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.

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.

The forensic medical investigation of occurrence mechanisms (causes) and color spectrum of cadaveric spots in corpses of persons who were victims of general accidental hypothermia remains a relevant topic, causing many discussions in the scientific literature. Issues concerning the color, localization, degree of pronouncement and timing of cadaveric spots occurrence require careful analysis as they are important both for forensic medical practice and criminalistics and for understanding the processes developing in the human body after death. In the investigation of cadaveric spots resulting from general hypothermia, it should be considered that these spots are formed as a result of blood redistribution in tissues. This phenomenon is related to the fact that when the body temperature is lowered, there is a vasoconstriction, which contributes to the accumulation of blood in certain areas, as well as direct primary cryodestruction of erythrocytes in superficial tissues occurs. As a result of this process, spots, which can vary in color from bright red to purple depending on the degree of tissue hypoxia and conversely tissue oxygen saturation as well as time since death, are formed. According to our own observations and literature analysis, cadaveric spots in death from general hypothermia begin to occur on average 1-2 h after death coming. They become most pronounced after 6-12 h, while their maximum brightness is observed after about 24 h. The localization of cadaveric spots usually depends on the body's position and can vary: spots most commonly emerge on the back, buttocks and posterior surfaces of the extremities when laying down without changing the position. The color spectrum of cadaveric spots can change as well. Initially they may have a bright pink-red shade, which over time changes to darker tones such as purple, violet or even black, depending on the environmental impact and tissue condition. These changes may be caused by both the internal processes and influence of external factors such as ambient temperature. The study of the mechanisms of cadaveric spots formation is important for forensic medical practice, as it allows forensic medical experts to determine more accurately the time and cause of death. Understanding of how general hypothermia affects the process of thanatogenesis can help to establish legally significant facts, for example in cases involving accidents or crimes. Thus, the examination of cadaveric spots in victims of general accidental hypothermia is a complex and multifaceted process that requires careful approach and in-depth analysis. This knowledge not only contributes to a more accurate interpretation of forensic medical data, but also broadens the understanding of the pathophysiological changes that occur during cooling in the human body before death, at the time of death and after death from hypothermia.

The unique climate of plateau regions increases the risk of cold-related conditions, such as hypothermia and frostbite. Therefore, it is essential to study and improve severe-cold protective equipment for use in these environments. This research involved an experiment simulating a plateau at an altitude of 4,500 m, with an ambient temperature of -9℃ and 23℃. Sixteen healthy male participants performed two types of physical activities-weighted hiking and heavy lifting-while thermophysiological and subjective thermal responses were recorded, including local skin temperature and thermal sensation. Statistical analysis revealed that different physical activities and environmental temperatures in plateau environments significantly influence human thermophysiology. During hiking, the back and shoulders exhibited weaker correlations with other body segments, likely due to insulation effects of the carried backpack. During lifting, weak correlations were primarily observed in the upper and lower limbs, which were more actively engaged. Time-series analysis further showed that skin temperatures in the head, chest, shoulders, armpits, forearms, thighs, and feet remained relatively stable, while the back, pelvis, hands, and calves displayed consistent declines, indicating insufficient insulation in these areas. Thermal perception results aligned with objective measurements. Hiking under severe-cold conditions was perceived as more thermally comfortable, whereas lifting induced colder sensations in the extremities and a warmer feeling in the torso. These findings provide an important reference for the targeted design of cold-protective equipment and offer practical insights for improving thermal safet in high-altitude, low-temperature environments.

Lipedema is a chronic, progressive adipose connective tissue disorder characterized by symmetrical, disproportionate fat accumulation, typically affecting the lower extremities and arms, accompanied by pain, swelling, and a sensation of heaviness. This study introduces intermediate Stages 1.5 and 2.5 to the established lipedema classification (Stages 1, 2 and 3), and other affected areas, based on physical examination, a questionnaire, and photographic documentation. Bioelectrical Impedance Spectroscopy (BIS) was employed to quantify total body water (TBW) across stages. A significant and linear increase in BMI was observed from Stage 1 to 3, correlating with increased reported pain and heaviness in the thighs, calves, and upper arms. Systemic symptoms of brain fog, debilitating fatigue, and hypothermia were significantly prevalent. TBW demonstrated a significant, stage-dependent increase in the lower extremities. Adipose tissue accumulation over the knees and feet significantly increased with lipedema stage. In contrast, shin involvement was evident in early stages and remained consistently elevated throughout later stages. Skeletal Muscle Mass (SMM) exhibited a significant increase across lipedema stages, positively correlating with fat mass (FM) in Stage 3. This study elucidates previously underrecognized clinical features and distribution patterns of lipedema, offering a refined staging system to improve understanding of its progression and burden.

To identify independent risk factors for lower extremity deep vein thrombosis (DVT) following robot-assisted radical prostatectomy (RARP), develop a risk prediction model, and propose targeted nursing intervention strategies. A retrospective analysis was conducted on clinical data from 199 RARP patients treated between January 2023 and April 2024. Univariate and multivariate logistic regression analyses were employed to identify risk factors, followed by the development and validation of a predictive model. Non-O blood type (OR = 3.058), elevated preoperative D-dimer levels (OR = 13.729), and intraoperative hypothermia (OR = 3.497) were identified as independent risk factors for DVT. The composite prediction model demonstrated an Area Under the Curve (AUC) of 0.777. Based on these findings, nursing strategies including intraoperative temperature management, early mobilization protocols, and personalized anticoagulation regimens were formulated. Nursing practitioners should prioritize high-risk patients and implement multidimensional interventions to reduce DVT incidence. The generalizability of these findings may be limited by the retrospective single-centre design and relatively small number of DVT events.

Sickle cell disease is the most common serious genetic disease in the world. It is a systemic disease, characterized by vaso-occlusive phenomena, especially in the bone capillary network. Orthopedic complications are thus the most common, with a strong impact on quality of life. In children, these complications mainly comprise bone infarction, epiphyseal aseptic osteonecrosis, and bone and joint infection: acute or chronic osteomyelitis, osteoarthritis and septic arthritis. Aseptic osteonecrosis mainly involves the proximal extremities of the femur and humerus. It may be completely asymptomatic in childhood, but almost systematically deteriorates during the 3rd decade without early management, while in childhood there are opportunities for revascularization and remodeling. Prognosis is more severe in sickle-cell-related than community-based childhood bone and joint infection, as treatment is often delayed by diagnostic difficulties due to the absence of specific clinical and paraclinical signs differentiating it from an acute vaso-occlusive crisis. The most common pathogens are minor Salmonella and Staphylococcus aureus. Due to high rates of iterative surgery and sequelae, systematic radio-clinical monitoring is required. Any surgery in children with sickle-cell disease requires special precautions, based primarily on preventive measures to avoid dehydration, hypoxia, hypothermia, acute anemia and pain that can trigger a life-threatening vaso-occlusive crisis. All orthopedic complications should be managed in a specialized reference center with experienced multidisciplinary medical-surgical teams. LEVEL OF EVIDENCE: : V, expert opinion.