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Objective: To date, systematic reviews of frostbite injuries predominantly focus on the treatment of frostbite, which narrows the scope of prevention and disregards the impact of frostbite-related predisposing factors. Comprehensively synthesizing relevant evidence to understand the psychosocial and personal predisposing factors to frostbite injury and related amputation would provide new insight into frostbite injury prevention. This review investigated the psychosocial and personal predisposing factors of frostbite injury and associated amputation. Methods: Databases, including Embase, PubMed, and PsycINFO, were systematically searched for relevant studies. Two independent reviewers performed the screening, data extraction, and quality assessment. Inclusion criteria were studies that reported cold injury, predisposing factors for frostbite injury or related amputations, and assessed the relationship between a predisposing factor and the frostbite injury or amputation outcome based on a descriptive or inferential test. Results: Thirty-six (36) studies met the inclusion criteria; 29 reported on both frostbite injury and amputations, and seven reported on only frostbite injury. Six psychosocial predisposing factors were observed in 28 out of the 36 studies reviewed, which included people experiencing homelessness, low socioeconomic status, alcohol intoxication/abuse, smoking, psychiatric disorders, and substance use. Personal predisposing factors identified included inadequate/improper winter clothing, delay in seeking medical care, and lack of knowledge of how to deal with the cold. Conclusions: While it is crucial to allocate additional resources and research toward improving the treatment of individuals affected by frostbite injuries and associated limb loss, it is equally important to direct efforts toward addressing the psychosocial and personal predisposing factors that predispose individuals to these injuries and amputations. [ABSTRACT FROM AUTHOR]

Introduction This study aimed to examine the prevalence of cold injuries and review the cold injury monitoring system in the South Korean military. Materials and Methods This study conducted a retrospective and cross-sectional analysis using data from the Defense Medical Statistic Information System (DMSIS) on cold injuries among military personnel from 2018 to 2023. It incorporated findings from the Korean Armed Forces Medical Command's cold injury surveillance system and analyzed cases from the Armed Forces Capital Hospital, covering all branches of the military by status and rank. Results An analysis of cold injury in the South Korean military over the past 5 years revealed varying numbers of cases treated, from 799 in 2018-2019 to 467 in 2022-2023. According to the surveillance system in 2023-2024, the Army experienced the majority of these cases, with 94.5% of the total. The incidence per 1,000 personnel was the highest in the Army at 0.98 compared to the Air Force and Navy/Marine Corps. Rank-based analysis indicated the most affected were private first-class soldiers. Frostbite was the most frequent condition, alongside chilblains, hypothermia, and immersion injuries, with no marked difference in the type of illness across branches. Conclusions The study underscores the need for focused prevention and treatment, particularly in the Army. By analyzing data from a newly implemented surveillance system, it revealed a higher incidence of frostbite and chilblains among lower ranks. The findings highlight the importance of targeted educational measures and enhanced response strategies to protect personnel against cold injuries. [ABSTRACT FROM AUTHOR]

Military cold weather operations (CWOs) introduce a range of challenges, including extreme temperatures, strong winds, difficult terrain, and exposure to snow, ice, and water. Personnel undertaking these missions face a heightened risk of cold weather injury (CWI), such as hypothermia, freezing cold injuries, and non-freezing cold injuries. The risk of these injuries is influenced by various factors, including age, sex, and body composition. To ensure optimal and safe performance in CWOs, it is crucial to implement effective preventive measures against CWI. This article emphasizes the most pertinent strategies for CWI prevention in CWOs. Initially, it is important to assess individual vulnerability to CWI. Education and training on CWI prevention should be provided before deployment in CWOs. During CWOs, attention should be given to crucial behaviors such as using a proper layered clothing system, recognizing the risks associated with prolonged stationary periods in cold conditions, consuming adequate calories, and staying hydrated. Additionally, environmental monitoring using tools like the windchill index and regular checks on physical status are essential. Although monitoring by itself does not prevent CWI, it can prompt necessary behavioral adjustments. Education and behavioral modifications are central to preventing CWI. Given the limited research on CWI prevention in military settings, despite the frequent occurrence of these injuries, there is a pressing need for further studies to evaluate effective preventive strategies within this specific operational framework. [ABSTRACT FROM AUTHOR]

Background: One of the challenges of physical training in extreme condition is frostbite, especially in Northeast China. In this study, we aimed to construct a risk prediction model for frostbite among soldiers in Northeast China, and verify its effect. Methods: 698 participants were selected via convenience sampling from Northeast China from December 2021 to January 2022 (winter). They were randomly divided into a training set (N = 479) and a testing set (N = 202) in a ratio of 7:3. All participants completed a researcher-made questionnaire on frostbite. The prediction model was constructed through the use of Logistic regression analysis, which was used to predict the independent risk factors for frostbite formation and screen significant indicators. The model's performance was assessed using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) to evaluate the prediction efficiency and goodness of fit. Results: The incidence of frostbite in the training set was 19.83% (95 people), all of which were first-degree frostbite. Among them, frostbite in multiple parts was the most common (58.95%), followed by singular body parts like hands (24.21%), ears (11.58%) and feet (5.26%). Single factor logistic regression analyses showed that ambient temperature, ambient wind speed, outdoor stationary time, stationary status, and history of frostbite are independent risk factors that affect the occurrence of frostbite. Furthermore, we constructed the frostbite risk prediction model for soldiers in the northeastern region of China. The area under the receiver operating characteristic curve (AUC) for the risk of frostbite in the training set and testing set was 0.816 (95% CI, 0.770 ~ 0.862) and 0.787 (95% CI, 0.713 ~ 0.860), respectively. The Hosmer-Lemeshow test of the model showed χ2 = 11.328 and P = 0.184 (> 0.05). The DCA curve indicated that most of the clinical net benefits of the model are greater than 0, demonstrating good clinical usefulness. Conclusion: The constructed frostbite prediction model can effectively identify soldiers with a higher risk of frostbite. It provided theoretical support for commanders to take preventive measures to reduce the incidence of frostbite among soldiers and was of great clinical guiding significance. [ABSTRACT FROM AUTHOR]

Fossati, Alexandre, and Aleid C. J. Ruijs. Changes in fingertip cold-induced vasodilatation (hunting reaction) on acute exposure to altitude. High Alt Med Biol. 25:212–217, 2024. Objective: Cold-induced vasodilation (CIVD) of the extremities is an interesting part of human physiology. Although the physiology of the CIVD reaction remains unknown, there are indications that hypoxia influences our CIVD reaction. The objective of this study is to measure the influence of acute hypoxia on the CIVD reaction of the fingertips. Methods: The CIVD reaction was measured using immersion of one hand in a water bath of 0°C in 12 healthy volunteers at low (1,235 m) and high (3,800 m) altitude during 35 minutes. High altitude was reached by a 20-minute cable car ride. Testing was performed indoors (room temperature, 22–25°C) at both altitudes. Data analysis was performed measuring the parameters of the CIVD reaction. Differences were found using the paired Student's t-test. Results: There was no significant difference in baseline finger temperature, onset time, peak time, and frequency of the CIVD reaction. However, at high altitude, maximum temperature and amplitude were significantly higher, slope was steeper, and minimum temperature was lower. Conclusion: We did not find evidence for a diminished CIVD reaction at high altitude due to hypoxia. [ABSTRACT FROM AUTHOR]

This study examines a rare case of frostbite on the hands caused by liquid nitrogen, focusing on the scar maturation process. Frostbite is typically less prone to abnormal scarring compared to burns, and this report contrasts the differences in scar maturation between the two. A 31-year-old male hospital employee sustained first- to second-degree frostbite on his gloved hands from a 20-s exposure to liquid nitrogen while changing a cylinder. Conservative treatment was applied, and the patient was monitored for 9 months. The deeply affected area took 50 days to epithelialize but healed without hypertrophic scarring. A mild extension contracture was noted in the distal interphalangeal joint of the right index finger, but the skin remained supple and soft. Incidents of liquid nitrogen-induced frostbite are uncommon, with only 14 cases reported in PubMed previously. In frostbite, the wound healing involves a slow replacement of damaged connective tissue, which acts as an internal splint, reducing wound contraction. This contrasts with burns, where rapid connective tissue replacement occurs, often leading to significant wound contraction due to the presence of myofibroblasts in granulation tissue. In the presented case, the slow healing process and minimal wound contraction led to mature scarring without abnormalities, underlining a distinctive healing trajectory in frostbite injuries compared to burns. [ABSTRACT FROM AUTHOR]

Abstract Objective To date, systematic reviews of frostbite injuries predominantly focus on the treatment of frostbite, which narrows the scope of prevention and disregards the impact of frostbite-related predisposing factors. Comprehensively synthesizing relevant evidence to understand the psychosocial and personal predisposing factors to frostbite injury and related amputation would provide new insight into frostbite injury prevention. This review investigated the psychosocial and personal predisposing factors of frostbite injury and associated amputation. Methods Databases, including Embase, PubMed, and PsycINFO, were systematically searched for relevant studies. Two independent reviewers performed the screening, data extraction, and quality assessment. Inclusion criteria were studies that reported cold injury, predisposing factors for frostbite injury or related amputations, and assessed the relationship between a predisposing factor and the frostbite injury or amputation outcome based on a descriptive or inferential test. Results Thirty-six (36) studies met the inclusion criteria; 29 reported on both frostbite injury and amputations, and seven reported on only frostbite injury. Six psychosocial predisposing factors were observed in 28 out of the 36 studies reviewed, which included people experiencing homelessness, low socioeconomic status, alcohol intoxication/abuse, smoking, psychiatric disorders, and substance use. Personal predisposing factors identified included inadequate/improper winter clothing, delay in seeking medical care, and lack of knowledge of how to deal with the cold. Conclusions While it is crucial to allocate additional resources and research toward improving the treatment of individuals affected by frostbite injuries and associated limb loss, it is equally important to direct efforts toward addressing the psychosocial and personal predisposing factors that predispose individuals to these injuries and amputations.

Abstract Background One of the challenges of physical training in extreme condition is frostbite, especially in Northeast China. In this study, we aimed to construct a risk prediction model for frostbite among soldiers in Northeast China, and verify its effect. Methods 698 participants were selected via convenience sampling from Northeast China from December 2021 to January 2022 (winter). They were randomly divided into a training set (N = 479) and a testing set (N = 202) in a ratio of 7:3. All participants completed a researcher-made questionnaire on frostbite. The prediction model was constructed through the use of Logistic regression analysis, which was used to predict the independent risk factors for frostbite formation and screen significant indicators. The model’s performance was assessed using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) to evaluate the prediction efficiency and goodness of fit. Results The incidence of frostbite in the training set was 19.83% (95 people), all of which were first-degree frostbite. Among them, frostbite in multiple parts was the most common (58.95%), followed by singular body parts like hands (24.21%), ears (11.58%) and feet (5.26%). Single factor logistic regression analyses showed that ambient temperature, ambient wind speed, outdoor stationary time, stationary status, and history of frostbite are independent risk factors that affect the occurrence of frostbite. Furthermore, we constructed the frostbite risk prediction model for soldiers in the northeastern region of China. The area under the receiver operating characteristic curve (AUC) for the risk of frostbite in the training set and testing set was 0.816 (95% CI, 0.770 ~ 0.862) and 0.787 (95% CI, 0.713 ~ 0.860), respectively. The Hosmer-Lemeshow test of the model showed χ 2 = 11.328 and P = 0.184 (> 0.05). The DCA curve indicated that most of the clinical net benefits of the model are greater than 0, demonstrating good clinical usefulness. Conclusion The constructed frostbite prediction model can effectively identify soldiers with a higher risk of frostbite. It provided theoretical support for commanders to take preventive measures to reduce the incidence of frostbite among soldiers and was of great clinical guiding significance.

Cold injury or frostbite is a common medical condition that causes serious clinical complications including sensory abnormalities and chronic pain ultimately affecting overall well-being. Opioids are the first-choice drug for the treatment of frostbite-induced chronic pain; however, their notable side effects, including sedation, motor incoordination, respiratory depression, and drug addiction, present substantial obstacle to their clinical utility. To address this challenge, we have exploited peripheral mu-opioid receptors as potential target for the treatment of frostbite-induced chronic pain. In this study, we investigated the effect of dermorphin [D-Arg2, Lys4] (1–4) amide (DALDA), a peripheral mu-opioid receptor agonist, on frostbite injury and hypersensitivity induced by deep freeze magnet exposure in rats. Animals with frostbite injury displayed significant hypersensitivity to mechanical, thermal, and cold stimuli which was significant ameliorated on treatment with different doses of DALDA (1, 3, and 10 mg/kg) and ibuprofen (100 mg/kg). Further, molecular biology investigations unveiled heightened oxido-nitrosative stress, coupled with a notable upregulation in the expression of TRP channels (TRPA1, TRPV1, and TRPM8), glial cell activation, and neuroinflammation (TNF-α, IL-1β) in the sciatic nerve, dorsal root ganglion (DRG), and spinal cord of frostbite-injured rats. Treatment with DALDA leads to substantial reduction in TRP channels, microglial activation, and suppression of the inflammatory cascade in the ipsilateral L4–L5 DRG and spinal cord of rats. Overall, findings from the present study suggest that activation of peripheral mu-opioid receptors mitigates chronic pain in rats by modulating the expression of TRP channels and suppressing glial cell activation and neuroinflammation. [ABSTRACT FROM AUTHOR]

This article provides information on hypothermia and frostbite, focusing on their causes, recognition, and management. It emphasizes the importance of quick intervention for hypothermia and provides guidelines for rewarming techniques. The article also discusses the classification and management of frostbite, including the use of medications to enhance tissue viability. Long-term complications of frostbite are mentioned, such as amputation, chronic nerve damage, and chronic arthritis. The text highlights the importance of preventing future episodes by avoiding cold exposure. [Extracted from the article]

Why you should read this article: • To learn about the history of nitrous oxide (N2O) as a recreational drug and as an analgesic and anaesthetic • To enhance your understanding of the adverse effects and risks of recreational N2O use • To refresh your knowledge of the pathophysiology and management of cold burn injuries. Nitrous oxide (N2O) has become one of the most popular recreational drugs in Europe. While N2O is often used in medical settings as an analgesic and anaesthetic agent, its recreational use was documented many years before its introduction into clinical practice. The desired effects from inhaling N2O for recreational purposes include rapid feelings of relaxation, calmness and euphoria, which can be accompanied by giddiness and laughter. There are various adverse effects associated with N2O use, including headache, nausea, vomiting, drowsiness and the development of permanent neurological damage. Furthermore, its use is associated with cold burns and road accidents. This article details the case of a patient who sustained an N2O tank burn to his forearm from recreational use. It also discusses the prevalence, legal status and adverse effects of N2O use as well as the pathophysiology and management of cold burn injuries. [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]

Jiayan Li,1,&ast; Jie Ding,1,&ast; Haoyang Wu,1 Chenyan Lu,1 Jian Wu,2 Qianqian Luo1 1Department of Hypoxic Biomedicine, Institute of Special Environmental Medicine and Coinnovation Center of Neuroregeneration, Nantong University, Nantong, 226019, People’s Republic of China; 2Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian Wu, Department of Pharmacy, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, People’s Republic of China, Tel +86-21-54601295, Email jianwu12@fudan.edu.cn Qianqian Luo, Department of Hypoxic Biomedicine, Institute of Special Environmental Medicine and Coinnovation Center of Neuroregeneration, Nantong University, 9 Seyuan Road, Chongchuan District, Nantong, Jiangsu, 226019, People’s Republic of China, Tel +86-513-85503378, Email qianqianluo@ntu.edu.cnBackground: Frostbite is a chemia resulting from cold-induced skin damage. The process of frostbite is often accompanied by inflammation, and the therapeutic strategies focusing on anti-inflammation are the main direction to data. Tat-CIRP is a 15 amino acid peptide containing HIV protein and cold-inducible RNA-binding protein (CIRP), which is believed to compete with endogenous CIRP for myeloid differentiation 2 (MD2) binding. This study aims to investigate the efficacy of Tat-CIRP in the treatment of frostbite.Methods: A mouse model of frostbite was established, and on the first day after frostbite occurrence, Tat-CIRP peptide was administered intravenously via the tail with a dosage interval of one day for a total of three doses. Frozen mouse skin sections were subjected to histological analysis, including hematoxylin–eosin (HE) staining, Masson staining, and immunohistochemical examination. Western blotting was performed to detect the expression level of Ki-67 in mouse skin tissue.Results: One day after frostbite, mice exhibited skin swelling and a solid appearance. From day 1 to 5 after frostbite, MD2 expression was significantly upregulated, while CIRP expression was downregulated. Compared to the frostbite group, mice treated with Tat-CIRP showed accelerated frostbite recovery, reduced levels of inflammatory factors and MD2. Furthermore, the expression of cell proliferation-associated protein Ki-67 and angiogenesis-related protein CD31 was upregulated.Conclusion: Tat-CIRP promotes frozen wound healing via inhibiting inflammation and promoting angiogenesis in frostbitten mice.Keywords: frostbite, Tat-CIRP, inflammation, angiogenesis

Peanuts were susceptible to frost damage during harvesting, transportation, storage, and processing due to temperature and humidity changes, which could affect the quality of peanuts and their products. In order to explore the mechanism of peanut frost damage and improve the detection efficiency of frost-damaged peanuts, this study used near-infrared hyperspectral technology to study the feasibility of non-destructive detection of peanut frost damage, optimization methods based on feature variable screening discriminant models, and the mechanism of peanut frost damage. The effects of five preprocessing methods, including standard normalized variate (SNV), multiplicative scatter correction (MSC), Savizkg-Golag (SG) smoothing, SG smoothing-SNV, and SG smoothing-MSC, on the original data were experimentally studied. Then, eight variable selection methods, including competitive adaptive reweighted sampling (CARS), random frog (RF), variable importance in projection (VIP), successive projections algorithm (SPA), Monte Carlo uninformative variable elimination (MC-UVE), iteration retention information variable (IRIV), variable combination population analysis-iteration retention information variable (VCPA-IRIV), and variable combination population analysis-genetic algorithm (VCPA-GA), were used to screen the feature wavelengths related to peanut frost damage. Support vector machine (SVM) was used to select the feature wavelengths that reached the discrimination accuracy threshold of 90% as the feature wavelengths of peanut frost damage. The results showed that the detection of peanut frost damage based on near-infrared hyperspectral imaging technology was generally feasible and had high accuracy. All variable selection methods can effectively screen the feature wavelengths related to frost damage. Among them, the VCPA-GA algorithm selected the least 7 feature wavelengths, accounting for only 3.125% of all wavelengths in the dataset. The accuracy of the training set and the test set were 91.60% and 90.12%, respectively. The selected frostbite characteristic wavelength reflects information about oleic acid and protein, verifying that excessively low temperatures can lead to a decrease in oleic acid content and an increase in protein content in peanuts. This study provides a theoretical basis and technical support for the rapid non-destructive detection of peanut frost damage.

AbstractHistorical documentaries not only involve narrative indexicality and archives, but also dedicate to cultural landscape, distinctive perspectives and ethical enlightenment. So, does this legacy activate sensory experiences? Will it vary by culture? Based on previous research on multimodal discourse analysis (MDA), we hypothesize that it can evoke sensory memory in people, whose meaning-making may differ among cultures. To test the above hypothesis, we establish two multimodal corpora from historical documentaries Frozen Chosin and The Battle of Chosin depicting the same historical event from different cultural perspectives, using ELAN 6.4 to analyze sensory contours of coldness. The findings reveal that filmmakers actualize frostbite-laden experiences by adopting a structural adversity of iciness, with compositional meaning-making as the top, interactive as the second, while the last two are representational and linguistic. Behind this overall homogeneity, the lethal frostbite during engagement and post-battle are heterogeneously mediated by different ways of contacts, perspectives and salience, in which the Chinese film narrates in a slightly convergent multimodality while the American depicts a divergence-prone pattern. Finally, we justify that MDA can help scholars gain deeper insights into the sensory endeavor made by documentarists.

Background: Nitrous oxide (N2O) has been in industrial and recreational use since the 18th century and is commonly perceived as a safe substance. Despite its increasing uptake, there is a lack of data on N2O-related harm. This article explores the misuse of N2O associated with various complications, with a focus on frostbite as a novel phenomenon. We aimed to review the existing body of literature and describe the epidemiology, presentation, pathophysiology, and management of patients with N2O-related frostbite injuries in the upper aerodigestive tract. Methods: A literature search was conducted across PubMed, MEDLINE and Embase databases, focusing on English language articles related to N2O use patterns, associated injuries, pathophysiology, investigations, and management. Results: The search yielded 122 results, of which fifteen case reports and case series were included in the study. There are 54 total cases included in the analysis. There is an equal distribution of males and females among a young population with a median age of 27.5 years. Presentations of skin and mucosal injuries across different anatomical sites as well as their management approaches are described. Conclusions: The pathophysiology of frostbite involves both direct and indirect effects, leading to tissue ischaemia, inflammation, and immune responses. Complications, including airway obstruction, underscore the severity of N2O-related injuries. Management strategies include securing the airway, surgical debridement, and pharmacological interventions such as prophylactic corticosteroids and antibiotics. N2O is a documented causative agent of frostbite injuries. Awareness of its rising prevalence and potential complications is key in the treatment of patients with complications sustained from the use of N2O. Level of evidence: Not ratable [ABSTRACT FROM AUTHOR]

To prevent frostbite in cold environments, proper dimensions and materials for different parts of shoes along with the optimal design of shoe geometry were investigated. Furthermore, the optimal geometry of shoes was computed using an optimization algorithm to provide maximum thermal protection for the foot while having the lowest weight. The results showed that the length of the shoe sole and the thickness of the sock are the most effective parameters in foot protection against frostbite. Using thicker socks, which only increased the weight by roughly 11%, enhanced the minimum foot temperature by more than 2.3 times. Optimal design of shoe geometry is used to prevent frostbite in cold environments. A model of a biothermal nonlinear model is developed for the barefoot. Length of the shoe sole and the thickness of the sock are the most effective parameters in protecting the foot against frostbite. For the selected weather conditions, the toes are most likely to have frostbite. The best shoe for the selected weather conditions is the shoe that has the highest amount of thermal insulation in the toe area. [ABSTRACT FROM AUTHOR]

This Clinical Practice Guideline addresses severe frostbite treatment. We defined severe frostbite as atmospheric cooling that results in a perfusion deficit to the extremities. We limited our review to adults and excluded cold contact or rapid freeze injuries that resulted in isolated devitalized tissue. After developing population, intervention, comparator, outcomes (PICO) questions, a comprehensive literature search was conducted with the help of a professional medical librarian. Available literature was reviewed and systematically evaluated. Recommendations based on the available scientific evidence were formulated through consensus of a multidisciplinary committee. We conditionally recommend the use of rapid rewarming in a 38 to 42°C water bath and the use of thrombolytics for fewer amputations and/or a more distal level of amputation. We conditionally recommend the use of "early" administration of thrombolytics (≤12 hours from rewarming) compared to "later" administration of thrombolytics for fewer amputations and/or a more distal level of amputation. No recommendation could be formed on the use of vascular imaging studies to determine the use of and/or the time to initiate thrombolytic therapy. No recommendation could be formed on the use of intravenous thrombolytics compared to the use of intra-arterial thrombolytics on fewer amputations and/or a more distal level of amputation. No recommendation could be formed on the use of iloprost resulting in fewer amputations and/or more distal levels of amputation. No recommendation could be formed on the use of diagnostic imaging modalities for surgical planning on fewer amputations, a more distal level of amputation, or earlier timing of amputation. [ABSTRACT FROM AUTHOR]

Background: Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries. Case Report: The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient's progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries. Results: The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient's feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient's ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity. Conclusion: This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management. [ABSTRACT FROM AUTHOR]

Discharging against medical advice can have significant, detrimental effects on burn patient outcomes as well as higher hospital readmission rates and healthcare expenditures. The goal of this study is to identify characteristics of patients who left against medical advice and suggest solutions to mitigate these factors. Data were collected at our American Burn Association verified Burn Unit over a 15-year period. Between 2007 and 2022, 37 patients were identified as having left against medical advice from the burn unit. The average patient age was 37 years old with 64.9% being male, and 70.2% were identified as having a substance abuse history. The majority (51.4%) had Medicaid or State health insurance, 29.7% had no insurance, and 18.9% had private insurance. The mechanism of injury was most commonly frostbite (43.2%). The majority sustained < 1% total body surface area injuries. Most (83.7%) had social work and/or case management involved during their admission, and all (100%) had their involvement if the length of admission was greater than one day. Over half (59.5%) returned to the ED within 2 weeks with complications. This study found that patients discharging against medical advice from the burn unit suffered from smaller injuries, often due to cold related injuries. These patients had comorbid substance abuse or psychiatric histories, and the majority had Medicaid or state health insurance. Recruiting interdisciplinary care members, including social work, psychiatry, and addiction medicine, early may help these patients by encouraging completion of their hospital care and setting up crucial follow-up care. • Discharging against medical advice affects patient outcomes. • Most patients leaving AMA had Medicaid or state health insurance. • Most patients leaving AMA had a history of substance use disorder. • Over half of patients leaving AMA returned within 2 weeks with complications. • Interdisciplinary teams may assist with completion of hospital care and follow-up. [ABSTRACT FROM AUTHOR]

Objective: Accurate assessment of burn depth and burn wound healing potential is essential to determine early treatments. Infrared thermography (IRT) is a non-invasive and objective tool to do this. This systematic review evaluated the accuracy of IRT to determine burn wound healing potential. Method: This systematic review and meta-analysis used MEDLINE, EMBASE, CINAHL, PEDro, DiTA and CENTRAL databases. IRT data were extracted from primary studies and categorised into four cells (i.e., true positives, false positives, true negatives and false negatives). Subgroup analysis was performed according to methods used to capture thermal images. Results: The search strategy identified 2727 publications; however, 15 articles were selected for review and 11 for meta-analysis. In our meta-analysis, the accuracy of IRT was 84.8% (63% sensitivity and 81.9% specificity). Conclusion: IRT is a moderately accurate tool to identify burn depth and healing potential. Thus, IRT should be used carefully for evaluating burn wounds. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Peanuts were susceptible to frost damage during harvesting, transportation, storage, and processing due to temperature and humidity changes, which could affect the quality of peanuts and their products. In order to explore the mechanism of peanut frost damage and improve the detection efficiency of frost-damaged peanuts, this study used nearinfrared hyperspectral technology to study the feasibility of non-destructive detection of peanut frost damage, optimization methods based on feature variable screening discriminant models, and the mechanism of peanut frost damage. The effects of five preprocessing methods, including standard normalized variate (SNV), multiplicative scatter correction (MSC), Savizkg-Golag (SG) smoothing, SG smoothing-SNV, and SG smoothing-MSC, on the original data were experimentally studied. Then, eight variable selection methods, including competitive adaptive reweighted sampling (CARS), random frog (RF), variable importance in projection (VIP), successive projections algorithm (SPA), Monte Carlo uninformative variable elimination (MC-UVE), iteration retention information variable (IRIV), variable combination population analysis-iteration retention information variable (VCPA-IRIV), and variable combination population analysis-genetic algorithm (VCPA-GA), were used to screen the feature wavelengths related to peanut frost damage. Support vector machine (SVM) was used to select the feature wavelengths that reached the discrimination accuracy threshold of 90% as the feature wavelengths of peanut frost damage. The results showed that the detection of peanut frost damage based on near-infrared hyperspectral imaging technology was generally feasible and had high accuracy. All variable selection methods can effectively screen the feature wavelengths related to frost damage. Among them, the VCPA-GA algorithm selected the least 7 feature wavelengths, accounting for only 3.125% of all wavelengths in the dataset. The accuracy of the training set and the test set were 91.60% and 90.12%, respectively. The selected frostbite characteristic wavelength reflects information about oleic acid and protein, verifying that excessively low temperatures can lead to a decrease in oleic acid content and an increase in protein content in peanuts. This study provides a theoretical basis and technical support for the rapid non-destructive detection of peanut frost damage. [ABSTRACT FROM AUTHOR]

Paleopathological analysis of a below-knee amputation was conducted to explore the sociocultural reasons why the amputation took place. Older adolescent male (18–21 years) from the New Englander mass burial at the 18th century Fortress of Louisbourg. Macroscopic assessment and archival data. A surgical amputation of the right tibia and fibula, distal to the knee was identified. The cross-sectional diaphysis of the leg has kerf marks and a splinter (breakaway point) at the posterior-lateral border of the tibia suggesting the leg gave way from its own weight or was manually removed once most of the sawing was complete. Archival records suggest frostbite from prolonged exposure to freezing temperatures and trauma from unsafe working conditions at the Fortress were the main causes that led to amputation. This case study highlights the importance of contextualizing cases of amputation to understand factors leading to the amputation procedure and techniques used in the past, and the social and living conditions of the individual. Observations were restricted to skeletal material as soft tissue decomposed and there was no material evidence suggestive of amputation associated with this individual in their grave. Full trauma assessment of the Fortress of Louisbourg skeletal collection to provide additional insight into injury sustained at Louisbourg and 18th century surgical practices. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease that may be treated utilizing thermal therapies. Cryoablation is an effective, minimally invasive therapy that has been utilized for the treatment of various cancers, offering patients a quicker recovery and reduced side effects. Cryoablation has been utilized on a limited basis for the treatment of PDAC. With the recent reports on the success of cryoablation, there is a growing interest in the use of cryoablation as a standalone, minimally invasive procedure to treat PDAC. While offering a promising path, the application of cryoablation to PDAC is limited by current technologies. As such, there is a need for the development of new devices to support advanced treatment strategies for PDAC. To this end, this study investigated the performance of a new endoscopic ultrasound-compatible cryoablation catheter technology, FrostBite. We hypothesized that FrostBite would enable the rapid, effective, minimally invasive delivery of ultra-cold temperatures to target tissues, resulting in effective ablation via an endoscopic approach. Thermal properties and ablative efficacy were evaluated using a heat-loaded gel model, tissue-engineered models (TEMs), and an initial in vivo porcine study. Freeze protocols evaluated included single and repeat 3 and 5 min applications. Isotherm assessment revealed the generation of a 2.2 cm diameter frozen mass with the −20 °C isotherm reaching a diameter of 1.5 cm following a single 5 min freeze. TEM studies revealed the achievement of temperatures ≤ −20 °C at a diameter of 1.9 cm after a 5 min freeze. Fluorescent imaging conducted 24 h post-thaw demonstrated a uniformly shaped ellipsoidal ablative zone with a midline diameter of 2.5 cm, resulting in a total ablative volume of 6.9 cm3 after a single 5 min freeze. In vivo findings consistently demonstrated the generation of ablative areas measuring 2.03 cm × 3.2 cm. These studies demonstrate the potential of the FrostBite cryocatheter as an endoscopic ultrasound-based treatment option. The data suggest that FrostBite may provide for the rapid, effective, controllable freezing of cancerous pancreatic and liver tissues. This ablative power also offers the potential of improved safety margins via the minimally invasive nature of an endoscopic ultrasound-based approach or natural orifice transluminal endoscopic surgery (NOTES)-based approach. The results of this pre-clinical feasibility study show promise, affirming the need for further investigation into the potential of the FrostBite cryocatheter as an advanced, minimally invasive cryoablative technology. [ABSTRACT FROM AUTHOR]

Abstract Background Accidental hypothermia with severe frostbite is a rare combination of injuries with a high risk for long-term sequelae. There are widely accepted recommendations for the management of avalanche victims and for frostbite treatment, but no recommendation exists for the treatment of frostbite in severe hypothermic patients, specifically for the management of hypothermic avalanche victims presenting with frostbite. Case presentation We present a case of a previously healthy, 53-year-old male skier who was critically buried by an avalanche at 2300 m of altitude at an ambient temperature of − 8 °C for nearly 23 h. The victim was found with the right hand out of the snow and an air connection to outside. He was somnolent with Glasgow Coma Scale 11 (Eye 4, Verbal 2, Motor 5) and spontaneously breathing, in a severely hypothermic state with an initial core temperature of 23.1 °C and signs of cold injuries in all four extremities. After rescue and active external forced air rewarming in the intensive care unit, the clinical signs of first-degree frostbite on both feet and the left hand vanished, while third- to fourth-degree frostbite injuries became apparent on all fingers of the right hand. After reaching a core body temperature of approximately 36 °C, aggressive frostbite treatment was started with peripheral arterial catheter-directed thrombolysis with alteplase, intravenous iloprost, ibuprofen, dexamethasone and regional sympathicolysis with a right-sided continuous axillary block. After ten months, the patient had no tissue loss but needed neuropathic pain treatment with pregabalin. Conclusion The combination of severe accidental hypothermia and severe frostbite is rare and challenging, as drug metabolism is unpredictable in a hypothermic patient and no recommendations for combined treatment exist. There is general agreement to give hypothermia treatment the priority and to begin frostbite treatment as early as possible after full rewarming of the patient. More evidence is needed to identify the optimal dosage and time point to initiate treatment of frostbite in severely hypothermic patients. This should be taken into consideration by future treatment recommendations.

Death is a hierarchical process, and it is necessary for groups such as jurists and physicians to clarify its achievable dimensions, define its standards, and apply it. The category of the soul and its relation to the body can be traced back to Mulla Sadra's theory of essential movement. On the other hand, understanding the moral and religious norms of new topics in medicine requires an explanation of death. Cryopreservation is a new method of medicine in our time, and this method of bodily preservation can be studied from various doctrinal, philosophical, legal and ethical aspects. One of the biggest challenges facing this emerging method is determining the boundary between life and death, because this process occurs after the patient is declared dead. The current study analyzed the information using the descriptive analytical method and by searching for the concept of death in Mullah Sadra's theory of death, which is a divine theory.

Introduction: Frostbite is freezing of the tissue that mostly affects skin but also the underlying tissues. It results from prolonged exposure to temperatures below the freezing point of water (0°C). One of the many consequences of climate change is extreme cold events, which increase the risk of frostbite in the general population, particularly among individuals who are involuntarily exposed to cold for prolonged periods of time. Although frostbite has been a known phenomenon for a long time, occurring as early as 5000 years ago, the exact incidence of frostbite is not known. This is partly due to variable internal (frostbite susceptibility, hydration status, protective garments) and external etiological factors (wind chill, precipitation, altitude), that never coincide all at the same time. Objectives: The objective was to compare the incidence rates of frostbite in the published studies that focused on frostbite incidence. Methods: Out of a total of 61 studies using the keywords “frostbite” and “incidence” on PubMed, we selected seven that dealt with frostbite incidence over 20 years. We briefly summarized and compared the results of the studies. Results: The comparison of the seven studies shows a great variability of frostbite incidence depending on the population, its size, and the method of data collection. Studies that included civilian populations have significantly lower frostbite incidence rates than studies focusing on individuals who are exposed to temperatures below 0°C for extended periods, such as mountaineers, military personnel, workers in cold storage houses or homeless people. The results highlight different incidence rates for different populations and indicate that retrospectively collected data are insufficiently comparable among studies. Frostbite incidence, expressed as the ratio of injured individuals to non-injured inhabitants, is only comparable in studies using the same methodology. Enhanced frostbite susceptibility is a confirmed fact and was generally not considered in most of the studies. Conclusions: Frostbite incidences of the included studies are insufficiently comparable to draw any conclusions on possible general frostbite incidence in a population. To enhance our ability to estimate or predict frostbite occurrences within the general population, establishing an international or national frostbite registry in high-risk countries could be helpful.

Earthquakes are catastrophic natural disasters. Staying under rubble for a long time may cause compartment syndrome, especially in the extremities, and crush injuries due to severe trauma. In addition, frostbite injuries may occur due to extreme climate in the winter. In hyperbaric oxygen therapy (HBOT), patients breathe 100% oxygen in a closed chamber at pressures greater than 1 atmosphere absolute. HBOT provides elevated partial oxygen pressure, increased oxygen diffusion distance, decreased edema of the areas with circulatory disorder, augmented bactericidal effect, additive-synergistic effect with antibiotics, and enhanced wound healing. HBOT is a successful adjunctive treatment option for crush injuries, acute skeletal compartment syndromes, and frostbite injuries.

Abstract Introduction Our objective was to perform a systematic review of the outcomes of various frostbite treatments to determine which treatments are effective. We also planned to perform meta-analyses of the outcomes of individual treatments for which suitable data were available. Main Body We performed a systematic review and meta-analyses in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Cochrane Trials, and EMBase to identify primary references from January 1, 1900, to June 18, 2022. After eliminating duplicates, we screened abstracts to identify eligible studies containing information on treatment and outcomes of Grade 2 to 4 frostbite. We performed meta-analyses of groups of articles that provided sufficient data. We registered our review in the prospective registry of systematic reviews PROSPERO (Nr. 293,693). We identified 4,835 potentially relevant studies. We excluded 4,610 studies after abstract screening. We evaluated the full text of the remaining 225 studies, excluding 154. Ultimately, we included 71 articles with 978 cases of frostbite originating from 1 randomized controlled trial, 20 cohort studies and 51 case reports. We found wide variations in classifications of treatments and outcomes. The two meta-analyses we performed both found that patients treated with thrombolytics within 24 h had better outcomes than patients treated with other modalities. The one randomized controlled trial found that the prostacyclin analog iloprost was beneficial in severe frostbite if administered within 48 h. Conclusions Iloprost and thrombolysis may be beneficial for treating frostbite. The effectiveness of other commonly used treatments has not been validated. More prospective data from clinical trials or an international registry may help to inform optimal treatment.

Context: Postsurgical and acute orthopedic patients are frequently treated with consecutive systematic cryotherapy despite the void of data to support treatment safety or effectiveness. The purpose of this study was to examine the occurrence of frostbite and measure skin temperatures during the systematic application of 2 cryocompression protocols. Design: A repeated-measures design guided this study. Methods: Nine healthy, college-aged participants (4 men and 5 women; age = 20.7 [1.2] y; height = 174 [11.01] cm; mass = 74 [14] kg) received both cryocompression protocols separated by ≥ 1 week. The static cryocompression protocol consisted of seven 40-minute "on" cycles of cryotherapy (4.4°C) with 45 mm Hg of compression, each followed by a 30-minute "off' cycle (no cryotherapy, compression set at 5 mm Hg). The intermittent cryocompression protocol consisted of seven 40-minute "on" cycles of cryotherapy (4.4°C) with compression alternating between 5 and 45 mm Hg, each followed by a 30-minute "off' cycle (no cryotherapy, compression set at 5 mmHg). At the end of each "on" and "off' cycle, we used a checklist to assess for frostbite, a PT-6 thermocouple to measure skin temperature (in degrees Celsius), and a 10-cm Likert scale to assess comfort. Results: None of the participants experienced any signs or symptoms of frostbite. There were no differences in skin temperature between the compression conditions overtime (F14,112 = 1.43; P = .149) nor were there any differences between the 2 compression conditions (F1.8 = 3.75; P=.087; 1-β = 0.40). The skin temperatures were statistically different over the course of all 7 "on" and "off' cycles (F14,112 = = 95.12; P< .001). There was no difference between the skin temperatures produced at the end of each "on" cycle. Conclusions: The application of 7 consecutive cryotherapy treatments with compression did not result in any signs or symptoms of frostbite and produced similar skin temperatures with each "on" cycle. [ABSTRACT FROM AUTHOR]

Background: Accidental hypothermia with severe frostbite is a rare combination of injuries with a high risk for long-term sequelae. There are widely accepted recommendations for the management of avalanche victims and for frostbite treatment, but no recommendation exists for the treatment of frostbite in severe hypothermic patients, specifically for the management of hypothermic avalanche victims presenting with frostbite. Case presentation: We present a case of a previously healthy, 53-year-old male skier who was critically buried by an avalanche at 2300 m of altitude at an ambient temperature of − 8 °C for nearly 23 h. The victim was found with the right hand out of the snow and an air connection to outside. He was somnolent with Glasgow Coma Scale 11 (Eye 4, Verbal 2, Motor 5) and spontaneously breathing, in a severely hypothermic state with an initial core temperature of 23.1 °C and signs of cold injuries in all four extremities. After rescue and active external forced air rewarming in the intensive care unit, the clinical signs of first-degree frostbite on both feet and the left hand vanished, while third- to fourth-degree frostbite injuries became apparent on all fingers of the right hand. After reaching a core body temperature of approximately 36 °C, aggressive frostbite treatment was started with peripheral arterial catheter-directed thrombolysis with alteplase, intravenous iloprost, ibuprofen, dexamethasone and regional sympathicolysis with a right-sided continuous axillary block. After ten months, the patient had no tissue loss but needed neuropathic pain treatment with pregabalin. Conclusion: The combination of severe accidental hypothermia and severe frostbite is rare and challenging, as drug metabolism is unpredictable in a hypothermic patient and no recommendations for combined treatment exist. There is general agreement to give hypothermia treatment the priority and to begin frostbite treatment as early as possible after full rewarming of the patient. More evidence is needed to identify the optimal dosage and time point to initiate treatment of frostbite in severely hypothermic patients. This should be taken into consideration by future treatment recommendations. [ABSTRACT FROM AUTHOR]

The article describes the basics of frostbite pathophysiology, grading and evidence-based treatment based on available resources. Topics discussed include history and demographics of frostbite, a spectrum of presentation of cold weather injuries, and diagnosis and determination of the extent of frostbite.

Frostbite is a medically significant form of tissue injury that can lead to the potential need for amputation or necessitate tissue regeneration. It occurs most frequently at cryogenic temperatures in extreme altitude climbing, winter sports, and military activities. While acupuncture and herbal medicine have been reported to possess tissue regeneration effectiveness, there is currently no clinical evidence supporting their use in treating grade 3 frostbite cases at risk of amputation. Three patients were diagnosed with grade 3 frostbite based on the extent and severity of tissue damage after alpine climbing in the Himalayas. After an urgent treatment, partial body amputation was advised. In order to seek any complementary treatment options and avoid amputation, they were referred to a frostbite expert in traditional Korean medicine. They received a comprehensive treatment consisting of acupuncture, bloodletting, direct moxibustion, and herbal medicine. All the patients showed notable healing of the damaged tissue, which prevented the need for amputation. No adverse effects or other sequelae were observed. This case series suggests that complementary medicine, primarily acupuncture and herbal medicine, could be effective for severe frostbite. Further studies with larger sample sizes and control groups are needed to determine the efficacy and safety of this treatment modality for frostbite management. [ABSTRACT FROM AUTHOR]

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Introduction: Our objective was to perform a systematic review of the outcomes of various frostbite treatments to determine which treatments are effective. We also planned to perform meta-analyses of the outcomes of individual treatments for which suitable data were available. Main Body: We performed a systematic review and meta-analyses in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Cochrane Trials, and EMBase to identify primary references from January 1, 1900, to June 18, 2022. After eliminating duplicates, we screened abstracts to identify eligible studies containing information on treatment and outcomes of Grade 2 to 4 frostbite. We performed meta-analyses of groups of articles that provided sufficient data. We registered our review in the prospective registry of systematic reviews PROSPERO (Nr. 293,693). We identified 4,835 potentially relevant studies. We excluded 4,610 studies after abstract screening. We evaluated the full text of the remaining 225 studies, excluding 154. Ultimately, we included 71 articles with 978 cases of frostbite originating from 1 randomized controlled trial, 20 cohort studies and 51 case reports. We found wide variations in classifications of treatments and outcomes. The two meta-analyses we performed both found that patients treated with thrombolytics within 24 h had better outcomes than patients treated with other modalities. The one randomized controlled trial found that the prostacyclin analog iloprost was beneficial in severe frostbite if administered within 48 h. Conclusions: Iloprost and thrombolysis may be beneficial for treating frostbite. The effectiveness of other commonly used treatments has not been validated. More prospective data from clinical trials or an international registry may help to inform optimal treatment. [ABSTRACT FROM AUTHOR]

Burn injury can be defined as the tissue damage caused as a result of the effect of various factors. It is an important type of injury that should not be overlooked during earthquakes and other natural disasters. First aid and patient follow-up of burn cases are life changing. The first thing to do is to prevent furhter burning process by moving the patient away from the burning agent. The treatment and evaluation should be followed by airway, breathing, and circulation protocol before transfer to hospital. The extent, depth, and region of the burn affect the severity. The percentage of body area is calculated to determine the width. Early initiation of fluid resuscitation is very important. Burn dressings differ in varying degrees. Escharotomy, debridement, and wound care are used in surgical treatment. Although the source of damage is not heat but cold, frostbites cause similar damage to the tissues. Gradual heating and gentle debridement of the affected areas should be the first treatment. Surgical treatment should be delayed until demarcation occurs. [ABSTRACT FROM AUTHOR]

Frostbite is an insidious disease that normally affects people of cold climates. Winter Storm Uri, which occurred from February 12–20, 2021, created unique metrological conditions for Texas. It caused prolonged sub-freezing temperatures and led to rolling blackouts, affecting 2.8 million Texans including 300,000 people in San Antonio. We report 13 frostbite patients admitted to one burn center during this event. We aimed to determine the at-risk population for frostbite, to categorize their injury severity, and to describe their treatment. A secondary aim was to describe the rehabilitation management of these patients. This is a single-center retrospective study. Each patient's injuries were assessed by a topographical grading system. Comparisons were made among those who were admitted to the intensive care unit (ICU), admitted to the progressive care unit (PCU), and treated as outpatients. Thirteen patients were identified. Ten (76.9 %) considered themselves homeless, and 9 (69.2 %) were directly exposed to the elements. The median delay between time of injury and presentation to a medical facility was 3 days (IQR 1–6). Only 3 patients presented to a medical facility within 24 h. Six (46 %) sustained grade 2 injuries, 2 (15 %) sustained grade 3 injuries, and 5 (38%) sustained grade 4 injuries. Only one patient met criteria to receive tissue plasminogen activator (tPA), which was discontinued due to hematochezia. Patients admitted to the ICU, when compared to patients admitted to the ward, had a longer length of stay (median 73 days v. 12 days, p = 0.0215), and required more amputations at below-the-knee or higher levels (3 v. 0, p-value 0.0442). In a region unaccustomed and perhaps unprepared to deal with winter storms, the population is particularly vulnerable to frostbite. Lack of awareness of frostbite injuries likely led to the delay in the presentation of patients, which prevented the timely use of tPA. Increasing public awareness may increase readiness. • The homeless population was particularly vulnerable to frostbite. • Lack of awareness of frostbite injuries likely led to the delay in presentation, limiting therapeutic interventions. • Due to the homeless nature of many patients, rehabilitation was modified to best meet the patients' needs. [ABSTRACT FROM AUTHOR]

Kriemler, Susi, Kastė Mateikaitė-Pipirienė, Alison Rosier, Linda E. Keyes, Peter Paal, Marija Andjelkovic, Beth A. Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, Lenka Horakova, and Dominique Jean; for the UIAA MedCom Writing Group on Women's Health in the Mountains. Frostbite and mortality in mountaineering women: a scoping review—UIAA Medical Commission recommendations. High Alt Med Biol. 24:247–258, 2023. Background: The harsh environment of high altitudes (HA) poses many serious health risks for mountaineers, including cold injuries and death. The aim of this work was to review whether female mountaineers are at special risk for frostbite or death at HA compared with their male counterparts. Methods: The UIAA Medical Commission convened an international author team to review women's health issues at HA and to publish updated recommendations. Pertinent literature from PubMed and Cochrane was identified with additional publications found by hand search. The primary search focus was for articles assessing cold injuries and death in women mountaineers at HA. Results: We reviewed the literature and identified 20 relevant studies: 2 studies on frostbite at HA, plus 7 studies and 1 report for death at HA. An additional 10 studies about frostbite at low altitude were included. We found that female mountaineers at HA were at lower risk of death than their male counterparts, but sex differences in frostbite were inconclusive. Conclusions: The frequency of cold injuries and mortality in female mountaineers is not yet well studied, and the studies that have been published tend to lack precise exposure data. More studies and registries with sex-differentiated data are needed. [ABSTRACT FROM AUTHOR]

Flexible epidermal sensors based on conductive hydrogels hold great promise for various applications, such as wearable electronics and personal healthcare monitoring. However, the integration of conductive hydrogel epidermal sensors into multiple applications remains challenging. In this study, a multifunctional PAAm/PEG/hydrolyzed keratin (Hereinafter referred to as HK)/MXene conductive hydrogel (PPHM hydrogel) was designed as a high-performance therapeutic all-in-one epidermal sensor. This sensor not only accelerates wound healing but also provides wearable human-computer interaction. The developed sensor possesses highly sensitive sensing properties (Gauge Factor = 4.82 at high strain), strong mechanical tensile properties (capable of achieving a maximum elongation at break of 600 %), rapid self-healing capability, stable self-adhesive capability, biocompatibility, freeze resistance at −20 °C, and adjustable photo-thermal conversion capability. This therapeutic all-in-one sensor can sensitively monitor human movements, enabling the detection of small electrophysiological signals for diagnosing relevant activities and diseases. Furthermore, using a rat frostbite model, we demonstrated that the composite hydrogel sensor can serve as an effective wound dressing to accelerate the healing process. This study serves as a valuable reference for the development of multifunctional flexible epidermal sensors for personal smart health monitoring. Accelerated wound healing reduces the risk of wound infection, and conductive hydrogel-based sensors can monitor physiological signals. The multifunctional application of conductive hydrogel sensors combined with wound diagnostic and therapeutic capabilities can meet personalized medical requirements for wound healing and sensor monitoring. The aim of this study is to develop a multifunctional hydrogel patch. The multifunctional hydrogel can be assembled into a flexible wearable high-performance diagnostic and therapeutic integrated sensor that can effectively accelerate the healing of frostbite wounds and satisfy the real-time monitoring of multi-application scenarios. We expect that this study will inform efforts to integrate wound therapy and sensor monitoring. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Freezing cold injuries (FCI) are a common risk in extreme cold weather warfare operations. The Norwegian Armed Forces (NAF) have the expertise and capabilities in education and training for warfighting capabilities in the Arctic. Nevertheless, a substantial number of Norwegian soldiers sustain freezing cold injuries annually. The aim of this study was to describe the FCI in the NAF, the associated risk factors and clinical associations. Methodology: The subjects for the study were soldiers registered with FCI in the Norwegian Armed Forces Health Registry (NAFHR) between January 1st 2004–July1st 2021. The soldiers answered a questionnaire regarding background, activities at the time of injury, description of the FCI, risk factors, medical treatment and any sequelae from their FCI. Results: FCI in the NAF were most frequently reported among young conscripts (mean20.5 years). Hands and feet are most often injured (90.9%). Only a minority (10.4%) received medical treatment. The majority (72.2%) report sequelae. Extreme weather conditions was the most important risk factor (62.5%). Conclusions: Most soldiers had the knowledge to avoid FCI, but they were injured anyway. It is concerning that only one in 10 injured soldiers received medical treatment after diagnosed with FCI, increasing the risk of FCI sequelae. [ABSTRACT FROM AUTHOR]

Introduction: Cold Weather Injury (CWI) represents a spectrum of pathology, the two main divisions being Freezing Cold Injury (FCI) and Non-Freezing Cold Injury (NFCI). Both are disabling conditions associated with microvascular and nerve injury often treated hours after initial insult when presenting to a healthcarestablishment. Given that iloprost is used for the treatment of FCI, could it be used in a forward operating environment to mitigate treatment delay? Is there a role for its use in the forward treatment of NFCI? This review sought to evaluate the strength of evidence for the potential use of iloprost in a forward operating environment. Methods: Literature searches were undertaken using the following question for both FCI and NFCI: in [patients with FCI/NFCI] does [the use of iloprost] compared to [standard care] reduce the incidence of [long-term complications]. Medline, CINAHL and EMBASE databases were searched using the above question and relevant alternative terminology. Abstracts were reviewed before full articles were requested. Results: The FCI search yielded 17 articles that were found to refer to the use of iloprost and FCI. Of the 17, one referred to pre-hospital treatment of frostbite at K2 base camp; however, this was utilising tPA. No articles referred to pre-hospital use in either FCI or NFCI. Discussion: Although evidence exists to support the use of iloprost in the treatment of FCI, its use to date has been in hospital. A common theme is delayed treatment due to the challenges of evacuating casualties from a remote location. There may be a role for iloprost in the treatment of FCI; however, further study is required to better understand the risk of its use. [ABSTRACT FROM AUTHOR]

Introduction: Freezing cold injuries (FCI) are a common risk in extreme cold weather operations. Although the risks have long been recognised, injury occurrences tend to be sparse and geographically distributed, with relatively few cases to study in a systematic way. The first challenge to improve FCI medical management is to develop a common nomenclature for FCI classification. This is critical for the development of meaningful epidemiological reports on the magnitude and severity of FCI, for the standardisation of patient inclusion criteria for treatment studies, and for the development of clinical diagnosis and treatment algorithms. Methodology: A scoping review of the literature using PubMed and cross-checked with Google Scholar, using search terms related to freezing cold injury and frostbite, highlighted a paucity of published clinical papers and little agreement on classification schemes. Results: A total of 74 papers were identified, and 28 were included in the review. Published reports and studies can be generally grouped into four different classification schemes that are based on (1) injury morphology; (2) signs and symptoms; (3) pathophysiology; and (4) clinical outcome. The nomenclature in the different classification systems is not coherent and the discrete classification limits are not evidence based. Conclusions: All the classification systems are necessary and relevant to FCI medical management for sustainment of soldier health and performance in cold weather operations and winter warfare. Future FCI reports should clearly characterise the nature of the FCI into existing classification schemes for surveillance (morphology, symptoms, and appearance), identifying risk-factors, clinical guidelines, and agreed inclusion/exclusion criteria for a future treatment trial. [ABSTRACT FROM AUTHOR]