Effects of cool resistance exercise on oxygen metabolism in muscle tissue and clinical application

Resistance training is beneficial for elite athletes and the elderly, alike. It plays a key role in healthy ageing, helping retain muscle mass, and it can also help reduce the chances of chronic diseases such as osteoporosis and high blood pressure. In order for resistance exercise to be effective, there is an ongoing need for proven techniques that can assist with their resistance training. Professor Masahiro Goto, Director of the Department of Physical Therapy, Aino University, Japan, works to understand the physiological dynamics at play during resistance exercise with a view to developing novel exercise methods and using new technologies to improve resistance exercise outcomes. A brief intramuscular hypoxic state is key to promoting muscle growth and this has therefore been a target for improving resistance techniques, but a challenge arises in terms of monitoring hypoxia. That is why Goto is looking to establish a method that can accurately, quickly and cheaply test the intramuscular oxygenation state during resistance exercise. Recognising the potential of near infrared spectroscopy (NIRS), he performed a study on volunteers who have resistance exercise carrier more than one year over eight weeks to find out whether NIRS can be used as an effective measure of internal muscular oxygenation levels and if cold pack treatment of muscles prior to exercise results in better muscle mass gain. He used electromyograms to measure muscle contraction, ultrasound to monitor changes in muscle mass and arterial oxygen saturation measurements to elucidate oxygenation levels. He found that NIRS was effective for routine monitoring of oxygen levels and that cold pack treatment during resistance exercise causes higher muscle activity and creates a more hypoxic muscular environment than without any cold treatment.

Standardizing Instructions for Ice and Cold Pack Use Can Mitigate Summer Temperatures on Two Commercially Available Outdoor Courier Lockboxes

Introduction/Objective Clinical and Laboratory Standards Institute document GP44 recommends samples avoid temperatures >22°C during sample transport and storage. Outdoor courier lockboxes used in external sample transport can experience extreme temperatures (>40°C) in the summer. Ice (frozen at -20°C) and cold (refrigerated at 4-8°C) packs can be used to reduce internal lockbox temperatures during hot summer days. Unfortunately, there are no universally accepted instructions to maintain internal lockbox temperatures during these conditions. Therefore, our goal was to elucidate the impact of placing ice and cold packs at two specific time points to mitigate external summer temperatures in two commercially available outdoor courier lockboxes used at our institution. Methods/Case Report Two pairs of uniquely manufactured courier lockboxes (steel vs. urethane polymer) were placed outside in direct sunlight in Nashville, Tennessee during the second week of June 2021. Ambient outdoor and lockbox temperatures were monitored using data loggers during a four-day cycle. Each type of lockbox design had a control with no ice or cold packs. These controls were then compared to each experimental, paired lockbox with four ice packs placed at 8am and replaced with four cold packs at 4pm. Results (if a Case Study enter NA) The mean ambient outdoor temperature over these four days was 27.7°C (range: 22.2-39.8°C). Temperatures within the steel and urethane polymer lockboxes without ice or cold packs was 28.3°C (range: 22.4-40.8°C) and 31.6°C (range: 23.8-41.0°C), respectively. The addition of four ice packs at 8am and replaced with four cold packs at 4pm reduced temperatures in the steel box to 24.3°C (range: 17.4-27.9°C) whereas in the urethane polymer box temperatures were reduced to 13.4°C (range: 6.6-18.1°C). Conclusion Temperatures inside outdoor lockboxes can increase in summer commonly above the outdoor ambient temperature. Standardizing instructions for ice and cold packs can reduce internal outdoor courier lockbox temperatures during summer months, especially in urethane polymer lockboxes.

A Randomised Controlled Trial of Ice to Reduce the Pain of Immunisation—The ICE Trial

Background and objectives: vaccine injections are a common cause of iatrogenic pain and anxiety, contributing to non-compliance with scheduled vaccinations. With injection-related pain being recognised as a barrier to vaccination uptake in both adults and children, it is important to investigate strategies to effectively reduce immunisation pain. This prospective randomised controlled trial investigated the effects of applying an ice pack on vaccine-related pain in adults. Methods: medical students receiving the flu vaccination were randomised to receive an ice pack (intervention) or placebo cold pack (control) at the injection site for 30 s prior to needle insertion. Immediate post-vaccination pain (VAS) and adverse reactions in the proceeding 24 h were recorded. Results: pain scores between the intervention (n = 19) and control groups (n = 16) were not statistically significant (intervention: median pain VAS = 7.00, IQR = 18; control: median pain VAS = 11, IQR = 14 (p = 0.26). There were no significant differences in the number of adverse events between the two groups (site pain p = 0.18; localised swelling (p = 0.67); bruising p = 0.09; erythema p = 0.46). Discussion: ice did not reduce vaccination-related pain compared to cold packs. COVID-19 related restrictions impacted participant recruitment, rendering the study insufficiently powered to draw conclusions about the results.

A three-dimensional model of transient bioheat transfer in the lower extremity during cryotherapy

The purpose of this research was to create a computational model of the human thigh undergoing cryotherapy. The tissue temperatures were measured for five cold pack temperatures of −8°C, −4°C, 0°C, 4°C, and 8°C in addition to six different time intervals of cold application and ice removal. The depth of cold penetration and duration of local tissue cooling were investigated at 10 points during 30 min of application and 7 h of post-application. The model was created in CATIA, using a mid-axial cut of the human thigh MRI without pathology. After validation by the available clinical data, this research applied the finite-volume discretization method to solve bioheat transfer equations. A 16°C decrease in the cold pack temperature reduced the tissue temperatures located 1 and 2 cm below the fat by almost 3.34°C and 1.4°C, respectively, after 30 min of cold application. It took the tissues 10–15 min to start cooling down, and the temperature reached its plateau after 100 min. Thirty minutes of cold application declined the superficial tissue and deep tissue temperatures near the bone by 22.59°C and 0.48°C, respectively. Intense cryotherapy led to an insignificant change in the deep tissue temperature at 2 cm and deeper below the fat tissue. After ice removal, tissues continued cooling down for about 8 min until 40 min, depending on the tissue depth. This study proposed a 100-min cold therapy with 10 min of ice removal to optimize tissue cooling.

Air Flow Cooling Improves Anterolateral Thigh Perforator Mapping Using the FLIR ONE Thermal Camera

Background Due to the variable vascular anatomy preoperative perforator mapping facilitates anterolateral thigh (ALT) free flap harvesting. Dynamic infrared perforator imaging can assist preoperative planning by displaying hot spots that represent angiosomes. This study aims to compare previously described precooling methods to develop a standardized simplified protocol for ALT perforator planning. Methods Fifty thighs were examined with a FLIR ONE thermal camera. Four different cold challenges, including alcoholic disinfection, wet laparotomy sponge cooling, fan cooling, and cold pack application, were compared. Hot spot locations within a 250 mm × 80 mm area were compared double-blinded to perforator locations determined by Doppler ultrasonography considered as gold standard. Results The matching rate of thermographic hot spots and sonographically identified perforators was 34.9 ± 22.2%. An increased matching rate of 62.2 ± 42.2% was noted taking only favored perforators (septocutaneous course, diameter >1 mm, distance <3 cm to the center, and visible concomitant veins) into account. Precooling with a fan followed by alcoholic disinfection provided clearest thermograms and fastest results. Conclusion Thermographic imaging is a reliable method for perforator imaging. Its supplemental use to ultrasound may reduce examination time and yield additional information. Precooling by air flow or alcoholic disinfection can be easily implemented and provide the best thermograms. The matching rate of thermographic hot spots and perforators increases when taking only clinically relevant perforators into account. Thermal perforator mapping therefore reduces distraction by negligible perforators.

The Effect of Temperature on the Stability of PCSK-9 Monoclonal Antibody: An Experimental Study

Background: PCSK9 monoclonal antibody lowers plasma PCSK9 and LDL-cholesterol levels. The manufacturers recommend drug storage at 2–8°C, and not above 25°C. This study aimed to investigate drug stability at various temperatures that this drug could be exposed to during medication handling and transportation in tropical countries. Methods: Alirocumab and evolocumab were tested in 3 study conditions: room temperature (RT), cooler device with cold pack, and freeze-thaw for 9 and 18 hours. Heated drugs were used as negative control. Free plasma PCSK9 levels from 9 hyperlipidemia subjects were measured with ELISA. Results: Average subject age was 49.2±18.4 years. Percent PCSK9 inhibition significantly declined in heated drugs compared to baseline. Average RT during the study period was 30.4°C. Change in percent PCSK9 inhibition of PCSK9 mAb at RT from baseline was -5.8±4.4 (p=0.005) and -11.0±8.9% (p=0.006) for alirocumab at 9 hours and 18 hours, and -9.7±11.8% (p=0.04) and -15.1±14.3% (p=0.01) for evolocumab at 9 and 18 hours, respectively. In contrast, there were no significant changes in percent PCSK9 inhibition from baseline when PCSK9 mAb was stored in a cooler. In freeze-thaw condition, changes in percent PCSK9 inhibition from baseline to 9 and 18 hours were -5.2±2.9% (p=0.001) and -2.6±4.9% (p=0.16) for alirocumab, and -1.8±4.2% (p=0.24) and 0.4±6.1% (p=0.83) for evolocumab. Conclusion: Proper drug storage according to manufacturer’s recommendation is essential. Drug storage at RT in tropical climate for longer than 9 hours significantly decreased drug efficacy; however, storage in a cooler device with cold pack for up to 18 hours is safe.

P5: EFFECT OF VITAMIN C AND COLD ON GROWTH FACTOR RELEASE FROM PLATELET-RICH PLASMA

Introduction Platelet-rich plasma (PRP) has gathered great momentum in surgery. The main outcome of the study was to assess whether there was a difference in growth factor release from PRP with addition of vitamin C, cooling, or both vitamin C and cooling. Method Blood samples from 10 volunteers were centrifuged to produce PRP. Activated autologous thrombin was produced from platelet-poor plasma (PPP), which was added to PRP to activate it. PRP from each participant was then divided by activation method into three groups: A) cold pack only; B) vitamin C only; C) cold pack/vitamin C. Growth factor quantification was performed for human VEGF, IGF-1 and PDGF-AB using enzyme-linked immunosorbent assays. Result At 24 hours, VEGF concentration in the cold group was significantly higher cf. the vitamin C group (p=0.02) and the cold/vit C group (p&lt;0.01), whereas IGF concentration in the cold group was significantly higher cf. the vitamin C group (p=0.02) but not the cold/vit C group. At 1 hour and 24 hours, PDGF concentration in the cold group was significantly higher cf. both the vitamin C group (p&lt;0.01) and the cold/vit C group (p=0.02 and p&lt;0.0001 respectively). Conclusion Cooling lead to increased growth factor release at 24 hours, indicating that cooling may lead to sustained release of growth factors. There was a trend for PRP treated with vitamin C to remain in a gel-like consistency rather than clot. This may prove useful in clinical practice where currently activated PRP is constrained to topical application only due to its consistency. Take-home message Cooling may lead to sustained release of growth factors from platelet-rich plasma, whereas the addition of vitamin C may provide opportunity for injectable activated PRP.

The effect of temperature on the stability of PCSK-9 monoclonal antibody: an experimental study

Background PCSK9 monoclonal antibody lowers plasma PCSK9 and LDL-cholesterol levels. The manufacturers recommend drug storage at 2–8 °C, and not above 25 °C. This study aimed to investigate drug stability at various temperatures that this drug could be exposed to during medication handling and transportation in tropical countries. Methods Alirocumab and evolocumab were tested in 3 study conditions: room temperature (RT), cooler device with cold pack, and freeze-thaw for 9 and 18 h. Heated drugs were used as negative control. Free plasma PCSK9 levels from 9 hyperlipidemia subjects were measured with ELISA. Results Average subject age was 49.2 ± 18.4 years. Percent PCSK9 inhibition significantly declined in heated drugs compared to baseline. Average RT during the study period was 30.4 ±2.6 °C. Change in percent PCSK9 inhibition of PCSK9 mAb at RT from baseline was − 5.8 ± 4.4% (P = 0.005) and − 11.0 ± 8.9% (P = 0.006) for alirocumab at 9 h and 18 h, and − 9.7 ± 11.8% (P = 0.04) and − 15.1 ± 14.3% (P = 0.01) for evolocumab at 9 and 18 h, respectively. In contrast, there were no significant changes in percent PCSK9 inhibition from baseline when PCSK9 mAb was stored in a cooler. In freeze-thaw condition, changes in percent PCSK9 inhibition from baseline to 9 and 18 h were − 5.2 ± 2.9% (P = 0.001) and − 2.6 ± 4.9% (P = 0.16) for alirocumab, and − 1.8 ± 4.2% (P = 0.24) and 0.4 ± 6.1% (P = 0.83) for evolocumab. Conclusion Proper drug storage according to manufacturer’s recommendation is essential. Drug storage at RT in tropical climate for longer than 9 h significantly decreased drug efficacy; however, storage in a cooler device with cold pack for up to 18 h is safe.

Effects of Cryotherapy on Temperature Change in Caudal Thigh Muscles of Dogs

Objective The aim of the study reported here was to determine the effect of cryotherapy on the caudal thigh muscles of dogs. We hypothesized that temperature changes would be greatest in superficial tissues and decrease with tissue depth. Study Design Eight mixed-breed dogs (mean weight 21.2 kg, mean age 3.3 years) were studied. Temperature was measured at the skin surface and at depths of 1.0 and 3.0 cm below the skin using needle thermistor probes that were inserted beneath the site of cold pack application. Treatment consisted of a standard 1.0°C cold pack applied for 20 minutes. Temperature was recorded every minute for the 20 minute cold pack treatment, and for 80 minutes following treatment. Results Cutaneous temperatures significantly decreased (p < 0.01), with rapid rewarming of the skin following cold pack removal. Tissue cooling was less profound with increasing tissue depths, but was still significant (p < 0.05). There was no significant difference in muscle temperature between haired and clipped limbs. Conclusion A single application of a cold pack to the caudal thigh muscles of dogs for 20 minutes resulted in significant temperature reduction at all tissue depths (p < 0.05). This decrease persisted for ∼60 minutes. The presence of hair did not have a significant effect on muscle cooling (p > 0.05).

PENGARUH PEMBERIAN KOMPRES DINGIN TERHADAP PENURUNAN SKALA NYERI PADA PASIEN POST OPERASI FRAKTUR DI RS SILOAM SRIWIJAYA PALEMBANG TAHUN 2020

Pemberian kompres dingin adalah memberikan rasa dingin pada daerah tertentu dengan menggunakan kain, es batu atau ice gel (cold pack) sehingga memberikan efek rasa dingin pada daerah tersebut. Tujuan penelitian ini adalah untuk mengetahui pengaruh pemberian kompres dingin terhadap penurunan skala nyeri pada pasien post operasi fraktur. Sampel yang digunakan berjumlah 15 responden yang diperoleh dengan cara purposive sampling dengan kriteria inklusi dan ekslusi. Penelitian ini merupakan penelitian kuantitaif dengan menggunakan uji statistik paired t-test. Hasil penelitian ini diperoleh skala nyeri sebelum pemberian kompres dingin dengan kategori sedang sebanyak 9 responden (60%) dan dengan kategori berat sebanyak 6 responden (40%), skala nyeri setelah kompres dingin dengan kategori ringan sebanyak 10 responden (66,7 %) dan dengan kategori sedang sebanyak 5 responden (33,3%). Hasil penelitian ini menunjukkan bahwa terdapat pengaruh pemberian kompres dingin terhadap penurunan skala nyeri pada pasien post operasi fraktur dengan nilai p value 0,000. Diharapkan kepada RS Siloam Sriwijaya Palembang penelitian ini dapat menjadi bahan masukkan dan informasi dalam penatalaksanaan penurunan skala nyeri pada pasien post operasi fraktur.