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Purpose: To investigate the influence of shorter, more frequent rest breaks with per-cooling as an alternative heat-acclimation session on physiological, perceptual, and self-paced maximal cycling performance, compared with continuous heat exposure. Methods: Thirteen participants completed 1 continuous and 3 intermittent-heat-exposure (IHE) maximal self-paced cycling protocols in a random order in heat (36 °C, 80% relative humidity): 1 × 60-minute exercise (CON), 3 × 20-minute exercise with 7.5-minute rest between sets (IHE-20), 4 × 15-minute exercise with 5-minute rest between sets (IHE-15), and 6 × 10-minute exercise with 3-minute rest between sets (IHE-10). Mixed-method per-cooling (crushed-ice ingestion and cooling vest) was applied during rest periods of all IHE protocols. Results: Total distance completed was greater in IHE-10, IHE-15, and IHE-20 than in CON (+11%, +9%, and +8%, respectively), with no difference observed between IHE protocols. Total time spent above 38.5 °C core temperature was longer in CON compared with IHE-15 and IHE-20 (+62% and +78%, respectively) but similar to IHE-10 (+5%). Furthermore, a longer time above 38.5 °C core temperature occurred in IHE-10 versus IHE-15 and IHE-20 (+54% and +69%, respectively). Sweat loss did not differ between conditions. Conclusion: IHE with per-cooling may be a viable alternative heat-acclimation protocol in situations where training quality takes precedence over thermal stimulus or when both factors hold equal priority. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate acute psychophysiological responses to repeated-sprint training in hypoxia (RSH) combined with whole-body cryotherapy (WBC). Method: Sixteen trained cyclists performed 3 sessions in randomized order: RSH, WBC-RSH (WBC pre-RSH), and RSH-WBC (WBC post-RSH). RSH consisted of 3 sets of 5 × 10-second sprints with 20-second recovery at a simulated altitude of 3000 m. Power output, muscle oxygenation (tissue saturation index), heart-rate variability, and recovery perception were analyzed. Sleep quality was assessed on the nights following test sessions and compared with a control night using nocturnal ActiGraphy and heart-rate variability. Results: Power output did not differ between the conditions (P =.27), while the decrease in tissue saturation index was reduced for WBC-RSH compared to RSH-WBC in the last set. In both conditions with WBC, the recovery perception was higher compared to RSH (WBC-RSH: +15.4%, and RSH-WBC: +21.9%, P <.05). The number of movements during the RSH-WBC night was significantly lower than for the control night (−18.7%, P <.01) and WBC-RSH (−14.9%, P <.05). RSH led to a higher root mean square of the successive differences of R-R intervals and high-frequency band during the first hour of sleep compared to the control night (P <.05) and RSH-WBC (P <.01). Conclusions: Inclusion of WBC in an RSH session did not modify the power output but could improve prolonged performance in hypoxia by maintaining muscle oxygenation. A single RSH session did not deteriorate sleep quality. WBC, particularly when performed after RSH, positively influenced recovery perception and sleep. [ABSTRACT FROM AUTHOR]

Context: The medial collateral ligament is the most commonly injured ligament in the knee. The high-speed pivoting and agility movements that are common in the sport of American Football put participants at an increased risk for a valgus force stress from contact or noncontact injuries. Positional release therapy (PRT) also considered strain/counterstrain focuses on releasing the tension in a tissue through unloading the involved body part. Case Presentation: Two male student-athletes participating in football with a mean age of 20.5 years were diagnosed by a physician with medial collateral ligament grade 2 sprain. Both patients sustained their injuries in a regular season game with a contact valgus force from an opposing player. Management and Outcomes: After the initial 72 hours of compression, elevation, and cryotherapy, the patients were both treated with PRT followed by progressive loading exercises. Following 4 treatment sessions of PRT over the next 6 days, the patients started with quadriceps engagement exercises, single-leg squats to 60° knee flexion, side steps, triceps dips, slow controlled lunges, and toe walk. The patients progressed to full body weight squats, single-leg landing, step-up tri-extension, and sidekicks with a leg on table. Then, the patients completed function movements and sports-specific exercises. Conclusions: In this case series, 2 patients competing in intercollege American Football were treated with PRT and progressive loading exercises to facilitate return to unrestricted activities and improve outcome measures. Commonly, a grade 2 medial collateral ligament sprain is conservatively treated with return to sport taking 20 days on average. In this type 2 case series, the clinician found success utilizing PRT early in the recovery process, which in these 2 cases lead to restoration of function, outcome measure improvement, and an expedited return to sport. The expedited return to sport occurred at an average of 18 days for these patients. [ABSTRACT FROM AUTHOR]

Context: Exertional heat stroke (EHS) is the most deadly form the exertional heat illness with a higher incidence among active duty US military members than in the general population. Current guidelines on EHS recovery timelines and return to duty vary among the military branches. In some cases, individuals experience prolonged heat and exercise intolerance with repeat exertional heat illness events, which can complicate the recovery process. Management and rehabilitation of such individuals is unclear. Case Presentation: This manuscript addresses the case and management of a US Air Force Special Warfare trainee who experienced 2 episodes of EHS, despite early recognition, gold standard treatment, and undergoing 4 weeks of a stepwise recovery after an initial EHS. Management and Outcomes: After the second episode, a 3-step process was utilized, consisting of a prolonged and personalized recovery period, heat tolerance testing using Israeli Defense Force advanced modeling, and stepwise reacclimatization. This process allowed the trainee to successfully recover from repeat EHS and return to duty, and set a framework for future repeat EHS treatment guidelines. Conclusions: In individuals with repeat EHS, a prolonged recovery period followed by heat tolerance testing can be used to demonstrate appropriate thermotolerance and safely clear an individual to begin stepwise reacclimatization. Overall, patient care and military readiness may be improved by unified Department of Defense guidelines for return to duty after EHS. [ABSTRACT FROM AUTHOR]

Background: Post-cardiac arrest syndrome (PCAS) presents a multifaceted challenge in clinical practice, characterized by severe neurological injury and high mortality rates despite advancements in management strategies. One of the important critical aspects of PCAS is post-arrest lung injury (PALI), which significantly contributes to poor outcomes. PALI arises from a complex interplay of pathophysiological mechanisms, including trauma from chest compressions, pulmonary ischemia–reperfusion (IR) injury, aspiration, and systemic inflammation. Despite its clinical significance, the pathophysiology of PALI remains incompletely understood, necessitating further investigation to optimize therapeutic approaches. Methods: This review comprehensively examines the existing literature to elucidate the epidemiology, pathophysiology, and therapeutic strategies for PALI. A comprehensive literature search was conducted to identify preclinical and clinical studies investigating PALI. Data from these studies were synthesized to provide a comprehensive overview of PALI and its management. Results: Epidemiological studies have highlighted the substantial prevalence of PALI in post-cardiac arrest patients, with up to 50% of survivors experiencing acute lung injury. Diagnostic imaging modalities, including chest X-rays, computed tomography, and lung ultrasound, play a crucial role in identifying PALI and assessing its severity. Pathophysiologically, PALI encompasses a spectrum of factors, including chest compression-related trauma, pulmonary IR injury, aspiration, and systemic inflammation, which collectively contribute to lung dysfunction and poor outcomes. Therapeutically, lung-protective ventilation strategies, such as low tidal volume ventilation and optimization of positive end-expiratory pressure, have emerged as cornerstone approaches in the management of PALI. Additionally, therapeutic hypothermia and emerging therapies targeting mitochondrial dysfunction hold promise in mitigating PALI-related morbidity and mortality. Conclusion: PALI represents a significant clinical challenge in post-cardiac arrest care, necessitating prompt diagnosis and targeted interventions to improve outcomes. Mitochondrial-related therapies are among the novel therapeutic strategies for PALI. Further clinical research is warranted to optimize PALI management and enhance post-cardiac arrest care paradigms. [ABSTRACT FROM AUTHOR]

Introduction: Subglottic stenosis, manifested by granulation tissue hyperplasia, is challenging and requires multiple repeated treatments and stent maintenance at times. Corticosteroids prevent severe subglottic stenosis development owing to their antifibrotic and anti-inflammatory properties. Submucosal injection of glucocorticoids, a useful adjuvant therapeutic method, improves the mean interval between endoscopic procedures and reduces airway restenosis risks. Case Presentation: We report a rare case of a man with complex subglottic stenosis who underwent balloon dilatation combined with cryotherapy, stent placement, and adjuvant submucosal triamcinolone injection. The drug was injected efficiently and safely into the submucosal layer under percutaneous ultrasound guidance, and subglottic stenosis was well-controlled at a low cost. Conclusion: POCUS-guided medication injections may be a useful adjuvant medical therapy for subglottic stenosis. [ABSTRACT FROM AUTHOR]

Despite optimal cognitive function being essential for performance, there is a lack of research on the effectiveness of combined cooling interventions on team sport athlete's cognitive function when exercising in the heat. In a randomised, crossover design, 12 unacclimatised men (age: 22.3 ± 3.0 years, body mass: 73.4 ± 5.1 kg, height: 181.0 ± 5.3 cm and V˙O2 $\dot{\mathrm{V}}{\mathrm{O}}_{2}$ max: 51.2 ± 9.5 mL/kg/min) participated in a control (CON) and combined cooling trial (ice slurry and ice collar; COOL). A battery of cognitive tests were completed prior to, during (at half‐time) and following a 90‐min intermittent running protocol in the heat (33°C, 50% relative humidity (RH)). Perceptual and physiological measures were taken throughout the protocol. In CON, response times were quicker on the Stroop task complex level (p = 0.002) and the visual search test complex level at full‐time (p = 0.014) compared to COOL. During COOL, response times were quicker at half‐time on the Stroop task complex level (p = 0.024) compared to CON. Lower rectal temperatures were seen during COOL (CON: 37.44 ± 0.65°C and COOL: 37.28 ± 0.68°C) as well as lower skin, neck and forehead temperatures (main effect of trial, all p < 0.05). Lower ratings of thermal sensation and perceived exertion and enhanced thermal comfort were recorded during COOL (main effect of trial, all p < 0.05). Whilst minimal differences in cognitive function were found when using the combined cooling intervention, the findings highlight a practical and effective strategy to improving many physiological and perceptual responses to intermittent exercise in the heat. Highlights: Many studies have investigated the use of a combined cooling strategy on endurance exercise in the heat and found positive benefits on physiological, perceptual and cognitive responses to the intervention; however, there is a lack of research on intermittent exercise.The combined cooling intervention, consisting of an ice slurry and ice collar, was successful at lowering rectal, neck, forehead and skin temperatures as well as perceptual ratings of thermal sensation, comfort and perceived exertion.However, the combined cooling strategy did not elicit any consistent findings regarding cognitive function. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cryotherapy is widely utilized for therapeutic purposes, yet its specific effects on knee joint proprioception and quadriceps muscle performance in healthy individuals remain unclear. This study addresses this gap by examining the impact of a 20-minute cryotherapy session on knee joint proprioception and related muscle parameters in a cohort of healthy college students. OBJECTIVES: To investigate the effects of cryotherapy on knee joint proprioception and quadriceps muscle peak moment, work and power in healthy college male and female students. METHODS: Thirty-two healthy students, aged 19–23, underwent a 20-minute cryotherapy session using Cryogel packs applied to the anterior thigh and knee. An isokinetic dynamometer measured knee joint proprioception and quadriceps muscle parameters before, immediately after, 10-min, and 20-min post-cryotherapy. RESULTS: Proprioception values did not significantly differ between genders or post-tests (p > 0.05). However, the female group exhibited significantly lower moment, power, and work values compared to males (p < 0.05). No significant differences were observed within or between post-tests in moment, power, and work for both genders (p > 0.05). CONCLUSIONS: A 20-minute cryotherapy application demonstrated no adverse effects on knee joint proprioception or quadriceps muscle metrics in healthy college students, supporting the safety of cryotherapy in this context. [ABSTRACT FROM AUTHOR]

This randomized clinical trial aims to evaluate cryotherapy as a therapeutic option for pain prevention after endodontic treatment with and without foraminal enlargement, in patients with asymptomatic apical periodontitis.120 teeth of patients with preoperative Visual Analogue Scale score indicating zero were treated. Specimens were randomly allocated into 4 groups: Control, Cryotherapy (ICT), Foraminal Enlargement (FE), and Cryotherapy and Foraminal Enlargement (ICT + FE). Working length was determined with an Electronic Apex Locator (EAL). Cryotherapy groups passed through a final irrigation protocol using 20 ml (2.5 ℃) of cold saline solution delivered at working length for 5 min. In FE groups a #40 K-file was used up to the 0.0 mark on the EAL display. Obturation was performed and postoperative pain was checked at 6, 12, 24, 48, and 72 h and 7 days after endodontic treatment.All experimental groups showed an increase in the level of postoperative pain, which started to decrease after 12 h. Foraminal enlargement caused a statistically significant increase in postoperativepain compared to ICT and control groups within the first 6 h (p < 0.05). Cryotherapy did not influence postoperative pain, regardless of whether or not foraminal enlargement was performed. [ABSTRACT FROM AUTHOR]

Objective: Cervical ectropion occurs due to the eversion of the endocervix that exposes glandular cells to the vaginal milieu. The aim of the present study was to evaluate and compare the clinical efficacy of effervescent vaginal tablets of tranexamic acid and cryotherapy in women with symptomatic cervical ectopy. Methods: The current randomized clinical trial was conducted on 92 samples of women with cervical erosive ectropion from March 20, 2022 to August 27, 2022. Participants were divided into two groups; the intervention group (n = 46) was treated with a 400 mg effervescent vaginal tablet of tranexamic acid and the control group (n = 46) underwent cryotherapy. All the patients were requested to visit weekly in the first month and then monthly for the next 3 months, and the outcomes encompass improvement of symptoms (leukorrhea, dyspareunia, pelvic pain, post‐coital bleeding, and suprapubic pain) and cervical erosive ectropion view were monitored based on repeated examinations. Results: In this study, no statistically significant difference was observed in cure rate of symptoms between study groups (P value > 0.05). Women in both the tranexamic acid and cryotherapy groups reported significant improvements in dyspareunia (34 [75%] vs 31 [67%]), pelvic pain (34 [75%] vs 34 [74%]), post‐coital bleeding (37 [81%] vs 31 [67%]), leukorrhea (36 [78%] vs 36 [78%]), suprapubic pain (32 [71%] vs 33 [73%]) disappearance of cervical ectropion tranexamic acid (40 [86%], vs 39 [84%]). Conclusion: Our findings highlighted the equal effect of tranexamic acid and cryotherapy for treating cervical ectropion. Due to the ease of use, availability, and fewer side effects of tranexamic acid, it can be a suitable alternative to cryotherapy. Trial Registration: IRCT20220115053719N1. The name of the registry: Iranian Registry of Clinical Trials. URL of registration: https://en.irct.ir/trial/61483. Synopsis: Tranexamic acid and cryotherapy are effective in cervical ectropion treatment. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) in children under 15 years often results in airway compression, with bronchus intermedius (BI) being the most common site. Endoscopic enucleations can be used to remove lymph nodes and establish an airway in severe cases. Both rigid and flexible bronchoscopy are suitable, with alligator forceps being preferred for its ability to extract tissue. Recent studies have also explored cryoprobe enucleation. Case Presentation: An HIV-positive boy with persistent symptoms after 9 months of TB treatment was diagnosed based on his mother's and sister's Xpert MTB/RIF positive status. He was started on 4-drug TB treatment, but the child remained clinically symptomatic with abnormal chest X-ray and unconfirmed TB. Bronchoscopy was performed, revealing complete obstruction of BI due to caseating granulomas causing collapse of the right middle and lower lobes. Cryotherapy was used to recanalize the airway, and follow-up bronchoscopy confirmed patent BI. Conclusion: While cryotherapy was effective in the restoration of airway patency in this case, there is a lack of knowledge about its use in children. [ABSTRACT FROM AUTHOR]

Cryoablation is a well-established medical procedure for surgically treating atrial fibrillation. Cryothermal catheter therapy induces cellular necrosis by freezing the insides of pulmonary veins, with the goal of disrupting abnormal electrical heart signals. Nevertheless, tissue damage induced by cold temperatures may also lead to other complications after cardiac surgery. In this sense, the simulation of catheter ablation can provide safer environments for training and the performance of cryotherapy interventions. Therefore, in this paper, we propose a novel approach to help better understand how temperature rates can affect this procedure by using computer tools to develop a simulation framework to predict lesion size and determine optimal temperature conditions for reducing the risk of major complications. The results showed that a temperature profile of around −40 °C caused less penetration, reduced necrotic damage, and smaller lesion size in the tissue. Instead, cryotherapy close to −60 °C achieved a greater depth of temperature flow inside the tissue and a larger cross-section area of the lesion. With further development and validation, the framework could represent a cost-effective strategy for providing personalized modeling, better planning of cryocatheter-based treatment, and preventing surgical complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Rotator cuff tendonitis (RCT) is one of the most common shoulder pathologies. It causes pain, limits shoulder joint movements, and impairs function. Despite various treatment methods, there are currently no specific guidelines regarding the most effective intervention for RCT. To the best of our knowledge, no studies have compared the effects of Kinesio taping (KT) and cold therapy (CT) on individuals with RCT. To this end, this study aimed to investigate and compare the short-term effects of KT and CT on pain relief and upper extremity functionality in individuals with RCT. Materials and Methods: One hundred and fourteen individuals were assessed for eligibility. Fifty-two individuals with RCT who met the inclusion criteria and agreed to participate were randomly allocated into either the KT or the CT group. A standardized home exercise program was given to all the participants. Their pain intensity, upper extremity function, shoulder range of motion (ROM), and grip strength were evaluated initially and after the three days of KT or CT applications. Results: All the assessment values significantly improved in the KT group. In the CT group, only the pain scores (except for the numerical rating scale (NRS) pain score during activity) were significantly improved in the CT group at the end of the third day of application compared to the initial values (p < 0.05). For all the measurement outcomes, the effects of time × group interactions were statistically significant (p < 0.05) in favor of the KT group, except for the resting pain (p = 0.688). Conclusions: The findings suggest that KT and CT could be used as adjunctive modalities to exercise for resting and night pain relief in patients with RCT. KT also had positive effects on the activity pain, function, ROM, and grip strength. The use of KT along with an exercise program could be a more effective therapeutic choice than the use of CT for improving night pain, activity pain, and upper extremity function during the short-term rehabilitation of RCT patients. [ABSTRACT FROM AUTHOR]

Even when pain control is implemented, calves may experience pain for days after hot-iron disbudding. Whether calves seek pain relief post-disbudding offers a novel approach to assessing pain in these animals. By employing an approach-aversion paradigm, we explored the ability of cold therapy to provide immediate pain relief in disbudded calves. Calves were habituated to the manual placement of a cool or ambient pack on their forehead for a short duration simultaneous to milk reward consumption, prior to disbudding. Calves were then disbudded under local anaesthesia (procaine) and analgesia (meloxicam), and responses to the packs were observed over subsequent days. Individual calves were consistently exposed to either cool or ambient packs in different halves of a two-sided experimental pen, allowing for the testing of approach-aversion and conditioned place preference. We found calves approached milk rewards quicker and maintained contact for longer when receiving cold therapy compared to the ambient control. However, calves did not display any conditioned preference for the pen where they received the cool pack. These results add to the growing evidence of lasting pain following disbudding procedures and suggests that cold therapy provides some form of pain relief post-disbudding. Future studies should seek other ways to use cold therapy post-disbudding to reduce aversiveness and human involvement. [ABSTRACT FROM AUTHOR]

Introduction: Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Transcutaneous electrotherapies have been widely used to treat CLBP but, with the partial exception of transcutaneous electrical nerve stimulation (TENS), their effect on pain, disability, quality-of-life, and psychosocial outcomes have not been systematically reviewed. The purpose of this systematic review and meta-analysis was to clarify the overall effect of transcutaneous electrotherapies on patient-reported outcome measures (PROMs) in CLBP patients. Methods: Four databases and two study registries were searched for studies that utilized transcutaneous electrotherapies as a primary intervention for CLBP, compared against active or passive controls. Two reviewers independently extracted study data and assessed risk of bias. Studies were grouped by intervention vs. comparison, and by time of follow-up. Meta-analyses were conducted where appropriate. Results: A total of 89 full-text were assessed for eligibility; 14 studies were included, with 6 in the meta-analyses (all TENS or mixed TENS). Pain: meta-analyses revealed no significant difference for TENS vs. active control, TENS vs. passive control, or mixed TENS vs. active control at post-intervention, nor for mixed TENS vs. active control at 1-month post-intervention. Interferential current (IFC) was more effective than active control (2 studies), while electromyostimulation (EMS) was generally superior to passive, but not active, controls (6 studies). Disability: Meta-analyses revealed no significant difference for TENS vs. active control at post-intervention, mixed TENS vs. active control at post-intervention, or mixed TENS vs. active control at 1-month post-intervention. IFC was more effective than active control (2 studies), while the EMS results were mixed (6 studies). We were unable to perform metaanalyses for quality-of-life or psychosocial outcomes. Conclusion: There is moderate evidence that TENS is similar to all controls for improving pain and disability. There is limited evidence that IFC is superior to active controls for improving pain and disability. There is limited evidence that EMS is superior to passive but not active controls for improving pain, and similar to all controls for improving disability. [ABSTRACT FROM AUTHOR]

The use of whole-body cryotherapy (WBC) for musculoskeletal ailments is growing. WBC, involving brief exposure to extremely low temperatures, is increasingly used for its analgesic, anti-inflammatory, and antioxidant effects. The paper examines the physiological impacts of WBC on cardiovascular, musculoskeletal, hematologic, hormonal, and metabolic systems. Specific orthopaedic applications discussed include its role in the management of fractures, osteoarthritis, osteonecrosis of the femoral head, osteomyelitis, adhesive capsulitis, tendinopathies, rheumatic pathologies, chronic pain syndromes, and fibromyalgia. The study also highlights the benefits and drawbacks of WBC, including its potential to improve athletic performance, recovery, mood, and well-being, while noting risks like frostbite and impaired muscle strength. Clinical evidence from various studies is evaluated, revealing a spectrum of outcomes. For instance, WBC shows promise in enhancing bone health in athletes and providing relief in osteoarthritis and fibromyalgia patients. However, evidence for its efficacy in conditions like chronic pain syndromes and osteomyelitis is less robust. The paper underscores the need for further research to establish standardised protocols and understand long-term effects. While WBC offers significant benefits in orthopaedics, understanding its limitations and potential risks is crucial for its safe and effective clinical application. [ABSTRACT FROM AUTHOR]

Introduction: In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre‐puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture. Methods: This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel‐group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale. Findings: A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively). Discussion: Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure. [ABSTRACT FROM AUTHOR]

Background and Purpose: Cryotherapy is an affordable and popular treatment of soft tissue injuries, which can reduce inflammation and pain. Studies have specifically addressed young adults and athletes, and these findings have been extended to older adults in clinical practice. Aging is associated with changes in the skin, including collagen degradation, decreased fat layer thickness, and reduced blood flow, which can alter the skin response to stress. Because of age-related changes, there are concerns about the direct use of ice on the skin of older individuals. Skin injuries were also observed after cryotherapy. This study aimed to assess the most effective and safe cryotherapy for superficial skin cooling among older women. Methods: Eighteen older women were enrolled in this blinded, randomized, crossover, clinical trial. The mean values (SD) of their age, height, and weight were 70.0 years (6.0), 156.0 cm (9.1), and 72.8 kg (19.5), respectively. The participants underwent cryotherapy using bagged ice, bagged ice plus a wet towel, or gel pack for 20 minutes. The surface temperature of the skin was measured at the end ofa 20-minute cryotherapy session using an infrared thermometer. Repeated-measures analysis of variance was conducted to analyze the effect of cryotherapy modalities and time, as well as the interaction between these 2 factors. The secondary outcome wasthe presence ofcryotherapy-induced lesions. Results and Discussion: Cryotherapy modalities had significant effects on superficial skin temperature (P = .001). Time points after application also had an effect (P< .001) and no interaction was observed between cryotherapy modalities and time points (P = .051). Bonferroni post hoc evaluation showed that bagged ice (P = .008) and gel (P = .007) were more effective in decreasing the superficial skin temperature than bagged ice plus wet towel. No difference was observed between bagged ice and gel (P = .32). Three of the 18 patients experienced adverse effects with the gel pack. Conclusion: This study of older women found that ice and gel cooled the skin more effectively than ice wrapped in towels. However, the gel pack had some adverse effects. Therefore, bagged ice is recommended for cryotherapy in older women. [ABSTRACT FROM AUTHOR]

Topical ice has been shown to reduce pain scores and opioid use in adults with midline abdominal incisions. This study was designed to evaluate the efficacy of a cold therapy system in children following laparoscopic appendectomy. Patients 7 years and older who underwent laparoscopic appendectomy at our institution from December 2021–September 2022 were eligible. Patients were randomized to standard pain therapy (control) or standard plus cold therapy (treatment) utilizing a modified ice machine system with cool abdominal pad postoperatively. Pain scores on the first 3 postoperative days (PODs), postoperative narcotic consumption, and patient satisfaction were analyzed. Fifty-eight patients were randomized, 29 to each group. Average survey response rate was 74% in control and 89% in treatment patients. There was no significant difference in median pain scores or narcotic use between groups. Cold therapy contributed to subjective pain improvement in 71%, 74%, and 50% of respondents on PODs 1, 2, and 3 respectively. A majority of patients reported cold therapy to be a helpful adjunct in pain control after appendectomy, though it did not reduce postoperative pain scores or narcotic use in our cohort - likely due to this population's naturally expedient recovery and low baseline narcotic requirement. Randomized Controlled Trial. Level I. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is an underaddressed and distressing common side effect of cancer treatment. Effective management of CIPN merits a comprehensive team approach. Nurse navigators are in a unique position to provide education and support to people with CIPN and to advocate for treatment options. Objectives: To report on our experience in development and patient feedback of a CIPN clinical pathway with embedded patient education. We also report on the role of the nurse navigator in developing and implementing this project. Methods: We reviewed patient-reported outcome data to identify the incidence of CIPN in our gynecologic oncology patient population and developed a clinical pathway for management of CIPN. We also developed CIPN patient education materials and developed a process to deliver them to patients. We surveyed patients about their experience with CIPN and their satisfaction with their CIPN-related education. Results: Ten patients completed the satisfaction survey on CIPN education. Eight of 10 patients (80%) answered "Agree" or "Strongly agree" that the education was given in a timely manner. Eight of 10 patients (80%) answered that the education was easy to understand. Conclusion: Earlier identification of symptoms and awareness of resources, such as utilization of the CIPN pathway, can provide relief for people with CIPN and can minimize the effects of CIPN, leading to improved quality of life. The nurse navigator is uniquely positioned to impact the patient experience of CIPN. Next steps include evaluation of provider use of the pathway and continued tracking of patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Cryotherapy is widely used in health contexts, including first aid, treating acute musculoskeletal injuries and women undergoing chemotherapy. Studies have shown that frozen gloves can help reduce nail toxicity for women undergoing chemotherapy. Nail toxicity is a common issue among people undergoing chemotherapy, causing disfigurement and pain. Although cooling gloves have been shown to reduce nail toxicity, the range of temperatures used remains unclear, often resulting in discomfort. In this innovative study, we used a quasi-experimental, two group pretest-posttest design to evaluate the effectiveness of Chemo-Cooling Gloves developed by the researchers to help prevent nail toxicity. We assessed satisfaction with the gloves among 27 Thai women undergoing chemotherapy who were purposively recruited according to the inclusion criteria from a chemotherapy center of a university-affiliated hospital in a southern region of Thailand. Participants underwent a regimen of cyclophosphamide in combination with doxorubicin and 5-flu- orouracil every 21 days for six cycles. Each participant served as their own control, wearing the cooling glove on the one hand randomly selected, while the other hand remained unprotected and acted as the control. Data were collected using a demographic questionnaire, the Common Terminology Criteria for Adverse Events version 3.0, and the Chemo-Cooling Gloves Satisfaction Questionnaire. Data analysis utilized descriptive statistics and Cochran's Q test. The results revealed that nail toxicity was significantly lower in the protected hand than in the control hand during cycles 2 to 3 and 2 to 4, but no significant difference between the two hands during cycles 2 to 5 and 2 to 6. Overall satisfaction with the Chemo-Cooling Gloves was at the highest level. The use of frozen gloves aligns with evidence-based practice, as supported by our study. Nurses need to be trained in the proper use and application of the gloves and educate patients on the benefits and correct usage to maximize comfort and efficacy. By incorporating the Chemo-Cooling Gloves into routine practice, nurses can help improve patient adherence to chemotherapy regimens and potentially enhance treatment outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Cold water immersion methods are not standardized in terms of operational indicators such as immersion temperature, duration and depth, leading to controversy over the efficacy of recovery from exercise fatigue in skeletal muscle. In this article, we analyze the effects of cold water immersion on muscle injury, muscle soreness and muscle strength recovery under different factors, in order to find the best immersion implementation plan, and thus provide evidence for the recovery of muscle fatigue. METHODS: A search of CNKI, WanFang Data, Web of Science, and PubMed databases was conducted for relevant literature published from January 1, 2000 to August 15, 2023. A total of 4 759 articles were initially retrieved, with 4 735 articles excluded through screening and 24 articles finally included. The Physical Therapy Evidence Database Scale was used to assess the methodological quality of the included literature, and Stata-MP 16 software was used to perform effect size combinations, subgroup analyses, Meta-regression, sensitivity tests, and publication bias analyses. RESULTS: (1) The article included a total of 24 randomized controlled trial studies, including 617 subjects, with overall high legal quality. (2) Meta-analysis showed that cold water immersion can significantly reduce creatine kinase blood value [standardized mean difference (SMD)=-0.17, 95% confidence interval (CI): -0.29 to -0.05, P < 0.01], alleviate muscle pain (SMD=-0.60, 95% CI: -0.81 to -0.38, P < 0.01), and promote maximum muscle strength recovery (SMD=0.17, 95% CI: 0.05 to 0.30, P < 0.01). (3) Subgroup analysis showed that: The immersing regimen with water temperature > 14 °C (SMD=-0.48, 95% CI: -0.76 to -0.20, P < 0.01) and duration of 12-14 minutes (SMD=-0.38, 95% CI: -0.61 to -0.15, P < 0.01) had the best effect in reducing creatine kinase blood values, and had a more significant intervention effect on endurance exercise (SMD=-0.45, 95% CI: -0.71 to -0.20, P < 0.01), while the immersion regimen with water temperature < 10 °C (SMD=-0.61, 95% CI: -0.79 to -0.43, P < 0.01), duration < 12 minutes (SMD=-0.76, 95% CI: -0.98 to -0.53, P < 0.01), and immersion depth above the iliac spine (SMD=-0.74, 95% CI: -0.97 to -0.52, P < 0.01) had the best effect on relieving muscle soreness, and had a more significant analgesic effect after endurance exercise (SMD=-0.42, 95% CI: -0.61 to -0.22, P < 0.01). (4) Meta regression showed that immersion water temperature, immersion duration, and exercise type were important regulatory factors affecting the effect size of creatine kinase; immersing water temperature and immersing depth were important regulatory factors affecting the effect size of visual analogue scale score, while exercise type was an important regulatory factor affecting the maximum isometric muscle strength effect size. CONCLUSION: (1) Evidence of extremely low to moderate strength suggests that cold water immersion can effectively reduce muscle damage, alleviate muscle soreness, and promote muscle strength recovery. (2) In terms of reducing muscle injury, immersion water temperature, immersion duration, and exercise type are significant regulatory factors that affect the efficacy of immersing. Among them, immersion water temperature > 14 °C and duration of 12-14 minutes are the best solutions to reduce muscle injury after exercise, and the immersing effect is better for endurance exercise. (3) In terms of reducing muscle soreness, immersion water temperature and immersion depth are important regulatory factors that affect the intervention effect. Among them, immersion water temperature < 10 °C, duration < 12 minutes, and immersing depth above the iliac spine are the best solutions to reduce muscle soreness, and have a better analgesic effect after endurance exercise. (4) In terms of promoting muscle strength recovery, exercise type is a key regulatory factor that affects the maximum isometric muscle strength effect. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of cooling on the reverse torque values of different abutments in bone-level and tissue-level implants. The null hypothesis was that there would be no difference in reverse torque values of abutment screws when cooled and uncooled implant abutments were compared. Materials and Methods: Bone-level and tissue-level implants (Straumann, each n = 36) were placed in synthetic bone blocks and subdivided into three groups (each n = 12) based on the abutment type (titanium base, cementable abutment, abutment for screw-retained restorations). All abutment screws were tightened to 35 Ncm torque. In half of the implants, a dry ice rod was applied on the abutments close to the implant-abutment connection for 60 seconds before untightening the abutment screw. The remaining implant-abutment pairs were not cooled. The maximum reverse torque values were recorded using a digital torque meter. The tightening and untightening procedure was repeated three times for each implant including cooling for the test groups, resulting in 18 reverse torque values per group. Two-way analysis of variance (ANOVA) was used to analyze the effect of cooling and abutment type on the measurements. Post hoc t tests were used to make group comparisons (a = .05). The P values of post hoc tests were corrected for multiple testing using the Bonferroni-Holm method. Results: The null hypothesis was rejected. Cooling and abutment type significantly affected the reverse torque values in bone-level implants (P = .004) but not in tissue-level implants (P = .051). The reverse torque values of bone-level implants significantly decreased after cooling (20.31 ± 2.55 Ncm vs 17.61 ± 2.49 Ncm). Overall mean reverse torque values were significantly higher in bonelevel implants compared to tissue-level implants (18.96 ± 2.84 Ncm vs 16.13 ± 3.17 Ncm; P < .001). Conclusion: Cooling of the implant abutment led to a significant decrease in reverse torque values in bone-level implants and may therefore be recommended as a pretreatment before the application of procedures to remove a stuck implant part. [ABSTRACT FROM AUTHOR]

Facial nerve palsy is most commonly idiopathic, but it can also result from infections, inflammatory and cerebrovascular disorders, tumors, and trauma. We report the case of a 68-year-old patient who developed iatrogenic facial nerve palsy subsequent to dermatological cryosurgery on the right cheek. Remarkably, a full recovery occurred within 8 weeks. Drawing upon the promising outcome of this case and the existing literature on neuropathies linked with cold application in sports injuries, we propose neurapraxia as the probable pathomechanism underlying cryotherapy-induced nerve damage. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spasticity is a common symptom of multiple sclerosis (MS), affecting 80% of patients. Many studies have aimed to detect methods to reduce spasticity under these conditions and found that spasticity can be efficiently reduced using cryotherapy. OBJECTIVE: To examine the impact of cryotherapy on spasticity among patients with MS. METHODS: Thirty-two participants were randomized into two groups. The study group was given airflow cryotherapy and a selected physical therapy program, whereas the control group was only given a selected physical therapy program. The treatment was administered three times each week for a total of twelve consecutive sessions. The outcome measures were the modified Ashworth scale and the H/M ratio. RESULTS: The study group showed significant decrease in calf muscle spasticity, indicated by a reduction in spasticity grade (p = 0.001) and a decrease in the H/M ratio of 33.81% (p = 0.001). The control group also showed significant reduction in calf muscle spasticity, as indicated by a reduction in spasticity grade (p = 0.001) and a reduction in the H/M ratio of 19.58% (p = 0.001). There was a significant decrease in the spasticity grade and H/M ratio of the study group posttreatment compared with those of the control group (p = 0.02 and p = 0.001). CONCLUSION: The combined effect of cryotherapy and a selected physical therapy program are more effective in controlling the spasticity of calf muscles in patients with MS than a selected physical therapy program alone. [ABSTRACT FROM AUTHOR]

Background: In burn care, achieving swift healing with minimal complications remains paramount. This investigation assesses the role of polyhexamethylene biguanide (PHMB) in managing pediatric superficial partial-thickness burns, focusing on the effects of various patient-specific factors on recovery. Methods: Through a retrospective analysis of 27 pediatric cases treated with PHMB, we evaluated the impact of age, burn size, dressing frequency, treatment delay, cold therapy application, and analgesic usage on the time until reepithelialization (TTRE). Results: The majority of patients benefited from early cold therapy, yet only 1 in 3 patients received analgesics. A mean healing time of 8.78 (SD: 2.64) days was observed, with the extent of the burn showing a strong correlation (r: 0.63) to TTRE. Most treatments were managed outpatient, evidenced by a negligible average hospital stay (0.96 days), with recorded no complications. Conclusions: Our findings endorse PHMB as a promising treatment for superficial second-degree burns in young patients, due to the observed stable and rapid wound closure without the association of increased risks. Continued exploration into the optimal application of prehospital interventions and the comprehensive benefits of PHMB in pediatric burn management is necessary. Future research should assess long-term outcomes, including functionality, scar quality, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies have reported the efficacy of the cryoballoon (CB)‐guided left atrial roof block line (LARB) creation in patients with persistent atrial fibrillation (AF). However, it can be technically challenging to attach the balloon to the left atrial (LA) roof due to its anatomical variations. We designed a new procedure called the "Raise‐up Technique," which may facilitate the firm adhesion of the CB to the LA roof during freezing. This study aimed to evaluate the efficacy of the Raise‐up technique in LARB creation. Methods and Results: In total, 100 consecutive patients with persistent AF who underwent CB‐LARB creation were enrolled. Fifty‐seven patients underwent LARB creation using the Raise‐up technique (Raise‐up group), and the remaining 43 did not use it (control group). The Raise‐up technique was performed as follows: An Achieve catheter was inserted as deeply as possible into the upper branch of the right superior pulmonary vein to anchor the CB. The balloon was placed below the targeted site on the LA roof and frozen. When the temperature of the CB reached approximately −10°C and the CB was easier to attach to the LA tissue, the CB was raised and pressed against the LA roof immediately by sheath advancement. Then the balloon could be in firm contact with the target site on the roof. If necessary, additional sheath advancement after sufficient freezing (−20°C to −30°C) was allowed the CB to have more firm and broad contact with the target site. LARB creation without touch‐up ablation was achieved in 54 of 57 patients (94.7%) in the Raise‐up group and 33 of 43 patients (76.7%) in the control group (p <.05). The lesion size of the LARB in the Raise‐up group was significantly larger than that in the control group (15.2 cm2 vs. 12.8 cm2, p <.05). Moreover, the width of the LARB lesion in the Raise‐up group was wider than that in the control group (32.0 mm vs. 26.6 mm, p <.05). Conclusion: The Raise‐up technique enabled the creation of seamless and thick LARB lesions with a single stroke. In addition, the CB‐LARB lesions created using the Raise‐up technique tended to be large, resulting in extensive debulking of the LA posterior wall arrhythmia substrates. In CB ablation for persistent AF, the Raise‐up technique can be considered one of the key strategies for LARB creation. [ABSTRACT FROM AUTHOR]

Curettage with or without the use of adjuvants is the standard of care in the treatment of an aneurysmal bone cyst (ABC). Historically, our approach combined curettage, high‐speed burr drilling, and cryoablation. However, treatments varied based on age, tumor location, and surgeon preference. We asked: (1) Does cryoablation in addition to curettage and burr drilling decrease the local recurrence rates? (2) Are there any risk factors for the local recurrence rate? (3) Does cryoablation improve postsurgical functional outcomes in these patients? Patients treated for an ABC, between January 2006 and December 2019 were included in this retrospective analysis. Patient and surgical characteristics, such as age, gender, tumor location, type of treatment, time of follow‐up, recurrence rate, and functional outcome measured by the Musculoskeletal Tumor Society Score 1993 (MSTS93) score were compared between those treated with and without cryoablation. Both groups, without cryoablation (n = 88) and with cryoablation (n = 42), showed no significant difference in local recurrence rates (9.1% vs. 7.1%, p = 0.553) and functional outcomes as measured by the MSTS93 score (28.9 vs. 27.8, p = 0.262). Risk factors analyzed did not significantly affect local recurrence risk, except for secondary ABC diagnosis (p = 0.017). The cryoablation group had a more extended follow‐up (45.6 vs. 73.2 months, p < 0.001), reflecting a shift in practice over time. We found no significant difference in local recurrence rate or functional outcome in patients treated with or without cryoablation. Formal curettage with additional high‐speed burr drilling provides effective tumor control and favorable functional outcomes, negating the need for adjuvant cryoablation. [ABSTRACT FROM AUTHOR]

Basal cell carcinoma (BCC) is a slow-growing, locally aggressive, rarely metastasizing, low-grade cutaneous neoplasm that arises from the epidermal basal layer and invades the adjoining tissues. It is the most common skin cancer. It is fairly common in fair Caucasians and quite uncommon in dark-skinned populations. It contributes to 65–75% of cutaneous malignancies in whites and 20–30% in Asian Indians. The most important causal factors appear to be radiation exposure and genetic predisposition. It may present as a nonhealing lesion that occasionally bleeds or as a pruritic lesion with no symptoms. Tumours rarely spread to regional lymph nodes. The clinical appearances and morphology of BCC are diverse. Clinical types include nodular, cystic, superficial, pigmented, morphoeaform, (sclerosing), keratotic and fibroepithelioma of Pinkus. Most of the lesions appear on the head and neck, usually above the line joining the tragus and the angle of the mouth. A biopsy should be performed on all lesions suspected of BCC. The primary aim of treatment is the complete excision of the tumour tissue. Other treatment modalities include cryotherapy, immunomodulatory drugs, laser treatment or locally applicable chemotherapeutic agents. Prevention consists of lifestyle changes such as avoiding sunburn, tanning beds and prolonged direct sun exposure, shade seeking, sunscreen application on the skin, and physical barrier methods such as protective clothing, hats and sunglasses. Regular sunscreen use in childhood and adolescence seems more beneficial than in adulthood. [ABSTRACT FROM AUTHOR]

Exploring sports-related musculoskeletal injuries and treatment characteristics in middle school sports may help inform patient care decisions such as appropriate medical coverage. To describe injury and treatment characteristics of middle school–aged athletes receiving care from athletic trainers within the Athletic Training Practice-Based Research Network (AT-PBRN). Descriptive study. Middle school. Middle school–aged athletes (n = 1011; male = 503, female = 506, 2 declined to answer) with sports-related musculoskeletal injuries. Electronic patient records were analyzed from the AT-PBRN from 59 athletic trainers across 14 states between 2010 and 2022. Summary statistics (frequency, percentages, median, and interquartile ranges [IQR]) were used to describe injury (age at injury, sex, sport, body part, and diagnosis) and treatment characteristics (type of treatment, number of visits, and number of procedures per visit). Football (17.7%, n = 179), basketball (17.6%, n = 178), and soccer (14.9%, n = 151) reported the highest number of injuries. The ankle (17.2%, n = 174), knee (16.5%, n = 167), and head (14.1%, n = 143) were the most common injury locations. Concussion (13.0%, n = 131), ankle strain/sprain (12.4%, n = 125), and thigh/hip/groin sprain/strain (11.1%, n = 112) were the most reported diagnoses. Therapeutic exercise or activities (27.6%, n = 1068), athletic trainer evaluation or re-evaluation (24.7%, n = 957), and hot/cold packs (19.8%, n = 766) were the most common services, with a median of 2 visits (IQR = 1 to 4) and 2 procedures (IQR = 1 to 2) per visit. Football, basketball, and soccer reported the most musculoskeletal injuries for middle school-aged athletes. Concussions were the most frequent diagnosis, followed by ankle sprains/strains. Our findings are similar to prior investigations at the high school and collegiate levels. Treatments at the middle school level were also similar to those that have been previously reported at the high school level with therapeutic exercise/activity, athletic trainer evaluation or re-evaluation, and hot/cold packs being the most common treatments. This information may be useful for informing patient care decisions at the middle-school level. [ABSTRACT FROM AUTHOR]

BACKGROUND: Excess heat accrual is perhaps the body's most dangerous exercise-induced stressor. While palm cooling uses conduction to reduce body temperatures, to date the volume of heat transferred by this treatment resulting from exercise is unknown. OBJECTIVE: Asses continuous palm cooling's impact on heat transfer and physiology. METHODS: Thirty-one subjects did two workouts; one with, and one without, palm cooling. Workouts entailed consecutive stages of submaximal pedaling against prescribed workloads. Gloves were worn at workouts; for palm cooling 10.6∘C gel packs were inserted into gloves at the workout's start and conclusion. Heart rate, auditory canal and palm skin temperatures, and heat transfer across the palm were collected. Data were obtained pre-exercise, at the end of a warm-up, and at multiple times during the 25 minutes of pedaling and 30 minutes of recovery. RESULTS: Auditory canal temperatures had a significant treatment effect (palm cooling < non-palm cooling). Palm skin temperature had an interaction, with higher non-palm cooling values at multiple times. Conversely, heat transfer also produced an interaction, but palm cooling had significantly higher values at multiple times. Heat transfer was 32% higher for the palm cooling workout. CONCLUSIONS: Continuous palm cooling produced significantly higher heat transfer from submaximal exercise. [ABSTRACT FROM AUTHOR]

The aim of this review is to assess the efficacy and safety of using heat and cold therapy for adults with lymphoedema. A multi-database search was undertaken. Only studies which included adults with lymphoedema who were treated with heat or cold therapy reporting any outcome were included. Screening, data extraction, and assessment of bias were undertaken by a single reviewer and verified by a second. Due to the substantial heterogeneity, a descriptive synthesis was undertaken. Eighteen studies were included. All nine studies which assessed the effects of heat-therapy on changes in limb circumference reported a point estimate indicating some reduction from baseline to end of study. Similarly, the five studies evaluating the use of heat-therapy on limb volume demonstrated a reduction in limb volume from baseline to end-of-study. Only four studies reported adverse events of which all were deemed to be minor. Only two studies explored the effects of cold therapy on lymphoedema. Tentative evidence suggests heat-therapy may have some benefit in treating lymphoedema with minimal side effects. However, further high-quality randomised controlled trials are required, with a particular focus on moderating factors and assessment of adverse events. This review highlights the potential benefit that heat therapy may have on reducing limb circumference and volume for adults with lymphoedema. There was no evidence that controlled localised heat therapy was unsafe. The current evidence-base is at a point where no specific clinical recommendations can be made. The use of heat therapy should only be applied as part of a methodologically robust study to treat lymphoedema. [ABSTRACT FROM AUTHOR]

Aim: Recent studies have extensively investigated hypothermia as a therapeutic approach for mitigating neural damage. Despite this, bibliometric analyses specifically focusing on this area remain scarce. Consequently, this study aims to comprehensively outline the historical framework of research and to pinpoint future research directions and trends. Methods: Articles spanning from 2003 to 2023, relevant to both "neuroprotection" and "hypothermia", were sourced from the Web of Science Core Collection. The CiteSpace software facilitated a comprehensive evaluation and analysis of these publications. This analysis included examining the annual productivity, collaboration among nations, institutions, and authors, as well as the network of co‐cited references, authors and journals, and the co‐occurrence of keywords, and their respective clusters and trends, all of which were visualized. Results: This study included 2103 articles on the neuroprotection effects of hypothermia, noting a consistent increase in publications since 1992. The United States, the University of California System, and Ji Xunming emerged as the most productive nation, institution, and author, respectively. Analysis of the top 10 co‐cited publications revealed that seven articles focused on the effects of hypothermia in infants with hypoxic–ischemic encephalopathy, while three studies addressed cardiac arrest. Shankaran S and the journal Stroke were the most frequently co‐cited author and journal, respectively. Keyword cluster analysis identified ischemic stroke as the primary focus of hypothermia therapy historically, with cardiac arrest and neonatal hypoxic–ischemic encephalopathy emerging as current research foci. Conclusions: Recent studies on the neuroprotective effects of hypothermia in cardiac arrest and neonatal hypoxic–ischemic encephalopathy suggest that hypothermia may mitigate neural damage associated with these conditions. However, the application of hypothermia in the treatment of ischemic stroke remains confined to animal models and in vitro studies, with a notable absence of evidence from multicenter randomized controlled trials (RCTs). Further research is required to address this gap. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate early pain management outcomes in patients undergoing total knee arthroplasty. Materials and methods: This descriptive cross-sectional study was conducted between 1 March and 30 September 2022. The sample consisted of 112 patients who underwent total knee replacement surgery. Data was collected during face-to-face interviews in the first 24 to 48 hours after surgery, using a patient information form and the revised American Pain Society patient outcome questionnaire (APS-POQ-R). One-way analysis of variance (ANOVA), independent-samples t test, Kruskal-Wallis test and Mann-Whitney test were used in statistical analyses. Ethical approval, institutional approval and written informed consent from the patients were obtained. Results: The mean age of the patients was 65.11 (±7.108) years, and 92.9 per cent of the patients were female. All patients received combined opioid and nonopioid analgesic and cold application therapy for pain management. In the 24 hours after surgery, the mean mildest pain score was 1.29 (±0.79), the mean most severe pain score was 9.25 (±1.086) and the mean perceived percentage of time in severe pain was 70.54 per cent (±13.546). The highest emotional effect caused by pain was anxiety with a score of 4.55 (±2.543). The patient level of satisfaction with the results of pain treatment was 8.87 (±1.663) points. It was determined that female patients and patients under 65 years of age had more severe pain and experienced more sleep and emotional effects (p<0.05). Conclusion: It was observed that patients experienced pain and related anxiety in the early period after total knee arthroplasty. We recommend the use of other nonpharmacological methods along with cold application for effective management of pain and that health professionals should be supported with in-service training in order to better encourage patients. [ABSTRACT FROM AUTHOR]

Stimuli‐responsive domains capable of releasing loaded molecules, "on‐demand," have garnered increasing attention due to their enhanced delivery, precision targeting, and decreased adverse effects. The development of an on‐demand delivery system that can be easily triggered by dental clinicians might have major roles in dental and oral tissue engineering. A series of random graft poly(NIPAm‐co‐HEMA‐Lactate) copolymers were synthesized using 95:5, 85:5, 60:40, and 40:60 ratios of thermosensitive NIPAm and HEMA‐poly lactate respectively then electrospun to produce nanofibrous scaffolds loaded with bovine serum albumin (BSA). Cumulative BSA release was assessed at 25C and 37°C. To appraise the use of scaffolds as on‐demand delivery systems, they were subjected to thermal changes in the form cooling and warming cycles during which BSA release was monitored. To confirm the triggered releasing ability of the synthesized scaffolds, the copolymer made with 60% NIPAm was selected, based on the results of the release tests, and loaded with bone morphogenetic protein‐2 (BMP‐2). The loaded scaffolds were placed with mesenchymal‐like stem cells (iMSCs) derived from induced pluripotent stem cells (iPSCs), and subjected to temperature alterations. Then, the osteogenic differentiation of iMSCs, which might have resulted from the released protein, was evaluated after 10 days by analyzing runt‐related transcription factor 2 (RUNX‐2) osteogenic gene expression by the cells using real‐time quantitative polymerase chain reaction (qRT‐PCR). BSA release profiles showed a burst release at the beginning followed by a more linear pattern at 25°C, and a much slower release at 37°C. The release also decreased when the PNIPAm content decreased in the scaffolds. Thermal triggering led to a step‐like release pattern in which the highest release was reported 30 min through the warming cycles. The iMSCs cultivated with scaffolds loaded with BMP‐2 and exposed to temperature alteration showed significantly higher RUNX‐2 gene expression than cells in the other experimental groups. The synthesized scaffolds are thermo‐responsive and could be triggered to deliver biological biomolecules to be used in oral and dental tissue engineering. Thermal stimuli could be simulated by dental clinicians using simple means of cold therapy, for example, cold packs in intraoral accessible sites for specified times. [ABSTRACT FROM AUTHOR]

Cryotherapy leverages controlled freezing temperature interventions to engender a cascade of tumor‐suppressing effects. However, its bottleneck lies in the standalone ineffectiveness. A promising strategy is using nanoparticle therapeutics to augment the efficacy of cryotherapy. Here, a cold‐responsive nanoplatform composed of upconversion nanoparticles coated with silica – chlorin e6 – hyaluronic acid (UCNPs@SiO2‐Ce6‐HA) is designed. This nanoplatform is employed to integrate cryotherapy with photodynamic therapy (PDT) in order to improve skin cancer treatment efficacy in a synergistic manner. The cryotherapy appeared to enhance the upconversion brightness by suppressing the thermal quenching. The low‐temperature treatment afforded a 2.45‐fold enhancement in the luminescence of UCNPs and a 3.15‐fold increase in the photodynamic efficacy of UCNPs@SiO2‐Ce6‐HA nanoplatforms. Ex vivo tests with porcine skins and the subsequent validation in mouse tumor tissues revealed the effective HA‐mediated transdermal delivery of designed nanoplatforms to deep tumor tissues. After transdermal delivery, in vivo photodynamic therapy using the UCNPs@SiO2‐Ce6‐HA nanoplatforms resulted in the optimized efficacy of 79% in combination with cryotherapy. These findings underscore the Cryo‐PDT as a truly promising integrated treatment paradigm and warrant further exploring the synergistic interplay between cryotherapy and PDT with bright upconversion to unlock their full potential in cancer therapy. [ABSTRACT FROM AUTHOR]

Objectives: To examine recent changes in the numbers of Medicare‐subsidised keratinocyte cancer excisions, particularly for younger people exposed to primary prevention campaigns since the early 1980s. Study design: Retrospective cohort study; analysis of administrative data. Setting, participants: Analysis of Medicare Benefits Schedule (MBS) claims data for procedures related to the diagnosis and treatment of keratinocyte cancer in Australia, 2012–2021. Main outcome measures: Age‐standardised rates for MBS‐subsidised claims for first surgical squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) excisions, Mohs surgery, surgical excisions of benign lesions, skin biopsies, and cryotherapy or serial curettage of premalignant and malignant lesions, overall, and by sex, state/territory, and age group; average annual percentage change in rate for time intervals determined by joinpoint regression. Results: In men, the age‐standardised rate of BCC/SCC excisions increased by 1.9% (95% confidence interval [CI], 1.4–2.4%) per year during 2012–2019 (from 2931 to 3371 per 100 000 men) and then declined by 3.8% (95% CI, 0.5–7.0%) per year during 2019–2021 (to 3152 per 100 000). In women, the age‐standardised rate increased by 2.2% (95% CI, 1.7–2.8%) per year during 2012–2019 (from 1798 to 2093 per 100 000 women); the decline to 1967 excisions per 100 000 women in 2021 was not statistically significant. BCC/SCC excision rates declined for men under 55 years of age (by 1.0–3.4% per year) and women under 45 years of age (by 1.7–2.3% per year). Age‐standardised biopsy rates increased during 2012–2021 in all age groups (by 2.8–6.9% per year). Conclusions: Rates of MBS‐subsidised treatment for keratinocyte cancers increased during 2012–2019, but BCC/SCC treatment rates declined among younger Australians, who have probably been exposed to less sunlight than earlier generations because of public health interventions and population‐wide lifestyle changes related to technology use. [ABSTRACT FROM AUTHOR]

Breastfeeding difficulties are often present in the first weeks of the postpartum period, and various factors can cause a mother's early cessation of breastfeeding. Such factors include mothers' self-efficacy and perception of insufficient milk. This study aimed to examine the effect of a hot application on the breast with the help of the Thera Pearl in the postpartum period on milk perception and breastfeeding self-efficacy. This was a randomized controlled trial. This study was completed with 64 puerperal mothers, 31 of whom were control and 33 were experimental. A Personal Information Form, Breastfeeding Observation Form, Breastfeeding Self-Efficacy Scale, and Insufficient Milk Perception Scale were used to collect data. The average breastfeeding self-efficacy scale scores of the experimental group were 42.46 and 62, respectively, at the first and last follow-up, while the control group's mean scores were 57.42 and 47. The average scores of the experimental group on the insufficient milk perception scale were 19, 28, and 48, respectively, from the first to the last follow-up, while those of the control group were 28, 24, and 34, respectively. As a result, self-efficacy and milk perception are important factors affecting breastfeeding. In this study, we found that Thera Pearl application increased breastfeeding self-efficacy but did not affect milk perception. [ABSTRACT FROM AUTHOR]

Simple Summary: Whole-body cryotherapy and winter swimming (cold bath) are treatments that use low temperature as a therapeutic stimulus and have become increasingly popular in recent years. These treatments have many positive effects on the human body. The most important reactions of the body include analgesic and anti-swelling effects, as well as reactions of the immune and circulatory systems and changes in the concentration of many hormones. However, some reports indicate that exposure to extremely low temperatures may induce the production of reactive oxygen species in the body. Healthy people often have an increased level of oxidative stress, which may cause abnormal endothelial function and, consequently, an increased risk of developing hypertension, atherosclerosis and other diseases. Oxidative stress can likewise cause acute or chronic inflammation. In order to combat the harmful effects of free oxygen radicals, in this study we assessed the level of antioxidant enzymes in patients after receiving a cold stimulus. The aim of this study was to investigate the effect of a series of 20 whole-body cryotherapy sessions and 20 winter swimming sessions on the level of catalase, glutathione peroxidase and superoxide dismutase. The experimental group consisted of 60 people (30 people received cryotherapy and 30 people swam in cold water). The control group—without intervention: 30 people. Each of the three groups was tested twice. Analyzing the changes in the examined indicators, a statistical increase of CAT was observed in men after the use of WBC, as well as an increase of SOD in women and a decrease of SOD in men after the winter swimming season. Regular WS does not seem to place an excessive burden on the body in terms of intensifying oxidative processes. WS sessions once a week can be recommended as an effective method of improving health by causing positive adaptive changes and strengthening the body's antioxidant barrier. WBC may be used as an adjunct therapy in the treatment of diseases caused by oxidative stress, as it improves the body's antioxidant capacity. Further research is needed to elucidate antioxidant mechanisms in humans and to determine the short- and long-term effects of exposure to WS and WBC. [ABSTRACT FROM AUTHOR]

Background: Series of whole-body cryotherapy (WBC) among healthy and physically active individuals can potentially reduce inflammatory response, although exact mechanisms remain unclear. Methods: The impact of whole-body cryotherapy on inflammation modulators among 28 young males, categorized as non-training (NTR, N = 10), non-training with WBC (NTR-WBC, N = 10), and training with WBC (TR-WBC, N = 8), is investigated in this study. Over a period of eight weeks, NTR-WBC and TR-WBC subjects underwent 24 WBC treatments (−130 °C for 3 min, three times a week), examining changes in mRNA expressions of IL-1A, IL-6, IL-10, IFN-G, SIRT1, SIRT3, SOD2, GSS, and ICAM-1. Results: The received data indicate an acute inflammatory response to initial WBC (increased IL-1A, IL-6, and SIRT), with a greater effect in NTR-WBC. Subsequent sessions showed enhanced expressions of antioxidative genes in both WBC groups, particularly non-trained, suggesting improved oxidative stress adaptation. A notable decrease in ICAM-1 mRNA post-24 WBC treatments in NTR-WBC signifies a potential systemic anti-inflammatory effect. Conclusions: The findings of the study suggest that the combination of regular physical activity with WBC administered three times per week can potentially modulate inflammatory and antioxidant responses. This modulation is evidenced by changes in the expression of genes related to these processes. [ABSTRACT FROM AUTHOR]

Chronic pain management remains a challenging aspect of neurosurgical care, with facet arthrosis being a significant contributor to the global burden of low back pain. This study evaluates the effectiveness of cryotherapy as a minimally invasive treatment for patients with facet arthrosis. By focusing on reducing drug dependency and pain intensity, the research aims to contribute to the evolving field of pain management techniques, offering an alternative to traditional pain management strategies. Through a retrospective longitudinal analysis of patients with facet osteoarthritis treated via cryotherapy between 2013 and 2023, we evaluated the impact on medication usage and pain levels, utilizing the Visual Analog Scale for pre- and posttreatment comparisons. The study encompassed 118 subjects, revealing significant pain alleviation, with Visual Analog Scale scores plummeting from 9.0 initially to 2.0 after treatment. Additionally, 67 patients (56.78%) reported decreased medication consumption. These outcomes underscore cryotherapy's potential as a pivotal tool in chronic pain management. The findings illuminate cryotherapy's efficacy in diminishing pain and curtailing medication dependency among patients with facet arthrosis. This study reaffirms cryotherapy's role in pain management and propels the discourse on nontraditional therapeutic avenues, highlighting the urgent need for personalized and innovative treatment frameworks. [ABSTRACT FROM AUTHOR]

Objective: To determine whether an investigational head–neck cooling device, Pro2cool, can better reduce symptom severity compared with standard postconcussion care in early adolescent athletes after a sports-related concussion. Design: Prospective, longitudinal, randomized trial design conducted over a 28-day period. Setting: Six pediatric medical centers in Ohio and Michigan. Participants: The study enrolled 167 male and female 12- to 19-year-old athletes who experienced a sports-related concussion within 8 days of study enrollment and registering a Sports Concussion Assessment Tool 5 (SCAT5) composite score.7. Interventions: Pro2cool, an investigational head–neck cooling therapy device, was applied at 2 postinjury time points compared with postconcussion standard of care only. Main Outcome Measures: Baseline SCAT5 composite symptom severity scores were determined for all subjects. Sports Concussion Assessment Tool 5 scores for concussed athletes receiving cooling treatment were analyzed across 6 independent postenrollment time points compared with subjects who did not receive cooling therapy and only standard care. Adverse reactions and participate demographics were also compared. Results: Athletes who received Pro2cool cooling therapy (n 5 79) experienced a 14.4% greater reduction in SCAT5 symptom severity scores at the initial visit posttreatment, a 25.5% greater reduction at the 72-hour visit posttreatment, and a 3.4% greater reduction at the 10-day visit compared with subjects receiving only standard care (n 5 88). Overall, 36 adverse events (increased blood pressure, decreased pulse, and dizziness) were reported, with 13 events associated with the device, of which 3 were classified as moderate in severity. Conclusions: This study demonstrates the efficacy and safety of head and neck cooling for the management of concussion symptoms in adolescent athletes of an age group for which little to no prior data are available. [ABSTRACT FROM AUTHOR]

Introduction: The use of cryobiopsy in conjunction with robotic assisted bronchoscopy is on the rise due to the safety and increased diagnostic yield of cryobiopsy. The incorporation of 3D fluoroscopy in the procedure improves the workflow and helps confirm the accuracy of sampling of peripheral pulmonary nodules. Methods: We describe an observational series of 12 patients comprising 14 nodules where cryobiopsy was performed during shape-sensing robot-assisted bronchoscopy cryobiopsy under general anesthesia. 3D fluoroscopy was used to confirm accurate placement of the cryoprobe. All these patients underwent a second spin with the 3D fluoroscopy either to sample a second lesion intraoperatively or to investigate suspected pneumothorax. Results: The development of a pneumatocele was noted after cryobiopsy in each of the cases. The majority of these were in the upper lobe with the median size of a sampled nodule being 14 mm. The majority of patients were asymptomatic with 1 patient developing mild hemoptysis and 4 patients developing chest tightness or dyspnea. None of the patients required an intervention for the pneumatocele. Conclusion: The development of pneumatoceles appears to be a fairly frequent and benign occurrence following cryobiopsy, likely due to increased tissue destruction. The increased use of intraoperative 3D fluoroscopy is likely to highlight changes to the pulmonary parenchyma that were previously not known. The occurrence of pneumatoceles does not appear to adversely impact the safety or tolerability profile of cryobiopsy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes. OBJECTIVE: The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries. METHODS: A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury. RESULTS: Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p < 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier. CONCLUSION: HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers. [ABSTRACT FROM AUTHOR]

Introduction: In dermatology, inflammatory skin conditions impose a substantial burden worldwide, with existing therapies showing limited efficacy and side effects. This report aims to compare a novel immunological activation induced by hyperthermic 20 MHz high intensity focused ultrasound (HIFU) with conventional cryotherapy. The bioeffects from the two methods are initially investigated by numerical models, and subsequently compared to clinical observations after treatment of a patient with the inflammatory disease granuloma annulare (GA). Methods: Clinical responses to moderate energy HIFU and cryotherapy were analysed using numerical models. HIFU-induced pressure and heat transfer were calculated, and a three-layer finite element model simulated temperature distribution and necrotic volume in the skin. Model output was compared to 22 lesions treated with HIFU and 10 with cryotherapy in a patient with GA. Results: Cryotherapy produced a necrotic volume of 138.5 mm3 at − 92.7 °C. HIFU at 0.3–0.6 J/exposure and focal depths of 0.8 or 1.3 mm generated necrotic volumes up to only 15.99 mm3 at temperatures of 68.3–81.2 °C. HIFU achieved full or partial resolution in all treated areas, confirming its hyperthermic immunological activation effect, while cryotherapy also resolved lesions but led to scarring and dyspigmentation. Conclusion: Hyperthermic immunological activation of 20 MHz HIFU shows promise for treating inflammatory skin conditions as exemplified by GA. Numerical models demonstrate minimal skin necrosis compared to cryotherapy. Suggested optimal HIFU parameters are 1.3 mm focal depth, 0.4–0.5 J/exposure, 1 mm spacing, and 1 mm margin. Further studies on GA and other inflammatory diseases are recommended. [ABSTRACT FROM AUTHOR]