The association between cold hypersensitivity in the hands and feet and chronic disease: results of a multicentre study

Cold hypersensitivity in the lower extremities: an underappreciated symptom in patients with varicose veins

BACKGROUND

This study aimed to investigate the frequently overlooked symptoms of cold hypersensitivity and heavy legs related to varicose veins in a large sample of patients.

METHODS

Data on 8782 adults aged 30-70 years without a history of cancer were sourced from the Taiwan Biobank between 2008 and 2020. Varicose veins, cold hypersensitivity and heavy leg sensations were assessed using questionnaires and analysed using logistic regression models with various covariates. Statistical analyses were performed, with analysis of variance for continuous variables and χ2 tests for categorical variables at a significance level of 0.05.

RESULTS

Our analysis showed significant associations between varicose veins, cold hypersensitivity, and heavy legs (p<0.0001). Logistic regression models showed that moderate and severe cold hypersensitivity increased the risk of varicose veins with ORs of 1.490 (95% CI 1.205 to 1.842) and 1.894 (95% CI 1.546 to 2.320), respectively. Similarly, heavy legs were strongly associated with varicose veins (OR 4.239, 95% CI 3.381 to 5.315), and the interaction between cold hypersensitivity and heavy legs was significant (p=0.0009). Notably, the greatest risk for varicose veins was observed in individuals with heavy legs and severe cold hypersensitivity (OR 7.135, 95% CI 4.980 to 10.221).

CONCLUSIONS

The results of this study highlight the clinical significance of considering cold hypersensitivity and heavy legs as vital symptoms for diagnosing varicose veins, particularly in the absence of arterial disorders, which can improve diagnostic accuracy and patient outcomes.

Study Protocol for Multi-Center, Open-Label, Randomized Controlled Trial for Assessing the Efficacy and Safety of Electroacupuncture for Cold Hypersensitivity in Hands and Feet

Objectives

Cold hypersensitivity in the hands and feet (CHHF) is defined as the symptom of a sensation of coldness in the extremities under conditions that are not considered cold by an unaffected person. CHHF can affect the quality of life by placing restrictions on one's daily activities. Although electroacupuncture (EA) and acupuncture have been widely used for treating CHHF, randomized clinical trial (RCT) has not yet been conducted for evaluating the safety and efficacy of EA or acupuncture for the treatment of CHHF. This study aims to evaluate the effects of EA in CHHF patients.

Methods

This study is a randomized, multicenter, and parallel design clinical trial. Overall, 72 participants will be randomly assigned to the EA treatment group, acupuncture treatment group, and untreated control group in 111 ratio via a web-based randomization system. The EA treatment group and acupuncture treatment group will receive EA or acupuncture treatment by visiting ten times at intervals of twice a week for five weeks. Follow-up visits will be made four weeks after the end of treatment. For the untreated control group, three visits will be made. The primary outcome measures will be the CHHF visual analogue scale score. Secondary outcome measures will be the body temperature of hands and feet, total scores of the Korean version of the World Health Organization Quality of Life Scale abbreviated version, the results of the questionnaire of health-related quality of life, questionnaire of demonstration, and questionnaire of cold hypersensitivity.

Conclusion

This study will be the first clinical trial to evaluate the efficacy and safety of EA for the treatment of CHHF. We expect this study to provide basic evidence for the treatment of CHHF with EA and future large-scale RCTs.

Association between subjective health status and responses to traditional Korean medicine assessments in healthy adults: A cross-sectional study

Subjective health status comprises an individual's self-assessment of health and indicates their actual health outcomes. This study aimed to explore the relationship between traditional Korean Medicine (KM) inquiry outcomes and subjective health status to provide a better understanding of the potential benefits of KM practices, which have been overlooked in existing research. This observational study recruited 5987 healthy adults (age ≥ 19 years) between April 11, 2022, and December 19, 2023. Participants were surveyed using standardized KM inquiries and subjective health status assessments. Statistical analyses included chi-square tests and multivariate logistic regression analyses to examine the relationship between KM inquiry outcomes and subjective health status. An analysis of 4935 respondents who completed KM inquiries revealed that factors affecting subjective health status for both men and women included appetite, digestive discomfort, residual urine sensation, waking condition, cold intolerance, and exercise habits. Factors affecting subjective health status differed slightly by sex; for men, dry mouth and alcohol consumption were significant, whereas, for women, dry mouth, meal frequency, sleep quality, and feelings after sweating were significant. This study confirms the utility of KM inquiries in assessing the subjective health status of healthy adults and provides insights into the development of sex-specific lifestyle health-management strategies.

Effectiveness of electroacupuncture and acupuncture in alleviating cold hypersensitivity in the hands and feet: A randomized controlled trial

OBJECTIVE

Cold hypersensitivity in the hands and feet(CHHF) is a common condition that reduces the quality of life and causes daily discomfort. The current treatments are primarily pharmacological. This study aimed to expand treatment options by comparing the efficacy of electroacupuncture (EA) and acupuncture (AC) with that of no treatment (control).

METHODS

A three-group randomized controlled trial was conducted with 72 women diagnosed with cold hypersensitivity in the hands and feet, as confirmed by subjective symptoms and objective temperature differences. Participants were randomly assigned to the EA, AC, or control groups. Outcome measures included hand and feet visual analog scale (VAS) scores, temperature changes measured using a non-contact thermometer, and World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores assessed at pretreatment (T0), posttreatment (T1), and follow-up (T2). Repeated measures ANOVA and 2-way mixed-model ANOVA were used to evaluate group, time, and interaction effects.

RESULTS

Both the EA and AC groups showed significant improvements in hand and feet VAS and WHOQOL-BREF scores compared with those of the control group posttreatment (T1). Notably, the EA group demonstrated sustained benefits at follow-up (T2), with significant reductions in feet VAS scores and positive changes in several WHOQOL-BREF domains. Interaction effects between group and time were observed, indicating that the changes in the EA and AC groups were meaningfully different form those in the control group. The control group also exhibited a statistically significant reduction in the VAS scores at follow-up (T2), likely due to the natural variability of cold extremity symptoms and psychological factors.

CONCLUSION

This study demonstrated that EA and AC are effective in alleviating the symptoms of CHHF and enhancing the quality of life compared to no treatment. EA showed long-lasting effects than those of AC, suggesting its potential to regulate the autonomic nervous system. These findings provide a foundation for expanding non-pharmacological treatment options for CHHF and offer clinical guidance on the use of EA and AC.

Sex-related differences regarding headache triggered by low barometric pressure in Japan

PURPOSE

The prevalence of migraine headache is higher in women. Low barometric pressure is a factor in headache triggering, but sex-related differences have not been identified. The purpose of this study was to examine sex-related differences in headache triggered by low barometric pressure.

METHODS

Study subjects aged 20-49 years were randomly selected from a research company's (Macromill, Inc.) web panel. Those with chronic migraine or tension-type headache invited to complete a web-based self-administered questionnaire. Logistic regression analysis was performed with the objective variable as the Headache Impact Test-6 (HIT-6) high scores (56 or more) or headache triggered by low barometric pressure.

RESULTS

Participants were 332 women and 337 men in the headache population. HIT-6 high scores were associated with age at headache occurrence 20 years or younger (OR: odds ratio 1.85, 95% CI: confidence interval 1.15-2.99, p = 0.012) and headache triggered by low barometric pressure (OR 2.11, 95%CI 1.51-2.94, p < 0.001). Headache triggered by low barometric pressure was significantly associated with women (OR 2.92, 95%CI 2.12-4.02, p < 0.001).

CONCLUSIONS

Headache triggered by low barometric pressure were related to sex-related differences. It was suggested that a sex-specific treatment approach for headache triggering is needed.

Cold sensitivity among female clinical nurses in Japan: A nationwide study

Objectives

This study aimed to clarify the nature of cold sensitivity in female nurses working in hospitals in Japan.

Design

A cross-sectional post survey research design.

Settings

The questionnaire targeted nurses working in 14 hospitals across ten prefectures throughout Japan.

Participants

1,138 female nurses.

Methods

The survey captured participants' characteristics, work environment, health, and lifestyle. The factors investigated were perceived cold sensitivity, cold sensitivity according to the Hiesho Sensation Scale, and cold sensitivity during nursing care. The Diagnostic Inventory of Health and Life Habits (DIHAL.2) assessed health and lifestyle habits.

Results

Of the respondents, 44.3 % were aware of daily cold sensitivity and 21.4 % had a cold sensitivity disorder. The majority of respondents (63.1 %) felt cold in their hands when providing nursing care, and 28.1 % felt discomfort due to the coldness of their hands. Individuals diagnosed with cold sensitivity disorders exhibited poorer overall health compared to those without such disorders. However, there was no statistically significant difference in the overall health status between individuals who reported perceiving cold sensitivity and those who did not. The group with perceived cold sensitivity had significantly lower scores on exercise behavior, meal regularity, rest, sleep regularity, and sleep sufficiency. The proportion of female nurses working in Japanese hospitals who experienced cold sensitivity was similar to that of Japanese women with the same sensitivity. Most female nurses experienced cold in their hands while providing care. Nearly 30 % of the respondents experienced discomfort owing to cold hands.

Conclusions

The study underscores the widespread issue of cold sensitivity among female nurses in Japanese hospitals, emphasizing the critical need for targeted interventions to improve their comfort and optimize care provision.

Resting energy expenditure differs among individuals with different levels of perceived thermal sensitivity: A cross-sectional study

Metabolic rate has been used in thermophysiological models for predicting the thermal response of humans. However, only a few studies have investigated the association between an individual's trait-like thermal sensitivity and resting energy expenditure (REE), which resulted in inconsistent results. This study aimed to explore the association between REE and perceived thermal sensitivity. The REE of healthy adults was measured using an indirect calorimeter, and perceived thermal intolerance and sensation in the body were evaluated using a self-administered questionnaire. In total, 1567 individuals were included in the analysis (women = 68.9%, age = 41.1 ± 13.2 years, body mass index = 23.3 ± 3.3 kg/m2, REE = 1532.1 ± 362.4 kcal/d). More women had high cold intolerance (31.8%) than men (12.7%), and more men had high heat intolerance (23.6%) than women (16.1%). In contrast, more women experienced both cold (53.8%) and heat (40.6%) sensations in the body than men (cold, 29.1%; heat, 27.9%). After adjusting for age, fat-free mass, and fat mass, lower cold intolerance, higher heat intolerance, and heat sensation were associated with increased REE only in men (cold intolerance, P for trend = .001; heat intolerance, P for trend = .037; heat sensation, P = .046), whereas cold sensation was associated with decreased REE only in women (P = .023). These findings suggest a link between the perceived thermal sensitivity and REE levels in healthy individuals.

Cold hypersensitivity in the hands and feet is associated with erectile dysfunction in young Taiwanese men

Cold hypersensitivity in the hands and feet (CHHF) is a protective or predisposing factor for many diseases; however, the relationship between CHHF and erectile dysfunction (ED) remains unclear. We aimed to investigate associations between CHHF and ED among young men of Southeast Asian origin. In this cross-sectional study, sexually active Taiwanese men aged 20-40 years were enrolled via an online questionnaire comprising general demographic information, comorbidities, subjective thermal sensations of their hands and feet in the past 6 months, and their erectile function using the International Index of Erectile Function-5 (IIEF-5). Participants who reported cold sensation of hands and feet were classified to have CHHF; those with IIEF-5 score ≤ 21 were considered to have ED. Total 54.2% and 27.9% of participants had ED and CHHF, respectively. Men with CHHF were significantly younger, had lower body mass index and IIEF-5 scores (p < 0.001), and a lower prevalence of diabetes mellitus (p = 0.033) along with higher prevalence of ED, psychiatric disorders, and insomnia (p < 0.001). After adjusting for predisposing factors of ED, CHHF (odds ratio 1.410, 95% confidence interval 1.159-1.714; p = 0.001) remained an independent predictor of ED. Thus, CHHF is independently associated with ED, affecting more than a quarter of young Taiwanese men. Autonomic dysregulation and subclinical endothelial dysfunction may be common pathophysiologies of CHHF and ED.

Exploratory study of cold hypersensitivity in Japanese women: genetic associations and somatic symptom burden

Temperature perception is essential for humans to discern the environment and maintain homeostasis. However, some individuals experience cold hypersensitivity, characterized by a subjective feeling of coldness despite ambient environmental temperatures being normal, the underlying mechanisms of which are unknown. In this study, we aimed to investigate the relationship between subjective cold symptoms and somatic burden or single nucleotide polymorphisms to understand the causes of cold hypersensitivity. We conducted an online questionnaire survey [comprising 30 questions, including past medical history, subjective symptoms of cold hypersensitivity, and the Somatic Symptom Scale-8 (SSS-8)]. Respondents were 1200 Japanese adult female volunteers (age: 20-59 years), recruited between April 21 and May 25, 2022, who were customers of MYCODE, a personal genome service in Japan. Among the 1111 participants, 599 (54%) reported cold hypersensitivity. Higher cold hypersensitivity severity was positively associated with the SSS-8 scores. Additionally, a genome-wide association study for cold hypersensitivity was conducted using array-based genomic data obtained from genetic testing. We identified 11 lead variants showing suggestive associations (P < 1 × 10-5) with cold hypersensitivity, some of which showed a reasonable change in expression in specific tissues in the Genotype-Tissue Expression database. The study findings shed light on the underlying causes of cold hypersensitivity.

Segmental bioelectrical impedance analysis for Korean older population with cold pattern

OBJECTIVE

This study examined the association of whole-body composition and segmental bioimpedance variables with cold pattern (CP) in different sexes.

METHODS

We assigned 667 older individuals to a CP group (n = 488) and a non-CP group (n = 179) by using an eight-item self-administered questionnaire. Seven body composition variables and three pairs of segmental bioimpedance variables for the upper and lower extremities, which were obtained from a segmental multifrequency bioimpedance analyzer, were employed to investigate their association with CP. Participants' characteristics were first described. Then we compared the selected body composition and bioimpedance variables between the CP and non-CP groups. Finally, their association with CP was investigated using univariate and multivariate regression analyses. All analyses were performed separately for women and men.

RESULTS

Both women and men exhibited a comparable mean age in the CP and non-CP groups; however, women with CP had significantly lower blood pressures, whereas men with CP showed a higher proportion of osteoarthritis than those without CP. Compared with the non-CP group, individuals with CP exhibited significantly smaller body sizes indicated by shorter height and smaller weight, lower body mass index, and smaller volume-to-body surface area ratio in both sexes. After controlling for age, height, weight, and other covariates, we found significant reductions in body lean mass such as fat-free mass and body cell mass, basal metabolic rate per unit mass, total body water, and intra-to-extracellular water ratio in the CP group. With regard to segmental bioimpedance analysis, the resistance ratios and phase angles in the upper and lower extremities yield significant associations with CP incidence, as demonstrated by the odds ratio (95% confidence interval) of 1.72 (1.16-2.57), 1.69 (1.18-2.48), 0.60 (0.40-0.89), and 0.57 (0.39-0.82), respectively. However, these results did not emerge in men.

CONCLUSION

Abnormal cellular water distribution and deterioration in body cell mass and/or cell strength are associated with CP prevalence, regardless of age, height, weight. These findings are similar in the upper and lower extremities and are more pronounced in women. The abovementioned patterns may be considered effective indicators for identifying CP in the older adult population.

Efficacy and safety of sympathetic radiofrequency thermocoagulation in the treatment of cold hypersensitivity

Background

Cold hypersensitivity (CH) is a sensation of cold in the limbs and (or) body of a patient in an environment that is not considered cold by unaffected people, or a strong feeling of cold at a relatively low temperature. However, the currently available treatments are limited and often unsatisfactory. This study aimed to evaluate the clinical efficacy and safety of the sympathetic radiofrequency thermocoagulation (RF-TC) technique in patients with CH disorder.

Methods

The study is a retrospective analysis. A total of 71 were entered into the final analysis and all patients underwent computed tomography-guided thoracic (lumbar) sympathetic nerve RF-TC on an elective basis. The values of terminal temperature (T) and perfusion index (PI) of patients before and after treatment were recorded. Patients were followed up clinically at regular intervals and their Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) scores were recorded to detect postoperative complications and assess patient satisfaction with the treatment.

Results

All patients completed the radiofrequency treatment. Compared with the preoperative period, VAS and PSQI scores were significantly lower at all postoperative time periods (P < 0.001). Patients had significantly higher postoperative terminal temperatures and perfusion indices on the right and left sides than before surgery (P < 0.001). The overall patient satisfaction score was 4 (3–5) at 3 years of postoperative follow-up. There were 20 recurrences (28.2%). The main postoperative complications were postoperative local pain and compensatory hyperhidrosis. No other adverse events or deaths were observed.

Conclusion

RF-TC for CH could be a feasible, effective, and safe treatment option to improve patients' symptoms of cold sensation. Yet, more researches are needed to verify this potentially efficient and standardized treatment.

Systematic Analysis of the Molecular Mechanisms of Cold and Hot Properties of Herbal Medicines

Effective treatments for patients experiencing temperature-related symptoms are limited. The hot and cold effects of traditional herbal medicines have been utilized to treat and manage these symptoms, but their molecular mechanisms are not fully understood. Previous studies with arbitrarily selected herbs and ingredients may have produced biased results. Here, we aim to systematically elucidate the molecular mechanisms of the hot and cold properties of herbal medicines through an unbiased large-scale investigation of herbal ingredients, their target genes, and the transcriptome signatures induced by them. Using data regarding 243 herbs retrieved from two herbal medicine databases, we statistically identify (R)-Linalool, (-)-alpha-pinene, peruviol, (L)-alpha-terpineol, and cymol as five new hot-specific ingredients that share a common target, a norepinephrine transporter. However, no significant ingredients are cold-specific. We also statistically identify 14 hot- and 8 cold-specific new target genes. Pathway enrichment analysis of hot-specific target genes reveals the associated pathways including neurotransmitter reuptake, cold-induced thermogenesis, blood pressure regulation, adrenergic receptor signaling, and cation symporter activity. Cold-specific target genes are associated with the steroid pathway. Transcriptome analysis also shows that hot herbs are more strongly associated with coagulation and synaptic transmission than cold herbs. Our results, obtained from novel connections between herbal ingredients, target genes, and pathways, may contribute to the development of pharmacological treatment strategies for temperature-related pain using medicinal plants.

Evaluation of thermal sensitivity is of potential clinical utility for the predictive, preventive, and personalized approach advancing metabolic syndrome management

A possible association between metabolic disorders and ambient temperature has been suggested, and cold exposure as a way of increasing energy expenditure has gained considerable interest for preventative/therapeutic measures toward metabolic disorders. Although thermal sensitivity, which has recently been studied in regard to its utility as a risk assessment/patient stratification for various diseases, might influence physiological responses to ambient temperature on an individual basis, more studies are needed. We aimed to investigate the association between self-identified thermal intolerance/sensation and metabolic syndrome (MetS) to verify the working hypothesis that individuals with altered thermal sensitivity may have a predisposition to MetS. We fitted generalized additive models for thermal intolerance/sensation using body mass index (BMI) and waist–hip ratio in women, and identified those with higher/lower thermal intolerance/sensation than those predicted by the models. Higher heat intolerance, higher heat sensation, and lower cold intolerance were associated with a higher prevalence of MetS. The risk of having MetS was increased in those who had two or three associated conditions compared with those with none of these conditions. In an analysis for MetS components, significant associations of thermal sensitivity were present with high glucose, triglyceride, and blood pressure levels. Overall, higher heat intolerance/sensation and lower cold intolerance were associated with increased prevalence of MetS even at a similar level of obesity. Our study indicates that evaluation of thermal sensitivity may help identify individuals at high risk for MetS, and lead to more advanced patient stratification and personalized treatment strategies for MetS, including cold-induced thermogenesis.

[Development of a Risk Prediction Model and a Simple Assessment Sheet for Cold Disorder (Hiesho) in Middle-aged and Older Adults]

OBJECTIVES

In this study, we aimed to develop a risk prediction model and a simple assessment sheet for cold disorder (hiesho) in middle-aged and older adults.

METHODS

The 889 participants in this study were from a community-dwelling general population (mean age, 62.4±8.8 years). The skin surface temperatures of the face and hands of the participants were measured by thermography. The cold disorder was objectively defined as having a temperature difference of ≥8°C between the forehead and fingertips. Data on the body regions with cold perception and the various concomitant signs were collected by a self-administered questionnaire and structured interviews.

RESULTS

The objectively assessed cold disorder was observed in 22.7% of participants and strongly associated with coldness of the back of the hand, palms, fingers, dorsal torso, toes, and soles of the feet. Its prevalence was found to increase with the number of signs of coldness. Older age, being female, low body mass index, hypertension, anemia, and physical inactivity were identified as potential risk factors. A logistic model for predicting the cold disorder was designed on the basis of the perceived cold, accompanying signs, and risk factors. The model showed good discrimination (area under the curve=0.737) and calibration capabilities (Hosmer-Lemeshow test, P=0.426). On the basis of this prediction model, a simple assessment sheet was developed to estimate the individual risk of experiencing the cold disorder, in middle-aged and older adults.

CONCLUSIONS

With the proposed risk prediction model showing good discrimination capability, the assessment sheet may serve as a prescreening tool to evaluate the potential of middle-aged and older population to develop the cold disorder.

The Immediate Effect of Sinapis nigra and Zingiber officinale as Thermogenic Substances during Footbaths: A Randomized Controlled Crossover Trial

OBJECTIVE

Warm footbaths infused with Sinapis nigra (mustard, or MU) or Zingiber officinale (ginger, or GI) are used for various thermoregulatory conditions, but little is known about how they are perceived by individuals, both short- and long-term. We analyzed the immediate and long-term effects of MU and GI on warmth and stimulus perception in healthy adults.

METHODS

Seventeen individuals (mean age 22.1±2.4 years; 11 female) received three footbaths (mean temperature was 40 ± 0.2°C, administered between 1:30 and 6:30 p.m.) in a randomized order with a crossover design: 1. with warm water only (WA), 2. with warm water and MU, and 3. with warm water and GI. Warmth and stimulus perception at the feet were assessed at the 1st, 5th, 10th, 15th, and 20th minute of the footbaths, in the late evening (EVE), and the following morning (MG). We further assessed well-being (at EVE and MG) and sleep quality (at MG). The primary outcome measure was the warmth perception at the feet at the 10th minute of the footbath.

RESULTS

At the 10th minute of the footbath, warmth perception at the feet was significantly higher with MU and GI compared to WA. The immediate thermogenic effects pointed to a quick increase in warmth and stimulus perception with MU, a slower increase with GI, and a gradual decrease with WA. Regarding the long-term effects, warmth and stimulus perception were still higher after GI compared to WA at EVE and MG. No differences were seen for general well-being and sleep quality.

CONCLUSION

Thermogenic substances can significantly alter the dynamics of warmth and stimulus perception when added to footbaths. The different profiles in the application of GI and MU could be relevant for a more differentiated and specific use of both substances in different therapeutic indications.

Herbal Medicine for Patients with Cognitive Impairment: An Observational Study

PURPOSE

The potential effects of herbal medicine for patients with cognitive disorders have been reported in various human and animal studies. This study aimed to explore the effect of herbal medicine treatment according to the Korean Medicine (KM) pattern identification for patients with mild cognitive impairment and early dementia.

PATIENTS AND METHODS

Twenty patients with mild cognitive impairment or mild dementia who planned to receive herbal medicine treatment were enrolled. Herbal formulae were prescribed based on the KM pattern for 12-24 weeks. Seoul Neuropsychological Screening Battery II (SNSB-II) and Montreal Cognitive Assessment (MoCA) were assessed at the baseline, after 12 weeks, and after 24 weeks (Trial registration: cris.nih.go.kr, KCT0004799).

RESULTS

Herbal medicine products, including Yukmijihwang-tang, Samhwangsasim-tang, Palmul-tang, Banhasasim-tang, and Yukgunja-tang, were prescribed to the patients. Among the SNSB-II five cognitive function domains, the T scores for language, visuospatial function, memory, and frontal/executive function increased over time. The MoCA score also improved following the treatment (mean difference 4.23 [95% CI: 2.60, 5.86], p < 0.0001 at 12-week follow-up compared to the baseline). Considering the KM pattern scores, phlegm-dampness and fire-heat scores tended to improve after the treatment. No serious adverse events related to the intervention were reported.

CONCLUSION

The potential effect of herbal medicine formulae products on improving cognitive functions in patients with cognitive impairment was observed. Further research is needed to objectify the KM pattern identification process and evaluate the KM pattern-related signs and symptoms.

Venous leg symptoms, ecchymosis, and coldness in patients with peripheral varicose vein: A multicenter assessment and validation study (VEIN-VIOLET study)

OBJECTIVES

We aimed to evaluate peripheral varicose vein symptoms including ecchymosis and coldness by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire.

METHODS

A total of 1120 patients were enrolled to the analysis after the exclusion of 199 patients who did not match the inclusion criteria. Patients were asked to answer the VEINES-Sym questionnaire and questions about ecchymosis and coldness. Scores of ecchymosis and coldness were calculated similar to VEINES-Sym questionnaire. Classifications of peripheral varicose vein were made according to the clinical part of clinical, etiological, anatomical, and pathophysiological classification system and patients with grade 2 or higher were considered as positive for peripheral varicose vein.

RESULTS

Frequency of symptoms present in the VEINES-Sym instrument, ecchymosis and coldness were significantly higher in patients with peripheral varicose vein. Mean score of each symptom was significantly lower in peripheral varicose vein patients including scores of ecchymosis and coldness. Logistic regression analysis revealed that presence of hemorrhoids and all symptoms in VEINES-Sym questionnaire except restless leg were significantly and independently associated with peripheral varicose vein. Besides, ecchymosis (odds ratio: 2.04, 95% confidence interval: 1.34-3.08, p = 0.008) but not coldness was significantly and independently associated with peripheral varicose vein. There was also significant correlation of VEINES-Sym score with ecchymosis (r = 0.43, p < 0.001) and coldness (r = 0.47, p < 0.001).

CONCLUSIONS

Venous leg symptoms present in VEINES-Sym questionnaire except restless legs, presence of hemorrhoids and ecchymosis are significantly and independently associated with peripheral varicose vein. Not only ecchymosis but also coldness has shown an independent association with total VEINES-Sym score.

Ecchymosis and Coldness in Peripheral Varicose Vein Patients: Observations From VEIN-TURKEY Study

The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, P = .002, respectively), and ecchymosis (16.6%, 2.7%, P < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis ( r = 0.18, P < .001) and coldness ( r = 0.35, P < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction.

Flammer syndrome in multiple sclerosis: diagnostics, prediction, and personalization of treatments

Background

Flammer syndrome (FS) occurs from well-described signs and symptoms. The syndrome itself is not a disease, but it may be a directive marker for advancing therapeutic approaches by predictive and preventive measures as well as for personalization of treatments. The syndrome is related to many diseases, but FS has been rarely studied in multiple sclerosis (MS). The study aimed to determine whether FS signs and symptoms occur more often in people with MS than in healthy controls, and in order to personalize the treatment, we investigated the possible effect of current therapies on FS signs and symptoms.

Methods

Two hundred twenty-two MS patients and 203 healthy controls answered the questionnaire consisting of 15 signs and symptoms of FS.

Results

MS patients had significantly more complaints in 9 items of FS signs and symptoms (cold hands or/and feet, the reduced feeling of thirst, dizziness, drug side effects, other headaches (tension-type, medication overuse), weight loss, feeling cold, long sleep-onset time, and skin blotches) compared to healthy controls. Six items (low blood pressure, tinnitus, increased odor sensitivity, low pain threshold, and perfectionism) were similar between the two groups. The treatment agents currently used did not have any effect on the signs and symptoms of FS.

Conclusion

This study showed that FS might be associated with MS. Injectable or oral agents are not related to the signs and symptoms of FS. Further studies are needed to validate this association.

Relevance of the article for predictive preventive and personalized medicine

FS is common among MS patients. Being aware of this incidence that might impair the life quality of MS patients is useful to predict the comorbidity and develop preventive strategies and applying personalized treatment options and procedures.

The Relationship between Cold Hypersensitivity in the Hands and Feet and Health-Related Quality of Life in Koreans: A Nationwide Population Survey

Aim

We investigated the distribution of cold hypersensitivity in the hands and feet (CHHF) and examined the association between CHHF and health-related quality of life (HRQOL) among Koreans.

Methods

Stratified multistage sampling was used for random selection of 2,201 adults. HRQOL was assessed using the Short-Form 12-Item Health Survey (SF-12). Cold hypersensitivity was measured using a new self-report questionnaire to score the extent of cold sensation in their hands, feet, and abdomen using a 7-point scale. The correlation between CHHF and HRQOL was analysed using multiple regression analysis.

Results

Cold hypersensitivity was present in the hands of 21.6%, the feet of 23.0%, and the abdomen in 22.5% of participants. Cold hypersensitivity in the hands and feet was observed in 17.9%, at least one body part (hands, feet, or abdomen) in 34.2%, and all three body regions in 12.3% of participants. The prevalence of cold hypersensitivity was significantly higher among women than among men, irrespective of the involved body part. Cold hypersensitivity scores in the hands and feet correlated negatively with body mass index, but not with age. The physical component summary (PCS) and mental component summary (MCS) of the SF-12 were both significantly lower in women with than in those without CHHF. Among men, only the PCS was significantly lower in the CHHF group. Multiple regression analysis, adjusted for sociodemographic variables, age, sex, and body mass index (BMI), confirmed that CHHF had negative effects on PCS and MCS.

Conclusions

CHHF is more common in women and in individuals with a lower BMI. CHHF has an independent negative effect on HRQOL.

Are cold extremities an issue in women's health? Epidemiological evaluation of cold extremities among Japanese women

Background

Unlike traditional East Asian medicine, the necessity of health care services for cold extremities is yet to be acknowledged in Western medicine. In this study, we aimed to conduct an epidemiological evaluation of this unremarkable symptom among women in Japan.

Materials and methods

A cross-sectional study was conducted from February 2016 to April 2017, and data of 238 women throughout Japan were analyzed. Questionnaires were used to examine participants’ demographics, health-related behaviors, health status, and frequency of subjective symptoms over the past 1 year. The association between cold extremities and other subjective symptoms was examined by the multiple logistic regression analysis.

Results

The prevalences of mild and severe cold extremities were 49.6% and 35.3%, respectively. Temperature and utilization of health care services were not significantly different by the severity of cold extremities. The accompanying symptoms that were significantly associated with the cold extremities were shoulder stiffness, fatigue, low back pain, headache, nasal congestion, itching, injury, and difficulty hearing. After multiple logistic regression analysis, low back pain (OR: 4.91) and difficulty hearing (OR: 4.84) kept the significance. Factors related to cold extremities including mental quality of life, sleep quality, and habitual drinking were significantly associated with other accompanying symptoms.

Conclusion

Women with cold extremities have various accompanying symptoms and health-risk behaviors. Symptomatic treatment for cold extremities may not be sufficient, and comprehensive care would be required.