Hypothermia is a common potentially serious complication of veterinary anesthesia, particularly affecting species with a large body surface area-to-mass ratio, such as Chiroptera. There are limited options for monitoring temperature in bats, with size being a significant limiting factor. This study evaluated three methods of temperature measurement-esophageal, rectal, and axillary-in a convenience sample of nine apparently healthy anesthetized large flying foxes (Pteropus vampyrus). At the time of anesthetic induction and every 5 min until recovery, rectal and esophageal temperatures were recorded. At the same time points, a temperature was obtained in the nonhaired axillary fold by using an infrared thermometer. There were significant differences in the mean temperatures obtained between sites at each time interval (P < 0.05). Esophageal temperature was consistently the lowest, with axillary and rectal temperature averaging -15 and -17°C (5.1 and 1.3°F) higher, respectively. Esophageal measurements correlated strongly with rectal temperatures (P < 0.0001), whereas axillary/esophageal and axillary/rectal correlations approached significance (P = 0.0519 and P = 0.0562, respectively). Esophageal thermometry should be used for accurate body temperature measurement in anesthetized large flying foxes if practical, with the rectal modality remaining an option for monitoring trends over time. Further research is necessary to validate the use of axillary thermometry with an infrared thermometer for monitoring temperature trends in this bat species.

Intracardiac extension of hepatocellular carcinoma (HCC) via the inferior vena cava (IVC) is uncommon and may result in fatal cardiac complications. We report a case of urgent cardiac surgery performed to prevent imminent cardiac deterioration and facilitate subsequent multidisciplinary treatment. A 64-year-old man with a history of right hepatectomy for stage III HCC and radiofrequency ablation for recurrent disease was admitted following a traffic accident. Echocardiography revealed a 4.6 × 3.6 cm right atrial mass continuous with the IVC. Although the patient had no overt cardiac symptoms, frequent episodes of non-sustained ventricular tachycardia and bilateral lower extremity oedema raised concern regarding impending cardiac complications. Urgent tumour resection was performed under moderate hypothermic circulatory arrest (lowest rectal temperature, 32 °C). Following cardiac and orthopaedic surgery, the patient underwent transcatheter arterial chemoembolization and systemic therapy with durvalumab plus tremelimumab. At a 1-year follow-up, no intracardiac recurrence was observed, pulmonary metastatic lesions had regressed, and the patient remained clinically stable. Urgent cardiac surgery may serve as a bridge to multidisciplinary treatment in selected patients with HCC and intracardiac extension.

Extreme alpine summer sports are increasingly popular and expose participants to high-energy trauma in remote mountain environments. This pictorial essay reviews the emergency radiology of severe acute injuries associated with down-hill mountain biking, rock climbing, paragliding, BASE jumping, canyoning, and rafting, with emphasis on mechanism-based imaging interpretation. Injury patterns differ across disciplines but are largely determined by velocity, fall height, landing posture, impact surface, axial loading, torsional forces, and water-related hazards. Down-hill mountain biking commonly produces extremity, thoracic, craniofacial, abdominal, and spinal injuries after high-speed crashes or handlebar impact. Rock climbing and paragliding frequently involve falls from height and hard landings, leading to thoracolumbar fractures, pelvic trauma, calcaneal or ankle injuries, and, in severe cases, neurologic compromise or visceral injury. BASE jumping is associated with high-velocity landing trauma, particularly involving the lower limbs, pelvis, and spine. Canyoning and rafting combine blunt trauma with environmental risks such as submersion, aspiration, hypothermia, and drowning-related complications. In high-energy trauma or polytrauma, whole-body computed tomography is the cornerstone of emergency assessment, enabling rapid evaluation of head, spine, chest, abdomen, and pelvis. Radiography remains useful for isolated appendicular injuries, whereas magnetic resonance imaging is essential for spinal cord, ligamentous, marrow, and selected soft-tissue injuries. Awareness of sport-specific mechanisms helps radiologists optimize image selection, maintain an appropriate search pattern, recognize injuries that may coexist after axial loading, and communicate urgent findings promptly. A mechanism-oriented approach may improve diagnostic accuracy, guide multidisciplinary management, and reduce missed injuries in patients presenting after alpine summer extreme sports trauma.

Inadvertent hypothermia caused by redistribution of core heat after anesthesia induction is a common perioperative complication. This randomized controlled trial evaluated whether brief (five-minute) limb-focused warming added to whole-body prewarming improves efficiency and attenuates redistribution hypothermia during general anesthesia. Eighty-two adults undergoing laparoscopic lower gastrointestinal surgery were randomly assigned to a prewarming group (n = 41) or control group (n = 41). The intervention combined standard whole-body prewarming with targeted warming of both forearms and lower legs for five minutes before anesthesia induction. Core temperature, peripheral temperature, and perfusion index were recorded at baseline and peri-induction intervals. At 30 minutes after induction, the prewarming group had a higher median core temperature (36.8 °C versus 36.5 °C [98.2 °F versus 97.7 °F]; P = .046) and a smaller decline from baseline (P < .001), as well as higher peripheral temperature. This brief nurse-led approach provides efficient thermal protection without delaying anesthesia induction.

We present the case of a 22-year-old female with a history of systemic lupus erythematosus and antiphospholipid syndrome, complicated by recurrent deep vein thrombosis of the lower extremities and pulmonary embolism, who subsequently developed chronic thromboembolic pulmonary hypertension. The patient presented with progressive dyspnea, ultimately limiting daily activities, and was managed with long-term anticoagulation and pulmonary vasodilator therapy. Diagnostic workup, including imaging and hemodynamic assessment, revealed multiple bilateral segmental perfusion defects, right heart dilation, and significantly elevated pulmonary pressures with increased pulmonary vascular resistance, consistent with operable chronic thromboembolic disease. The patient underwent pulmonary endarterectomy via median sternotomy under cardiopulmonary bypass with deep hypothermia and intermittent total circulatory arrest. Two periods of circulatory arrest, of 19 and 18 minutes, were utilized during the procedure. Organized thromboembolic material was successfully removed from both pulmonary arteries, achieving adequate endarterectomy planes without major intraoperative complications. In the immediate postoperative period, the patient remained hemodynamically stable, with expected improvement in right ventricular afterload and pulmonary hemodynamics. This case highlights the importance of recognizing chronic thromboembolic pulmonary hypertension in young patients with autoimmune disease and recurrent thrombotic events, as well as the role of pulmonary endarterectomy as a potentially curative treatment when performed in specialized centers.

Objective: Intraoperative hypothermia is a common perioperative complication. This large-scale, multicenter, prospective clinical study aimed to delineate the occurrence patterns of intraoperative hypothermia in adults and to identify its major independent risk factors, thereby providing evidence-based support for early clinical risk assessment and intervention. Methods: This study adopted a multicenter, prospective, observational design. Eligible participants were screened based on predefined inclusion and exclusion criteria, and a total of 4516 surgical patients (≥18 years) from 12 tertiary general hospitals across China were ultimately enrolled. Core body temperature was continuously monitored intraoperatively using standardized methods. Data on demographic characteristics, surgical and anesthesia-related parameters, and perioperative temperature management interventions were collected. Patients were stratified into groups according to the presence or absence of hypothermia (core temperature <36.0 °C). Univariate analyses were first conducted to identify associated factors, followed by multivariable logistic regression to determine factors independently associated with intraoperative hypothermia. Results: The overall incidence of intraoperative hypothermia among surgical patients was 23.82%. Hypothermia occurred most frequently in patients with a preoperative baseline core temperature ≤ 35.9 °C (85.93%). Among surgical specialties, hand surgery had the highest incidence of hypothermia (51.35%), and among surgical sites, procedures involving the upper extremities showed the highest rate (35.00%). Multivariable logistic regression analysis identified the following as independent risk factors for intraoperative hypothermia: Type of anesthesia (OR = 1.743, 95% CI: 0.834-3.644), ASA classification (OR = 1.408, 95% CI: 1.197-1.657), Surgical approach (OR = 0.735, 95% CI: 0.577-0.936), Skin disinfection site (OR = 2.024, 95% CI: 1.534-2.670), Volume of cold intravenous fluids infused (mL) (OR = 1.365, 95% CI: 1.140-1.633), Volume of transfused blood (U) (OR = 1.116, 95% CI: 0.807-1.542), Intraoperative blood loss (mL) (OR = 1.252, 95% CI: 0.892-1.756), and Duration of surgery (hours) (OR = 2.014, 95% CI: 1.683-2.411). Conclusions: The incidence of intraoperative hypothermia in adults was relatively high at 23.82% and was observed to be associated with multiple modifiable perioperative factors. These findings support the need to strengthen risk assessment and implement individualized temperature management strategies in clinical practice, with the goal of reducing the risk of intraoperative hypothermia and improving perioperative safety and outcomes.

We propose a new bioheat model for thermoregulation in the human body in response to cold environments, with emphasis on hypothermia and frostbite in exposed extremities. The model couples the bioheat transfer equation in the extremity with a differential equation that describes the core temperature. We used simulations to illustrate the connection between microscale vascular exchange and the effective perfusion term in the bioheat transfer equation. The nonlinear coupling proposed here incorporates physiologically motivated feedback laws for local and reflex vasoconstriction, as well as heat exchange with the environment. We illustrated the model numerically with realistic scenarios of thermoregulation regarding the thermal response of the body, which involves preservation of core temperature despite an increased frostbite risk. The model provides a robust framework for predictive studies of cold-induced injuries.

IntroductionCold exposure initially induces peripheral vasoconstriction. After 5-10 min, distal blood vessels will transiently and cyclically vasodilate and vasoconstrict in a phenomenon known as cold-induced vasodilation (CIVD). Increased CIVD response is thought to improve dexterity and confer a reduced risk of frostbite injuries. Current guidelines recommend the use of an intravenous synthetic prostacyclin (PGI2) analog for the treatment of some cases of severe frostbite. This double-blind crossover study investigates the effects of the inhaled PGI2 analog epoprostenol on CIVD response through continuous finger temperature measurement during cold water immersion.ResultsFourteen healthy volunteers completed both sessions of the study and were included in the analysis. Compared to placebo, inhaled epoprostenol sessions showed higher mean finger temperature (9.16 vs 8.34° C; p = .027), mean maxima temperature (10.86 vs 9.88° C; p = .045), and mean minima temperature (7.45 vs 6.80° C; p = .024). No significant difference was detected in the number of cycles (10.0 vs 7.93; p = .104). No hypotension, hypothermia, or hypoxia was observed, and no subject requested discontinuation due to side effects.ConclusionIn this small study, inhaled epoprostenol induced a statistically significant increase in mean temperature, mean maxima temperature, and mean minima temperature in fingers immersed in a cold-water bath, consistent with an augmented CIVD response. The ability to deliver an inhaled PGI2 analog via nebulizer raises the possibility of early interventions to manage frostbite in austere environments, but further study is needed to draw any conclusions regarding the use of epoprostenol for frostbite care.

IntroductionSubmersion injuries are rare yet life-threatening events. The Trauma Quality Improvement Program (TQIP) registry is the largest national trauma registry in the United States. We describe the epidemiology and outcomes of submersion injuries in the TQIP registry.MethodsWe analyzed data from the TQIP registry for all encounters with a primary or secondary mechanism that included a submersion or drowning description. We used descriptive statistics to portray encounter data including disposition and survival. We used inferential and multivariable logistic regression analyses to identify associations with survivalResultsFrom 2017 to 2023, there were a total of 8,014,737 trauma encounters, of which, 1677 met our inclusion criteria of a primary or secondary mechanism that included a submersion injury. Of the 1150 survivors, 656 (57%) were discharged home without additional services planned. In our multivariable logistic regression, we noted the following associations with survival: age in years (unit odds ratio, 0.98; 95% CI, 0.98-0.99), male sex odds ratio 1.25 (95% CI, 0.89-1.73), prehospital arrest odds ratio 0.15 (95% CI, 0.11-0.21), interfacility transfer odds ratio 0.52 (95% CI, 0.37-0.71), any signs of life on arrival odds ratio 11.33 (95% CI, 5.90-21.75), head/neck injury odds ratio 0.42 (95% CI, 0.31-0.58), thorax injury odds ratio 0.36 (95% CI, 0.24-0.55), abdomen injury odds ratio 0.36 (95% CI, 0.24-0.56), extremities injury odds ratio 2.70 (95% CI, 0.65-11.16), skin injury odds ratio 1.49 (95% CI, 0.69-3.21), any in-hospital arrest odds ratio 0.13 (95% CI, 0.08-0.20), emergency department intubation odds ratio 0.97 (95% CI, 0.65-1.43), and hypothermia <35°C odds ratio = 0.30 (95% CI, 0.21-0.44).ConclusionsSubmersion injuries were rare in the TQIP registry. In the setting of trauma, most survived to hospital discharge, of whom most were discharged home. Prehospital arrest, in-hospital arrest, lack of signs of life on arrival to the emergency department, and serious injuries to all body regions were associated with lower survival to discharge.