Shapiro syndrome is a rare condition with fewer than 100 cases reported, initially characterized by the triad of hypothermia, hyperhidrosis, and agenesis of the corpus callosum. The diagnostic triad is no longer systematic, and the condition is now more broadly referred to as spontaneous periodic hypothermia. An 86-year-old patient presented with coma, hypothermia, and sweating. The differential diagnoses of hypothermia were ruled out and a diagnosis of a variant of Shapiro syndrome was made. Brain imaging revealed small corpus callosums. Treatment was symptomatic, with external warming and management of complications. The outcome was favorable, with cessation of hypothermia and gradual incomplete neurological recovery. This case highlights the importance of considering this syndrome when hypothermia and hyperhidrosis occur together. Elderly patients are at increased risk of serious complications and require appropriate management.

Necrotizing enterocolitis (NEC) predominantly affects preterm infants and remains uncommon in term neonates. When it occurs in full-term newborns, it usually reflects underlying vulnerability or cumulative perinatal risk factors. We report the case of a term male newborn (40 + 1 weeks' gestation) who developed NEC in the context of multiple risk factors, including perinatal asphyxia with hypoxic-ischemic encephalopathy managed by therapeutic hypothermia, suspected early-onset neonatal infection requiring empirical antibiotics, and formula feeding. On day 4 of life, the infant presented with signs of an acute abdomen. Imaging revealed pneumoperitoneum, and surgery confirmed NEC with colonic perforation. Histopathology demonstrated inflammatory and hemorrhagic necrosis, and Hirschsprung's disease was excluded. A colostomy was performed, with restoration of intestinal continuity at six months and normal neurodevelopment at 18 months. This case highlights that NEC in term neonates, although rare, may result from the convergence of multiple perinatal insults, including hypoxic-ischemic injury and therapeutic hypothermia, and underscores the need for careful evaluation of predisposing factors that compromise intestinal integrity.

This study investigated the effects of acute cold stress on digestive function and gastrointestinal pathology in juvenile yellowfin tuna (Thunnus albacares). The experimental setup encompassed a control group (CG, 30°C), a low-temperature group (HT, 24°C), and an ultra-low-temperature group (LT, 18°C), with sampling conducted at 0, 12, 24, and 36 h, respectively, over a total experimental duration of 36 h. We analyzed digestive enzyme activities in the gastric tissue and intestine, expression of key digestive genes, and gastrointestinal histopathology. Results showed that low-temperature stress significantly altered digestive enzyme activities. During the early stage of acute cold exposure (12-24 h), intestinal amylase and trypsin showed enzyme-specific changes, indicating an energy-saving response. With continued exposure over the 36-h experimental period, lipase activity increased substantially in the LT group, suggesting a metabolic shift toward lipid mobilization for energy and membrane fluidity maintenance. Pepsin activity was highest in the HT group and fluctuated in the LT group, reflecting complex gastric microenvironment disruption. Gene expression analysis revealed transcriptional-physiological decoupling. Histopathological findings showed cellular edema, necrosis, and mucous cell hyperplasia in both HT and LT groups, worsening with colder temperatures and longer exposure. By 36 h, the LT group exhibited severe mucosal detachment and glandular structure disruption. In summary, juvenile yellowfin tuna responded to acute cold stress through a biphasic metabolic strategy-initial inhibition followed by compensation-and dynamic gene-enzyme decoupling. While short-term stress activated metabolic plasticity, severe acute cold exposure caused significant gastric tissue damage and digestive dysfunction. These findings provide new insights into thermal adaptation mechanisms and support improved temperature management in aquaculture.

A 69-year-old woman with a recurrent skull-base meningioma developed recurrent hypothermia during rehabilitation, initially misattributed to infection. Episodes followed a circadian pattern and were associated with delirium, pancytopenia, and signs of central endocrine dysfunction. MRI showed a large meningioma compressing the hypothalamus with an intact corpus callosum. Infection and adrenal insufficiency were excluded. Hypothermia resolved with external warming, and pancytopenia normalized spontaneously. Subclinical hypothyroidism and central hypogonadism were noted, consistent with hypothalamic-pituitary axis involvement. These findings supported a diagnosis of acquired spontaneous periodic hypothermia (SPH) due to hypothalamic compression. This case illustrates that early recognition of SPH in patients with skull-base tumors can prevent misdiagnosis and guide appropriate supportive care and monitoring.

A 22-year-old intact female donkey was referred for acute recumbency and inappetence. Physical examination revealed hypothermia, tachycardia and dermal abrasions consistent with prolonged recumbency. Clinicopathological findings included metabolic acidosis, electrolyte derangements and evidence of systemic inflammation. Despite intensive supportive care, the donkey's condition deteriorated, and euthanasia was elected 72 h after presentation. Post-mortem examination identified multilobulated pancreatic enlargement and oedema along with pulmonary fibrosis. Histopathology confirmed severe, necrotizing pancreatitis and chronic interstitial pulmonary fibrosis. This case underscores the diagnostic challenge of acute pancreatitis in equids, which often presents with non-specific clinical signs such as recumbency, and highlights the critical role of post-mortem examination in obtaining a definitive diagnosis.

The Extracorporeal Life Support Organization (ELSO) has progressively transformed its guideline framework to meet the increasing clinical, scientific, and operational demands of modern extracorporeal life support. Since its establishment in 1989, ELSO has supported Extracorporeal Membrane Oxygenation (ECMO) programs worldwide through education, data reporting, and consensus-building. Recent expansions in ECMO utilization, coupled with rapidly growing evidence, have necessitated a more structured, transparent, and internationally representative approach to guideline development.In 2023, ELSO expanded the Guideline Subcommittee (GSC) to ensure participation from all ELSO chapters and key professional disciplines. This expansion enables the implementation of a standardized workflow encompassing proposal submission, methodological review, authorship requirements, external peer review, plagiarism screening, and final Board approval. The updated process emphasizes consistency, timely production, and methodological rigor across all ELSO guidelines.This manuscript summarizes the current ELSO guideline development process and highlights four recently published guidelines addressing early mobility, adult neuromonitoring, ECMO in pregnancy and the peripartum period, and accidental hypothermia. Each guideline reflects the available evidence integrated with multidisciplinary expert input, with the goal of providing globally applicable, practical recommendations for ECMO clinicians. The review also outlines the formal guideline update cycle and ELSO's expanding collaborations with international societies to produce joint guidance documents.As ECMO practice continues to evolve, ELSO remains committed to advancing high-quality, accessible guidelines that support consistent standards of care across diverse healthcare systems. Future priorities include guidelines on ECMO during cardiopulmonary resuscitation, trauma, and other high-impact clinical areas, along with enhanced education and training pathways to strengthen ECMO practice globally.

IntroductionPersistent asystole following restoration of mechanical circulation during extracorporeal cardiopulmonary resuscitation (E-CPR) is typically considered fatal. However, in profound hypothermia, electrical silence may not reflect irreversible myocardial injury.Case ReportA term neonate with severe meconium aspiration syndrome (MAS) was initially supported on veno-arterial ECMO at a regional hospital and transported to a tertiary ECMO facility. Following decannulation, she suffered cardiac arrest. Mechanical circulation was achieved after prolonged E-CPR with central cannulation, but the patient remained asystolic in the context of profound hypothermia (31.2°C). Electrical activity reappeared only after controlled rewarming to 33°C. She was discharged home on day 35 with a good long term neurological outcome.DiscussionNeonates are particularly prone to rapid hypothermia during resuscitation. Controlled rewarming is essential to determine cardiac viability before establishing futility.ConclusionUnder profound hypothermia, asystole after restoration of mechanical circulation does not preclude irreversible myocardial damage. Cautious rewarming is mandatory to assess myocardial prognosis.

Extracorporeal membrane oxygenation (ECMO) is increasingly used as an adjunct in the management of critically injured trauma patients requiring operative intervention. Although trauma represents a small proportion of overall ECMO use, its application has expanded due to advances in circuit technology, cannulation strategies, and anticoagulation practices. This review examines the role of ECMO in stabilizing operative trauma patients across preoperative, intraoperative, and postoperative phases. Preoperatively, ECMO is most commonly indicated for refractory hypoxemia or severe acidosis resulting from thoracic or airway injury, aspiration, transfusion-related acute lung injury, or acute respiratory distress syndrome. Early cannulation can restore gas exchange, improve hemodynamic stability, reduce ventilator-induced lung injury, and facilitate safe transport to the operating room during damage control resuscitation. Emerging evidence also supports selective use of ECMO in patients with traumatic brain injury requiring urgent neurosurgical intervention. Intraoperatively, ECMO has been used during high-risk damage control procedures, including trauma pneumonectomy, retrohepatic inferior vena cava injury, and operations complicated by hemorrhage, hypothermia, and acidosis. Veno-venous ECMO may improve oxygenation and reduce right ventricular strain, while veno-arterial ECMO may be appropriate in select cases of traumatic cardiogenic shock. Postoperatively, ECMO is most often employed for delayed respiratory failure due to acute respiratory distress syndrome, transfusion-related lung injury, or bronchopleural fistula, allowing lung-protective ventilation and recovery. Although evidence supporting ECMO for traumatic respiratory failure continues to grow, data for other perioperative indications remain limited. Prospective multicenter studies are needed to refine patient selection, timing, and outcomes in operative trauma populations.