL after a stroke., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the effects of repeated use of cold-water immersion (CWI) during a training week on performance and perceptive outcomes in competitive adolescent swimmers., Methods: This randomized-crossover study included 20 athletes, who received each intervention [CWI (14 ± 1 °C), thermoneutral water immersion (TWI) (27 ± 1 °C) as placebo, and passive recovery (PAS)] three times a week between the land-based resistance training and swim training. The interventions were performed in a randomized order with a 1-week wash-out period. We tested athletes before and after each intervention week regarding swim (100 m freestyle sprints) and functional performance (flexibility, upper and lower body power, and shoulder proprioception). We monitored athlete's perceptions (well-being, heaviness, tiredness, discomfort and pain) during testing sessions using a 5-item questionnaire. Athlete preferences regarding the interventions were assessed at the end of the study. We used generalized linear mixed models and generalized estimating equations for continuous and categorical variables, respectively (intervention x time)., Results: We found a time effect for swim performance (p = .01) in which, regardless the intervention, all athletes improved sprint time at post-intervention compared to baseline. There was an intervention effect for pain (p = .04) and tiredness (p = .04), but with no significant post-hoc comparisons. We found no significant effects for other outcomes. All athletes reported a preference for CWI or TWI in relation to PAS., Conclusion: The repeated use of CWI throughout a training week did not impact functional or swim performance outcomes of competitive adolescent swimmers. Perceptive outcomes were also similar across interventions; however, athletes indicated a preference for both CWI and TWI., (© 2024. The Author(s).)

Purpose: In recent years, there has been significant advancement in the guidelines for recovery protocols involving heat or cold water immersion. However, comparison between the effects of hot and cold water immersion on key markers of neuromuscular recovery following exercise-induced muscle damage (EIMD) is lacking., Methods: Thirty physically active males completed an individualized and tailored EIMD protocol immediately followed by one of the following recovery interventions: cold water immersion (11°C, CWI 11 ), hot water immersion (41°C, HWI 41 ), or warm-bath control (36°C, CON 36 ). Gastrointestinal temperature was tracked throughout HWI 41 . Knee extensors' maximal isokinetic strength (peak torque ( Tpeak )) and explosive strength (late-phase rate of force development (RFD 100-200 )) were measured before EIMD (pre-), 24 h (post-24 h), and 48 h (post-48 h) post-EIMD. In addition, pressure pain threshold (PPT) was measured to quantify the recovery from muscle soreness. Surface electromyography signals (sEMG) from the vastus lateralis were captured to extract the rates of electromyography rise (REMGR) and the spectral power in the low-frequency band., Results: At post-48 h, Tpeak returned to baseline values following both CWI 11 (-8.3% ± 6.8%, P = 0.079) and HWI 41 (-1.4% ± 4.1%, P = 1). In contrast, RFD 100-200 (-2.3% ± 29.3%, P = 1) and PPT (+5.6% ± 14.6%, P = 1) returned to baseline values at post-48 h only following HWI 41 . Spectral analysis of the sEMG signal revealed that the low-frequency band was significantly increased following CWI 11 (+9.0% ± 0.52%, P = 0.012). REMGR was unchanged regardless of the condition (all P > 0.05)., Conclusions: A single session of HWI 41 , rather than CWI 11 , improved the recovery of the late-phase rate of force development following EIMD in physically active males. This suggests that in athletic contexts where a rapid force development is a key performance determinant, hot bath should be preferred over cold bath., (Copyright © 2024 by the American College of Sports Medicine.)

Introduction: We tested the hypothesis that a carbohydrate (CHO: 6.5%) or carbohydrate-electrolyte (CHO + E: 6.5% + 50 mmol/L NaCl) drink would better recover plasma volume (PV) and exercise performance compared to water (H2O) after immersion diuresis., Methods: Twelve men (24 ± 2 years; 82.4 ± 15.5 kg; and V̇O2max: 49.8 ± 5.1 mL · kg-1 · min-1) completed four experimental visits: a no-immersion control (CON) and three 4-h cold-water (18.0 °C) immersion trials (H2O, CHO, and CHO + E) followed by exercise in a warm environment (30 °C, 50% relative humidity). The exercise was a 60-minute loaded march (20.4 kg; 55% VO2max) followed by a 10-minute intermittent running protocol. After immersion, subjects were rehydrated with 100% of body mass loss from immersion diuresis during the ruck march. PV is reported as a percent change after immersion, after the ruck march, and after the intermittent running protocol. The intermittent running protocol distance provided an index of exercise performance. Data are reported as mean ± SD., Results: After immersion, body mass loss was 2.3 ± 0.7%, 2.3 ± 0.5%, and 2.3 ± 0.6% for H2O, CHO, and CHO + E. PV loss after immersion was 19.8 ± 8.5% in H2O, 18.2 ± 7.0% in CHO, and 13.9 ± 9.3% in CHO + E, which was reduced after the ruck march to 14.7 ± 4.7% (P = .13) in H2O, 8.8 ± 8.3% (P < .01) in CHO, and 4.4 ± 10.9% (P = .02) in CHO + E. The intermittent running protocol distance was 1.4 ± 0.1 km in CON, 1.4 ± 0.2 km in H2O, 1.4 ± 0.1 km in CHO, and 1.4 ± 0.2 km in CHO + E (P = .28)., Conclusions: Although CHO and CHO + E better restored PV after immersion, post-immersion exercise performance was not augmented compared to H2O, highlighting that fluid replacement following immersion diuresis should focus on restoring volume lost rather than fluid constituents., (© The Association of Military Surgeons of the United States 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

To overcome the problem that takeaway noodles possessed poor immersion resistance, in this study noodles were prepared from post-ripened wheat flour, and changes in textural properties, protein components, and water status of noodles were determined. The firmness and tensile distance of noodles were gradually increased by 7.40%-35.88% when wheat flour was post-ripened for 20-40 d. Afterwards, noodle textural qualities were slightly decreased. Compared with control groups, contents of glutenin macropolymer (GMP) and disulfide bonds were significantly (p<0.05) increased and protein network was also more compact, whereas the Glutenin/Gliadin ratio and free sulfhydryl groups content were significantly (p<0.05) reduced. Contents of sodium dodecyl sulfate extractable protein (SDSEP) were reduced by 3.22%-6.23%. Meanwhile, the decrease in A 23 indicated that wheat flour post-ripening limited water-absorbing capacity of noodles during immersion. In conclusion, wheat flour post-ripening promoted the immersion resistance of noodles by inducing protein cross-linking, and the best post-ripening time was 20-40 d., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study investigated the effects of cold water immersion (CWI) and partial body cryotherapy (PBC) applied within a 15-min post-exercise recovery period on thermoregulatory responses, subjective perceptions, and exercise performance under hot conditions (39 °C). Twelve male soccer players participated in team-sports-specific assessments, including Agility T-test (T-test), 20-m sprint test (20M-ST), and Yo-Yo Intermittent Endurance Test Level 1 (YY-T), during two exercise bouts (1 st bout and 2 nd bout) with a 15-min post-exercise recovery period. Within the recovery period, a 3-min of PBC at -110 °C or CWI at 15 °C or a seated rest (CON) was performed. Mean skin temperature (T skin ) decreased by 4.3 ± 1.08°C (p < 0.001) immediately after PBC, while CWI induced a reduction of 2.5 ± 0.21°C (p < 0.01). Furthermore, PBC and CWI consistently reduced T skin for 15 and 33 min, respectively (p < 0.05). During the 2 nd bout, core temperature (T core ) was significantly lower in PBC compared to CON (p < 0.05). Heart rate (HR) was significantly lower in CWI compared to CON and PBC during the intervention period. Thermal sensation (TS) was significantly greater in PBC compared to CON and CWI (p < 0.05). Compared to the 1 st bout, PBC alleviated the declines in T-test (p < 0.05) and 20M-ST (p < 0.05), while CWI alleviated the decreases in T-test (p < 0.05) and YY-T (p < 0.05), concurrently significantly enhancing 20M-ST (p < 0.05). 20M-ST and YY-T was greater from PBC (p < 0.05) and CWI (p < 0.05) compared with CON in 2 nd bout. Additionally, the T-test in CWI was significantly greater than CON (p < 0.05). These results indicate that both PBC and CWI, performed between two exercise bouts, have the potential to improve thermoregulatory strain, reduce thermal perceptual load, and thereby attenuate the subsequent decline in exercise performance., Competing Interests: Declaration of competing interest There are no actual or potential conflicts of interest for any of the authors., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Immersion in cold or ice water, either passively or actively by swimming, has become very popular. Many people use this method for health promotion, both mentally and physically, as well as an extreme environment for competitive swimming. Nevertheless, despite the popularity of this phenomenon, professional knowledge, science and practical regulations are lacking. On one hand, research findings tend to generally support ice water immersion or swimming for health and resilience, but on the other hand, it involves significant exposure to stress, which may expose participants to major risks, especially in the occurrence of certain risk factors. Studies in this field describe many different protocols, conditions, definitions and populations, making further quality and in-depth research necessary in order to develop a set of criteria for a useful, healthy, and safe practice. Assuming this phenomenon is here to stay, it is of great importance to educate medical staff and introduce up to date basic physiological and medical data, which is required for proper professional guidance, support and risk management.

Purpose: To evaluate the effect of immersion in water on deformation of maxillary denture bases created with CAD/CAM and heat-polymerized resin fabrication techniques under loading condi8ons., Materials and Methods: 2-mm-thick denture bases were fabricated using four techniques: CAD/CAM milling (CCM; Polywax PMMA blank, Yamachi PMMA disk Yamahachi Dental); 3D prin8ng (3DP; BV005, NextDent Base); compression molding (CM; Luciton 199, Dentsply Sirona); and injec8on molding (IM; Ivobase, Ivoclar; n = 5 per group). Three static 49-N loads were applied perpendicular to each denture base, and the mean strain value (MSV) was recorded with strain gauges a[ached to the denture surface. The denture bases were stored at 37°C in distilled water for 14 and 28 days, and the MSVs under the same static load were recorded., Results: The highest MSVs were observed at the posterior palatal seal, tuberosity, and labial notches of the dentures. The lowest MSVs were recorded for the CCM group and then the CM and IM groups. The highest MSVs were recorded for the 3DP group. No significant differences in regional MSVs (P > .05) were observed among the CCM, CM, and IM aber 14 and 28 days in water. Large devia8ons in MSVs were recorded for the 3DP group across the measurement sites aber water exposure (P < .05)., Conclusions: CCM had the lowest denture deformation under static loading. After immersion in water, the deformation changes under static loading were stable for CCM, CM, and IM. However, variations among the materials used in 3DP group influenced the mechanical performance and presented larger deformations.

This study tested the hypothesis that acute moderate normobaric hypoxia augments circulating thyroid hormone concentrations during and following 1 h of cold head-out water immersion (HOWI), compared with when cold HOWI is completed during normobaric normoxia. In a randomized crossover single-blind design, 12 healthy adults (27 ± 2 yr, 2 women) completed 1 h of cold (22.0 ± 0.1°C) HOWI breathing either normobaric normoxia ([Formula: see text] = 0.21) or normobaric hypoxia ([Formula: see text] = 0.14). Free and total thyroxine (T3) and triiodothyronine (T4), and thyroid-stimulating hormone (TSH) concentrations were measured in venous blood samples obtained before (baseline), during (15-, 30-, and 60 min), and 15 min following HOWI (post-), and were corrected for changes in plasma volume. Arterial oxyhemoglobin saturation and core (rectal) temperature were measured continuously. Arterial oxyhemoglobin saturation was lower during hypoxia (90 ± 3%) compared with normoxia (98 ± 1%, P < 0.001). Core temperature fell from baseline (normoxia: 37.2 ± 0.4°C, hypoxia: 37.2 ± 0.4°C) to post-cold HOWI (normoxia: 36.4 ± 0.5°C, hypoxia: 36.3 ± 0.5°C, P < 0.001) in both conditions but did not change differently between conditions (condition × time: P = 0.552). Circulating TSH, total T3, free T4, total T3, and free T4 concentrations demonstrated significant main effects of time (all P ≤ 0.024), but these changes did not differ between normoxic and hypoxic conditions (condition × time: all P ≥ 0.163). These data indicate that acute moderate normobaric hypoxia does not modify the circulating thyroid hormone response during 1 h of cold HOWI. NEW & NOTEWORTHY Acute head-out cold (22°C) water immersion (HOWI) decreased core temperature and increased thermogenesis. This thermogenic response was paralleled by the activation of the hypothalamic-pituitary-thyroid axis, as evidenced by changes in thyroid hormones. However, cold HOWI in combination with moderate normobaric hypoxia did not modify the thermogenic nor the circulating thyroid hormone response. This finding suggests that hypoxia-induced alterations in thyroid hormone concentrations are unlikely to acutely contribute to adaptations resulting from repeated cold-water exposures.

Introduction: Despite mitigation efforts, exertional heat stroke (EHS) is known to occur in military personnel during training and operations. It has significant potential to cause preventable morbidity and mortality. International consensus from sports medicine organisations supports treating EHS with early rapid cooling by immersing the casualty in cold water. However, evidence remains sparse and the practice is not yet widespread in the UK., Methods: Following changes to enable on-site ice cold water immersion (ICWI) at the Royal Marines Commando Training Centre, Lympstone, UK, we prospectively gathered data on 35 patients treated with ICWI over a 3-year period. These data included the incidence of adverse events (e.g. death, cardiac arrest or critical care admission) as the primary outcome. Basic anthropometric data, cooling rates achieved and biochemical and haematological test results on days 0-5 were also gathered and analysed., Results: Despite being a cohort of patients in whom we might expect significant morbidity and mortality based on the severity of EHS at presentation, none experienced a serious adverse event. In this cohort with rapid initiation of effective cooling, biochemical derangement appeared less severe than that reported in previous studies. Higher body mass index (BMI) was associated with a lower cooling rate across a range of values previously reported as potentially of clinical significance., Conclusions: This case series supports recent updates to UK military guidance that ICWI should be more widely adopted for the treatment of EHS. Clinicians should be aware of likely patterns of blood test abnormalities in the days following EHS. Further work should seek to establish the impact of lower rates of cooling and develop strategies to optimise cooling in patients with higher BMI., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Exercise and passive heating induce some similar vascular hemodynamic, circulating blood marker, and perceptual responses. However, it remains unknown whether post exercise hot water immersion can synergise exercise derived responses and if they differ from hot water immersion alone. This study investigated the acute responses to post moderate-intensity exercise hot water immersion (EX+HWI) when compared to exercise (EX+REST) and hot water immersion (HWI+HWI) alone. Sixteen physically inactive middle-aged adults (nine males and seven females) completed a randomized cross-over counterbalanced design. Each condition consisted of two 30-min bouts separated by 10 min of rest. Cycling was set at a power output equivalent to 50% V̇o 2 peak . Water temperature was controlled at 40°C up to the mid sternum with arms not submerged. Venous blood samples and artery ultrasound scans were assessed at 0 (baseline), 30 (immediately post stressor one), 70 (immediately post stressor two), and 100 min (recovery). Additional physiological and perceptual measures were assessed at 10-min intervals. Brachial and superficial femoral artery shear rates were higher after EX+HWI and HWI+HWI when compared with EX+REST (p < 0.001). Plasma nitrite was higher immediately following EX+HWI and HWI+HWI than EX+REST (p < 0.01). Serum interleukin-6 was higher immediately after EX+HWI compared to EX+REST (p = 0.046). Serum cortisol was lower at 30 min in the HWI+HWI condition in contrast to EX+REST (p = 0.026). EX+HWI and HWI+HWI were more enjoyable than EX+REST (p < 0.05). Irrespective of whether hot water immersion proceeded exercise or heating, hot water immersion enhanced vascular and blood marker responses, while also being more enjoyable than exercise alone., (© 2024 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Air exposure stress can induce stress response of Eriocheir sinensis and affect its normal life activities. The goal of this study was to investigate the effects of water immersion on the recovery of hepatopancreas immune-related enzyme activity, intestinal microbial diversity and metabolic level of Chinese mitten crabs after exposure to air. The results show that immersion can effectively alleviate the adverse effects of air exposure on the antioxidant capacity and immune capacity of Chinese mitten crabs, and the longer the time of immersion, the more obvious the recovery effect. Among them, the levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and acid phosphatase significantly increased after exposure to air (P < 0.05), reached a peak at 3 h, began to decline after immersion, and returned to a level close to the initial value at 24 h (P < 0.05). In addition, after exposure to air, the glucose and total cholesterol in haemolymph of Eriocheir sinensis were significantly different from the initial values (P < 0.05), gradually recovered to the initial level after re-immersion. However, changes in intestinal flora and hepatopancreas metabolism caused by air exposure did not fully recover after water exposure, and its negative effects did not completely disappear. The sequencing results showed that the species composition and diversity of intestinal microorganisms of Chinese mitten crab changed after air exposure and immersion treatment. The relative abundance of Actinomycetes increased significantly, while that of Proteobacteria and Firmicutes decreased significantly. Metabolomics analysis showed that air exposure and immersion destroyed the metabolic balance of amino acids and carnitine, reduced the level of carnitine metabolism, hindered the absorption of nutrients, and led to the accumulation of harmful substances., Competing Interests: Declaration of competing interest All authors participated and shared the work, and no part of this study has been submitted or published elsewhere. There are no competing financial interests or personal relationships that would affect the work reported in this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This joint position statement (JPS) on immersion pulmonary oedema (IPO) and diving is the product of a workshop held at the 52nd Annual Scientific Meeting of the South Pacific Underwater Medicine Society (SPUMS) from 12-17 May 2024, and consultation with the United Kingdom Diving Medical Committee (UKDMC), three members of which attended the meeting. The JPS is a consensus of experts with relevant evidence cited where available. The statement reviews the nomenclature, pathophysiology, risk factors, clinical features, prehospital treatment, investigation of and the fitness for future compressed gas diving following an episode of IPO. Immersion pulmonary oedema is a life-threatening illness that requires emergency management as described in this statement. A diver with previous suspected or confirmed IPO should consult a medical practitioner experienced in diving medicine. The SPUMS and the UKDMC strongly advise against further compressed gas diving if an individual has experienced an episode of IPO., Competing Interests: Dr Turner acts as a consultant and proctor for St Jude Medical, Medtronic and Edwards Lifesciences, as a consultant and lecturer for Gore Medical and performs PFO closures on private patients. The other authors declare that they have no conflicts of interest. Professor Mitchell is the editor of Diving and Hyperbaric Medicine Journal, but as a societal consensus guideline this manuscript was not subject to peer review and a resulting publication decision. No external funding was declared., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Background: Eccentric exercise (ECC) can induce NLRP3-related inflammation in skeletal muscle tissue. Limited available data have shown that Cold water immersion (CWI) after ECC can suppress skeletal muscle inflammation. This study aims to investigate the effect of CWI after ECC on the NLRP3 inflammasome pathway, and the expression of ubiquitin-proteasome-related proteins (UPPs) in the skeletal muscle of rats., Methods: Twenty-five male Wistar rats were randomly divided into control, ECC, ECC + CWI, ECC + NWI (normal water immersion), and ECC + AR (active recovery) groups. The Eccentric exercise consisted of 90 min of downhill running on a treadmill with a speed of 16 m/min and -16° incline. Animals in the NWI and CWI groups were immersed in water at 25 °C and 10 °C after ECC. Eventually, The soleus muscle was isolated and the expression of NLRP3, caspase-1, FBXL2, TRIM31, and PARKIN was evaluated by western blot. Tissue levels of IL-1β and IL-18 were measured by ELISA assay., Results: ECC significantly increased the expression of NLRP3, caspase-1, and the tissue levels of IL-1β and IL-18 compared to the control group. After ECC, FBXL2, and PARKIN were downregulated, whereas TRIM31 was up-regulated (P < 0.05). CWI after ECC suppressed the NLRP3 inflammasome components and increased the protein levels of FBXL2 and TRIM31 at higher levels than other recovery methods (P < 0.05). CWI and AR had the same increase in PARKIN expression and the same decrease in CK level compared to the ECC group (P < 0.05)., Conclusion: Our results indicated that CWI increased the expression of NLRP3-related UPPs in concomitant with suppression of NLRP3 in the soleus muscle of rats after ECC. As a result the beneficial effects of CWI on the attenuation of skeletal muscle inflammation may contribute to an alteration of UPPs expression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The experience of pain that is induced by extremely cold temperatures can exert a modulatory effect on motor cortex circuitry. Although it is known that immersion of a single limb in very cold water can increase corticomotor excitability it is unknown how afferent input to the cortex shapes excitatory and inhibitory processes. Therefore, the purpose of this study was to examine motor-evoked potentials (MEP), short-latency afferent inhibition (SAI) and long-latency afferent inhibition (LAI) in response to immersion of a single hand in cold water. Transcranial magnetic stimulation (TMS) was used to assess MEPs, and peripheral nerve stimulation of the median nerve paired with TMS was used to measure SAI and LAI in motor circuits of the ipsilateral hemisphere. Measurements were obtained from electromyography (EMG) of the first dorsal interosseous (FDI) at baseline, during cold-water immersion, and during recovery from cold-water immersion. The intervention caused unconditioned MEPs to increase during exposure to the cold stimulus (P = 0.008) which then returned to baseline levels once the hand was removed from the cold water. MEP responses were decoupled from SAI responses, where SAI was reduced during exposure to the cold stimulus (P = 0.005) and remained reduced compared to baseline when the hand was removed from the cold water (P = 0.002). The intervention had no effect on LAI. The uncoupling of SAI from MEPs during the recovery period suggests that the mechanisms underlying the modulation of corticospinal excitability by sensory input may be distinct from those affecting intracortical inhibitory circuits. HIGHLIGHTS: What is the central question of this study? Does immersion of a limb in very cold water influence corticospinal excitability and the level of afferent inhibition exerted on motor cortical circuits? What is the main finding and its importance? In additional to perception of temperature, immersion in 6°C water also induced perceptions of pain. Motor evoked potential (MEP) amplitude increased during immersion, and short-latency afferent inhibition (SAI) of the motor cortex was reduced during immersion; however, these responses differed after the limb was removed from the cold stimulus, as MEPs returned to normal levels while SAI remained suppressed., (© 2024 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Abstract: Wheelock, CE, Stooks, J, Schwob, J, Hess, HW, Pryor, RR, and Hostler, D. Partial and complete fluid replacement maintains exercise performance in a warm environment following prolonged cold-water immersion. J Strength Cond Res 38(2): 290-296, 2024-Special warfare operators may be exposed to prolonged immersion before beginning a land-based mission. This immersion will result in substantial hypohydration because of diuresis. This study tested the hypothesis that both partial and full postimmersion rehydration would maintain performance during exercise in the heat. Seven men (23 ± 2 years; V̇o2max: 50.8 ± 5.3 ml·kg-1·min-1) completed a control trial (CON) without prior immersion and 3 immersion (18.0°C) trials without rehydration (NO) or with partial (HALF) or full (FULL) rehydration. After immersion, subjects completed a 60-minute weighted ruck march (20.4 kg; 5.6 kph) and a 15-minute intermittent exercise protocol (iEPT) in a warm environment (30.0°C and 50.0% relative humidity). The primary outcome was distance (km) covered during the iEPT. A priori statistical significance was set to p ≤ 0.05. Immersion resulted in 2.3 ± 0.4% loss of body mass in all immersion trials (p < 0.01). Distance covered during the first 13-minute interval run portion of iEPT was reduced in the NO rehydration trial (1.59 ± 0.18 km) compared with all other conditions (CON: 1.88 ± 0.18 km, p = 0.03; HALF: 1.80 ± 0.18 km, p < 0.01; FULL: 1.86 ± 0.28 km, p = 0.01). During the final 2 minutes of the iEPT, distance in the NO rehydration trial (0.31 ± 0.07 km) was reduced compared with the FULL rehydration trial (0.37 ± 0.07 km; p < 0.01) but not compared with CON (0.35 ± 0.07 km; p = 0.09) or HALF (0.35 ± 0.07 km; p = 0.08). Both partial and full postimmersion fluid replacement maintained intermittent exercise performance and should be applied as rehydration strategies., (Copyright © 2023 National Strength and Conditioning Association.)

We convened an expert panel to develop evidence-based guidelines for the evaluation, treatment, and prevention of nonfreezing cold injuries (NFCIs; trench foot and immersion foot) and warm water immersion injuries (warm water immersion foot and tropical immersion foot) in prehospital and hospital settings. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. Treatment is more difficult with NFCIs than with warm water immersion injuries. In contrast to warm water immersion injuries that usually resolve without sequelae, NFCIs may cause prolonged debilitating symptoms, including neuropathic pain and cold sensitivity., (Copyright © 2023 Wilderness Medical Society. All rights reserved.)

The aim of this this study was to evaluate the surface roughness and color stability of resin composites (RCs) with color adjustment potential (CAP): Omnichroma (OM), (Tokuyama Dental, Tokyo, Japan); Neo Spectra ST (NS) (Dentsply Sirona, York, PA,USA); and Charisma Diamond One (CD) (Kulzer, Hanau, Germany), compared to a conventional RC, Filtek Z350XT (FZ) (3M ESPE, St. Paul, MN,USA), after immersion in three staining solutions, cola, coffee, and black tea, with distilled water as a control. Forty specimens (8 mm diameter x 2 mm thickness) were prepared for each RC material and divided into subgroups (n=10/group) based on the immersion solution. Surface roughness was measured at baseline and after 21 days of immersion using a non-contact optical profilometer. Color change (ΔE00) was evaluated at baseline, 1, 7, and 21 days with a spectrophotometer. The results showed that FZ demonstrated the lowest surface roughness (0.14), significantly differing from that of the other RCs with CAP (p<0.05), while no significant differences in surface roughness were observed between RCs with CAP (p>0.05). There were no significant changes in surface roughness before and after immersion in various solutions. The results for color change (ΔE00) were statistically significant. Neo Spectra ST showed the lowest tendency for color change, while Filtek Z350XT displayed a moderate potential, and Omnichroma and Charisma Diamond One showed the highest potential for color change., (©Operative Dentistry, 2025.)

In order to study the optimal use of Lactobacillus plantarum in sea cucumber (Apostichopus japonicus), 49 days feeding trial was conducted to determine the influence of immersion bathing in different concentrations of Lactobacillus plantarum CLY-05 on body weight gain rate and non-specific immune activities. The potential effect of CLY-05 on gut microbiota was also analyzed during the immersion bathing at the optimum concentration. The results showed that the body weight growth rate of all bathing groups was higher than that of control. The highest specific growth rate (4.58%) and weight gain rate (25.35%) was achieved at the bacterial concentration of 1×103 CFU/mL. The activities of non-specific immune enzymes (ACP, AKP, SOD and LZM) of all bathing groups increased after immersion bathing, and the enzyme activities of groups bathed with the bacterium at 1×103 and 1×104 CFU/mL reached the highest. Therefore, 1×103 CFU/mL was considered as the optimum concentration of L. plantarum CLY-05 for A. japonicus pond culture. The results of gut microbiota analysis showed that the gut microbiota changed with the addition of L. plantarum CLY-05, and the richness and diversity of the gut microbiota peaked on day 14 and day 21, respectively. The correlation analysis revealed that the non-specific immune enzyme activities were significantly correlated to some gut bacteria (in the phyla Proteobacteria, Firmicutes) after immersion bathing in L. plantarum CLY-05. These findings provide the theoretical foundation for probiotic application in sea cucumber farming., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: The authors declare that they have no conflict of interest.

Traumatic brain injury (TBI) is a major cause of death and disability worldwide, with its severity potentially exacerbated by seawater immersion. Ferroptosis, a form of regulated cell death driven by iron-dependent lipid peroxidation, has been implicated in TBI pathogenesis. However, the specific occurrence and underlying mechanisms of ferroptosis in the context of TBI compounded by seawater immersion remain unclear. Subsequently, we investigated the effects of seawater immersion on ferroptosis after the application of deferoxamine (DFO), an iron chelator and ferroptosis inhibitor, to explore its potential therapeutic value. We conducted RNA sequencing, protein expression analysis, oxidative stress assessment, histopathological examination, and behavioral testing to comprehensively evaluate the impact of DFO on ferroptosis and neurological outcomes. Our results demonstrated that seawater immersion significantly exacerbated ferroptosis in TBI. DFO treatment, however, attenuated ferroptosis, alleviated oxidative stress, reduced brain tissue damage, improved neuronal survival, and promoted motor function recovery. Despite these benefits, DFO exhibited limited effects on anxiety, novel object recognition, and spatial learning and memory. These findings suggest that ferroptosis represents a novel pathological mechanism in TBI under seawater immersion, and that DFO is a promising neuroprotective agent capable of modulating ferroptosis and enhancing neurological function. This study offers new insights into the complex injury conditions associated with TBI and seawater immersion, highlighting the potential of targeting ferroptosis for therapeutic intervention., Competing Interests: Declaration of competing interest Authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A polar plunge is a term referring to an ice-cold water immersion (CWI), usually in the winter period. It is also a part of a specific training program (STP) which currently gains popularity worldwide and was proven to display paradigm-shifting characteristics. The aim of this study was to compare the indices of mental functioning (including depression, anxiety, mindfulness) and duration of upper respiratory tract infection (URTI) measured among the study participants. A set of questionnaires was distributed via the Internet. Participants declaring regular STP practice were selected ( N  = 77). Two groups were matched based on a case-control principle: the first one (the control group) comprised participants who did not declare nor CWI practice, nor STP practice. The second one comprised participants declaring regular CWI practice only. The CWI only group displayed better mental health indices and shorter URTIs compared to the control group. Moreover, the STP group also displayed better general mental health, less somatic complaints, and shorter URTIs compared to the CWI only group. This study suggests the existence of CWI's potential in boosting mental health and immune system functioning, however when complemented by a specific breathwork, this potential can be increased. However, further research is required.

Background: Astronauts in Earth's orbit experience microgravity, resulting in a decline of skeletal muscle mass and function. On Earth, models simulating microgravity have shown that the extent of the loss in muscle force is greater than the loss in muscle mass. The reasons behind this disproportionate loss of muscle force are still poorly understood. In the present study, we hypothesize that alongside the loss in skeletal muscle mass, modifications in the expression profile of genes encoding critical determinants of resting membrane potential, excitation-contraction coupling and Ca 2+ handling contribute to the decline in skeletal muscle force., Methods: Healthy male volunteers (n = 18) participated in a 5-day dry immersion (DI) study, an Earth-based model of simulated microgravity. Muscle force measurement and MRI analysis of the cross-sectional area of thigh muscles were performed before and after DI. Biopsies of the vastus lateralis skeletal muscle performed before and after DI were used for the determination Ca 2+ properties of isolated muscle fibres, molecular and biochemical analyses., Results: The extent of the decline in force, measured as maximal voluntary contraction of knee extensors (-11.1%, P < 0.01) was higher than the decline in muscle mass (-2.5%, P < 0.01). The decline in muscle mass was molecularly supported by a significant repression of the anabolic IGF-1/Akt/mTOR pathway (-19.9% and -40.9% in 4E-BP1 and RPS6 phosphorylation, respectively), a transcriptional downregulation of the autophagy-lysosome pathway and a downregulation in the mRNA levels of myofibrillar protein slow isoforms. At the single fibre level, biochemical and tension-pCa curve analyses showed that the loss in force was independent of fibre type (-11% and -12.3% in slow and fast fibres, respectively) and Ca 2+ activation properties. Finally, we showed a significant remodelling in the expression of critical players of resting membrane potential (aquaporin 4: -24.9%, ATP1A2: +50.4%), excitation-contraction coupling (CHRNA1: +75.1%, CACNA2D1: -23.5%, JPH2: -24.2%, TRDN: -15.6%, S100A1: +27.2%), and Ca 2+ handling (ATP2A2: -32.5%, CASQ1: -15%, ORAI1: -36.2%, ATP2B1: -19.1%)., Conclusions: These findings provide evidence that a deregulation in the expression profile of critical molecular determinants of resting membrane potential, excitation-contraction coupling, and Ca 2+ handling could be involved in the loss of muscle force induced by DI. They also provide the paradigm for the understanding of muscle force loss during prolonged bed rest periods as those encountered in intensive care unit., (© 2024 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Streptococcus agalactiae is a common pathogenic bacterium caused of streptococcosis, which has a negative impact on Nile tilapia aquaculture. Numerous vaccines have been developed recently to combat this disease, which are key components of global health efforts to prevent disease outbreaks. MONTANIDE™ IMS 1312 is a micro-emulsion recommended for immersion of fish. However, the data on the effectiveness of those immersion vaccines containing this aqueous adjuvant in fish are limited. The objective of this research was to explore the potential of MONTANIDE™ IMS 1312, an adjuvant for immersion vaccination, administered with an S. agalactiae inactivated whole-cell vaccine (SAIV) in Nile tilapia. Fish were separated into three groups: 1) fish were vaccinated by immersion vaccination with PBS (CTRL), 2) fish were vaccinated by immersion vaccination with SAIV vaccine alone (SAIV), and 3) fish were vaccinated by immersion vaccination with SAIV containing MONTANIDE™ IMS 1312. We found that the activity of several innate immunity parameters was increased significantly (P < 0.05) following the immunization. As expected, the levels of specific IgM antibody were significantly increased post-vaccination, and the highest IgM antibody levels were found in the fish vaccinated with SAIV containing MONTANIDE™ IMS 1312. Analysis of the transcriptional expression of major pro-inflammatory cytokines, as well as the presence of IgM + B cells, revealed significant increases, suggesting that Nile tilapia were able to initiate cellular immune responses following vaccination. Taken together, our results indicate that using MONTANIDE™ IMS 1312 in combination with a SAIV can induce strong protection post S. agalactiae infection. Importantly, administration of an adjuvanted immersion vaccine is safe, no side effects were observed, and it does not negatively impact fish growth. In conclusion, MONTANIDE™ IMS 1312 has the potential to be used as adjuvants for immersion vaccines against streptococcosis in Nile tilapia., Competing Interests: Declaration of competing interest Authors declare that there were no known competing financial interests to influence the work reported in this study., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Competing Interests: The authors declare that they have no conflict of interest.

Foot immersion and neck cooling are recommended cooling strategies for protecting heat-vulnerable persons during heat waves. While we recently showed that these strategies do not limit core temperature increases in older adults during prolonged heat exposure, we did observe small reductions in heart rate. Expanding on these findings, we examined the effects of foot immersion with and without neck cooling on cardiac autonomic function. Seventeen adults (9 females; 65-81 years) underwent 3 randomized, 6 h exposures to 38 °C and 35% relative humidity with: no cooling (control), foot immersion (20 °C water), or foot immersion with a wet towel (20 °C) around the neck. Cardiac autonomic responses were measured at baseline and end-exposure. These included heart rate variability, cardiac and systolic blood pressure responses to standing, indexed via the 30:15 ratio and supine-to-standing systolic pressure change, respectively, and baroreflex sensitivity during repeated sit-to-stand maneuvers. The 30:15 ratio was 0.04 [95% CI: 0.01, 0.07] greater with foot immersion and neck cooling (1.08 (SD: 0.04)) relative to control (1.04 (0.06); P  = 0.018). Similarly, standing systolic blood pressure was elevated 9 [0, 17] mmHg with foot immersion and neck cooling ( P  = 0.043). That said, neither difference remained statistically significant after adjusting for multiplicity ( P ≥ 0.054). No differences in 30:15 ratio or standing systolic blood pressure were observed with foot immersion alone, while heart rate variability and baroreflex sensitivity were unaffected by either cooling intervention. While foot immersion with neck cooling potentially improved cardiac autonomic responses in older adults exposed to simulated indoor overheating, these effects were small and of questionable clinical importance.adjusted  ≥ 0.054). No differences in 30:15 ratio or standing systolic blood pressure were observed with foot immersion alone, while heart rate variability and baroreflex sensitivity were unaffected by either cooling intervention. While foot immersion with neck cooling potentially improved cardiac autonomic responses in older adults exposed to simulated indoor overheating, these effects were small and of questionable clinical importance., Competing Interests: GPK, RDM, JJM, PB, and RJS reported receiving grants from the Canadian Institutes of Health Research and Health Canada. No other disclosures are declared by the authors.

Background: The aim of this study was to investigate the effect of an immune-boosting beverage with Sambucus nigra (SAM), an energy beverage (ENE), an in-office bleaching agent with a novel composition, and a fine-grain professional dental prophylaxis (PDP) paste on the surface roughness (Ra) and microhardness (MH) of CAD/CAM restorative materials over time., Methods: Feldspathic ceramic (FC) and polymer infiltrated ceramic network (PICN) specimens were prepared (N = 126). Glazing, polishing, bleaching and immersion in beverages groups were formed. Bleaching gel containing 25% Hydrogen Peroxide Superior was applied to the specimens with a bleaching pen. Ra and MH were measured at five time points of baseline, days 1, 14, 28 and after PDP. Scanning electron microscopy (SEM) images were taken after PDP. Statistics were performed by ANOVA and Bonferroni tests (α = 0.05)., Results: Ra increased over time regardless of material type, polishing method, beverage type and bleaching (p < 0.0001). Glazed and polished FCs caused higher roughness than PICN, SAM and ENE than distilled water, and bleaching than no bleaching (p < 0.0001). For glazed or polished FCs, MH decreased slightly lower at all time points, but for PICN, MH increased until day 28, not changing after PDP. Beverages decreased the MH of ceramics at all time points, but PDP did not lead to a change for PICN (p < 0.0001). The MH decreased more in bleached specimens than in non-bleached specimens up to day 28 (p < 0.0001). According to the SEM images after PDP, the glazed FC had numerous crack marks, pores and detached particles. The polished FC had traces of mechanical polishing. The polymer part of the PICN had voids, but the ceramic part was better preserved., Conclusions: Both energy beverages and immune-boosting beverages can increase roughness on FCs compared to PICNs. There was no significant difference between glazing and polishing in terms of lower roughness in FCs. PDP tended to slightly increase the roughness for ceramics, while it tended not to change it for PICN. Beverages decreased the microhardness of ceramics. PDP further decreased the microhardness in glazed ceramics, but increased it in polished ones. In PICN the microhardness increased over time, but decreased slightly after PDP., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval is not applicable as this is an in vitro study in which humans and animals, including materials/data, are not used for experimental purposes. Consent for publication: As this article is an in vitro study not involving human use, consent for publication is not required. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background and Aim: Achieving the aesthetic standards in tooth-colored restorative materials requires close attention to their color, translucency, and resistance to discoloration. This study aimed to evaluate the effect of sintering temperature on color stability and translucency in zirconia systems with low, high, and ultra-high translucencies., Methods: This experimental study was conducted on 60 zirconia disks with low, high and ultra-high translucencies (n = 20 per group), each group divided into subgroups to be sintered at either 1450°C or 1550°C (n = 10 per subgroup). Baseline color and translucency parameters were measured, the specimens were then immersed in coffee solution for 30 days, and the measurements were repeated post-immersion. Changes in color (ΔE) and translucency (ΔTP) were calculated via CIELAB formula and compared by using two-way ANOVA and Tukey's post hoc test (α = 0.05)., Results: Results of two-way ANOVA showed that the ΔE was significantly different among the three zirconia translucencies (P<0.001), but no significant difference was found between the two sintering temperatures (P = 0.712). Additionally, the interaction between zirconia type and sintering temperature was not statistically significant for ΔE (P = 0.264). The low-translucency group showed significantly greater ΔE than the high-translucency and ultra-high-translucency groups (P<0.05), while the high- and ultra-high-translucency groups were not significantly different in this regard (P>0.05). Regarding the ΔTP, two-way ANOVA showed that the difference was not statistically significant either among the three zirconia types (P = 0.4430) or between the two sintering temperatures (P = 0.4544). Nor was the interaction between zirconia type and sintering temperature statistically significant (P = 0.5505)., Conclusion: It was concluded that sintering temperature had no effect on color and translucency changes after immersion in coffee. Whereas zirconia type significantly affected the color changes after immersion in coffee; with the higher-translucency zirconia types being significantly more color-stable than the low-translucency zirconia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Giti, Mosallanezhad. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This article explores aquatic engagements - particularly the practice of therapeutic sea bathing - in Goa, a coastal state in India. Goa accommodates a number of natural water bodies and residents engage with them in various ways, including by participating in sea bathing and swimming activities. This article uses the practice of sea bathing as a departure point to examine embodied aquatic engagements among women in Goa. It situates these practices within broader constraints imposed by structural and material restrictions while simultaneously showing how these embodied aquatic engagements create an inclusive space that offers new ways of thinking about well-being. The article argues that multiple framings of sea bathing provide a lens through which to understand the diverse domains that constitute well-being in India. In doing so, this article provides novel insights on the relationship between blue spaces and well-being., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. None, (Copyright © 2024. Published by Elsevier Ltd.)

Fish skin, the mucosal site most exposed to external antigens, requires protection by an efficient local mucosal immune system. The mucosal reserve of IgM is recognized as an immune strategy that blocks pathogen invasion to maintain homeostasis, whereas the mechanism of skin-associated local IgM production induced by mucosal antigens is not well know. In this study, we found that the skin of flounder (Paralichthys olivaceus) was equipped with the immune cellular and molecular basis for processing mucosal antigens and triggering local specific responses, i.e., CD4 + Zap-70 + T cells, CD4 - Zap-70 + T/NK cells, IgM + MHCII + B cells, PNA + MHCII + antigen-presenting cells, UEA-1 + WGA + and UEA-1 + WGA - antigen-sampling cells, as well as secreted IgM and pIgR, as demonstrated by indirect immunofluorescence assay using different antibodies and lectins. After immersion immunization with inactivated Edwardsiella tarda, qPCR assay displayed up-regulation of immune-related genes in flounder skin. Flow cytometry analysis and EdU labeling demonstrated that the mucosal inactivated vaccine induced local proliferation and increased amounts of cutaneous IgM + B cells. Skin explant culture proved the local production of specific IgM in the skin, which could bind to the surface of E. tarda. ELISA, laser scanning confocal microscopy, and Western blot revealed that, in addition to the elevated IgM levels, pIgR protein level was significantly up-regulated in skin tissue and surface mucus containing the pIgR (secretory component, SC)-tetrameric IgM complex, indicating that mucosal vaccine stimulated up-regulation of IgM and pIgR, which were secreted as a complex into skin mucus to exert the protective effects as secretory IgM. These findings deepen the understanding of IgM-based local responses in the mucosal immunity of teleosts, which will be critical for subsequent investigation into the protective mechanism of mucosal vaccines for fish health., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Cold water immersion (CWI) involves rapid cooling of the body, which, in healthy individuals, triggers a defence response to an extreme stimulus, to which the body reacts with stress. The aim of the study was to determine the effect of CWI on hemorheological blood indicators. The study group consisted of 13 young males. Blood samples were collected before and after CWI. The assessed parameters included the complete blood count, fibrinogen, hs-C-reactive protein (CRP), proteinogram, and blood rheology factors, such as erythrocyte elongation index (EI), half-time of total aggregation, and aggregation index. Additionally, the effect of reduced temperature on primary human vascular endothelium was investigated in vitro. CWI resulted in the decrease of body temperature to 31.55 ± 2.87 °C. After CWI, neutrophil count and mean corpuscular volume (MCV) were significantly increased in the study group, while lymphocyte count was significantly decreased. Significantly higher levels of total blood protein and albumin concentration were detected after the immersion. Among hemorheological characteristics, erythrocyte EIs at shear stress values ranging from 2.19 to 60.30 Pa were significantly lower after CWI. No significant changes in other rheological, morphological or biochemical parameters were observed. In vitro, human umbilical vein endothelial cells responded to 3 h of temperature decrease to 25 °C with unchanged viability, but increased recruitment of THP-1 monocytic cells and changes in cell morphology were observed. This was the first study to evaluate the effect of single CWI on rheological properties of blood in healthy young men. The results indicate that a single CWI may increase blood protein concentrations and worsen erythrocyte deformability parameters., (© 2024. The Author(s).)

Purpose: There is emerging evidence that demonstrates the health benefits of hot water immersion including improvements to cardiovascular health and reductions in stress and anxiety. Many commercially available hot tubs offer underwater massage systems which purport to enhance many benefits of hot water immersion, however, these claims have yet to be studied., Methods: Twenty participants (4 females) completed three, 30-min sessions of hot-water immersion (beginning at 39 °C) in a crossover randomized design: with air massage (Air Jet), water massage (Hydro Jet) or no massage (Control). Cardiovascular responses comprising; heart rate, blood pressure and superficial femoral artery blood flow and shear rate were measured. State trait anxiety, basic affect, and salivary cortisol were recorded before and after each trial. Data were analysed using a mixed effects model., Results: Post immersion, heart rate increased (Δ31bpm, P < 0.001, d = 1.38), mean arterial blood pressure decreased (Δ16 mmHg, P < 0.001, d = -0.66), with no difference between conditions. Blood flow and mean shear rate increased following immersion (P < 0.001, Δ362 ml/min, d = 1.20 and Δ108 s -1 , d = 1.00), but these increases were blunted in the Air Jet condition (P < 0.001,Δ171 ml/min, d = 0.43 and Δ52 s -1 , d = 0.52). Anxiety and salivary cortisol were reduced (P = 0.003, d = -0.20, P = 0.014, d = -0.11), but did not vary between conditions. Enjoyment did not vary between conditions., Conclusion: These data demonstrate positive acute responses to hot water immersion on markers of cardiovascular function, anxiety, and stress. There was no additional benefit of water-based massage, while air-based massage blunted some positive vascular responses due to lower heat conservation of the water., Competing Interests: Declaration of competing interest The authors declare they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: In comparing the repeatability of the internal diameter and hemodynamic parameters of the dorsalis pedis artery measured by immersion ultrasound and contact ultrasound, the factors affecting the accuracy and repeatability of measurement were analyzed. This study aimed to provide a better method for ultrasound evaluation of the dorsalis pedis artery before flap transplantation., Methods: Two senior sonographers measured the diameter of the dorsalis pedis artery (D) of 56 healthy volunteers, measuring at the same location and at different time points using water immersion and contact ultrasound. Color Doppler ultrasound was used to measure the hemodynamics of the dorsalis pedis artery, including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI). The interclass correlation coefficient (ICC) was used to evaluate the intraobserver and interobserver repeatability for each group's measurements., Results: The intraobserver and interobserver reproducibility of D, PSV, EDV, and RI measurements by water immersion ultrasound was very good. The intraobserver and interobserver reproducibility of the contact ultrasound measurements of D, PSV, EDV, and RI was good., Conclusion: The repeatability of water immersion ultrasound is better than that of contact ultrasound in the measurement of the dorsalis pedis artery. Water immersion ultrasound can improve the near-field resolution of superficial tissues and increase the display of the lengths of blood vessels in images, thereby suggesting its superiority in ultrasound examination of dorsalis pedis arteries., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: The goal of interprofessional practice experiences in health professions programs is to develop interprofessional collaborative practice skills., Purpose: The purpose of the study was to explore the meaning final-semester Bachelor of Science in Nursing students attributed to interprofessional practice experiences during clinical immersion., Methods: The theoretical framework for this descriptive qualitative study was experiential learning theory. A sample of 12 participants was drawn from final-semester prelicensure Bachelor of Science in Nursing students at a college of nursing at a public research university. Data were collected through one-on-one semi-structured interviews and analyzed through inductive thematic analysis., Results: The analysis yielded four themes: professional and interprofessional identity, working with team members, communication practices, and trusting relationships. Patterns across themes were clinical environment culture, nursing school preparation, nurse preceptor role, fear/concern/worry, and night shift., Conclusion: Consistency in preceptors, welcoming clinical environments, and opportunities to practice communicating with team members contributed to interprofessional collaborative practice skill development and improved perceptions of readiness for practice. Academic and clinical educators may use findings to (a) identify immersion placements for interprofessional practice experiences, (b) design curricula reflective of interprofessional practice, (c) advance teaching strategies to promote interprofessional practice, and (d) create learning environments that aid in professional and interprofessional identity formation., Competing Interests: Declaration of competing interest The author has adjunct faculty appointment at the research site. Study design included strategies to mitigate potential conflict of interest such as expert review of data collection instrument; criteria to exclude students that may have had the faculty as an instructor or who knew her personally; and recruitment methods that included online notices posted by other faculty in their courses and e-flyers sent through distribution lists by student leaders and faculty advisors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Displaying antigens on yeast surface as an oral vaccine has been widely explored, while its potential as an immersion vaccine has not been evaluated. Here, an immersion vaccine was prepared by displaying ORF25 of Cyprinid herpesvirus 2 (CyHV-2) on the surface of Saccharomyces cerevisiae. Carassius auratus gibelio was immersion immunized by 2 × 10 7  CFU/mL yeast for 2 h, and reinforce the immunity using the same method 14 days after the first immunization. The results showed that ORF25 specific antibody in immunized crucian carp serum was detected at a high level, and the mRNA expression level of IgM, IgT, IL-1β, and IFN-1 in vaccinated head-kidney and spleen tissues were higher than the control group, indicating that innate and adaptive immunity were induced. Moreover, the immersion vaccination provided effective protection for fish against CyHV-2, leading to a relative percent survival of 50.2%. Meanwhile, immersion vaccination restrained virus replication and histological damage in CyHV-2 infected crucian carp. Our data suggested that immersion immunization of S. cerevisiae-displayed ORF25 could be served as a candidate vaccine to prevent CyHV-2 infection., (© 2024 John Wiley & Sons Ltd.)