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Nikbakht A, Ahmadikia H. Designing suitable shoes to prevent foot frostbite through optimization of the geometric dimensions of the shoe and sock model. Comput Methods Biomech Biomed Engin 2024; 27:775-784. [PMID: 37154522 DOI: 10.1080/10255842.2023.2202791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
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. HIGHLIGHTSOptimal 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.
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Affiliation(s)
- Ali Nikbakht
- Mechanical Engineering Department, University of Isfahan, Isfahan, Iran
| | - Hossein Ahmadikia
- Mechanical Engineering Department, University of Isfahan, Isfahan, Iran
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Bianca E, Dotti F, Orrico F, Ferri A. Thermoregulation of feet in cold environments: A study on alpinism. Appl Ergon 2024; 116:104205. [PMID: 38091693 DOI: 10.1016/j.apergo.2023.104205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024]
Abstract
Thermal comfort plays a crucial role in the performance and well-being of mountaineers, especially in extreme environments. The aim of this study was to develop a reliable protocol to assess the thermal comfort of mountaineering boots, with a specific focus on temperature variations in different regions of the foot and their correlation with physiological factors. Two different models of mountaineering boots were tested at two different environmental temperature (-15°C and -30°C). The mean skin temperature, measured according to International Standards BS EN ISO 9886:2004, was used as an indicator of overall thermal comfort. Physiological factors such as heart rate (HR), body mass index (BMI) and body surface area (BSA) were also measured to understand their relationship to thermoregulation. Kruskal-Wallis and Pearson's ProductMoment correlation tests were performed to investigate whether there was a statistically significant relationship. The results showed significant differences in foot temperature among the Testers, indicating variations in the perception of thermal comfort. The correlation analysis showed a strong positive relationship between mean skin temperature and HR, highlighting the influence of physiological factors on thermal comfort. In addition, the analysis showed that the dorsum and hallux areas had the largest temperature variations, suggesting the occurrence of vasoconstriction and potential discomfort. This study represents a preliminary approach to establishing a reliable protocol for assessing the thermal performance of cold protective footwear.
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Affiliation(s)
- Eleonora Bianca
- Department of Applied Science and Technology, Polytechnic of Turin, Turin, 10129, Italy.
| | - Francesca Dotti
- Department of Applied Science and Technology, Polytechnic of Turin, Turin, 10129, Italy.
| | | | - Ada Ferri
- Department of Applied Science and Technology, Polytechnic of Turin, Turin, 10129, Italy.
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Ma X, Pouoh JT, Hogue BT, Bougie E. Frostbite in the Pediatric Population: A Comprehensive Review and a Prospective Canadian Survey. Pediatr Emerg Care 2024:00006565-990000000-00372. [PMID: 38206303 DOI: 10.1097/pec.0000000000003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Frostbite in the pediatric population, where skeletal maturity has not been achieved, can have important repercussions on subsequent growth. Yet, the optimal management of frostbite injuries in children remains vague. This review aims to summarize the current evidence for frostbite management in children and understand Canadian practice trends on this topic. METHODS A review using Medline, Scopus, Web of Science, and gray literature was performed to identify relevant literature on the clinical manifestations, diagnostic methods, and treatment options in pediatric frostbite. An online survey was sent to plastic surgeons through the Canadian Society of Plastic Surgeons (CSPS) mailing list to further identify national practices and trends for pediatric frostbite management. RESULTS A total of 109 articles were reviewed. No article provided a specific algorithm for pediatric frostbite, with existing recommendations suggesting the use of adult guidelines for treating children. Our survey yielded 9 responses and highlighted the rarity of pediatric frostbite cases, with no responder treating more than 10 cases per year. Most (55.6%) do not use a pediatric-specific treatment algorithm, whereas 30% apply adult guidelines. A conservative approach focusing on rewarming (55.6%), limb elevation (50%), and tetanus status verification (66.7%) was predominant. Imaging and surgical interventions seem to be reserved for severe cases. CONCLUSIONS The current literature for pediatric frostbite management lacks specificity. Canadian practices vary, with a trend toward a conservative approach. The limited evidence and rarity of experience highlight the need for further research, ideally in a collaborative multicentric manner, to create a consensus for pediatric frostbite care.
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Affiliation(s)
- Xiya Ma
- From the Division of Plastic Surgery, Université de Montréal, Montreal, Quebec, Canada
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Poole A, Ahmed Y, Davidson M. The Occasional frostbite. Can J Rural Med 2024; 29:30-36. [PMID: 38358103 DOI: 10.4103/cjrm.cjrm_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/11/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Alexander Poole
- Whitehorse General Hospital, Yukon Hospital Corporation, Whitehorse, Yukon, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yousuf Ahmed
- Department of Emergency Medicine, Dalhousie University, Saint John, Canada
- Department of Family Medicine, Dalhousie University, Saint John, Canada
| | - Malcolm Davidson
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise. Eur J Appl Physiol 2024; 124:1-145. [PMID: 37796292 DOI: 10.1007/s00421-023-05276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 10/06/2023]
Abstract
In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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Steinberg T, Kristoffersen A, Bjerkan G, Norheim AJ. Freezing cold injuries among soldiers in the Norwegian Armed Forces - A cross sectional study. Int J Circumpolar Health 2023; 82:2227344. [PMID: 37389983 DOI: 10.1080/22423982.2023.2227344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
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.
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Affiliation(s)
- Tuva Steinberg
- Norwegian Armed Forces - Joint Medical Services (NAF-JMS), Sessvollmoen, Norway
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Agnete Kristoffersen
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Geir Bjerkan
- Norwegian Armed Forces - Joint Medical Services (NAF-JMS), Sessvollmoen, Norway
| | - Arne Johan Norheim
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
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Kriemler S, Mateikaitė-Pipirienė K, Rosier A, Keyes LE, Paal P, Andjelkovic M, Beidleman BA, Derstine M, Pichler Hefti J, Hillebrandt D, Horakova L, Jean D. Frostbite and Mortality in Mountaineering Women: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2023; 24:247-258. [PMID: 37824760 DOI: 10.1089/ham.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
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.
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Affiliation(s)
- Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kastė Mateikaitė-Pipirienė
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pharmacy, Singidunum University, Belgrade, Serbia
| | - Beth A Beidleman
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, Devon, United Kingdom
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anesthesiology, Perioperative and Intensive Care, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Pediatrics, Infectious Diseases, and Altitude Medicine, Grenoble, France
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Nikbakht A, Ahmadikia H. Optimum design of the geometry of boots and socks with the aim of minimum weight and preventing frostbite. Proc Inst Mech Eng H 2023; 237:1366-1376. [PMID: 37982189 DOI: 10.1177/09544119231208552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
In order to design shoes suitable for cold environments, knowledge of the thermal conditions inside the shoes and the variables affecting those conditions is necessary. A two-dimensional model of a boot and sock was developed to investigate the effect of the materials and dimensions of various parts of shoes and to design geometry for them to prevent foot frostbite. The optimization algorithm was used to optimize the dimensions of the boots to maximize the minimum foot temperature with the lowest boot weight. Two types of shoe soles and two kinds of shoe uppers were used to design suitable shoes. The results show the following: (1) In the design boots, the thermal insulation of the toe area plays an essential role in preventing frostbite. Two variables of the thickness of the toe cap and the length of the shoe sole had the greatest impact on the design of shoes with the least weight and the most protection against frostbite. So that to increase minimum foot temperature from 7°C to 15°C, 16°C, or 17°C, only the amounts of these variables should increase. (2) In designing the suitable boot, choosing the proper shoe sole had a significant effect on increasing the thermal insulation in the shoe and reducing its weight. So, for the boot with a minimum foot temperature of 20°C, by changing the shoe sole from EVA08 to EVA12, the weight is reduced by 42%. (3) To maximize the minimum foot temperature, it is necessary to use thick socks.
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Affiliation(s)
- Ali Nikbakht
- Department of Mechanical Engineering, University of Isfahan, Isfahan, Iran
| | - Hossein Ahmadikia
- Department of Mechanical Engineering, University of Isfahan, Isfahan, Iran
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Sidhar K, Elliott K, Ibrahem M. Heat, Cold, and Environmental Emergencies in Athletes. Clin Sports Med 2023; 42:441-461. [PMID: 37208058 DOI: 10.1016/j.csm.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
With the increase in outdoor events, there is an inevitable rise in climate-related environmental emergencies. Heat exposure can place athletes at risk for life-threatening heatstroke which requires emergent diagnosis and rapid in-field management. Cold exposure can lead to hypothermia, frostbite, and other nonfreezing injuries that require prompt evaluation and management to minimize morbidity and mortality. Altitude exposure can lead to acute mountain sickness or other serious neurologic or pulmonary emergencies. Finally, harsh climate exposure can be life-threatening and require appropriate prevention and event planning.
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Affiliation(s)
- Kartik Sidhar
- Department of Family Medicine, University of Michigan Medical School, 300 North Ingalls Street, NI4C06, Ann Arbor, MI 48109-5435, USA.
| | - Katlyn Elliott
- University of Pittsburgh Medical Center, McKeesport Family Medicine Residency, 2347 5th Avenue, McKeesport, PA 15132, USA
| | - Michael Ibrahem
- University of Pittsburgh Medical Center, Shadyside Family Medicine Residency, 5215 Center Avenue, Pittsburgh, PA 15232, USA
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Sun J, Fu L, Zhang W, Li D, Zhang M, Xu Z, Bai H, Ding P. Convolutional neural network models for automatic diagnosis and graduation in skin frostbite. Int Wound J 2023; 20:910-916. [PMID: 36054618 PMCID: PMC10031220 DOI: 10.1111/iwj.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022] Open
Abstract
The study aimed to develop and validate a convolutional neural network (CNN)-based deep learning method for automatic diagnosis and graduation of skin frostbite. A dataset of 71 annotated images was used for the training, the validation, and the testing based on ResNet-50 model. The performances were evaluated with the test set. The diagnosis and graduation performance of our approach was compared with two residents from burns department. The approach correctly identified all the frostbite of IV (18/18, 100%), but with respectively 1 mistake in the diagnosis of degree I (29/30, 96.67%), II (28/29, 96.55%) and III (37/38, 97.37%). The accuracy of the approach on the whole test set was 97.39% (112/115). The accuracy of the two residents were respectively 77.39% and 73.04%. Weighted Kappa of 0.583 indicates good reliability between the two residents (P = .445). Kendall's coefficient of concordance is 0.326 (P = .548), indicating differences in accuracy between the approach and the two residents. Our approach based on CNNs demonstrated an encouraging performance for the automatic diagnosis and graduation of skin frostbite, with higher accuracy and efficiency.
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Affiliation(s)
- Jiachen Sun
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Lin Fu
- Plastic Surgery Hospital of Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijingChina
| | - Wen Zhang
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Dongjie Li
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Ming Zhang
- Department of Burns and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Zineng Xu
- R&D DepartmentDeepcare Inc.BeijingChina
| | | | - Peng Ding
- R&D DepartmentDeepcare Inc.BeijingChina
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Chen F, Fu M, Li Y, Shen S, Yang J, Weng W. A numerical tool for assessing human thermal safety and thermal comfort in cold-weather activities. Int J Biometeorol 2023; 67:377-388. [PMID: 36515728 DOI: 10.1007/s00484-022-02416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
This paper describes a newly developed software tool to evaluate human thermal safety and thermal comfort in cold-weather activities aimed at guiding users to arrange activity plans and select appropriate clothing ensembles. The software inputs include conditions of activity, environment, human body, and clothing ensemble. It outputs physiological temperatures, cold injury risks, thermal sensations, and thermal comforts in intuitive ways like cloud maps and curves. The software tool is characterized by (1) integration of a thermoregulatory model that predicts human thermophysiological responses under exercise conditions in cold environments, (2) the functions of clothing ensemble database and individual parameter database, (3) the human centric outputs that directly reflect human physiological and mental status, and (4) the user-friendly operation interface and output interface, as well as a wide applicability. The software is validated with human test studies covering ambient temperatures from - 30.6 to 5 °C, clothing ensembles from 1.34 to 3.20 clo, and activity intensities from 2 to 9 Mets. The average prediction RMSEs of core temperature, mean skin temperature, thermal sensation, and thermal comfort are 0.16 °C, 0.45 °C, 0.58, and 1.41, respectively. The software is an advanced expansion to current standards and guidance of cold exposure assessment and a meaningful tool for the fields of occupational health care, cold protection, and environmental ergonomics.
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Affiliation(s)
- Feiyu Chen
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
| | - Ming Fu
- Hefei Institute for Public Safety Research, Tsinghua University, Hefei, 230601, Anhui Province, China.
- Anhui Province Key Laboratory of Human Safety, Hefei, 230601, Anhui Province, China.
| | - Yayun Li
- Hefei Institute for Public Safety Research, Tsinghua University, Hefei, 230601, Anhui Province, China
- Anhui Province Key Laboratory of Human Safety, Hefei, 230601, Anhui Province, China
| | - Shifei Shen
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, China.
| | - Jie Yang
- College of Safety Science and Engineering, Xi'an University of Science and Technology, Xi'an, 710054, China
| | - Wenguo Weng
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
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Chen F, Fu M, Li Y, Shen S, Guo X. Modelling and experimental study of thermo-physiological responses of human exercising in cold environments. J Therm Biol 2022. [DOI: 10.1016/j.jtherbio.2022.103316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/18/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
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Schimelpfenig SS, Jacobsen B. Pediatric Environmental Cold Injuries. Pediatr Rev 2022; 43:449-457. [PMID: 35909140 DOI: 10.1542/pir2020005179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cold weather injuries are relevant concerns for children during winter sports and outdoor activities. To mitigate the risk of cold injury in this high-risk population, providers can educate parents on proper outdoor attire as well as the added risks of wind and water exposure. There are 2 types of environmental cold injuries: freezing injuries and nonfreezing injuries. Frostbite is a freezing injury from direct contact with cold air or surfaces. The extent of injury depends on the depth to which the freezing extends. Treatment involves rewarming the frozen tissue with warm water baths and considering analgesia. Hypothermia is a nonfreezing cold injury, and it can occur even when ambient temperatures are above freezing. When there is a decrease in the body's core temperature, hypothermia progresses from mild to severe symptoms. Treatment of hypothermia is threefold but is also dependent on the core body temperature, as colder core temperatures will require more aggressive warming techniques. Hypothermia treatment involves passive protection from further heat loss (ie, removing wet clothing), which helps the body to warm itself. Treatment also involves active external rewarming wherein a heat source, such as a heated blanket, is used to increase body temperature. Active internal rewarming is the delivery of heat inside the patient's body, such as warmed intravenous fluids.
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Affiliation(s)
- Samuel S Schimelpfenig
- Avera Health, Sioux Falls, SD.,University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Britt Jacobsen
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD
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Crooks S, Shaw BH, Andruchow JE, Lee CH, Walker I. Effectiveness of intravenous prostaglandin to reduce digital amputations from frostbite: an observational study. CAN J EMERG MED 2022; 24:622-629. [DOI: 10.1007/s43678-022-00342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/07/2022] [Indexed: 11/02/2022]
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Guseynov NA, Ivashkevich SG, Boyko EM. Physiological features of cells and microvasculature under the local hypothermia influence. Vestn Ross univ družby nar , Ser Med 2022. [DOI: 10.22363/2313-0245-2022-26-1-34-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hypothermia or cold therapy is the local or systemic application of cold for therapeutic purposes. Local application of cold is used to control inflammation: pain and swelling, hematoma and trismus reduction. Despite the frequent use of cooling in prosthodontic rehabilitation and in physical therapy, as evidenced by many reports in the literature, there is scientific documentation that suggests disadvantages of using this treatment in maxillofacial surgery and oral surgery. Also the clinical studies that have been carried out in maxillofacial surgery and oral surgery have been conducted in an empirical manner, which casts doubt on the results. In view of this, it is relevant to study the mechanisms of microcirculatory preconditioning and hypothermia. This physiological process is so interesting for the development of medical devices of controlled hardware hypothermia to prevent inflammatory symptoms at the stage of rehabilitation by targeting the vascular and cellular component of the inflammatory process in different areas of the human body. To date, the use of local hardware controlled hypothermia in various pathological conditions in humans is a topical trend in medicine. Microcirculatory bloodstream is directly related to temperature factors. Although there are concepts of vascular spasm or dilatation in the microcirculatory bloodstream during systemic hypothermia, there are no reliable data on the cellular and vascular reactions during local hypothermia. In this paper, a search for fundamental and current scientific work on the topic of cellular and vascular changes under the influence of hypothermia was conducted. The search for data revealed that the mechanisms of intracellular hypothermia are of particular interest for the development of therapeutic treatments after surgical interventions in areas with extensive blood supply. With this in mind, it is relevant to investigate several areas: the role of endothelium, glycocalyx and blood cells in microcirculatory-mediated preconditioning and intracellular hypothermia, and in the molecular mechanism that regulates these processes, whether they occur in the same way in all tissues.
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Guseynov NA, Ivashkevich SG, Boyko EM. Physiological features of cells and microvasculature under the local hypothermia influence. Vestn Ross univ družby nar , Ser Med 2022. [DOI: 10.22363/2313-0245-2022-26-1-33-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hypothermia or cold therapy is the local or systemic application of cold for therapeutic purposes. Local application of cold is used to control inflammation: pain and swelling, hematoma and trismus reduction. Despite the frequent use of cooling in prosthodontic rehabilitation and in physical therapy, as evidenced by many reports in the literature, there is scientific documentation that suggests disadvantages of using this treatment in maxillofacial surgery and oral surgery. Also the clinical studies that have been carried out in maxillofacial surgery and oral surgery have been conducted in an empirical manner, which casts doubt on the results. In view of this, it is relevant to study the mechanisms of microcirculatory preconditioning and hypothermia. This physiological process is so interesting for the development of medical devices of controlled hardware hypothermia to prevent inflammatory symptoms at the stage of rehabilitation by targeting the vascular and cellular component of the inflammatory process in different areas of the human body. To date, the use of local hardware controlled hypothermia in various pathological conditions in humans is a topical trend in medicine. Microcirculatory bloodstream is directly related to temperature factors. Although there are concepts of vascular spasm or dilatation in the microcirculatory bloodstream during systemic hypothermia, there are no reliable data on the cellular and vascular reactions during local hypothermia. In this paper, a search for fundamental and current scientific work on the topic of cellular and vascular changes under the influence of hypothermia was conducted. The search for data revealed that the mechanisms of intracellular hypothermia are of particular interest for the development of therapeutic treatments after surgical interventions in areas with extensive blood supply. With this in mind, it is relevant to investigate several areas: the role of endothelium, glycocalyx and blood cells in microcirculatory-mediated preconditioning and intracellular hypothermia, and in the molecular mechanism that regulates these processes, whether they occur in the same way in all tissues.
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Castellani JW, Eglin CM, Ikäheimo TM, Montgomery H, Paal P, Tipton MJ. ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise. Curr Sports Med Rep 2021; 20:594-607. [PMID: 34752434 DOI: 10.1249/jsr.0000000000000907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT Cold injury can result from exercising at low temperatures and can impair exercise performance or cause lifelong debility or death. This consensus statement provides up-to-date information on the pathogenesis, nature, impacts, prevention, and treatment of the most common cold injuries.
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Affiliation(s)
- John W Castellani
- United States Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, MA
| | - Clare M Eglin
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
| | | | - Hugh Montgomery
- University College London, Centre for Human Health and Performance, London, United Kingdom
| | - Peter Paal
- Hospitallers Brothers Hospital, Anaesthesiology and Intensive Care Medicine, Salzburg, Austria
| | - Michael J Tipton
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
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Regli IB, Strapazzon G, Falla M, Oberhammer R, Brugger H. Long-Term Sequelae of Frostbite-A Scoping Review. Int J Environ Res Public Health 2021; 18:ijerph18189655. [PMID: 34574580 PMCID: PMC8465633 DOI: 10.3390/ijerph18189655] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
Frostbite is tissue damage caused by freezing temperatures and constitutes an important cause of morbidity in cold climate zones and high altitude. The direct effects of sub-zero temperatures lead to tissue freezing, electrolyte shifts and pH alterations, microvascular damage, and eventually to cell death. Upon rewarming, inflammatory reperfusion injury and thrombosis may lead to further tissue damage. Several studies and various case reports show that many patients suffer from long-term sequelae such as vasomotor disturbances (associated with susceptibility to refreezing), and neuropathic and nociceptive pain, as well as damage to skeletal structures. There are still many uncertainties regarding the pathophysiology of these sequelae. It has been shown that the transient receptor potential channel (TRP) family plays a role in cold allodynia. Botulinum Toxin type A (BTX-A) injections have been reported to be beneficial in vasomotor and neuropathic disturbances secondary to frostbite. Epidural sympathetic block has been used for short-term treatment of frostbite induced chronic pain. Furthermore, amitriptyline, gabapentinoids, and duloxetine may have some benefits. Frostbite arthritis clinically resembles regular osteoarthritis. In children there is a risk of epiphyseal cartilage damage leading to bone deformities. Despite some promising therapeutic concepts, the scarcity of data on frostbite long-term sequelae in the literature indicates the need of more in-depth studies of this pathology in all its aspects.
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Affiliation(s)
- Ivo B. Regli
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy; (G.S.); (M.F.); (H.B.)
- Department of Anaesthesia and Intensive Care, “F. Tappeiner” Hospital, 39012 Merano, Italy
- Correspondence: ; Tel.: +39-0471-055-863
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy; (G.S.); (M.F.); (H.B.)
- Department of Anaesthesia and Intensive Care, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy; (G.S.); (M.F.); (H.B.)
- Center for Mind/Brain Sciences, University of Trento, 38123 Rovereto, Italy
| | - Rosmarie Oberhammer
- Department of Anaesthesia and Intensive Care, Hospital of Brunico, 39031 Brunico, Italy;
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy; (G.S.); (M.F.); (H.B.)
- Department of Anaesthesia and Intensive Care, Medical University Innsbruck, 6020 Innsbruck, Austria
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Abstract
Cold injury refers to local or systemic injury caused by a rapid, massive loss of body heat in a cold environment. The incidence of cold injury is high. However, the current situation regarding the diagnosis and treatment of cold injury in our country is not ideal. To standardize and improve the level of clinical diagnosis and treatment of cold injury in China, it is necessary to make a consensus that is practical and adapted to the conditions in China. We used the latest population-level epidemiological and clinical research data, combined with relevant literature from China and foreign countries. The consensus was developed by a joint committee of multidisciplinary experts. This expert consensus addresses the epidemiology, diagnosis, on-site emergency procedures, in-hospital treatment, and prevention of cold injury.
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Affiliation(s)
- Hong-Xu Jin
- Emergency Medicine Department, General Hospital of the Northern Theater Command, Shenyang, 110016, China
| | - Yue Teng
- Emergency Medicine Department, General Hospital of the Northern Theater Command, Shenyang, 110016, China
| | - Jing Dai
- Emergency Medicine Department, General Hospital of the Northern Theater Command, Shenyang, 110016, China
| | - Xiao-Dong Zhao
- Department of Emergency Medicine, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
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Pawar A, Ranjan P, Naik A, Bhardwaj S, Sharma P. Cold injuries in the glacial regions of India. J Mar Med Soc 2021. [DOI: 10.4103/jmms.jmms_51_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hassan W, Buabeid MA, Kalsoom U, Bakht S, Akhtar I, Iqbal F, Arafa EA. Cuscuta reflexa Roxb. Expedites the Healing Process in Contact Frostbite. Biomed Res Int 2020; 2020:4327651. [PMID: 33083466 DOI: 10.1155/2020/4327651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/19/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Frostbite is caused due to extreme vulnerability to cold, resulting in damage of deeper and superficial tissues alike. In this study, we report the anti-inflammatory and wound-healing properties of aqueous methanolic extract of Cuscuta reflexa (Cs.Cr) against contact frostbite. Thirty rats were divided into five groups including three treatment groups with increasing doses of Cs.Cr, a standard drug group receiving acetylsalicylic acid (ASA), and a metal bar-induced frostbite group. Frostbite injury was induced by a 3 × 3.5 cm metal bar frozen up to -79°C on shaved skin for continuous 3 minutes. Wounded area percentages were recorded to measure the healing rate in response to Cs.Cr administration. Haematological parameters and malondialdehyde content were also noted. On treatment with Cs.Cr, the healing rate is drastically increased and lipid peroxidation product malondialdehyde was decreased in a dose-dependent manner. Results were compared with frostbite and ASA (standard drug group). These results indicate that Cs.Cr possesses excellent wound-healing properties against frostbite injury and can prove to be a prospective compound in such conditions.
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Alwaleed A, Jamal A. Self-inflicted finger cold injury leading to amputation: Report of a case. Clin Pract 2020; 10:1217. [PMID: 32952983 PMCID: PMC7482180 DOI: 10.4081/cp.2020.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
A cold injury can result in devastating outcomes, leading to significant morbidity and loss of distal extremities. Amputations are common after severe frostbite injuries with delayed presentation, often mediated by post-injury arterial thrombosis. Ischemic injuries are managed according to the ischemia time. The most controversial aspect of treating a salvage injury is the time of surgical intervention, which used to be based on the previous management dogma freeze in January, amputate in July. Recently, the paradigm has shifted to early surgical management if the level of viability of the deep structure can be ascertained using 99mTc pertechnetate scintigraphy (99mTc bone scans). We present a case of a finger amputation resulting from a cold injury secondary to a crush injury.
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Affiliation(s)
- Alammar Alwaleed
- Department of Plastic Surgery Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Almadani Jamal
- Department of Plastic Surgery Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Shah FY, Hassan I, Zeerak S, Bashir S, Jabeen Y, Parveen S, Mubashir S, Sultan J, Jeelani S. Prevalence of Cold Dermatoses in Kashmir Valley: A Cross-Sectional Study from North India. Indian Dermatol Online J 2020; 11:731-737. [PMID: 33235838 PMCID: PMC7678543 DOI: 10.4103/idoj.idoj_543_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Often quoted as "heaven on earth," Kashmir forms one of the two divisions of the Union territory of Jammu and Kashmir. A high-altitude region with abundant precipitation and snowfall, the people of Kashmir experience peculiar dermatoses not commonly seen in the majorly tropical subcontinent of India. In this study, we focussed on cold dermatoses as a comprehensive cluster and attempted to study them as a group. AIMS To determine the prevalence of cold dermatoses in Kashmir valley and study their epidemiological characteristics. METHODS This observational, cross-sectional community-based study was conducted on native Kashmiri population in three districts of the valley, exclusively during the winter season of the year 2016-17 and 2017-18. The data were tabulated and analyzed with Chi-square test for discrete variables and t-test for continuous variables, using OpenEpi. A P value of less than 0.05 was taken as significant. RESULTS The study included a total of 1200 cases with 602 males and 598 females. Perniosis was most commonly encountered dermatoses in our study with a prevalence of 12.2%. Frostbite had a prevalence of 0.83%. Raynaud's phenomenon and asteatotic eczema were seen in 1.5% and 1.67% of the population, respectively. Cold panniculitis, cold urticaria, and livedo reticularis were each seen in 0.08% of the population. CONCLUSIONS Cold dermatoses form an important source of morbidity among the native population of Kashmir. These can be easily prevented by ensuring adequate protection against cold. Creating awareness regarding these disorders and probable association with connective tissue disorders is also imperative.
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Affiliation(s)
- Faizan Y. Shah
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Iffat Hassan
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Sumaya Zeerak
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shahnawaz Bashir
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Yasmeen Jabeen
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shagufta Parveen
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Syed Mubashir
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Javeed Sultan
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shazia Jeelani
- Department of Dermatology, STDs and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India
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Mugele H, Oliver SJ, Gagnon D, Lawley JS. Integrative crosstalk between hypoxia and the cold: Old data and new opportunities. Exp Physiol 2020; 106:350-358. [DOI: 10.1113/ep088512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Hendrik Mugele
- Department of Sport Science University of Innsbruck Innsbruck Austria
| | - Samuel J. Oliver
- Extremes Research Group School of Sport, Health and Exercise Sciences Bangor University Wales UK
| | - Daniel Gagnon
- Cardiovascular Prevention and Rehabilitation Centre Montreal Heart Institute Montréal Quebec Canada
- Department of Pharmacology and Physiology Faculty of Medicine Université de Montréal Montréal Quebec Canada
| | - Justin S. Lawley
- Department of Sport Science University of Innsbruck Innsbruck Austria
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Schellenberg M, Cheng V, Inaba K, Foran C, Warriner Z, Trust MD, Clark D, Demetriades D. Frostbite injuries: independent predictors of outcomes. Turk J Surg 2020; 36:218-223. [PMID: 33015567 DOI: 10.5578/turkjsurg.4632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
Objectives Frostbite injuries are important causes of morbidity and mortality after trauma. Epidemiology, injury patterns, and outcomes after frostbite among patients presenting to trauma centers are incompletely defined. The purpose of this study was to delineate patient demographics, clinical characteristics, and independent predictors of outcomes after frostbite. Material and Methods Patients with frostbite injury were identified from the National Trauma Data Bank (NTDB) (2007-2014). Demographics, clinical/injury data, and outcomes were collected. Patients were dichotomized into study groups based on intensive care unit (ICU) admission. Univariate analysis was performed with the Mann-Whitney U, Fisher's exact, or Chi-Square test as appropriate. Multivariate analysis using logistic regression determined independent predictors of outcomes. Results Over the study period, 241 patients were identified. Median body temperature on admission was 36.3⁰C (IQR 33.4-36.7). Mortality was 3% (n= 7). ICU admission was required in 101 (42%) patients and 48 (20%) underwent surgical intervention. On multivariate analyses, mortality was predicted by lower admission GCS (p= 0.027) and amputation by higher HR (p= 0.013). Need for ICU admission was predicted by older age (p= 0.010), male gender (p= 0.040), higher HR (p= 0.031) and ISS (p <0.001), and lower GCS (p= 0.001). Prolonged hospital LOS was predicted by higher heart rate (p <0.001) and ISS (p <0.001). Conclusion Frostbite injuries are uncommon but can necessitate surgical intervention and cause mortality. Lower GCS and higher heart rate, but not body temperature, portend poor outcomes. These findings can be used to triage patients appropriately upon admission and to better inform prognosis after frostbite injuries.
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Affiliation(s)
- Morgan Schellenberg
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
| | - Vincent Cheng
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
| | - Kenji Inaba
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
| | - Christopher Foran
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
| | - Zachary Warriner
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
| | - Marc D Trust
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
| | - Damon Clark
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
| | - Demetrios Demetriades
- Department of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, United States of America
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Abstract
Introduction High altitude mountaineering is characterized by high energetic requirements due to the environment in which the activity is developed: negative energy balance, extreme cold, high altitude and the assumption of potential risks can be found during the practice of this sport. High altitude mountaineering, as a result of the previous factors, induces changes in body composition which have never been studied previously in a systematic review. A search within four different databases (PubMed, SportDiscus, Scopus and Medline) was performed using the thesaurus terms "Mountaineering" and "Body composition". A second search was performed using the following terms "Altitude" and "Body composition". The selection criteria included studies with healthy adults which evaluated the effects of at least 14 days of uninterrupted stays at altitudes above 4,000 m. The studies included in the review assessed body composition through different methods such as anthropometry, bioimpedance, dual energy x-ray absorptiometry, hydrostatic weighing and air displacement plethysmography. The search was performed up to and including December 1st 2018. Eleven observational studies met the inclusion criteria. All studies reported weight loss, of which five reported significant reductions in lean mass and six reported reductions in fat mass. Also, three studies reported reductions in both fat mass and lean mass. Current evidence is limited to observational studies with important confounding factors affecting the final conclusions. Longitudinal studies with a better methodological design and control groups are needed in order to verify these results.
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Jørum E, Opstad PK. A 4-year follow-up of non-freezing cold injury with cold allodynia and neuropathy in 26 naval soldiers. Scand J Pain 2020; 19:441-451. [PMID: 30939119 DOI: 10.1515/sjpain-2019-0035] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Non-freezing cold injuries (NFCI), which typically may occur in military personnel, may result from exposure to cold, at temperatures around 0 °C or above, and worsened by wind and moisture. The injury is due to cooling but not freezing of tissue like in frostbite. NFCI may result in in chronic neuropathy and cold hypersensitivity. A recent retrospective study of small-and large fibres has suggested that NFCI results in neuropathic pain due to a sensory neuropathy and question a longitudinal study to verify a possible observation of improvement of NFCI over time. The present study is a 4-year follow-up investigation of large - and small-fibre function in 26 naval cadets and officers who were exposed to cold injury during the same military expedition. Methods The 26 soldiers were investigated clinically (with investigation of motor function, reflexes, sensibility), with nerve conduction studies (NCS) of major nerves in upper- and lower extremity, small fibre testing (QST, measurement of thermal thresholds), measurements of subcutaneous fat tissue and maximal O2 uptake. Investigations found place 2 months following the actual military expedition, with follow-up investigations of affected soldiers at 6-12 months and up to 3-4 years. In order to elucidate possible mechanisms (disinhibition of cold pain by myelinated nerve fibres) of cold allodynia, cold pain thresholds were measured following an ischemic block of conduction of large and small myelinated nerve fibres. Results Of 26 soldiers, 19 complained of numbness in feet and a large majority of 16 of cold hypersensitivity 2 months following injury. There were significant alterations of both large- and small-fibre function, indicating a general large- and small-fibre neuropathy. The most prominent finding was a pronounced cold allodynia, inversely correlated with the amount of subcutaneous fat. During the first year, results of NCS and thermal testing gradually normalized in most. Seven soldiers developed chronic symptoms in the form of cold hypersensitivity and with findings of cold allodynia, which was not further enhanced, but abolished following block of conduction of myelinated nerve fibres. Seven soldiers were free of symptoms from that start of the investigation, probably because they had been more eager to keep their legs moving during the exposure to cold. Conclusions Of a total of 26 soldiers, only seven developed chronic symptoms of cold hypersensitivity, corresponding to the finding of cold allodynia by thermal testing. The cold allodynia may not be explained by disinhibition of cold pain by myelinated fibres as in healthy subjects. A large majority recovered from an initial large-and small fibre neuropathy, demonstrating that recovery from NFCI may occur. Implications Although large-and small fibre neuropathy may be restored following cold injury, there is a risk of a permanent and disabling cold hypersensitivity, corresponding to the findings of cold allodynia. It is of uttermost importance to secure military personnel from the risk of cold injuries. It seems important to avoid immobilisation of extremities during exposure to cold.
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Affiliation(s)
- Ellen Jørum
- Section of Clinical Neurophysiology, The Department of Neurology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Oslo University Hospital - Rikshospitalet and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Vishnuprasad R, Agrawal V, Prakash MS, Chatterjee P, Choudhury A, Lal A, Kotwal A. Epidemiology and treatment outcome of frostbite at high altitudes in North India – A cross-sectional study. J Mar Med Soc 2020. [DOI: 10.4103/jmms.jmms_60_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Norrbrand L, Kölegård R, Keramidas ME, Mekjavic IB, Eiken O. Finger- and toe-temperature responses to local cooling and rewarming have limited predictive value identifying susceptibility to local cold injury-a cohort study in military cadets. Appl Ergon 2020; 82:102964. [PMID: 31604187 DOI: 10.1016/j.apergo.2019.102964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 06/10/2023]
Abstract
The purpose was to evaluate whether a cold-water immersion test could be used to identify individuals susceptible to local cold injuries (LCI). Sixty-five healthy non-injured (N-I) subjects, and fifteen subjects, who were tested either prior to or after a LCI, sequentially immersed one hand and one foot, in 8 °C water for 30 min (CWI phase); this was followed by 15 min of spontaneous rewarming (RW phase). The LCI group showed a lower toe temperature during the CWI phase, and a lower maximum RW temperature of the fingers than the N-I group. However, digit temperatures during the CWI and RW phases exhibited low predictive values for LCI, e.g. results implied that to identify 80% of the LCI subjects, 34-78% of the N-I subjects would also be excluded. Thus, the results suggest that, in practice, hand or foot cold-water immersion tests cannot be used to identify individuals at high risk of LCI.
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Affiliation(s)
- Lena Norrbrand
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Berzelius väg 13, SE-171 65, Solna, Sweden.
| | - Roger Kölegård
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Berzelius väg 13, SE-171 65, Solna, Sweden
| | - Michail E Keramidas
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Berzelius väg 13, SE-171 65, Solna, Sweden
| | - Igor B Mekjavic
- Department of Automation, Robotics and Biocybernetics, Jozef Stefan Institute, Jamova 39, SI-1000, Ljubljana, Slovenia; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
| | - Ola Eiken
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Berzelius väg 13, SE-171 65, Solna, Sweden
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VanBaak KD, Nally LM, Finigan RT, Jurkiewicz CL, Burnier AM, Conrad BP, Khodaee M, Lipman GS. Wilderness Medical Society Clinical Practice Guidelines for Diabetes Management. Wilderness Environ Med 2019; 30:S121-S140. [PMID: 31753543 DOI: 10.1016/j.wem.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
The Wilderness Medical Society convened an expert panel in 2018 to develop a set of evidence-based guidelines for the treatment of type 1 and 2 diabetes, as well as the recognition, prevention, and treatment of complications of diabetes in wilderness athletes. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures, as well as best practice recommendations for both routine and urgent therapeutic management of diabetes and glycemic complications. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each recommendation.
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Affiliation(s)
- Karin D VanBaak
- Department of Family Medicine and Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO.
| | - Laura M Nally
- Department of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT
| | | | - Carrie L Jurkiewicz
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Barry P Conrad
- Division of Endocrinology, Stanford Children's Hospital, Stanford, CA
| | - Morteza Khodaee
- Department of Family Medicine and Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
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Keramidas ME, Kölegård R, Mekjavic IB, Eiken O. Interactions of mild hypothermia and hypoxia on finger vasoreactivity to local cold stress. Am J Physiol Regul Integr Comp Physiol 2019; 317:R418-R431. [PMID: 31241983 DOI: 10.1152/ajpregu.00103.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We examined the interactive effects of mild hypothermia and hypoxia on finger vasoreactivity to local cold stress. Eight male lowlanders performed, in a counterbalanced order, a normoxic and a hypoxic (partial pressure of oxygen: ~12 kPa) hand cold provocation (consisting of a 30-min immersion in 8°C water), while immersed to the chest either in 21°C [cold trials; 0.5°C fall in rectal temperature (Trec) from individual preimmersion values], or in 35.5°C water, or while exposed to 27°C air. The duration of the trials was kept constant in each breathing condition. Physiological (Trec, skin temperature, cutaneous vascular conductance, oxygen uptake) and perceptual (thermal sensation and comfort, local pain, affective valence) reactions were monitored continually. Hypoxia accelerated the drop in Trec by ~14 min (P = 0.06, d = 0.67). In the air-exposure trials, hypoxia did not alter finger perfusion during the local cooling, whereas it impaired the finger rewarming response following the cooling (P < 0.01). During the 35.5°C immersion, the finger vasomotor tone was enhanced, especially in hypoxia (P = 0.01). Mild hypothermia aggravated finger vasoconstriction instigated by local cooling (P < 0.01), but the response did not differ between the two breathing conditions (P > 0.05). Hypoxia tended to attenuate the sensation of coldness (P = 0.10, r = 0.40) and thermal discomfort (P = 0.09, r = 0.46) in the immersed hand. Both in normoxia and hypoxia, the whole body thermal state dictates the cutaneous vasomotor reactivity to localized cold stimulus.
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Affiliation(s)
- Michail E Keramidas
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Roger Kölegård
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ola Eiken
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
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Piqueras Pérez JM, Blanco Schweizer P, Bendito Guilarte B, Martín Luengo A, Fernández Rodríguez ML, Sánchez Ballesteros J, Rodríguez Mateos JI, Núñez Orduña E, Concejo Casas C, Abrio Peinado I, López Gamo A, Vicente García J, Larrea Prieto J, Pellicer Artigot JL. Cold-Induced Injury Affecting 27% of TBSA: A Case Report. J Burn Care Res 2019; 40:1012-1014. [DOI: 10.1093/jbcr/irz107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Frostbite is a particularly severe form of cold-induced injury that most frequently causes tissular damage in acral parts (hands and feet) and usually involves a small extension of the TBSA. Here, we present a rare case of frostbite affecting a large area (27%), which was successfully treated in a similar way to a thermal burn injury.
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Affiliation(s)
| | | | | | - Ana Martín Luengo
- Department of Intensive Care, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | | | - Eduardo Núñez Orduña
- Department of Plastic Surgery, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Iris Abrio Peinado
- Department of Plastic Surgery, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ana López Gamo
- Department of Plastic Surgery, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Javier Larrea Prieto
- Department of Plastic Surgery, Hospital Universitario Río Hortega, Valladolid, Spain
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Carceller A, Javierre C, Ríos M, Viscor G. Amputation Risk Factors in Severely Frostbitten Patients. Int J Environ Res Public Health 2019; 16:ijerph16081351. [PMID: 30991721 PMCID: PMC6517929 DOI: 10.3390/ijerph16081351] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 01/20/2023]
Abstract
In recent years, the incidence of frostbite has increased among healthy young adults who practice winter sports (skiing, mountaineering, ice climbing and technical climbing/alpinism) at both the professional and amateur levels. Moreover, given that the population most frequently affected is healthy and active, frostbite supposes a substantial interruption of their normal activity and in most cases is associated with long-term sequelae. It particularly has a higher impact when the affected person’s daily activities require exposure to cold environments, as either sports practices or work activities in which low temperatures are a constant (ski patrols, mountain guides, avalanche forecasters, workers in the cold chain, etc.). Clinical experience with humans shows a limited reversibility of injuries via potential tissue regeneration, which can be fostered with optimal medical management. Data were collected from 92 frostbitten patients in order to evaluate factors that represent a risk of amputation after severe frostbite. Mountain range, years of expertise in winter mountaineering, time elapsed before rewarming and especially altitude were the most important factors for a poor prognosis.
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Affiliation(s)
- Anna Carceller
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, 08028 Barcelona, Spain.
- Medical Commission of the International Federation for Climbing and Mountaineering (UIAA MedCom), CH 3000 Bern, Switzerland.
| | - Casimiro Javierre
- Departament de Ciències Fisiològiques, Facultat de Medicina, Universitat de Barcelona, 08907 Barcelona, Spain.
| | - Martín Ríos
- Secció d'Estadística, Departament de Genètica, Estadística i Microbiologia, Facultat de Biologia, Universitat de Barcelona, 08028 Barcelona, Spain.
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, 08028 Barcelona, Spain.
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Gorjanc J, Morrison SA, McDonnell AC, Mekjavic PJ, Blagus R, Mekjavic IB. Ski-Everest (8848 m) Expedition: Digit Skin Temperature Responses to Cold Immersion May Reflect Susceptibility to Cold Injury. Wilderness Environ Med 2019; 30:141-149. [PMID: 30979538 DOI: 10.1016/j.wem.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/01/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We tested the hypothesis that individual susceptibility to freezing cold injury might be reflected in an attenuated cold-induced vasodilatation (CIVD) response by comparing the CIVD responses of an elite alpinist with a history of freezing cold injury in the feet (case alpinist) with those of an age- and ability- matched noninjured alpinists control group (controls). According to this hypothesis, the vasomotor responses to a CIVD test of the case alpinist would represent a pathophysiological response when compared with the normal physiological response of a noninjured cohort. METHODS The case alpinist and the controls in the cohort group conducted a cold water immersion test comprising sequential immersion of a hand and foot for 5 min in 35°C water, followed by a 30-min immersion in 8°C water and a 10-min recovery period in room air. During this test we monitored the finger and toe skin temperatures. RESULTS The case alpinist had a significantly attenuated CIVD response and a lower skin temperature in all injured and noninjured digits during immersion (∼2°C lower than in the control group) and an attenuated recovery of finger skin temperatures (∼6°C lower than in the control group). CONCLUSIONS The attenuated CIVD response of the case alpinist may reflect a previously unrecognized enhanced susceptibility to frostbite. In addition to the poor vasomotor response observed in the injured toes, he also exhibited a poor vasomotor response in his noninjured fingers. The results of the present study indicate that a test of vasomotor activity during thermal stress may identify individuals predisposed to cold injury.
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Affiliation(s)
- Jurij Gorjanc
- Department of Surgery, Hospital of the Brothers of St. John of God, St.Veit/Glan, Austria.
| | | | - Adam C McDonnell
- Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | | | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
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Irarrázaval S, Besa P, Cauchy E, Pandey P, Vergara J. Case Report of Frostbite with Delay in Evacuation: Field Use of Iloprost Might Have Improved the Outcome. High Alt Med Biol 2018; 19:382-387. [DOI: 10.1089/ham.2018.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sebastián Irarrázaval
- Orthopaedics Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Besa
- Orthopaedics Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Emmanuel Cauchy
- Institut de Formation et de Recherche en Médecine de Montagne, Hôpital de Chamonix, Chamonix, France
| | - Prativa Pandey
- Travel Medicine Center, CIWEC Hospital, Kathmandu, Nepal
| | - Jorge Vergara
- Orthopaedics Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Nindl BC, Billing DC, Drain JR, Beckner ME, Greeves J, Groeller H, Teien HK, Marcora S, Moffitt A, Reilly T, Taylor NA, Young AJ, Friedl KE. Perspectives on resilience for military readiness and preparedness: Report of an international military physiology roundtable. J Sci Med Sport 2018; 21:1116-24. [DOI: 10.1016/j.jsams.2018.05.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022]
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Rehan S, Pynn HJ, Williams I, Morris DS. Pulmonary embolism, frostbite and high-altitude retinopathy - a combination of life- and sight-threatening vascular complications at high altitude. Scott Med J 2018; 64:30-34. [PMID: 30354967 DOI: 10.1177/0036933018807343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of high altitude on the human vascular system are well described. This case demonstrates an interesting combination of vascular complications at high altitude which were both life- and sight-threatening. In May 2017, during an attempt on Mount Everest, a 58-year-old man was forced to descend from 8000 m because of adverse weather. He suffered significant frostbite of his right hand, later requiring termination of the distal phalanx of one of the affected digits. He also experienced increasing breathlessness and went on to develop pleuritic chest pain. A CT pulmonary angiogram performed upon return to sea level revealed multiple small sub-segmental pulmonary emboli. He was anticoagulated for three months and made a full recovery. The patient also reported visual loss in the left eye and on ophthalmic examination was found to have multiple retinal haemorrhages including a left macular haemorrhage, consistent with high altitude retinopathy. The retinal haemorrhages settled with conservative management. The vascular complications suffered by this patient demonstrate the potentially fatal changes that can occur at altitude. They also serve to act as a reminder for physicians, even at sea level of the potential complications in patients returning from high altitude.
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Affiliation(s)
- Shahzaib Rehan
- 1 FY2 Doctor, Cardiff Eye Unit, University Hospital of Wales, UK
| | - Harvey J Pynn
- 2 Consultant, Emergency Medicine Department, University Hospitals, Bristol NHS Foundation Trust, Bristol Royal Infirmary, UK
| | - Ian Williams
- 3 Consultant Vascular Surgeon, Vascular Department, University Hospital of Wales, UK
| | - Daniel S Morris
- 4 Consultant Eye Surgeon, Cardiff Eye Unit, University Hospital of Wales, UK
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Ströhle M, Rauch S, Lastei P, Brodmann Maeder M, Brugger H, Paal P. Frostbite Injuries in the Austrian Alps: A Retrospective 11-Year National Registry Study. High Alt Med Biol 2018; 19:316-320. [PMID: 30067104 DOI: 10.1089/ham.2018.0060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Frostbite is a cold injury mostly affecting the extremities. The objective of this study was to reveal the incidence of frostbite injuries in the Austrian Alps, to search for frostbite risk factors, and thereby optimize prevention and treatment. METHODS Out-of-hospital data in the National Registry of Alpine Accidents from January 1, 2005, to December 31, 2015, were screened for frostbite injuries. Cases in the registry were merged with clinical data from the major trauma center in western Austria, Innsbruck Medical University Hospital, and statistically analyzed. RESULTS Documented in the National Registry are 114,595 injured persons in the 11-year study period. Thirty-one frostbite cases were documented nationwide, 18 (58%) of which occurred in the western states of Austria and were therefore potentially referred to the Innsbruck Medical University Hospital. Six (19.6%) patients were female. Frostbite was almost exclusively related to fingers and toes (90% of cases). CONCLUSIONS Frostbite injuries in the Austrian Alps are rare. With an incidence of 0.07/100,000, three to four clinically relevant frostbite injuries occur annually. Men are at greater risk for frostbite injuries than women. Fingers and toes are at greatest risk. Proper preparation of outdoor activities and cold-protective gear can help prevent frostbite injuries.
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Affiliation(s)
- Mathias Ströhle
- 1 Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Rauch
- 2 EURAC Research, Institute of Mountain Emergency Medicine, Bolzano, Italy.,3 Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Lastei
- 1 Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Brodmann Maeder
- 2 EURAC Research, Institute of Mountain Emergency Medicine, Bolzano, Italy.,4 Department of Emergency Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hermann Brugger
- 2 EURAC Research, Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Peter Paal
- 5 Department of Anaesthesiology and Intensive Care Medicine, General Public Hospital of the Brothers of St. John of God Salzburg, Paracelsus Medical University, Salzburg, Austria
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Gorjanc J, Morrison SA, Blagus R, Mekjavic IB. Cold Susceptibility of Digit Stumps Resulting from Amputation After Freezing Cold Injury in Elite Alpinists. High Alt Med Biol 2018; 19:185-192. [PMID: 29608373 DOI: 10.1089/ham.2017.0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gorjanc, Jurij, Shawnda A. Morrison, Rok Blagus, and Igor B. Mekjavic. Cold susceptibility of digit stumps resulting from amputation after freezing cold injury in elite alpinists. High Alt Med Biol. 19:185-192, 2018. AIM The aim of the study was to assess whether previous freezing cold injury in fingers and/or toes might predispose alpinists to greater risk of further freezing cold injury, primarily due to a greater vasoconstrictor response to cold, resulting in a lower perfusion, reflected in lower skin temperature. METHODS Ten elite alpinists (N = 10; 8 male and 2 female) with amputations after freezing cold injury participated in a cold-water (8°C) immersion stress test of the hands and feet. Digit skin temperatures of amputated digits, their noninjured counterparts, noninjured digits of the affected side and noninjured digits of the corresponding side were measured. The skin temperatures were compared during three consecutive phases of the cold stress test: prewarming, cold water immersion, and passive heating. RESULTS Amputated toes cooled much faster compared to their uninjured counterparts (n = 26, p < 0.001), and attained lower skin temperatures during the cold exposure test (n = 26, p < 0.001). Higher cooling rate was observed in all the toes on the injured limb compared with the toes on the uninjured limb (n = 40, p < 0.001). In contrast to the toes, the fingers on the injured limb after freezing cold injury were warmer during cooling phase compared to uninjured fingers (n = 15, p < 0.001). CONCLUSIONS The lower digit temperatures observed in affected toe stumps during the cold stress test compared to the nonamputated toes may indicate a heightened risk of future freezing cold injury with subsequent cold exposures, as a consequence of less perfusion, reflected in the lower skin temperature. This relationship was not confirmed in the fingers.
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Affiliation(s)
| | | | - Rok Blagus
- 3 Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana , Ljubljana, Slovenia
| | - Igor B Mekjavic
- 4 Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute , Ljubljana, Slovenia .,5 Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia, Canada
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Nygaard RM, Endorf FW. Frostbite in the United States: An Examination of the National Burn Repository and National Trauma Data Bank. J Burn Care Res 2018; 39:780-5. [DOI: 10.1093/jbcr/irx048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hu J, Li H, Geng X, Jiao L, Song H, Lou L, Jiao M. Pathophysiologic Determination of Frostbite Under High Altitude Environment Simulation in Sprague-Dawley Rats. Wilderness Environ Med 2016; 27:355-63. [PMID: 27396924 DOI: 10.1016/j.wem.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Pathophysiologic changes of frostbite have been postulated but rarely understood, especially the changes caused by chilly high altitude environment. Therefore, we investigated the pathophysiologic changes of high altitude frostbite (HAF) caused by cold and hypoxia. METHODS Forty Sprague-Dawley rats were randomly divided into 5 equal groups, namely, control, superficial HAF (S-HAF), partial-thickness HAF (PT-HAF), full-thickness HAF (FT-HAF), and partial-thickness normal frostbite (PT-NF) groups. The S-HAF, PT-HAF, and FT-HAF groups were fed under hypobaric hypoxic conditions simulating an altitude of 5000 m. Then, the PT-NF, S-HAF, PT-HAF, and FT-HAF models were constructed by controlling the duration of the direct freezing by liquid nitrogen. Animal vital signs were measured after the operation, and histopathologic changes were observed after routine hematoxylin and eosin staining. In addition, the microcirculation of frostbite tissues was monitored and compared by contrast ultrasonography during wound healing. RESULTS The S-HAF, PT-HAF, and FT-HAF groups showed significant differences in the microcirculatory and histopathologic changes in the various tissue layers (P < .05). In addition, combined cold and hypoxia caused more damage to frostbite tissue than pure cold. The circulation recovery of HAF models was significantly slower relative to NF models (P < .05). CONCLUSIONS A safe and reproducible HAF model was proposed. More important, pathophysiologic determination of HAF provided the foundation and potential for developing novel and effective frostbite therapies.
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Affiliation(s)
- Jie Hu
- Department of Echocardiography, Affiliated Traditional Chinese Medicine Hospital, Xinjiang Medical University, Urumqi, China (Drs Hu and Li)
| | - Hua Li
- Department of Echocardiography, Affiliated Traditional Chinese Medicine Hospital, Xinjiang Medical University, Urumqi, China (Drs Hu and Li)
| | - Xiliang Geng
- Department of Medical Engineering, Urumchi General Hospital of Lanzhou Military Region, Urumchi, China (Drs Geng, Jiao, Lou, and Jiao)
| | - Lin Jiao
- Department of Medical Engineering, Urumchi General Hospital of Lanzhou Military Region, Urumchi, China (Drs Geng, Jiao, Lou, and Jiao)
| | - Hongping Song
- Department of Ultrasound, Xijing Hospital, The Fourth Military Medical University, Xi'an, China (Dr Song)
| | - Lin Lou
- Department of Medical Engineering, Urumchi General Hospital of Lanzhou Military Region, Urumchi, China (Drs Geng, Jiao, Lou, and Jiao)
| | - Mingke Jiao
- Department of Medical Engineering, Urumchi General Hospital of Lanzhou Military Region, Urumchi, China (Drs Geng, Jiao, Lou, and Jiao).
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Abstract
INTRODUCTION The debilitating impact of cold weather on the human body is one of the world's oldest recorded injuries. The severe and life-changing damage which can be caused is now more commonly seen recreationally in extreme outdoor sports rather than in occupational settings such as the military. The diagnosis and treatment of these injuries need to be completed carefully but quickly to reduce the risk of loss of limb and possibly life. Therefore, we have conducted a systematic review of the literature surrounding cold weather injuries (CWIs) to ascertain the epidemiology and current management strategies. SOURCES OF DATA Medline (PubMED), EMBASE, CINHAL, Cochrane Collaboration Database, Web of Science, Scopus and Google Scholar. AREAS OF AGREEMENT IMMEDIATE FIELD TREATMENT The risk of freeze thaw freeze injuries. Delayed surgical intervention when possible. Different epidemiology of freezing and non-freezing injuries. AREAS OF CONTROVERSY Prophylatic use of antibiotics; the use of vasodilators surgical and medical. GROWING POINTS The use of ilioprost and PFG2a for the treatment of deep frostbite. AREAS TIMELY FOR DEVELOPING RESEARCH The treatment of non-freezing CWIs with their long-term follow-up.
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Affiliation(s)
| | | | - Greg Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anna Porter
- Newcastle University, Newcastle upon Tyne, UK
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Abstract
CONTEXT Hypothermia and frostbite injuries occur in cold weather activities and sporting events. EVIDENCE ACQUISITION A PubMed search was used to identify original research and review articles related to cold, frostbite, and hypothermia. Inclusion was based on their relevance to prevention and treatment of cold-related injuries in sports and outdoor activities. Dates of review articles were limited to those published after 2010. No date limit was set for the most recent consensus statements or original research. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Frostbite and hypothermia are well-documented entities with good prevention strategies and prehospital treatment recommendations that have changed very little with time. A layered approach to clothing is the best way to prevent injury and respond to weather changes. Each athlete, defined as a participant in a cold weather sport or activity, will respond to cold differently depending on anthropometric measurements and underlying medical risk factors. An understanding of wind-chill temperatures, wetness, and the weather forecast allows athletes and event coordinators to properly respond to changing weather conditions. At the first sign of a freezing cold injury, ensure warm, dry clothes and move to a protected environment. CONCLUSION Cold injuries can be prevented, and cold weather activities are safe with proper education, preparation, and response to changing weather conditions or injury.
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Affiliation(s)
- Jessie Fudge
- Activity, Sports and Exercise Medicine Department, Group Health Cooperative, Everett, Washington
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Massey HC, House JR, Tipton MJ. Vasomotor responses to hypoxia and cold air. Extrem Physiol Med 2015. [PMCID: PMC4580823 DOI: 10.1186/2046-7648-4-s1-a53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Although regular physical activity is encouraged for individuals with diabetes, exercise at high altitude increases risk for a number of potential complications. This review highlights our current understanding of the key physiological and clinical issues that accompany high-altitude travel and proposes basic clinical strategies to help overcome obstacles faced by trekkers with Type 1 or Type 2 diabetes. Although individuals with diabetes have adaptations to the hypoxia of high altitude (increased ventilation, heart rate, blood pressure and hormonal responses), elevated counter-regulatory hormones can impair glycaemic control, particularly if mountain sickness occurs. Moreover, high-altitude-induced anorexia and increased energy expenditure can predispose individuals to dysglycaemia unless careful adjustments in medication are performed. Frequent blood glucose monitoring is imperative, and results must be interpreted with caution because capillary blood glucose meter results may be less accurate at high elevations and low temperatures. It is also important to undergo pre-travel screening to rule out possible contraindications owing to chronic diabetes complications and make well-informed decisions about risks. Despite the risks, healthy, physically fit and well-prepared individuals with Type 1 or Type 2 diabetes who are capable of advanced self-management can be encouraged to participate in these activities and attain their summit goals. Moreover, trekking at high altitude can serve as an effective means to engage in physical activity and to increase confidence with fundamental diabetes self-management skills.
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Affiliation(s)
- S Mohajeri
- School of Kinesiology and Health Science, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto
| | - B A Perkins
- Division of Endocrinology and Department of Medicine, University of Toronto
| | - P L Brubaker
- Department of Physiology and Department of Medicine, University of Toronto, Toronto, Canada
| | - M C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto
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Morrison SA, Gorjanc J, Eiken O, Mekjavic IB. Finger and Toe Temperature Responses to Cold After Freezing Cold Injury in Elite Alpinists. Wilderness Environ Med 2015; 26:295-304. [PMID: 25754904 DOI: 10.1016/j.wem.2014.12.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/17/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess whether previous freezing cold injuries (FCI) would affect digit skin temperatures and rewarming rates during a follow-up cold stress test protocol. DESIGN Nonrandomized control trial. METHODS Twenty elite alpinists participated; alpinists with previous FCI requiring digit amputations (injured, INJ: n = 10 total, n = 8 male) were compared with ability-matched, uninjured alpinists (control, CON: n = 10, all male). Digit skin temperature was measured using infrared thermography as an index of peripheral digit perfusion after a cold stress test, which consisted of 30 minutes of immersion in 8°C water. RESULTS The INJ alpinists' injured toes were warmer (approximately 6%) than their uninjured toes immediately after cold immersion (95% CI, 0.01°C to 1.00°C; P = .05); there were no differences between the rates of rewarming of injured and uninjured toes (INJ, 0.5° ± 0.1°C/min; CON, 0.7° ± 0.3°C/min; P = .16). Although the INJ alpinists had colder injured fingers immediately after the 35°C warm bath compared with their own uninjured fingers (32.2° ± 2.0°C vs 34.5° ± 0.5°C; P = .02), there were no differences observed between the rates of rewarming of injured and uninjured fingers after cold exposure (INJ, 1.1° ± 0.2°C/min; CON, 1.3° ± 0.5°C/min; P = .22). CONCLUSIONS Even after FCI that requires digit amputation, there is no evidence of different tissue rates of rewarming between the injured and uninjured fingers or toes of elite alpinists.
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Affiliation(s)
- Shawnda A Morrison
- Environmental Physiology and Ergonomics Laboratory, Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia (Drs Morrison and Mekjavic).
| | - Jurij Gorjanc
- Department of Surgery, Hospital of the Brothers of St. John of God, St.Veit/Glan, Austria (Dr Gorjanc)
| | - Ola Eiken
- Department of Environmental Physiology, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden (Dr Eiken)
| | - Igor B Mekjavic
- Environmental Physiology and Ergonomics Laboratory, Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia (Drs Morrison and Mekjavic)
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Némethy M, Pressman AB, Freer L, Mcintosh SE. Mt Everest Base Camp Medical Clinic “Everest ER”: Epidemiology of Medical Events During the First 10 Years of Operation. Wilderness Environ Med 2015; 26:4-10. [DOI: 10.1016/j.wem.2014.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 06/24/2014] [Accepted: 07/21/2014] [Indexed: 11/24/2022]
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Abstract
An initial response to whole-body or local exposure of the extremities to cold is a strong vasoconstriction, leading to a rapid decrease in hand and foot temperature. This impairs tactile sensitivity, manual dexterity, and muscle contractile characteristics while increasing pain and sympathetic drive, decreasing gross motor function, occupational performance, and survival. A paradoxical and cyclical vasodilatation often occurs in the fingers, toes, and face, and this has been termed the hunting response or cold-induced vasodilatation (CIVD). Despite being described almost a century ago, the mechanisms of CIVD are still disputed; research in this area has remained largely descriptive in nature. Recent research into CIVD has brought increased standardization of methodology along with new knowledge about the impact of mediating factors such as hypoxia and physical fitness. Increasing mechanistic analysis of CIVD has also emerged along with improved modeling and prediction of CIVD responses. The present review will survey work conducted during this century on CIVD, its potential mechanisms and modeling, and also the broader context of manual function in cold conditions.
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Affiliation(s)
- Stephen S Cheung
- Environmental Ergonomics Laboratory; Department of Kinesiology ; Brock University; St. Catharines , Canada
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Weaver TL, Robinson D, Frey ES. Jack frost nips at alabama: severe frostbite in the deep South. Eplasty 2014; 14:ic20. [PMID: 25165499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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