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Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Objectives To examine the efficacy of weekly and bi-weekly heat training to maintain heat acclimatization (HAz) and heat acclimation (HA) for 8 weeks in aerobically trained athletes. Design Randomized, between-group. Methods Twenty-four males (mean [m ± standard deviation [sd]; (age, 34 ± 12 y; body mass, 72.6 ± 8.8 kg, VO2peak, 57.7 ± 6.8 mL·kg-1·min-1) completed five trials (baseline, following HAz, following HA (HAz + HA), four weeks into heat training [HTWK4], and eight weeks into HT [HTWK8] that involved 60 min of steady-state exercise (59.1 ± 1.8% vVO2peak) in an environmental laboratory (wet bulb globe temperature [WBGT], 29.6 ± 1.4 °C) on a motorized treadmill. Throughout exercise, heart rate (HR) and rectal temperature (Trec) were recorded. Following HAz + HA, participants were assigned to three groups: control group (HT0), once per week heat training (HT1), and twice per week heat training (HT2). HT involved heated exercise (WBGT, 33.3 ± 1.3 °C) to achieve hyperthermia (38.5-39.75 °C) for 60 min. Repeated measures ANOVAs were used to determine differences. Results HAz + HA resulted in significant improvements in HR (p Conclusions Bi-weekly HT provided clear evidence for the ability to maintain physiological adaptions for 8 weeks following HA.

Background. Hyperthermia causes cerebral dama­ge by three mechanisms: cellular, local and systemic. The aim of this research was to study the effectiveness of controlled normothermia in a complex of intensive care in patients with traumatic brain injury (TBI) complicated by the development of hyperthermia of central origin refractory to pharmacological therapy, assessing its effect on the rate of neurologic recovery and the level of mortality. Materials and methods. Sixty patients (mean age 41.05 ± 12.90 years) with a diagnosis of severe TBI, who were treated in the trauma intensive care unit of I.I. Mechnikov Dnipropetrovsk Regional Clinical Hospital. Patients were divided into 4 groups. Group I (n = 15) — controlled normothermia using Blanketrol II (CSZ, USA) in patients with a fever of 38.3–39.5 °C, to achieve the target body temperature — 37 °C; group II (n = 15) — induction of cooling by 4 °C infusion of Ringer’s lactate solution at a dose of 20–23 ml/kg was carried out, followed by maintenance of controlled normothermia with Blanketrol II, in patients with a temperature of ≥ 39.5 °C, to achieve the target body temperature — 37 °C; group III (n = 15) — patients with hyperthermia of 38.3–39.5 °C, with standard intensive care; group IV (n = 15) — patients with hyperthermia ≥ 39.5 °C, with standard intensive care. All patients were evaluated the dynamics of neurological status on the Glasgow Coma Scale (GCS), the duration of the mechanical ventilation of the lungs (MVL). The outcomes of the previous TBI were determined on the basis of the Cerebral Performance Categories (CPC) scale on the 28th day of the study. Results. In group I (38.98 ± 0.28 °C) and group III (38.94 ± 0.27 °C), there were no significant differences in the level of initial hyperthermia. There was a tendency for a deeper neurological deficit initially in group I compared with group III of patients: 6.26 ± 0.77 points and 6.60 ± 0.71 points on the GCS, respectively. On the contrary, the group II of patients had significantly more deeper level of neurological deficit on the baseline (GCS 5.33 ± 0.47 points, p < 0.05), compared with patients of group IV (GCS 5.66 ± 0.47 points). When analyzing the duration of MVL, there were no significant differences between group I (10.86 ± 9.49 days) and group III (10.26 ± 4.13 days). The tendency of longer MVL in the group IV (25.53 ± 8.09 days) was revealed in comparison with the patients of the group II (18.86 ± 8.39 days).The level of mortality in the group I was 20 %, in group III — 13.3 %, in group II — 33.3 %, in group IV — 46.7 %, but the diffe­rences were also not significant. When analyzing the neurological outcome on the 28th day using the CPC scale, there was a tendency to improve outcomes in group I (2.20 ± 1.27 points) as compared to patients of group III (2.86 ± 1.08 points). On the contrary, there was a significant improvement in neurological outcomes in group II (2.60 ± 1.40 points) compared with group IV patients (3.66 ± 1.49 points). We did not detect clinically significant side effects of the proposed variants of controlled normothermia. Conclusions. The proposed method of controlled normothermia creates more favourable conditions for a more complete restoration of disturbed neurological functions after severe traumatic brain injury.

Background. Hyperthermia causes cerebral injury and worsens neurological outcomes in severe traumatic brain injury (TBI). The aim of the work was to study neurological outcomes in patients with severe TBI and refractory hyperthermia, while providing the target temperature management (TTM) with using an esophageal cooling device in the intensive care as compared to the control group. Materials and methods. Twenty patients aged 23 to 54 years with a diagnosis of severe TBI were examined. They were divided into 2 groups: I (n = 10) — these patients underwent a standard intensive care based on the international guidelines for the management of severe head injury (2007, 2016); II group (n = 10) — the TTM was carried out with the help of the Blanketrol II (CSZ, USA) and invasive technology ­using the Esophageal Cooling Device (ACT, USA) to achieve normothermia in the range of 36.5–37 C. The indication for the use of TTM was the development of febrile and hectic fevers of non-infectious origin in patients with TBI. The trigger for the start of TTM was hyperthermia ≥ 38.3 C, which can not be ameliorated by pharmacological correction with antipyretics. The TTM was performed to achieve the target value of the body’s normothermia. Exclusion criterion from the study was a neurological deficit ≤ 4 on the Glasgow Coma Scale (GCS). All patients were assessed neurological status on the GCS at the stages: initially, on days 5, 10 and at the time of discharge from the hospital. The outcomes of the TTM were determined on the scale of Cerebral Performance Categories (CPC) at the stages: the maximum score when in the ICU and at the time of discharge. Results. There were no deaths in any group of patients examined. An analysis of the dynamics of neurologic recovery at the time of discharge from the hospital showed a significant improvement in the group of patients using TTM on the GCS in comparison with control group. During the analysis of poor outcomes, in the group using TTM, a decrease in the severity of neurologic damage was revealed compared to the control group of patients. Thus, the most unfavorable outcome of severe TBI as a delay of neurologic recovery at the level of the apallic syndrome or akinetic mutism of the corresponding CPC-4 in the first group developed in 30 % of patients, while in the second group — in no patient. We did not find any clinically significant side effects when using the Esophageal Cooling Device. It should be emphasized that factors limiting the application of the Esophageal Cooling Device for the purpose of arresting hyperthermia of the central origin have been identified, such as the inability to conduct enteral nutrition and the lesser accuracy of monitoring the body temperature when using a rectal sensor. Limitations of this study are a small sample of patients and heterogeneity of traumatic brain injury, which requires additional studies. Conclusions. An analysis of the dynamics of neurologic recovery after severe TBI at the time of discharge from the hospital showed a significant improvement in the group of patients using the TTM of 13.50 ± 1.36 points on the GCS in comparison with 11.50 ± 1.80 points in the control group (p < 0.05). Accor­ding to the best scores on the scale of outcomes of the CPC when in the ICU, a good neurologic recovery was achieved in 20 and 50 % of the corresponding CPC 1–2, and a poor neurologic recovery at the level of the CPC 3–4 was found in 70 and 50 % of patients in the control group and the main group with the application of TTM, respectively. At the discharge from the hospital, neurologic recovery at the level of CPC 1–2 was detected in 30 compared to 80 %, and at the level of CPC 3–4 — in 70 and 20 % of patients in the control and TTM group, respectively. Intergroup differences in mean values on the scale of the CPC at the time of discharge from the hospital were reliable: 2.90 ± 0.94 and 2.00 ± 0.77 (P = 0.02) in the control and TTM groups, respectively. The use of target temperature management to maintain normothermia creates more favorable conditions for a more complete restoration of impaired neurological functions after severe TBI.

The long-term survival of advanced-stage ovarian cancer patients remains poor, despite extensive cytoreductive surgery, chemotherapy, and the recent addition of poly (ADP-ribose) polymerase inhibitors (PARPi). Hyperthermic intraperitoneal chemotherapy (HIPEC) has shown survival benefit by specifically targeting peritoneal metastases, the primary site of disease recurrence. Different aspects of how HIPEC exerts its effect remain poorly understood. Improved understanding of the effects of hyperthermia on ovarian cancer cells, the synergy of hyperthermia with intraperitoneal chemotherapy, and the pharmacological and pharmacokinetic properties of intraperitoneally administered cisplatin may help identify ways to optimize the efficacy of HIPEC. This review provides an overview of these translational and pharmacological principles of HIPEC and aims to expose knowledge gaps that may direct further research to optimize the HIPEC procedure and ultimately improve survival for women with advanced ovarian cancer.

Supplemental Digital Content is available in the text., Background and importance Previous studies found that septic patients with normothermia have higher mortality than patients with fever. We hypothesize that antibiotic therapy is less frequently initiated if infectious patients present with normothermia to the emergency department (ED). Objectives To examine the association of body temperature with the initiation of antibiotic therapy in patients attending the ED with suspected and proven infection. Additionally, the association of temperature with 30-day mortality was assessed. Design, settings and participants We conducted a retrospective cohort study between 2012 and 2016 at a tertiary university hospital. Adult patients attending the ED with a blood culture taken (i.e. suspected infection) and a positive blood culture (i.e. proven bacteremia) were included. Exposure Tympanic temperature at arrival was categorized as hypothermia (38.0°C). Outcome measures and analysis Primary outcome was the initiation of antibiotic therapy. A secondary outcome was 30-day mortality. Multivariable logistic regression was used to control for covariates. Main results Of 5997 patients with a suspected infection, 45.8% had normothermia, 44.6% hyperthermia and 5.6% hypothermia. Patients with hyperthermia received more often antibiotic therapy (53.5%) compared to normothermic patients (27.6%, adjusted odds ratio [95% confidence interval], 2.59 [2.27–2.95]). Patients with hyperthermia had lower mortality (4.7%) than those with normothermia (7.4%, adjusted odds ratio [95% confidence interval], 0.50 [0.39–0.64]). Sensitivity analyses in patients with proven bacteremia (n = 934) showed similar results. Conclusion Normothermia in patients presenting with infection was associated with receiving less antibiotic therapy in the ED compared to presentations with hyperthermia. Moreover, normothermia was associated with a higher mortality risk than hyperthermia.

This study sought to compare the brachial and carotid hemodynamic response to hot water immersion (HWI) between healthy young men and women. Ten women (W) and 11 men (M) (24 ± 4 yr) completed a 60-min HWI session immersed to the level of the sternum in 40°C water. Brachial and carotid artery hemodynamics (Doppler ultrasound) were measured at baseline (seated rest) and every 15 min throughout HWI. Within the brachial artery, total shear rate was elevated to a greater extent in women [+479 (+364, +594) s−1] than in men [+292 (+222, +361) s−1] during HWI ( P = 0.005). As shear rate is inversely proportional to blood vessel diameter and directly proportional to blood flow velocity, the sex difference in brachial shear response to HWI was the result of a smaller brachial diameter among women at baseline ( P < 0.0001) and throughout HWI (main effect of sex, P < 0.0001) and a greater increase in brachial velocity seen in women [+48 (+36, +61) cm/s] compared with men [+35 (+27, +43) cm/s] with HWI ( P = 0.047) which allowed for a similar increase in brachial blood flow between sexes [M: +369 (+287, +451) mL/min, W: +364 (+243, +486) mL/min, P = 0.943]. In contrast, no differences were seen between sexes in carotid total shear rate, flow, velocity, or diameter at baseline or throughout HWI. These data indicate the presence of an artery-specific sex difference in the hemodynamic response to a single bout of HWI.

BACKGROUND An increasing number of studies report the beneficial effects of regional hyperthermia in association with chemotherapy (CHT) and radiotherapy for the treatment of pancreatic cancer; in particular, the use of modulated electro-hyperthermia (mEHT) results in increased survival and tumor response. AIM To compare outcomes of CHT alone or in association with mEHT for the treatment of stage III and IV pancreatic cancer. METHODS This was an observational retrospective study; data were collected for patients with stage III-IV pancreatic cancer that were treated with CHT alone or in combination with mEHT from 2003 to 2019. A total of 158 patients were included in the study out 270 patients screened in four Italian hospitals; 58 (37%) of these received CHT + mEHT and 100 (63%) CHT. CHT was mainly gemcitabine-based regimens in both groups. RESULTS Overall (19.5 mo vs 11.02 mo, P < 0.001) and progression-free (12 mo vs 3 mo, P < 0.001) survival were better for the CHT + mEHT group compared to the CHT group. The association of mEHT resulted also in an improvement of tumor response with disease control rate 95% vs 58% (P < 0.001) at 3 mo. Toxicity was comparable in the two study groups, and mEHT related adverse events were limited in 8 patients presenting G1-2 skin burns. CONCLUSION The addition of mEHT to systemic CHT improved overall and progression-free survival and local tumor control with comparable toxicity.

Background. In view of the worsening forecast for global temperature rise worldwide, it seems relevant to study the effects of abnormal heat waves on systemic regulatory processes in people with chronic diseases, in particular coronary artery disease (CAD).Aims. This study aimed to investigate the effect of hyperthermia on oxidative stress parameters in patients with various severity of CAD and in healthy subjects.Materials and methods. We studied the level of malonic dialdehyde (MDA) and the activity of Cu,Zn-containing superoxide dismutase (Cu,Zn-SOD) in healthy subjects under conditions of 30-day long simulated hyperthermia and in patients with different severity of CAD after the summer heat wavesResults. We revealed signs of oxidative stress in healthy volunteers during model hyperthermia that manifested as an increase in content of MDA in blood plasma. At the same time we observed increasing activity of Cu,Zn-SOD in erythrocytes that utilizes reactive oxygen species. The increase of Cu,Zn-SOD activity started with a certain latency what also can be explained by de novo enzyme biosynthesis induction. We also studied oxidative stress parameters in patients at high and moderate cardiovascular risk according to the SCORE risk chart with uncomplicated CAD course and in patients with complicated CAD with severe coronary damage according to angiography during the summer heat waves. We observed accumulation of MDA in blood plasma and increasing activity of erythrocyte Cu,Zn-SOD in patients with uncomplicated CAD. At the same time we noted that accumulation of MDA in blood plasma was not followed by any increase in activity of red blood cell Cu,Zn-SOD in patients with severe complicated CAD. This fact indicates dysregulation of free radical processes in patients with severe course of CAD during the heat waves.Conclusions. The dysregulation of free-radical processes in patients with a severe clinical course of CAD has been revealed.

Hyperthermia increased the core human body temperature above normal 36.7-37.5 °C, usually caused by infection, resulting in fever, and was the most common manifestation. One of the efforts that could be done to overcome the symptoms of hyperthermia was the application of warm compresses to the frontal, axillary, and dorsalis pedis. The study aimed to describe body temperature changes in hyperthermic patients after warm compress was applied. This study used a descriptive design with a literature review approach. Twelve articles were included in this review by six journal databases: PubMed, JSTOR, Wiley Online Library, Sage Journal, Taylor and Francis Online, and Google Scholar. The selection was carried out by assessing articles that met the inclusion criteria, including the publication range for 2008-2021, English and Indonesian languages ??, and open access to full-text pdf. The critical assessment was carried out by using the Critical Appraisal Skills Programmed instrument. The review results showed that the warm compress method had a positive effect in lowering body temperature in the nursing process in patients with hyperthermia. Based on the literature from the reviewed articles, it could be concluded that a warm compress intervention needed to be given to hyperthermic patients to lower the patient's body temperature whether they were undergoing treatment or not

Heating cancer cells over an extended period of time, referred to as hyperthermia, has been proven to enhance the effects of chemotherapy and radiotherapy without inducing additional toxicity or undesirable side effects, and is therefore considered a highly valuable adjuvant therapy in cancer treatment. In this work, a model predictive control (MPC) setup is developed for improving performance and robustness in regulating the temperature for magnetic-resonance-guided high-intensity focused ultrasound (MR-HIFU) hyperthermia treatments. The proposed control design incorporates a disturbance estimator as encountered in offset-free MPC that is able to remove the steady-state temperature error caused by plant-model mismatch. For the considered healthcare application, such modeling errors are inevitable in practice due to the high variability of tissue properties in patients, some of which even exhibit time- and temperature-dependent behavior due to the body's thermoregulatory response, combined with the fact that extensive model identification is undesirable in the clinic. The controller's performance is demonstrated by means of in vivo experiments on a porcine thigh muscle using a clinical MR-HIFU treatment setup.

Non-invasive monitoring of temperature elevations inside tumor tissue is imperative for the oncological thermotherapy known as hyperthermia. In the present study, two cancer patients, one with a developing right renal cell carcinoma and the other with pseudomyxoma peritonei, underwent hyperthermia. The two patients were irradiated with radiofrequency current for 40 min during hyperthermia. We report the results of our clinical trial study in which the temperature increases inside the tumor tissues of patients with right renal cell carcinoma and pseudomyxoma peritonei induced by radiofrequency current irradiation for 40 min could be detected by statistical analysis of ultrasonic scattered echoes. The Nakagami shape parameter m varies depending on the temperature of the medium. We calculated the Nakagami shape parameter m by statistical analysis of the ultrasonic echoes scattered from the tumor tissues. The temperature elevations inside the tumor tissues were expressed as increases in brightness on 2-D hot-scale maps of the specific parameter αmod, indicating the absolute values of the percentage changes in m values. In the αmod map for each tumor tissue, the brightness clearly increased with treatment time. In quantitative analysis, the mean values of αmod were calculated. The mean value of αmod for the right renal cell carcinoma increased to 1.35 dB with increasing treatment time, and the mean value of αmod for pseudomyxoma peritonei increased to 1.74 with treatment time. The increase in both αmod brightness and the mean value of αmod implied temperature elevations inside the tumor tissues induced by the radiofrequency current; thus, the acoustic method is promising for monitoring temperature elevations inside tumor tissues during hyperthermia.

BACKGROUND The EORTC 62961-ESHO 95 randomised trial showed improved long-term survival of patients with high-risk soft-tissue sarcoma by adding regional hyperthermia to neoadjuvant chemotherapy. We hypothesised that immune infiltrate of patients treated with neoadjuvant therapy associate with clinical outcome. METHODS Tumour infiltrating lymphocytes (TILs) and CD8, FOXP3, PD-1, and PD-L1 were evaluated in sequential biopsies of patients after four cycles of therapy. RESULTS From a subgroup of 109 patients who had been randomised between July 1997 and November 2006 to neoadjuvant chemotherapy (53 patients) or neoadjuvant chemotherapy with regional hyperthermia (56 patients), 137 biopsies were obtained. TILs increased in paired second biopsies independent of treatment allocation (p��

Hyperthermia causes hyperventilation and concomitant hypocapnia and cerebral hypoperfusion. The cerebral hypoperfusion may underlie central fatigue. We demonstrate that sodium bicarbonate ingestion reduces heat-induced hyperventilation and attenuates hypocapnia-related cerebral hypoperfusion during prolonged exercise in the heat. In addition, we show that sodium bicarbonate ingestion reduces ratings of perceived exertion during the exercise. This study provides new insight into the development of an effective strategy for preventing central fatigue during exercise in the heat.

Background Malignant hyperthermia (MH) is a rare and potentially life-threatening pharmacogenetic disorder encountered during general anesthesia, with the incidence higher in children than in adults. Dantrolene is the specific antagonist of MH, but it is not readily available in China, thus developing alternative treatment protocols is of great practical importance. Case Presentation Herein, the authors report a two-month-old infant who underwent holmium laser epiglottis retrofitting through a bronchoscope, but developed limb muscular stiffness, tachypnea, tachycardia, and hyperthermia after sevoflurane exposure. After the diagnosis of MH, corresponding supportive treatment was implemented. Because there was no dantrolene available, continuous blood purification and mechanical ventilation were performed. A few days later, the boy recovered without any complications. Conclusion Based on the authors’ successful clinical practice, the authors consider continuous blood purification as a reliable treatment for MH. But its feasibility still needs to be clarified after multicenter clinical observations.

Currently, approaches to the choice of treatment tactics for cervical cancer have changed significantly. According to the recommendations of ESGO (2018), RUSSCO (2020), the use of a combination of surgical treatment and radiation therapy significantly increases the incidence of complications. Therefore, when planning the treatment of patients with IB1–IIA1, a combination of surgical treatment and radiation therapy should be avoided. The article presents an analysis of modern approaches to the treatment of initial, locally advanced and advanced cervical cancer. Modern approaches to organ-preserving treatment are considered, including the view from the point of view of expanding the indications for trachelectomy as part of combined treatment. The question of the expediency of using hyperthermia and indications for this type of treatment in combination with radiation therapy is considered. The author presents his own view of the problem as a whole and possible ways to solve this problem.

Background: The purpose of this study was to investigate effects of heat acclimatization (HAz) followed by heat acclimation (HA), and intermittent heat training (IHT) on time-trial performance. Hypothesis: Time-trial performance will improve after HA and will further improve with twice a week of IHT. Study Design: Interventional study. Level of Evidence: Level 3. Methods: A total of 26 male athletes (mean ± SD; age, 35 ± 12 years; body mass, 72.8 ± 8.9 kg; peak oxygen consumption [VO2peak], 57.3 ± 6.7 mL·kg−1·min−1) completed five 4-km time trials (baseline, post-HAz, post-HA, post-IHT4, post-IHT8) in the heat (ambient temperature, 35.4°C ± 0.3°C; relative humidity, 46.7% ± 1.2%) on a motorized treadmill. After baseline time trial, participants performed HAz (109 ± 10 days) followed by post-HAz time trial. Then, participants completed 5 days of HA, which involved exercising to induce hyperthermia (38.50°C-39.75°C) for 60 minutes. Participants were then divided into 3 groups and completed IHT either twice per week (IHTMAX), once per week (IHTMIN), or not at all (IHTCON) over an 8-week period. The exercise used for the IHT matched the HA. Four-kilometer time trials were performed after 4 weeks (post-IHT4) and 8 weeks of IHT (post-IHT8). Results: Time trial was faster in post-HA (17.98 ± 2.51 minutes) compared with baseline (18.61 ± 3.06 minutes; P = 0.037) and post-HAz (18.66 ± 3.12 minutes; P = 0.023). Percentage change in time trial was faster in IHTMAX (−3.9% ± 5.2%) compared with IHTCON (11.5% ± 16.9%) ( P = 0.020) and approached statistical significance with large effect (effect size = 0.96) compared with IHTMIN (1.6% ± 6.2%; P = 0.059) at post-IHT8. Additionally, IHTMAX (−2.2% ± 4.2%) was faster than IHTCON (3.6% ± 6.9%) ( P = 0.05) at post-IHT4. Conclusion: These results indicate that HA after HAz induces additional improvement in time-trial performance. IHT twice per week shows improvement after 8 weeks, while once per week maintains performance for 8 weeks. No IHT results in a loss of adaptations after 4 weeks and even greater losses after 8 weeks. Clinical Relevance: HA after HAz improves time-trial performance, twice a week of IHT improves performance further, and once a week of IHT maintains performance for at least 8 weeks.

BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) is commonly used to treat peritoneal surface malignancies. We aimed to identify risk factors of intraoperative patient hyperthermia and the postoperative outcome of adults undergoing HIPEC PATIENTS AND METHODS: A retrospective, IRB approved, single center cohort study was conducted. Adults treated with cytoreductive surgery and HIPEC between 2006 and 2021 were included. The primary outcome was bladder hyperthermia during perfusion, stratified by severity and duration. Secondary outcomes were postoperative complications and recurrence-free (RFS) and overall (OS) survival. Multivariable logistic regression models were fit to estimate the effects of important covariates. RESULTS Out of 214 patients, 114 had mild hyperthermia (≥ 38 °C) at any time, and in 73 of these it lasted for ≥ 30 min. Independent prognostic factors of mild hyperthermia ≥ 30 min were age (OR = 0.958, 95% CI 0.933-0.984), body mas index (BMI; OR = 0.959 95% CI 0.917-1.002), gender (OR = 0.199, 95% CI 0.092-0.431), and type of chemotherapy [cisplatin versus mitomycin (OR = 0.186, 95% CI 0.070-0.491; oxaliplatin versus mitomycin (OR = 0.430, 95% CI 0.163-1.139)]. Prognostic factors of moderate-to-severe hyperthermia (≥ 39 °C) at any time were perfusion duration (OR = 1.094, 95% CI 1.018-1.177) and blood transfusion (OR = 5.689, 95% CI 1.784-18.137). Intraoperative hyperthermia was not associated with increased postoperative complications but was associated with better RFS and OS. CONCLUSIONS Our study demonstrates age, gender, BMI, and chemotherapy type to be associated with hyperthermia ≥ 38 °C for ≥ 30 min, whereas longer perfusion time and blood transfusion were associated with hyperthermia ≥ 39 °C. Mild hyperthermia at the end of perfusion is associated with better RFS and OS.

В лекції наведені етіологія, патогенез, патофізіологія, клініка та лікування основних гіпертермічних синдромів. Серед гіпертермічних синдромів на догоспітальному етапі найчастіше виникають стан помірної тяжкості — теплове виснаження (температура ядра тіла < 39–40 °С) та найтяжча форма — тепловий інсульт (тепловий удар — температура ядра тіла > 40 °С). У стаціонарі нерідко зустрічається медикаментозно індукована гіпертермія, і найбільш важливими для анестезіолога її формами є: злоякісна гіпертермія, нейролептичний злоякісний синдром та серотоніновий синдром. Первинне пошкодження тканин у разі розвитку теплового удару зумовлюється прямим пошкодженням клітин організму температурою тіла вище 42 °С. За такої температури порушується функція мітохондрій з розвитком внутрішньоклітинного енергодефіциту. Це, в свою чергу, призводить до порушення ферментативних реакцій, передусім тих, що відповідають за підтримку внутрішньоклітинного електролітного гомеостазу, і, як результат, порушуються внутрішньоклітинний іонний гомеостаз, мембранний потенціал і функція клітин. Цей цитотоксичний ефект надмірно підвищеної температури поширюється практично на всі органи і тканини, виникає поліорганна дисфункція. Такі прояви надмірної гіпертермії, як дегідратація, метаболічний ацидоз, гіпоксія, посилюють гіпертермічні пошкодження тканин, може розвиватися поліорганна недостатність. Основними компенсаторно-захисними функціями організму при надмірній гіпертермії є підвищення потовиділення, вазодилатація судин шкіри і підвищення серцевого викиду, проте при тепловому інсульті настає їх декомпенсація. При цьому прогресують порушення гемодинаміки, наростає напруження симпатоадреналової системи, яка тимчасово забезпечує перфузію життєво важливих органів. Для попередження розвитку незворотних змін слід вчасно надати першу допомогу — припинити дію чинника, що викликає надмірну гіпертермію. Лікування включає застосування фізичних методів охолодження, регідратацію та підтримку життєво важливих функцій організму, тобто інтенсивну терапію.

Background Peritoneal metastases carry the worst prognosis among all sites of colorectal cancer (CRC) metastases. In recent years, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for selected patients with limited peritoneal involvement. We report the evolution of CRS and HIPEC for colorectal peritoneal metastases at a tertiary referral center over a 10-year period. Methods Patients with colorectal peritoneal metastases undergoing CRS and HIPEC were included and retrospectively analyzed at a tertiary referral center from January 2006 to December 2015. Main outcomes included evaluation of grade III/IV complications, mortality rate, overall and disease-free survival, and prognostic factors influencing survival on a Cox multivariate analysis. Results Sixty-seven CRSs were performed on 67 patients during this time for colorectal peritoneal metastases. The median patient age was 57 years with 55.2% being female. The median peritoneal carcinomatosis index (PCI) was 7, with complete cytoreduction achieved in 65 (97%) cases. Grade > 2 complications occurred in 6 cases (8.9%) with no mortality. The median overall survival for the entire cohort was 41 months, with a 3-year overall survival of 43%. In case of complete cytoreduction, median overall and disease-free survival were 57 months and 36 months respectively, with a 3-year disease-free survival of 62%. Complete cytoreduction and nonmucinous histology were key factors independently associated with improved overall survival. Conclusions CRS and HIPEC for limited peritoneal metastases from CRC are safe and effective, with acceptable morbidity. In selected patients, it offers a highly favorable long-term outcomes.

Background In patients with acute neurological injury, abrupt temperature change exacerbates increased intracranial pressures and negatively affects perfusion pressure and cerebral blood flow. Critical care nurses must provide coordinated and effective interventions to maintain normothermia without precipitating shivering immediately after acute neurological injury in pediatric patients. Objective To improve hyperthermia management in a 40-bed pediatric intensive care unit, an interdisciplinary pediatric critical care team developed, implemented, and evaluated a targeted temperature management protocol. Methods The project was guided by the organization’s plan-do-study-act quality improvement process. Quality improvement was assessed retrospectively using electronic medical records of patients meeting eligibility criteria. Samples of pediatric patients who received temperature interventions were compared before and after protocol implementation. The protocol included environmental, pharmacological, and body surface cooling device interventions, as well as use of a bedside shivering assessment scale and stepwise interventions to prevent and control shivering. Results Before implementation of the targeted temperature management protocol, 64% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 10% of patients. After protocol implementation, more than 80% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 62% of patients. Four patients (6%) before and 5 patients (31%) after protocol implementation were treated with body surface cooling without requiring use of neuromuscular blockade. Conclusions Creation and implementation of a targeted temperature management protocol increased nurses’ documented use of body surface cooling to manage hyperthermia in pediatric intensive care unit patients with acute neurological injury.

Актуальность. Постгипоксическое повреждение центральной нервной системы часто сопровождается полиорганной дисфункцией, персистирующим неврологическим дефицитом и может осложниться центральной гипертермией. Целью данного исследования было проанализировать литературные данные о методах лечения гипертермии центрального генеза и предложить стратегию отлучения от респираторной терапии у такого пациента. Материалы и методы. Поиск литературных источников проводился в базах данных PubMed и MedLine за последние 13 лет. Поисковыми словами были «гипертермия центрального генеза» и «отлучение от искусственной вентиляции легких у детей с постгипоксической энцефалопатией». Наблюдение и лечение пациента осуществлялись на клинической базе кафедры анестезиологии и интенсивной терапии Львовского национального медицинского университета имени Данила Галицкого в отделении анестезиологии с койками интенсивной терапии КНП «Львовская областная клиническая больница «ОХМАТДЕТ» в сентябре — октябре 2018 года. Результаты. У ребенка в возрасте 7 мес. после перенесенной клинической смерти и успешного восстановления спонтанного кровообращения развились постгипоксическая энцефалопатия, синдром полиорганной дисфункции и гипертермия центрального генеза. Это привело к росту минутной вентиляции легких, тахикардии и, соответственно, проблеме с отлучением от респираторной поддержки. Кроме того, у пациента был клинически значимый гипертонус мышц нижних конечностей с постоянным спонтанным разведением в тазобедренных суставах более 180°. В лечение был добавлен баклофен в дозе 0,3 мг/кг/сут per os, которая через 7 дней была увеличена до 0,6 мг/кг/сут. На 3-и сутки с момента назначения баклофена температура тела стала стабильно ниже 38 °C, на 5-е сутки не превышала 37,5 °C. Отлучение от искусственной вентиляции легких проводилось поэтапно — от принудительно-вспомогательного режима искусственной вентиляции легких с постепенным снижением параметров поддержки до вспомогательного режима с ежедневным увеличением интервала спонтанного дыхания пациента без респираторной поддержки, начиная от 2–4 ч в дневной период времени в течение 2–3 дней и перехода к плановой вспомогательной вентиляции только в ночное время и полному отлучению от вспомогательной вентиляции. Полное отлучение от искусственной вентиляции легких произошло на 7-е сутки с момента назначения баклофена. Выводы. Контроль над лихорадкой у пациентов, перенесших повреждения центральной нервной системы, может улучшить результаты лечения, особенно если будут разработаны более эффективные стратегии мониторинга и лечения гипертермии.

PURPOSE Chordoma is a locally aggressive tumor that most commonly affects the base of the skull/clivus, cervical, and sacral spine. Conventional radiotherapy (RT), cannot be safely increased further to improve disease control due to the risk of toxicity to the surrounding critical structures. Tumor-targeted hyperthermia (HT) combined with Proton Beam Radiation Therapy (PBRT) is known to act as a potent radiosensitizer in cancer control. In this study, we investigated whether PBRT efficacy for chordoma can be enhanced in combination with HT as a radiosensitizer. MATERIAL AND METHODS Human chordoma cell lines, U-CH2 and Mug-chor1 were treated in vitro with HT followed by PBRT with variable doses. The colony-forming assay was performed, and dose-response was characterized by linear-quadratic model fits. HSP-70 and Brachyury (TBXT) biomarkers for chordoma aggression levels were quantified by western blot analysis. Gene microarray analysis was performed by U133 Arrays. Pathway Analysis was also performed using IPA bioinformatic software. RESULTS Our findings in both U-CH2 and Mug-Chor1 cell lines demonstrate that hyperthermia followed by PBRT has an enhanced cell killing effect when compared with PBRT-alone (p

Hyperthermia is defined as an elevated body temperature above the normal range due to a failure of heat regulatory mechanisms. In addition to its effects on other organ systems, hyperthermia is associated with profound cardiovascular effects. We report the sentinel case of a 6-year-old girl with structurally and electrically normal heart, who presented with life-threatening hyperpyrexia-induced ventricular tachycardia, which was refractory to cardioversion and anti-arrhythmics but responded promptly to cooling. We emphasise the lifesaving role of immediate and aggressive cooling in such patients.

BACKGROUND: The success of cancer hyperthermia (HT) treatments is strongly dependent on the temperatures achieved in the tumor and healthy tissues as it correlates with treatment efficacy and safety, respectively. Hyperthermia treatment planning (HTP) simulations have become pivotal for treatment optimization due to the possibility for pretreatment planning, optimization and decision making, as well as real-time treatment guidance.MATERIALS AND METHODS: The same computational methods deployed in HTP are also used for in silico studies. These are of great relevance for the development of new HT devices and treatment approaches. To aid this work, 3 D patient models have been recently developed and made available for the HT community. Unfortunately, there is no consensus regarding tissue properties, simulation settings, and benchmark applicators, which significantly influence the clinical relevance of computational outcomes.RESULTS AND DISCUSSION: Herein, we propose a comprehensive set of applicator benchmarks, efficacy and safety optimization algorithms, simulation settings and clinical parameters, to establish benchmarks for method comparison and code verification, to provide guidance, and in view of the 2021 ESHO Grand Challenge (Details on the ESHO grand challenge on HTP will be provided at https://www.esho.info/).CONCLUSION: We aim to establish guidelines to promote standardization within the hyperthermia community such that novel approaches can quickly prove their benefit as quickly as possible in clinically relevant simulation scenarios. This paper is primarily focused on radiofrequency and microwave hyperthermia but, since 3 D simulation studies on heating with ultrasound are now a reality, guidance as well as a benchmark for ultrasound-based hyperthermia are also included.

Capture myopathy (CM) is a metabolic disease associated with mortality in mass boma captured (MBC) wildlife. The condition is induced by the forced pursuit, capturing, and restraint of wild animals, although its causal biology remains to be confirmed. A core feature of MBC-CM is rhabdomyolysis, which is associated with myoglobinuria and hyperthermia. Towards developing a translational model of CM-associated rhabdomyolysis, we investigated forced treadmill running to induce physical exhaustion and trigger rhabdomyolysis in Sprague Dawley (SD) rats. Twenty-four (24) SD rats (12 per sex) were subjected to treadmill habituation in a speed-tiered approach. Forty-eight hours after the last habituation session, one strenuous exercise (SE) session was performed at 75% of the theoretical VO2MAX (30 m/min) until animals reached physical exhaustion. Core and skin surface temperatures were measured before the SE session and after rats reached exhaustion, after which a 1-h—cumulative urine sample was collected, and the myoglobin content assayed. We show that most SE, but not control-exposed (non-exercise) rats presented with myoglobinuria, while core and surface body temperatures in both male and female rats were significantly higher post-exercise. This pre-clinical model framework shows potential for investigating the pathophysiology of MBC-CM.

Aim. To assess the efficacy and safety of interventional endovascular partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis.Material and methods. From September 2019 to March 2020, 5 partial spleen embolizations were performed at the surgical clinic of the Botkin Hospital. The indication was the impossibility of conducting courses of regional chemotherapy for primary liver cancer in 2 patients with cirrhosis, portal hypertension, hypersplenism, thrombocytopenia, in 3 patients – the impossibility of conducting adequate antiviral therapy with cirrhosis as a result of chronic viral hepatitis C. The platelet count was < 25 thousand/μl (19.34 ± 1.34 thousand/μl) in all patients at the time of the procedure. The median spleen volume was 1967.54 ± 476.13 (1324.34–2163.54) cm3 . We used Progreat® Terumo 2.8 Fr microcatheter 130 cm for catheterization branches of the splenic artery. Endovascular embolization was performed with microspheres 600 ± 75 nm – 2 ml before occlusion. Computed tomography scan of abdominal cavity with intravenous contrast enhancement and laboratory test of platelet levels were performed. Follow up of patients was carried out at 1, 3 and 6 months after this intervention.Results. The postoperative period in all patients was uncomplicated. Postembolization syndrome (pain, hyperthermia) developed in the early postoperative period in all patients on the next day after the procedure. Computed tomography scan of the abdominal cavity revealed areas of an irregular shape of low density that did not accumulate a contrast agent. The duration of hospitalization was 7.63 ± 3.32 (5–11) days. There were not in-hospital and 30-day mortality in our study.Conclusion. The first experience of endovascular partial spleen embolization showed its safety and efficacy in the correction of thrombocytopenia in patients with liver cirrhosis.

OBJECTIVE To describe a population of dogs with hops toxicosis, including clinical signs observed, treatments performed, patient outcome, and overall prognosis. Clinical findings and treatment interventions were evaluated for their potential effects on outcome. This study also aims to review hops toxicosis and treatment options. DESIGN Retrospective observational study. SETTING Poison Control Center. ANIMALS Seventy-one dogs presenting for hops ingestion. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Records of 71 dogs with known hops ingestion from the ASPCA - Animal Poison Control Center (ASPCA-APCC) database and the Tufts University medical record system were reviewed. Fifty-nine (77%) of the dogs survived. The most common clinical signs on presentation were hyperthermia and tachycardia, with presenting temperatures and heart rates significantly higher in nonsurvivors. There was no significant difference between survivors and nonsurvivors in regard to signalment. Time to presentation was shorter in survivors (5.0 vs 5.5 h; P

Hepatopancreatobiliary tumors are challenging to treat, and the advanced or metastatic forms have a very low 5-year survival rate. Several drug combinations have been tested, and new therapeutic approaches have been introduced in the last decades, including radiofrequency and heat based methods. Hyperthermia is the artificial heating of tumors by various biophysical methods that may possess immunostimulant, tumoricidal, and chemoradiotherapy sensitizer effects. Both whole-body and regional hyperthermia studies have been conducted since the 1980s after the introduction of deep-seated tumor hyperthermia techniques. Results of the effects of hyperthermia in hepatocellular and pancreatic cancer are known from several studies. Hyperthermia in biliary cancers is a less investigated area. High local and overall responses to treatment, increased progression-free and overall survival, and improved laboratory and quality-of-life results are associated with hyperthermia in all three tumor types. With the evolution of chemotherapeutic agents and the introduction of newer techniques, the combination of adjuvant hyperthermia with those therapies is advantageous and has not been associated with an increase in alarming adverse effects. However, despite the many positive effects of hyperthermia, its use is still only known at the experimental level, and its concomitant utilization in routine cancer treatment is not certain because of the lack of thorough clinical studies.

Although MDMA (ecstasy) is a relatively safe recreational drug and is currently considered for therapeutic use for the treatment of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), recreational MDMA use occasionally elicits hyperthermia and hyponatremia, sometimes with a fatal outcome. Specific risk factors for both adverse effects are profuse sweating while vigorously dancing under unfavorable conditions such as high ambient temperatures and insufficient fluid suppletion which result in dehydration. Concomitant use of MDMA and alcohol is highly prevalent, but adds to the existing risk, because alcohol facilitates the emergence of MDMA-induced adverse events, like hyperthermia, dehydration, and hyponatremia. Because of potential health-related consequences of concomitant use of MDMA and alcohol, it is important to identify the mechanisms of the interactions between alcohol and MDMA. This review summarizes the main drivers of MDMA-induced hyperthermia, dehydration, and hyponatremia and the role of concomitant alcohol use. It is shown that alcohol use has a profound negative impact by its interaction with most of these drivers, including poikilothermia, exposure to high ambient temperatures, heavy exercise (vigorous dancing), vasoconstriction, dehydration, and delayed initiation of sweating and diuresis. It is concluded that recreational and clinical MDMA-users should refrain from concomitant drinking of alcoholic beverages to reduce the risk for adverse health incidents when using MDMA. Supplementary Information The online version contains supplementary material available at 10.1007/s12640-021-00416-z.

The purpose of this study was to examine the effect of heat acclimation (HA) on thirst levels, sweat rate, and percentage of body mass loss (%BML), and changes in fluid intake factors throughout HA induction. Twenty-eight male endurance athletes (mean ± SD; age, 35 ± 12 years; body mass, 73.0 ± 8.9 kg; maximal oxygen consumption, 57.4 ± 6.8 ml·kg−1·min−1) completed 60 min of exercise in a euhydrated state at 58.9 ± 2.3% velocity of maximal oxygen consumption in the heat (ambient temperature, 35.0 ± 1.3 °C; relative humidity, 48.0 ± 1.3%) prior to and following HA where thirst levels, sweat rate, and %BML were measured. Then, participants performed 5 days of HA while held at hyperthermia (38.50–39.75 °C) for 60 min with fluid provided ad libitum. Sweat volume, %BML, thirst levels, and fluid intake were measured for each session. Thirst levels were significantly lower following HA (pre, 4 ± 1; post, 3 ± 1, p p = .039) and %BML (pre, 2.66 ± 0.53%; post, 2.98 ± 0.83%, p = .049) were significantly greater following HA. During HA, thirst levels decreased (Day 1, 4 ± 1; Day 2, 3 ± 2; Day 3, 3 ± 2; Day 4, 3 ± 1; Day 5, 3 ± 1; p p = .010) and fluid intake (Day 1, 1.20 ± 0.45 L; Day 2, 1.52 ± 0.58 L; Day 3, 1.69 ± 0.63 L; Day 4, 1.65 ± 0.58 L; Day 5, 1.74 ± 0.51 L; p

We are fortunate to live in a period of accelerated technological advancement and to be able to enjoy the benefits this brings. At the same time, we are fortunate to be directly involved in this te...

Hyperthermia is a proven clinical anti-cancer treatment, used in combination with radiotherapy and/or chemotherapy. During hyperthermia, tumour tissue is heated to 40–43 °C using radiofrequency or microwave antennas, which strongly enhances effectiveness of radiotherapy and chemotherapy. Hyperthermia treatment quality depends on tumour temperatures achieved and treatment planning (i.e., simulation and optimization of absorbed power and temperature distributions) could be very useful to ensure and improve treatment quality. Hyperthermia treatment planning was mainly a research tool for decades, because of high computational costs and limited quantitative accuracy of treatment planning predictions due to a lack of patient-specific tissue properties. Thanks to developments over the past decade, treatment planning becomes increasingly important in the clinical workflow. Presently, main clinical applications of hyperthermia treatment planning are 1) applicator selection, 2) heating ability evaluation and 3) on-line treatment guidance. To improve the reliability and further increase applicability of treatment planning, ongoing developments focus on 1) dielectric imaging to derive patient-specific dielectric properties, 2) advanced thermal modelling including discrete vasculature and 3) biological modelling to predict the radiosensitizing effect of hyperthermia in terms of equivalent radiation dose. The increased clinical application and ongoing efforts will further improve treatment quality.

Background Management of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CS/HIPEC) has historically favored liberal fluid administration owing to lengthy duration of surgery and hyperthermia. This practice has been challenged in recent years with studies demonstrating improved outcomes with restrictive fluid administration. Methods Patients who underwent CS/HIPEC between March 2010 and September 2018 were included for analysis. Patients who received an above-median fluid rate (high-IVF) versus below-median fluid rate (low-IVF) were compared, and multivariate analyses were performed for length of stay, 90-day unplanned readmissions, and major complications. Results The 167 patients had a mean age of 56.7 ± 11.4 years and body mass index of 29.5 ± 6.9 kg/m2. The median rate of total intraoperative crystalloid and colloid was 7.4 mL/kg/h. The low-IVF group had less blood loss (183 vs. 330 mL, p = 0.002), were less likely to need intraoperative vasopressor drip (2.4% vs. 11.9%, p = 0.018), and experienced fewer cardiac complications (2.4% vs. 10.7%, p = 0.031), pneumonias (0% vs. 6.0%, p = 0.024), and Clavien-Dindo grade 3-5 complications (14.5% vs. 33.3%, p = 0.004). Multivariate analyses identified bowel resection (HR 4.65, p = 0.0008) as a risk factor for 90-day unplanned readmission, while bowel resection, intraoperative fluid rate, and estimated blood loss were associated with increased length of stay. Conclusion Higher intraoperative fluid intake was associated with multiple postoperative complications and increased length of stay, and represents a potentially avoidable risk factor for morbidity in CS/HIPEC.

Autophagy has a complex dual role in tumor survival or cell death owning to that is an evolutionarily conserved catabolic mechanism and provides the cells with a sustainable source of biomolecules and energy for the maintenance of homeostasis under stressful conditions such as tumor microenvironment. Hyperthermia is a rapidly growing field in cancer therapy and many advances have been made in understanding and applying the mechanisms of hyperthermia. The shallow oral and maxillofacial position and its abundant blood supply are favorable for the use of hyperthermia. However, the relationship between hyperthermia and autophagy has not been examined of oral squamous cell carcinoma (OSCC) in the tumor hypoxia microenvironment. Here, the expression level of autophagy relative genes is examined to explore autophagy effect on the responses of hyperthermia, hypoxia, and innutrition tumor microenvironment. It is founded that hyperthermia and hypoxia cause autophagy in starvation conditions; further, in hypoxia and innutrition tumor microenvironment, hyperthermia combines YC-1 and 3-MA could inhibit HIF-1α/BNIP3/Beclin1 signal pathway and decrease the secretion of HMGB1; moreover, the cell apoptosis rate increases with an inhibited of cell migration capacity. Thus, the present study demonstrated that combined use of YC-1 and 3-MA might increase the death of tumor cells in physiological and hyperthermic conditions, which could be relevant with the inhibition of autophagy in OSCC tumor cells under hypoxia microenvironment in vitro, which offers new insight into the therapy of OSCC and its application in treating others study carcinomas.

Hyperthermic intraperitoneal chemotherapy (HIPEC) has been used for decades as a treatment for disseminated abdominal malignancies, including pseudomyxoma peritonei and peritoneal mesothelioma. HIPEC had been used to treat recurrent ovarian cancer only when curative options were lacking, but new data indicate that it may be suitable as a primary treatment for patients with late-stage epithelial ovarian cancer, increasing the recurrence-free time interval and improving quality of life. However, treatment can be challenging because of patient trauma from surgery, combined with the toxicity and high temperature of the chemotherapeutic agents. This article reviews HIPEC and its targeted intraoperative and postoperative management.

Objective: Organoids have recently been used as in vitro models to screen chemotherapy drugs in combination with hyperthermia treatment in colorectal cancer. Our research aimed to establish a library of patient-derived colorectal cancer organoids to evaluate synergism between chemotherapy drugs and hyperthermia; validate an index of the hyperthermia chemotherapy sensitization enhancement ratio (HCSER) to identify the chemotherapeutics most enhanced by hyperthermia; and recommend chemotherapy drugs for hyperthermic intraperitoneal treatment. Methods: Organoids were grown from cells extracted from colorectal cancer patient samples or colorectal cancer cell lines. Cells from both sources were encapsulated in 3D Matrigel droplets, which were formulated in microfluidics and phase-transferred into identical cell-laden Matrigel microspheres. The microspheres were seeded in 96-well plates, with each well containing a single microsphere that developed into an organoid after 7 days. The organoids were used to evaluate the efficacy of chemotherapy drugs at both 37 °C as a control and 43 °C for 90 min to examine hyperthermia synergism. Cell viability was counted with 10% CCK8. Results: We successfully established a library of colorectal cancer organoids from 22 patient parental tumors. We examined the hyperthermia synergism of 7 commonly used hyperthermic intraperitoneal chemotherapy drugs. In 11 of the 22 patient organoids, raltitrexed had significant hyperthermia synergism, which was indexed as the highest HCSER score within each patient group. Conclusions: Our results primarily demonstrated the use of patient-derived colorectal cancer organoids as in vitro models to evaluate hyperthermia synergistic chemotherapeutics. We found that hyperthermia enhanced the effect of raltitrexed the most among the common anti-colorectal cancer drugs.

Objectives To investigate the effect of progressive whole-body hyperthermia on maximal, and rapid voluntary torque production, and their neuromuscular determinants. Design Repeated measures, randomised. Methods Nine participants performed sets of neuromuscular assessments in HOT conditions (∼50 °C, ∼35% relative humidity) at rectal temperatures (Tre) of 37, 38.5 and 39.5 °C and in CON conditions (∼22 °C, ∼35% relative humidity) at a Tre of ∼37 °C and pre-determined comparative time-points. Electrically evoked twitch (single impulse) and octet (8 impulses at 300 Hz) responses were measured at rest. Maximum voluntary torque (MVT), surface electromyography (EMG) normalised to maximal M-wave, and voluntary activation (VA) were measured during 3−5 s isometric maximal voluntary contractions. Rate of torque development (RTD) and normalised EMG were measured during rapid voluntary isometric contractions from rest. Results All neuromuscular variables were unaffected by time in CON. In HOT, MVT, normalised EMG at MVT and VA were lower at 39.5 °C compared to 37 °C (p 0.05), despite lower normalised EMG at Tre 39.5 °C (p Conclusions Hyperthermia reduced late-phase voluntary RTD, likely due to reduced neural drive and the reduction in MVT. In contrast, early- and middle-phase voluntary RTD were unaffected by hyperthermia, likely due to the conflicting effects of reduced neural drive but faster intrinsic contractile properties.

Surgical masks are widely used for the prevention of respiratory infections. However, the risk of heat stroke during intense work or exercise in hot and humid environment is a concern. This study aimed to examine whether wearing a surgical mask increases the risk of heat stroke during mild exercise in such environment. Twelve participants conducted treadmill exercise for 30 min at 6 km/h, with 5% slope, 35°C ambient temperature, and 65% relative humidity, while wearing or not a surgical mask (mask and control trials, respectively). Rectal temperature (Trec), ear canal temperature (Tear), and mean skin temperature (mean Tskin) were assessed. Skin temperature and humidity of the perioral area of the face (Tface and RHface) were also estimated. Thermal sensation and discomfort, sensation of humidity, fatigue, and thirst were rated using the visual analogue scale. Trec, Tear, mean Tskin, and Tface increased during the exercise, without any difference between the two trials. RHface during the exercise was greater in the mask trial. Hot sensation was greater in the mask trial, but no influence on fatigue and thirst was found. These results suggest that wearing a surgical mask does not increase the risk of heat stroke during mild exercise in moist heat.