Human physiological responses to cold exposure: Acute responses and acclimatization to prolonged exposure

The interactive effect of extreme weather events and PM2.5 on respiratory health among the elderly: a case-crossover study in a high-altitude city

With climate change posing increasing threats and aging populations, understanding the complex relationship between extreme temperatures, PM2.5 pollution, and respiratory health among the elderly is crucial. While some research exists, there remains a significant gap in studying the combined effects of heat waves, cold spells, and PM2.5 on elderly respiratory health in high-altitude regions. We collected data from Xining (2016-2021), including respiratory disease outpatient visits, meteorological, and pollutant data. Employing a case-crossover design and conditional Poisson regression analysis, we investigated the individual and interactive impacts of heat wave, cold spell, and PM2.5 on outpatient visits for respiratory disease among the elderly. We used the relative excess odds due to interaction (REOI), proportion attributable to interaction (AP), and synergy index (S) as quantitative indicators of interaction. Our analysis revealed significant associations between heat wave, cold spell, PM2.5 exposure, and outpatient visits for respiratory disease among the elderly, with odds ratios of 1.10 (95%CI: 1.06, 1.15) and 1.16 (95%CI: 1.13, 1.20), respectively. Moreover, a synergistic effect between cold spell and PM2.5 was observed, particularly affecting vulnerable groups such as female and those aged ≥ 80. The combined exposure to cold spell and elevated PM2.5 levels was estimated to contribute to up to 0.18 (95%CI: 0.17, 0.27) of respiratory outpatient visits. This study underscores the need for urgent interventions, such as reducing PM2.5 exposure and enhancing extreme weather warning systems, to protect the respiratory health of the elderly, especially in high-altitude regions.

The impact of cold weather on older people and the vital role of community nurses

Over the past 160 years, the UK has experienced significant winter mortality among older people. A quarter of a million older people have died from cold-related illnesses over the past decade, with one older person dying every seven minutes. Misconceptions about winter deaths must be addressed. Evidence shows that winter deaths are avoidable. These deaths are not because of hypothermia and are unlikely to decline with climate change in the future. Improving indoor heating may only partially reduce winter deaths. An integrated policy is needed to reduce all risks equally, with community nursing playing a crucial role in such policies. This article explores the multifaceted impact of cold weather on older individuals and emphasises the crucial role that community nurses play in mitigating the associated challenges. Grounded in advanced concepts and research methodologies, the analysis encompasses physiological, psychological and social dimensions. The integration of primary sources and academic theories aims to provide a comprehensive understanding of the topic. The article also explores the specific responsibilities of community nurses and the evidence-based interventions required to address the unique needs of older individuals during the colder seasons.

Chronobiological Patterns and Risk of Acute Aortic Dissection: A Clinical Retrospective and Two-Sample Mendelian Randomisation Study

AIM

Acute aortic dissection (AAD) represents a cardiovascular ailment characterised by a notable mortality rate. Chronobiological patterns can offer a predictive framework for anticipating the onset of AAD.

METHOD

Data were gathered from 1,151 patients diagnosed with AAD at Changhai Hospital in Shanghai, China, spanning 2000-2023. The χ2 test was used to assess whether specific periods exhibited significantly different seasonal/weekly distributions compared with others. Fourier models were utilised for the analysis of rhythmicity in monthly/circadian distribution. Publicly available genome-wide association studies datasets were used to establish the causal relationship between chronotype and AAD. Two sets of genetics instruments were used for analysis, derived from publicly available genetic summary data: 75 single-nucleotide polymorphisms (SNPs) significantly associated with chronotype; and SNPs associated with AAD in the FinnGen consortium.

RESULTS

The mean age was 51.5±13.8 years, with 665 patients (57.8%) aged <55 years. Among the 1,151 patients, 80.9% were male. The distribution of DeBakey types was 73.2% (843) for DeBakey I, 21% (242) for DeBakey II, and 5.7% (66) for DeBakey III. Comorbidities included hypertension in 58.5% (673 cases) and diabetes in 7.8% (90 cases). A peak occurred during colder periods (winter/December), and a trough was noted in warmer periods (summer/June). Weekly distribution exhibited no significant variation. Fourier analysis revealed a statistically significant circadian variation (p<0.0001) with a trough between 23:00 and 00:00, a prominent peak from 07:00 to 08:00, and a minor peak between 20:00 and 21:00. Subgroup analyses identified circadian rhythmicity in all subgroups, except for the DeBakey III group and the female group. Using the 75 chronotype-related SNPs, evidence was found of a potential causal effect of chronotype on the risk of AAD, as the inverse-variance weighting analysis showed that self-report chronotype of morningness was associated with a decreased risk of AAD.

CONCLUSION

The findings substantiate that the initiation of AAD displays noteworthy seasonal, monthly, and circadian patterns. The Mendelian randomisation analysis also indicated that the onset of acute aortic dissection is related to circadian rhythm. These findings offer a fresh perspective, facilitating the identification of triggering factors for AAD and bolstering preventive measures for this catastrophic event.

The Effect of 7-Day Cold Water Acclimation on Autophagic and Apoptotic Responses in Young Males

While cold acclimation can enhance thermoregulation in humans, the potential to improve cellular cold tolerance remains unknown. Thus, this work aims to evaluate the effect of a 7-day cold-water acclimation on the cytoprotective mechanism of autophagy in young males. Further, this work assesses changes in cellular cold tolerance by employing hypothermic ex vivo (whole blood) cooling prior to and following acclimation. Peripheral blood mononuclear cells are isolated before and after cold exposures on days 1, 4, and 7 of acclimation and following ex vivo cooling. Proteins associated with autophagy, apoptosis, the heat shock response, and inflammation are analyzed via Western blotting. Indicators of autophagic dysfunction paired with increased apoptotic signaling are prevalent at the beginning of acclimation. At the end of acclimation, autophagic activity increased while apoptotic and inflammatory signaling decreased. Although an elevated heat shock response is observed following cold exposure, this does not change throughout the acclimation. Further, improvements of autophagic activity are observed during ex vivo cooling along with a reduction of apoptotic signaling, albeit still elevated compared to basal levels. This work shows that 7-day cold acclimation elicits improvements in cellular cold tolerance in young males through enhanced autophagic responses concomitant with reductions in apoptotic signaling.

Effects of high-intensity interval training in a cold environment on arterial stiffness and cerebral hemodynamics in sedentary Chinese college female students post-COVID-19

Many patients with COVID-19 experience increased arterial stiffness and abnormal cerebral hemodynamics. Although previous studies have explored the effects of cold environments on cardiovascular health and cerebral hemodynamics, there is still no research on the changes in cardiovascular and cerebral hemodynamics in sedentary female students recovering from COVID-19 while performing high-intensity interval training (HIIT) in cold environments. This study investigates the effects of 1 week of HIIT in a cold environment on cerebral hemodynamics and arterial stiffness (AS) in sedentary female college students, providing new insights into the pathophysiological mechanisms in this specific context. Thirty-six participants were randomly divided into a control group (n = 12), a room temperature (RE) group (n = 12), and a cold environment (CE) group (n = 12). HIIT was performed for four 4-min running training sessions, with a 4-min interval between each training session, The training duration was 1 week, with a frequency of 2 sessions per day, while the control group did not undergo any training. After training, the AS in the CE group significantly decreased (p < 0.05), with an average reduction of 11% in brachial-ankle pulse wave velocity, showing a significantly greater improvement compared to the RE group and the control group (p < 0.05), while no significant changes were observed in the RE group (p > 0.05). In the Y-Balance Tests (YBTs), the concentrations of cerebral oxygenated hemoglobin and total hemoglobin significantly increased (p < 0.05) during unilateral leg support tests in both the CE and RE groups, and the increase of CE group is greater than that of RE group. In contrast, in the control group, the concentrations of cerebral oxygenated hemoglobin and total hemoglobin significantly decreased during left leg support (p < 0.05). Our study found that performing HIIT in a cold environment not only effectively reduces AS in sedentary female college students after COVID-19, improves cardiovascular function, but also significantly enhances cerebral hemodynamics, helping them alleviate the negative impacts of post-COVID-19 sequelae and sedentary behavior on health. Future research should further explore the mechanisms by which sedentary behavior, post-COVID-19 recovery status, and adaptation to cold environments collectively influence cardiovascular function and cerebral hemodynamics, providing a more comprehensive understanding of these factors.

Epigenomic features associated with body temperature stabilize tissues during cold exposure in cold-resistant pigs

Cold stress in low-temperature environments can trigger changes in gene expression, but epigenomics regulation of temperature stability in vital tissues, including the fat and diencephalon, is still unclear. Here, we explore the cold-induced changes in epigenomic features in the diencephalon and fat tissues of two cold-resistant Chinese pig breeds, Min and Enshi black (ES) pigs, utilizing H3K27ac CUT&Tag, RNA-seq, and selective signature analysis. Our results show significant alterations in H3K27ac modifications in the diencephalon of Min pigs and the fat of ES pigs after cold exposure. Dramatic changes in H3K27ac modifications in the diencephalon of Min pig are primarily associated with genes involved in energy metabolism and hormone regulation, whereas those in the fat of ES pig are primarily associated with immunity-related genes. Moreover, transcription factors PRDM1 and HSF1, which show evidence of selection, are enriched in genomic regions presenting cold-responsive alterations in H3K27ac modification in the Min pig diencephalon and ES pig fat, respectively. Our results indicate the diversity of epigenomic response mechanisms to cold exposure between Min and ES pigs, providing unique epigenetic resources for studies of low-temperature adaptation in large mammals.

Chronic cold stress promotes inflammation and ER stress via inhibiting GLP-1R signaling, and exacerbates the risk of ferroptosis in the liver and pancreas

The cold climates in autumn and winter threatens human health. The aim of this study was to reveal the effects of prolonged cold exposure on the liver and pancreas based on GLP-1R signaling, oxidative stress, endoplasmic reticulum (ER) stress and ferroptosis by Yorkshire pig models. Yorkshire pigs were divided into the control group and chronic cold stress (CCS) group. The results showed that CCS induced oxidative stress injury, activated Nrf2 pathway and inhibited the expression of GLP-1R in the liver and pancreas (P < 0.05). The toll-like receptor 4 (TLR4) pathway was activated in the liver and pancreas, accompanied by the enrichment of IL-1β and TNF-α during CCS (P < 0.05). Moreover, the kinase RNA-like endoplasmic reticulum kinase (PERK), inositol requiring kinase 1 (IRE1), X-box-binding protein 1 (XBP1) and eukaryotic initiation factor 2α (eIF2α) expression in the liver and pancreas was up-regulated during CCS (P < 0.05). In addition, CCS promoted the prostaglandin-endoperoxide synthase 2 (PTGS2) expression and inhibited the ferritin H (FtH) expression in the liver. Summarily, CCS promotes inflammation, ER stress and apoptosis by inhibiting the GLP-1R signaling and inducing oxidative stress, and exacerbates the risk of ferroptosis in the liver and pancreas.

The Effect of Water Dousing on Heat Strain and Performance During Endurance Running in the Heat

OBJECTIVES

Assess the effect of water dousing on heat strain and performance during self- and fixed-paced exercise in the heat.

DESIGN

Crossover, block-randomized controlled trial.

METHODS

Thirteen trained runners completed a 10-km time trial (TT) and 60-minute fixed-pace run (60% velocity of V˙O2max) in a 30.4 °C, 47.4% relative humidity environment using either water dousing (DOUSE) or no dousing (CON).

RESULTS

Ten-kilometer TT performance was faster in DOUSE compared to CON (44:11 [40:48, 47:34] vs 44:38 [41:21, 47:56] min:s; P = .033). Change in core temperature (Tc) was not different between groups during the TT (+0.02 [-0.04, 0.07] °C in DOUSE; P = .853) or fixed-pace run (+0.02 [-0.15, 0.18] °C; P = .848). Change in mean skin temperature was lower in DOUSE during the TT (-1.80 [-2.15, -1.46] °C; P < .001) and fixed-pace run (-1.38 [-1.81, -0.96] °C; P < .001). Heart rate was lower for DOUSE during the fixed-pace run (-3.5 [-6.8, -0.2] beats/min; P = .041) but not during the TT (-0.2 [-2.5, 2.1] beats/min; P = .853). Thermal sensation was lower for DOUSE during the TT (-49.3 [-72.1, -26.1] mm; P < .001) and fixed-pace run (-44.7 [-59.7, -29.6] mm; P < .001). Rating of perceived exertion was not different between groups for the TT (-0.2 [-0.7, 0.3]; P = .390) or fixed-pace run (-0.2 [-0.8, 0.4]; P = .480). Sweat rate was lower for DOUSE for the TT (-0.37 [-0.53, -0.22] L/h; P < .001) and fixed-pace run (-0.37 [-0.48, -0.26] L/h; P < .001).

CONCLUSION

Water dousing improves 10-km TT performance in the heat but does not affect Tc. The positive change in thermal perception (via lower skin temperature) during the TT likely drives this benefit.

Optimal duration of whole-body cryostimulation exposure to achieve target skin temperature: influence of body mass index-a randomized cross-over controlled trial

BACKGROUND

The efficacy of whole-body cryostimulation (WBC) may be influenced by individual characteristics. The aim of this study is to determine the optimal exposure time required to reach the analgesic threshold of 13.6 °C, which has been proposed to be a target temperature to be reached at skin level. Our objective is also to follow the skin temperature changes during and after WBC considering the participants body mass index (BMI).

METHODS

Thirty healthy men were assigned into 2 groups based on their BMI [normal weight (n = 15; BMI = 21.53 ± 1.63 kg·m-2) and overweight (n = 15; BMI = 27.98 ± 1.16 kg·m-2)]. In a random order, each participant experienced a 4-min WBC exposure, as well as a control session with no cold exposure. Skin temperature was measured using a thermal imaging camera during and after cold exposure.

RESULTS

Normal weight participants reached the threshold in 4 min, whereas overweight participants reached it in 3 min 30 s. Following WBC, a rapid mean skin temperature (MsT°) increase was observed for both groups, immediately after exposure. However, after 30 min, MsT° remained significantly lower than at baseline.

CONCLUSION

Our findings suggest that appropriate WBC dosage may differ according to BMI. Understanding the impact of such variable on cold exposure outcomes can help to optimize WBC treatments and maximize potential benefits.

Non-optimum temperatures led to labour productivity burden by causing premature deaths: A multi-country study

BACKGROUND

Non-optimum temperatures are associated with a considerable mortality burden. However, there is a lack of evaluation of labour productivity losses related to premature deaths due to non-optimum temperatures. This study aimed to quantify the labour productivity burden associated with premature deaths related to non-optimum temperatures and explore the potential socio-economic vulnerabilities.

METHODS

Daily all-cause mortality data were collected from 1,066 locations in 7 countries (Australia, Brazil, Canada, Chile, New Zealand, South Korea, and Thailand). Productivity-Adjusted Life-Year (PALY) loss due to each premature death was calculated to measure the labour productivity loss, by multiplying the years of working life lost by the proportion of the equivalent full-time (EFT) workers. A two-stage times series design and the generalized linear regression model with a quasi-Poisson family were applied to assess the association between non-optimum temperatures and the PALY loss due to premature deaths.

RESULTS

We observed a U-shaped relationship between temperature and PALY lost due to premature mortality. We estimated that 2.51% (95% eCI: 2.05%, 2.92%) of PALY losses could be attributed to non-optimal temperatures, with cold-related deaths contributing 1.26% (95% eCI: 0.94%, 1.54%) and heat-related deaths contributing 1.25% (95% eCI: 0.96%, 1.51%). Cold temperature contributed to the most PALYs lost in those aged 45-54 and 55-64, while heat-related losses predominated among the 15-44 age group. We also observed that the fractions of PALY lost attributed to extreme heat were positively associated with the relative deprivation index, while negatively associated with GDP per capita.

CONCLUSION

This multi-country study highlights that non-optimum temperatures led to a considerable labour productivity loss and socioeconomically disadvantaged communities experience greater losses.

Characteristics of the Gut Microbiota Composition of the Arctic Zone Residents in the Far Eastern Region

Background. In many studies over the past decade, scientists have made a connection between the composition of gut microbiota and human health. A number of publications have shown that gut bacteria are involved in many metabolic and physiological processes of the organism. The composition of the gut microbiome is unique for each person and is formed under the influence of various factors associated with both the individual characteristics of the body and the characteristics of the environment. Different regional characteristics make it necessary for the body to adapt to certain conditions, including temperature fluctuations. Living in areas with low temperatures, such as the Arctic zone, dictates the need for increased energy consumption, which affects the composition of the gut microbiome. Methods. In our study, an extensive questionnaire was conducted among the participants, where many questions were included about the dietary preferences of the study participants, which allowed them us to further divide them into groups according to their diets. Stool samples were collected from participants from 3 groups: Arctic native, Arctic newcomer and the control group. The next step was the isolation of bacterial DNA and sequencing the 16S rRNA gene. The analysis of the results of the diversity of the intestinal microbiota was carried out both with and without taking into account the dietary preferences of the participants. Results. As a result of comparing the intestinal microbiota obtained from residents of the Arctic zone with the gut microbiota of residents of other regions with a milder climate, significant differences are found. These differences may be related to limited food resources and a reduction in the variety of food products characteristic of this Arctic region. t was also found that representatives of the bacterial families Christensenellaceae and Muribaculaceae dominated the control group, both with traditional nutrition and with a dairy-free diet in comparison with the Arctic groups. The control group was dominated by representatives of the Prevotellaceae, Enterobacteriaceae and Comamonadaceae families compared to the Arctic group (with a traditional diet). The results also show that the number of representatives of the families Desulfovibrionaceae (with traditional diet) and Enterobacteriaceae (with milk-free diet) is growing in the Arctic group. Conclusions. In the course of this work, bacterial families characteristic of people living in the Arc-tic zone of the Far Eastern region of the Russian Federation were identified. Poor diet, difficult climatic conditions, and problems with logistics and medical care can have a strong impact on the health of this population. The main type of diet for the inhabitants of the Arctic is the traditional type of diet. They consume a large number of low-cost products, obtainget animal protein from poultry and canned food, and also eat a small number of fresh vegetables and fruits. Such a diet is due to the social status of the study participants and the climatic and geographical features of the region (difficulties in agriculture). With such a diet, we observe a decrease in representatives of the Christensenellaceae, Muribaculaceae, Eubacteriaceae, and Prevotellaceae families and an increase in representatives of the Enterobacteriaceae and Desulfovibrionaceae families among Arctic residents. This imbalance in the futuremay cause, this population may to develop various diseases in the future, including chronic diseases such as obesity, intestinal dysbiosis, inflammatory bowel diseases, and type 2 diabetes.

Sex differences in autonomic functions and cognitive performance during cold-air exposure and cold-water partial immersion

Introduction

This study investigated the differences between males and females in autonomic functions and cognitive performance during cold-air exposure and cold-water partial-immersion compared to a room temperature-air environment. Although several studies have investigated the effects of cold-air or cold-water exposures on autonomic function and cognitive performance, biological sex differences are often under-researched.

Methods

Twenty-two males and nineteen females participated in the current study. Subjects completed a battery of cognitive tasks based upon those used within the Defense Automated Neurobehavioral Assessment (DANA), consisting of five subtasks that assess simple and procedural reaction time, spatial manipulation, attention, and immediate memory. In total, subjects took the battery within a 15-minute period across 30-minute intervals throughout the duration of environmental exposure. Across three separate days, subjects were exposed to three different environmental conditions: room temperature air (23°C), cold air (10°C), and cold water (15°C; in which subjects were immersed up to their necks). Room temperature and cold-air conditions consisted of five sessions (about 2.5 h), and the cold-water condition consisted of three sessions (about 1.5 h). During each experimental condition, physiological data were collected to assess autonomic function, including electrodermal activity (EDA) data and heart rate variability (HRV) derived from electrocardiogram signals.

Results

Females showed slower reaction time in spatial manipulation tasks, immediate memory, and attention during cold-air exposures compared to room temperature air, whereas the performance of males were similar or better during cold-air exposures compared to room temperature air. Cold-water immersion affected the immediate memory performance of males. Both males and females exhibited smaller EDA amplitudes during cold-air and cold-water conditions compared to room temperature air. For HRV, only male subjects exhibited significantly greater values in low-frequency and very-low-frequency components during cold air exposure compared to the normal condition.

Discussion

Sex introduces important differences in cognitive performance and autonomic functions during exposure to cold-air and cold-water. Therefore, sex should be considered when assessing the autonomic nervous system in cold environments and when establishing optimal thermal clothing for performance in operational environments. Our findings can assist with determination of operational clothing, temperature in operating environment, and personnel deployment to operational sites, particularly in settings involving both males and females.

Regular cold shower exposure modulates humoral and cell-mediated immunity in healthy individuals

BACKGROUND

Cold hydrotherapy is an ancient practice that has recently gained scientific interest for its potential health benefits. This study explored the effects of regular cold shower exposure on immune cell function.

METHODS

Sixty healthy Egyptian adults were randomized to take cold or hot showers daily for 90 days. Levels of immunoglobulins, cytokines, and interferon-gamma were measured in blood samples at baseline, 30, 60, and 90 days.

RESULTS

The cold shower group exhibited significant increases in immunoglobulin levels. Conversely, the hot shower group showed a significant decrease in IgM levels at 60 and 90 days compared to baseline, alongside nonsignificant decrease of IgG and IgA. the cold shower group demonstrated elevated levels of IL-2 and IL-4 at 90 days, indicating enhanced T-cell proliferation and humoral immunity, respectively. In contrast, the hot shower group did not exhibit significant changes in cytokine levels. There were no significant differences in IFN-γ and TNF-α levels between the groups.

CONCLUSIONS

Regular cold shower exposure appears to enhance humoral and cell-mediated immunity through the upregulation of antibodies, interleukin-2, and interleukin-4. Brief cold stressors may induce physiological adaptations that prime the immune response. This accessible, sustainable lifestyle modification could potentially serve as an alternative therapy to boost immunity. Further research on larger populations is warranted to better understand the physiological effects of cold temperatures on immunity.

Energy expenditure during physical work in cold environments: physiology and performance considerations for military service members

Effective execution of military missions in cold environments requires highly trained, well-equipped, and operationally ready service members. Understanding the metabolic energetic demands of performing physical work in extreme cold conditions is critical for individual medical readiness of service members. In this narrative review, we describe 1) the extreme energy costs of performing militarily relevant physical work in cold environments, 2) key factors specific to cold environments that explain these additional energy costs, 3) additional environmental factors that modulate the metabolic burden, 4) medical readiness consequences associated with these circumstances, and 5) potential countermeasures to be developed to aid future military personnel. Key characteristics of the cold operational environment that cause excessive energy expenditure in military personnel include thermoregulatory mechanisms, winter apparel, inspiration of cold air, inclement weather, and activities specific to cold weather. The combination of cold temperatures with other environmental stressors, including altitude, wind, and wet environments, exacerbates the overall metabolic strain on military service members. The high energy cost of working in these environments increases the risk of undesirable consequences, including negative energy balance, dehydration, and subsequent decrements in physical and cognitive performance. Such consequences may be mitigated by the application of enhanced clothing and equipment design, wearable technologies for biomechanical assistance and localized heating, thermogenic pharmaceuticals, and cold habituation and training guidance. Altogether, the reduction in energy expenditure of modern military personnel during physical work in cold environments would promote desirable operational outcomes and optimize the health and performance of service members.

Modelling personal temperature exposure using household and outdoor temperature and questionnaire data: Implications for epidemiological studies

Non-optimal temperature is a leading risk factor for global disease burden. Most epidemiological studies assessed only outdoor temperature, with important uncertainties on personal exposure misclassification. The CKB-Air study measured personal, household (kitchen and living room), and outdoor temperatures in the summer (MAY-SEP 2017) and winter (NOV 2017-JAN 2018) in 477 participants in China. After data cleaning, ∼88,000 person-hours of data were recorded across each microenvironment. Using multivariable linear regression (MLR) and random forest (RF) models, we identified key predictors and constructed personal temperature exposure prediction models. We used generalised additive mixed effect models to examine the relationships of personal and outdoor temperatures with heart rate. The 24-hour mean (SD) personal and outdoor temperatures were 29.2 (3.8) °C and 27.6 (6.4) °C in summer, and 12.0 (4.0) °C and 7.5 (4.2) °C in winter, respectively. The temperatures across microenvironments were strongly correlated (Spearman's ρ: 0.86-0.92) in summer. In winter, personal temperature was strongly related to household temperatures (ρ: 0.74-0.79) but poorly related to outdoor temperature (ρ: 0.30). RF algorithm identified household and outdoor temperatures and study date as top predictors of personal temperature exposure for both seasons, and heating-related factors were important in winter. The final MLR and RF models incorporating questionnaire and device data performed satisfactorily in predicting personal exposure in both seasons (R2summer: 0.92; R2winter: 0.68-0.70). We found consistent U-shaped associations between measured and predicted personal temperature exposures and heart rate (lowest at ∼ 14.5 °C), but a weak positive linear association with outdoor temperature. Personal and outdoor temperatures differ substantially winter, but prediction models incorporating household and outdoor temperatures and questionnaire data performed satisfactorily. Exposure misclassification from using outdoor temperature may produce inappropriate epidemiological findings.

The energy metabolism and transcriptomic responses of the Manila clam (Ruditapes philippinarum) under the low-temperature stress

Low temperature in winter poses a threat to the Manila clam Ruditapes philippinarum in North China. However, a number of low-temperature-tolerant clams could survive such condition. It is therefore of interest to explore the survival mechanisms underlying the cold tolerance of R. philippinarum. The Zebra II population of R. philippinarum (Zebra II) from North China and the native Putian population from South China were used as experimental materials. Both populations were stressed with low-temperature and the differences in their survival rates, energy metabolism and transcriptional responses were compared. The results shown that after cold treatment at -1.9 °C, survival rate of Zebra II was higher than that of the Putian group. For both groups, the respiration, ammonia excretion, and ingestion rates continuously decreased till 0 with reductions temperature. In addition, RNA-seq revealed that as compared with the Putian group, there were 3682 up-regulated differentially expressed genes (DEGs) and 3361 down-regulated DEGs in Zebra II group. Moreover, Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that these DEGs were mostly enriched in the purine, pyrimidine, and pyruvate metabolism pathways in Zebra II under low-temperature stress. Furthermore, qRT-PCR analysis further confirmed that Zebra II responded to low-temperature stress through upregulating genes involved in purine, pyrimidine, and pyruvate metabolism pathways. Taken together, all these results indicated that Zebra II has higher cold tolerance than the Putian group. Therefore, Zebra II is capable for overwintering in the intertidal zone of North China.

Adaptive Induction of Nonshivering Thermogenesis in Muscle Rather Than Brown Fat Could Counteract Obesity

Warm-blooded animals such as birds and mammals are able to protect stable body temperature due to various thermogenic mechanisms. These processes can be facultative (occurring only under specific conditions, such as acute cold) and adaptive (adjusting their capacity according to long-term needs). They can represent a substantial part of overall energy expenditure and, therefore, affect energy balance. Classical mechanisms of facultative thermogenesis include shivering of skeletal muscles and (in mammals) non-shivering thermogenesis (NST) in brown adipose tissue (BAT), which depends on uncoupling protein 1 (UCP1). Existence of several alternative thermogenic mechanisms has been suggested. However, their relative contribution to overall heat production and the extent to which they are adaptive and facultative still needs to be better defined. Here we focus on comparison of NST in BAT with thermogenesis in skeletal muscles, including shivering and NST. We present indications that muscle NST may be adaptive but not facultative, unlike UCP1-dependent NST. Due to its slow regulation and low energy efficiency, reflecting in part the anatomical location, induction of muscle NST may counteract development of obesity more effectively than UCP1-dependent thermogenesis in BAT.

Effects of Environmental Conditions on Athlete's Cardiovascular System

Environmental factors such as extreme temperatures, humidity, wind, pollution, altitude, and diving can significantly impact athletes' cardiovascular systems, potentially hindering their performance, particularly in outdoor sports. The urgency of this issue is heightened by the increasing prevalence of climate change and its associated conditions, including fluctuating pollution levels, temperature variations, and the spread of infectious diseases. Despite its critical importance, this topic is often overlooked in sports medicine. This narrative review seeks to address this gap by providing a comprehensive, evidence-based evaluation of how athletes respond to environmental stresses. A thorough assessment of current knowledge is essential to better prepare athletes for competition under environmental stress and to minimize the harmful effects of these factors. Specifically, adaptative strategies and preventative measures are vital to mitigating these environmental influences and ensuring athletes' safety.

Nationwide Analysis of the Relationship Between Low Ambient Temperature and Acute Aortic Dissection-related Hospitalizations

AIMS

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency. Therefore, identifying modifiable risk factors for AAD is of great public health significance. An association between ambient temperature (AT) and AAD has been reported; however, not all findings have been elucidated. This study examined the association between AAD-related hospitalization and AT using data from the Japanese Registry of All Cardiac and Vascular Diseases Diagnostic Procedure Combination (JROAD-DPC), which is a nationwide claims-based database.

METHODS

This nationwide time-stratified case-crossover study evaluated data of hospitalized patients with AAD from 1,119 certified hospitals between 2012 and 2020 using the JROAD-DPC database. Conditional logistic regression and distributed lag non-linear models were used to investigate the association between average daily temperature and AAD-related hospitalization.

RESULTS

Among the 96,812 cases analyzed. The exposure-response curve between AT and AAD-related hospitalization showed an increase in the odds ratio for lower temperatures, with a peak at timed -10°C (odds ratio: 2.28, 95% confidence interval: 1.92-2.71, compared with that at 20°C). The effects of temperature on lag days 0 and 1 were also significant.Stratified analyses showed a greater association between AT and AAD-related hospitalization for the following variables: older age (≥75 years), female sex (44.4%, the mean age ± SD was 76 ± 12 years), low body mass index (<22), winter season, and warmer regions.

CONCLUSIONS

Low AT is associated with an increased risk of AAD-related hospitalization. Several susceptible groups are affected by cold temperatures and have a higher risk of hospitalization.

Association between thermogenic brown fat and genes under positive natural selection in circumpolar populations

BACKGROUND

Adaptation to cold was essential for human migration across Eurasia. Non-shivering thermogenesis through brown adipose tissue (BAT) participates in cold adaptation because some genes involved in the differentiation and function of BAT exhibit signatures of positive natural selection in populations at high latitudes. Whether these genes are associated with the inter-individual variability in BAT thermogenesis remains unclear. In this study, we evaluated the potential associations between BAT activity and single nucleotide polymorphisms (SNPs) in candidate gene regions in East Asian populations.

METHODS

BAT activity induced by mild cold exposure was measured in 399 healthy Japanese men and women using fluorodeoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT). The capacity for cold-induced thermogenesis and fat oxidation was measured in 56 men. Association analyses with physiological traits were performed for 11 SNPs at six loci (LEPR, ANGPTL8, PLA2G2A, PLIN1, TBX15-WARS2, and FADS1) reported to be under positive natural selection. Associations found in the FDG-PET/CT population were further validated in 84 healthy East Asian men and women, in whom BAT activity was measured using infrared thermography. Associations between the SNP genotypes and BAT activity or other related traits were tested using multiple logistic and linear regression models.

RESULTS

Of the 11 putative adaptive alleles of the six genes, two intronic SNPs in LEPR (rs1022981 and rs12405556) tended to be associated with higher BAT activity. However, these did not survive multiple test comparisons. Associations with lower body fat percentage, plasma triglyceride, insulin, and HOMA-IR levels were observed in the FDG-PET/CT population (P < 0.05). Other loci, including TBX15-WARS2, which is speculated to mediate cold adaptation in Greenland Inuits, did not show significant differences in BAT thermogenesis.

CONCLUSIONS

Our results suggest a marginal but significant association between LEPR SNPs. However, robust supporting evidence was not established for the involvement of other loci under positive natural selection in cold adaptation through BAT thermogenesis in East Asian adults. Given the pleiotropic function of these genes, factors other than cold adaptation through BAT thermogenesis, such as diet adaptation, may contribute to positive natural selection at these loci.

Timing of acute cold exposure determines UCP1 and FGF21 expression - Possible interactions between the thermal environment, thermoregulatory responses, and peripheral clocks

Thermoregulation is synchronized across the circadian cycle to uphold thermal homeostasis. To test if time-of-day matters for the response to environmental cold exposure, mice were acclimated to thermoneutrality (27 °C) for 2 months were subjected acutely (8 h) to cold ambient conditions (15 °C), whereas controls were maintained at thermoneutral conditions. The thermal exposure was tested in separate groups (N = 8) at three distinct time-of-day periods: in the LIGHT phase (L); the DARK phase (D); and a mix of the two (D + L). The magnitude of UCP1 protein and mRNA induction in brown adipose tissue (BAT) in response to acute cold exposure was time-of-day sensitive, peaking in LIGHT, whereas lower induction levels were observed in D + L, and DARK. Plasma levels of FGF21 were induced 3-fold by acute cold exposure at LIGHT and D + L, compared to the time-matched thermoneutral controls, whereas cold in DARK did not cause a significant increase of FGF21 plasma levels. Cold exposure affected, in BAT, the temporal mRNA expression patterns of core circadian clock components: Bmal1, Clock, Per1, Per3, Cry1, Cry2 Nr1d1, and Nr1d2, but in the liver, none of the transcripts were modified. Behavioral assessment using the Thermal Gradient Test (TGT) showed that acute cold exposure reduced cold sensitivity in D + L, but not in DARK. RNA-seq analyses of somatosensory neurons in DRG highlighted the role of the core circadian components in these cells, as well as transcriptional changes due to acute cold exposure. This elucidates the sensory system as a gauge and potential regulator of thermoregulatory responses based on circadian physiology. In conclusion, acute cold exposure elicits time-of-day specific effects on thermoregulatory pathways, which may involve underlying changes in thermal perception. These results have implications for efforts aimed at reducing risks associated with the organization of shift work in cold environments.

Exploring the Factors Behind Regional Differences in Physical Fitness of Geological University Students

The intention of this study is to investigate the distribution of physical fitness of the geographical students. The indicators among freshmen at a Chinese geological university and compare their fitness levels with students from other types of institutions. The research revealed that students at higher latitudes exhibited greater physical strength but were less athletic than those at lower latitudes. Spatial dependence on physical fitness was more pronounced in males than in females, particularly for indicators characterizing athletic capacity. Influencing factors such as PM10, air temperature, rainfall, eggs consumption, grain consumption, and GDP which were identified as the major climate, dietary structure, and economic level were examined. Revised：PM10, air temperature and eggs consumption, factors influencing the spatial distribution of male physical fitness across the country. Rainfall, grains consumption and GDP, factors influencing the spatial distribution of female physical fitness across the country. respectively. These factors were found to affect males (42.43%) more than females (25.33%). These findings highlight the significance of regional differences in students' physical fitness levels, with students in geological universities demonstrating better overall physical fitness compared to their counterparts at other schools. Consequently, it is essential to develop tailored physical education strategies for students in various regions, taking into account local economic, climatic, and dietary factors. This study offers a greater explanation of physical fitness disparities between the Chinese university students as well as provides insights for designing effective physical education programs.

Association between baseline blood pressure variability and left heart function following short-term extreme cold exposure

Extreme cold exposure has been widely considered as a cardiac stress and may result in cardiac function decompensation. This study was to examine the risk factors that contribute to changes in cardiovascular indicators of cardiac function following extreme cold exposure and to provide valuable insights into the preservation of cardiac function and the cardiac adaptation that occur in real-world cold environment. Seventy subjects were exposed to cold outside (Mohe, mean temperature -17 to -34°C) for one day, and were monitored by a 24-h ambulatory blood pressure device and underwent echocardiography examination before and after extreme cold exposure. After exposure to extreme cold, 41 subjects exhibited an increase in ejection fraction (EF), while 29 subjects experienced a decrease. Subjects with elevated EF had lower baseline coefficients of variation (CV) in blood pressure compared to those in the EF decrease group. Additionally, the average real variability (ARV) of blood pressure was also significantly lower in the EF increase group. Multivariate regression analysis indicated that both baseline CV and ARV of blood pressure were independent risk factors for EF decrease, and both indicators proved effective for prognostic evaluation. Correlation analysis revealed a correlation between baseline blood pressure CV and ARV, as well as EF variation after exposure to extreme cold environment. Our research clearly indicated that baseline cardiovascular indicators were closely associated with the changes in EF after extreme cold exposure. Furthermore, baseline blood pressure variability could effectively predict alterations in left cardiac functions when individuals were exposed to extreme cold environment.

The maintenance of core temperature in SCUBA divers: Contributions of anthropometrics, patent foramen ovale, and non-shivering thermogenesis

OBJECTIVES

To determine the influence of a patent foramen ovale and fibroblast growth factor-21 on core temperature (Tc) responses in SCUBA divers. Additionally, we aimed to quantify the individual and combined influences of wetsuit thickness and anthropometric data on Tc changes during the dives.

DESIGN

An experimental study comparing the Tc responses between divers with (n = 17) and without a patent foramen ovale (n = 14).

METHODS

A total of 31 divers participated in the study. Tc was measured pre- and post-dive in 17-18 °C sea water using a telemetric pill. Additionally, blood was drawn pre-dive and ~1-2 h post-dive for measurement of fibroblast growth factor-21.

RESULTS

There was no influence of a patent foramen ovale on the Tc responses during SCUBA diving in either dive profile (p > 0.05). Additionally, there was no influence of SCUBA diving on fibroblast growth factor-21 concentrations (p > 0.05). The strongest positive and significant associations with the ∆Tc/min were found when multiplying wetsuit thickness in millimeters by body mass (r2 = 0.3147, p = 0.0010), BMI (r2 = 0.3123, p = 0.0011), and body surface area (r2 = 0.2877, p = 0.0019). There was a significant, negative linear relationship between the body surface area to mass ratio and ∆Tc/min (r2 = 0.2812, p = 0.0032).

CONCLUSIONS

These data suggest that Tc regulation during recreational SCUBA diving can be facilitated in part by the appropriate choice of wetsuit thickness for a given set of anthropometric characteristics.

Effects of swimming in cold water on lipolysis indicators via fibroblast growth factor-21 in male Wistar rats

This study aimed to investigate the effects of swimming in cold water on the release of FGF21 from various tissues and its impact on fat metabolism. Twenty Wistar rats were randomly divided into three groups: untrained (C), trained in thermo-neutral water (TN, 30 °C) and trained in cold water (TC, 15 °C). The training groups swam intervals (2-3 min) until exhaustion, 1 min rest, three days a week for six weeks, with 3-6% bodyweight load. The mRNA expression of variables was determined in white fat tissue (WAT), and FGF21 protein was also measured in the liver, brown fat tissue (BAT), serum, and muscle. The experimental protocols resulted in lower body weight gain, associated with reduced WAT volume; the most remarkable improvement was observed in the TC group. Swimming significantly increased FGF21 protein levels in WAT, BAT, and muscle tissues compared to the C group; substantial increases were in the TC group. Changes in FGF21 were highly correlated with the activation of genes involved in fat metabolisms, such as CPT1, CD36, and HSL, and with glycerol in WAT. The findings indicate a positive correlation between swimming in cold water and the activation of genes involved in fat metabolism, possibly through FGF21 production, which was highly correlated with fat-burning genes.

Pre-exercise cryotherapy reduces myoglobin and creatine kinase levels after eccentric muscle stress in young women

Introduction: The aim of this study was to investigate the effect of pre-exercise whole-body cryotherapy (WBC) on muscle damage indicators following eccentric treadmill exercise in young women. Methods: Twenty-seven participants underwent two 1-h downhill treadmill runs, replicating 60% of their maximal oxygen uptake, with a 4-week intermission for recovery and treatment application. In this intermission, one group underwent 20 sessions of WBC, delivered five times a week at -120°C for 3 min each, while the comparison group received no such treatment. Markers of muscle injury-serum myoglobin concentration, creatine kinase and lactate dehydrogenase activity and also uric acid, and cell-free DNA concentration-were measured before and after downhill runs. Results: The study observed a notable reduction in post-exercise myoglobin and CK levels in the WBC group after the second running session. Discussion: The results suggest that WBC can have a protective effects against muscle damage resulting from eccentric exercise.

Nitrate ingestion blunts the increase in blood pressure during cool air exposure: a double-blind, placebo-controlled, randomized, crossover trial

Cold exposure increases blood pressure (BP) and salivary flow rate (SFR). Increased cold-induced SFR would be hypothesized to enhance oral nitrate delivery for reduction to nitrite by oral anaerobes and to subsequently elevate plasma [nitrite] and nitric oxide bioavailability. We tested the hypothesis that dietary nitrate supplementation would increase plasma [nitrite] and lower BP to a greater extent in cool compared with normothermic conditions. Twelve males attended the laboratory on four occasions. Baseline measurements were completed at 28°C. Subsequently, participants ingested 140 mL of concentrated nitrate-rich (BR; ∼13 mmol nitrate) or nitrate-depleted (PL) beetroot juice. Measurements were repeated over 3 h at either 28°C (Norm) or 20°C (Cool). Mean skin temperature was lowered compared with baseline in PL-Cool and BR-Cool. SFR was greater in BR-Norm, PL-Cool, and BR-Cool than PL-Norm. Plasma [nitrite] at 3 h was higher in BR-Cool (592 ± 239 nM) versus BR-Norm (410 ± 195 nM). Systolic BP (SBP) at 3 h was not different between PL-Norm (117 ± 6 mmHg) and BR-Norm (113 ± 9 mmHg). SBP increased above baseline at 1, 2, and 3 h in PL-Cool but not BR-Cool. These results suggest that BR consumption is more effective at increasing plasma [nitrite] in cool compared with normothermic conditions and blunts the rise in BP following acute cool air exposure, which might have implications for attenuating the increased cardiovascular strain in the cold.NEW & NOTEWORTHY Compared with normothermic conditions, acute nitrate ingestion increased plasma [nitrite], a substrate for oxygen-independent nitric oxide generation, to a greater extent during cool air exposure. Systolic blood pressure was increased during cool air exposure in the placebo condition with this cool-induced blood pressure increase attenuated after acute nitrate ingestion. These findings improve our understanding of environmental factors that influence nitrate metabolism and the efficacy of nitrate supplementation to lower blood pressure.

Elucidation of the Role of TRPV1, VEGF-A, TXA2, Redox Homeostasis, and Inflammatory Cascades in Protection against Cold Injuries by Herbosomal-Loaded PEG-Poloxamer Topical Formulation

High-altitude regions, cold deserts, permafrost regions, and the polar region have some of the severest cold conditions on earth and pose immense perils of cold injuries to exposed individuals. Accidental and unintended exposures to severe cold, either unintentionally or due to occupational risks, can greatly increase the risk of serious conditions including hypothermia, trench foot, and cold injuries like frostbite. Cold-induced vasoconstriction and intracellular/intravascular ice crystal formation lead to hypoxic conditions at the cellular level. The condition is exacerbated in individuals having inadequate and proper covering and layering, particularly when large area of the body are exposed to extremely cold environments. There is a paucity of preventive and therapeutic pharmacological modalities that have been explored for managing and treating cold injuries. Given this, an efficient modality that can potentiate the healing of frostbite was investigated by studying various complex pathophysiological changes that occur during severe cold injuries. In the current research, we report the effectiveness and healing properties of a standardized formulation, i.e., a herbosomal-loaded PEG-poloxamer topical formulation (n-HPTF), on frostbite. The intricate mechanistic pathways modulated by the novel formulation have been elucidated by studying the pathophysiological sequelae that occur following severe cold exposures leading to frostbite. The results indicate that n-HPTF ameliorates the outcome of frostbite, as it activates positive sensory nerves widely distributed in the epidermis transient receptor potential vanilloid 1 (TRPV1), significantly (p < 0.05) upregulates cytokeratin-14, promotes angiogenesis (VEGF-A), prominently represses the expression of thromboxane formation (TXA2), and significantly (p < 0.05) restores levels of enzymatic (glutathione reductase, superoxide dismutase, and catalase) and nonenzymatic antioxidants (glutathione). Additionally, n-HPTF attenuates oxidative stress and the expression of inflammatory proteins PGF-2α, NFκB-p65, TNF-α, IL-6, IL-1β, malondialdehyde (MDA), advanced oxidative protein products (AOPP), and protein carbonylation (PCO). Masson's Trichrome staining showed that n-HPTF stimulates cellular proliferation, and increases collagen fiber deposition, which significantly (p < 0.05) promotes the healing of frostbitten tissue, as compared to control. We conclude that protection against severe cold injuries by n-HPTF is mediated via modulation of pathways involving TRPV1, VEGF-A, TXA2, redox homeostasis, and inflammatory cascades. The study is likely to have widespread implications for the prophylaxis and management of moderate-to-severe frostbite conditions.

Gastrointestinal function following endurance exercise under different environmental temperatures

PURPOSE

We determined the effects of different environmental temperatures on exercise-induced gastrointestinal (GI) damage and delayed gastric emptying (GE) rate.

METHODS

Eleven trained males completed three trials on different days, consisting of (1) exercise in a thermoneutral environment (CON, 23 °C), (2) exercise in a hot environment (HOT, 35 °C), and (3) exercise in a cold environment (COLD, 10 °C). The subjects performed high-intensity interval-type endurance exercises in all trials. Blood intestinal fatty acid binding protein (I-FABP) levels was determine before and after exercise. We evaluated Tmax (time when the 13C-excretion/h reached a maximum level) as an indication of the GE rate during post-exercise.

RESULTS

Rectal temperature during exercise was significantly higher (P < 0.001) in the HOT (38.7 ± 0.3 °C) trial compared with the CON (38.2 ± 0.3 °C) and COLD (38.2 ± 0.3 °C) trials, with no significant difference between the CON and COLD trials. Plasma I-FABP level after exercise (relative to the pre-exercise level) were significantly greater (P = 0.005) in the HOT trial (92.9 ± 69.6%) than in the CON (37.2 ± 31.6%) and COLD (37.6 ± 41.8%) trials. However, there was no significant difference between the CON and COLD trials. Moreover, the Tmax was delayed significantly (P = 0.006) in the HOT trial compared with the CON and COLD trials, with no significant difference between the CON and COLD trials.

CONCLUSION

GI function following endurance exercise was similar between thermoneutral and cold environments, while endurance exercise in a hot environment exacerbated GI function compared with thermoneutral and cold environments.

Impaired autophagy following ex vivo cooling of simulated hypothermic temperatures in peripheral blood mononuclear cells from young and older adults

Hypothermia is a critical consequence of extreme cold exposure that increases the risk of cold-related injury and death in humans. While the initiation of cytoprotective mechanisms including the process of autophagy and the heat shock response (HSR) is crucial to cellular survival during periods of stress, age-related decrements in these systems may underlie cold-induced cellular vulnerability in older adults. Moreover, whether potential sex-related differences in autophagic regulation influence the human cold stress response remain unknown. We evaluated the effect of age and sex on mechanisms of cytoprotection (autophagy and the HSR) and cellular stress (apoptotic signaling and the acute inflammatory response) during ex vivo hypothermic cooling. Venous blood samples from 20 healthy young (10 females; mean [SD]: 22 [2] years) and 20 healthy older (10 females; 66 [5] years) adults were either isolated immediately (baseline) for peripheral blood mononuclear cells (PBMCs) or exposed to water bath temperatures maintained at 37, 35, 33, 31, or 4 °C for 90 min before PBMC isolation. Proteins associated with autophagy, apoptosis, the HSR, and inflammation were analyzed via Western blotting. Indicators of autophagic initiation and signaling (LC3, ULK1, and beclin-2) and the HSR (HSP90 and HSP70) increased when exposed to hypothermic temperatures in young and older adults (all p ≤ 0.007). Sex-related differences were only observed with autophagic initiation (ULK1; p = 0.015). However, despite increases in autophagic initiators ULK1 and beclin-2 (all p < 0.001), this was paralleled by autophagic dysfunction (increased p62) in all groups (all p < 0.001). Further, apoptotic (cleaved-caspase-3) and inflammatory (IL-6 and TNF-α) signaling increased in all groups (all p < 0.001). We demonstrated that exposure to hypothermic conditions is associated with autophagic dysfunction, irrespective of age or sex, although there may exist innate sex-related differences in cytoprotection in response to cold exposure as evidenced through altered autophagic initiation.

Independent, additive and interactive effects of acute normobaric hypoxia and cold on submaximal and maximal endurance exercise

PURPOSE

To evaluate the independent and combined effects of hypoxia (FiO2 = 13.5%) and cold (- 20 °C) on physiological and perceptual responses to endurance exercise.

METHODS

14 trained male subjects ( V . O2max: 64 ± 5 mL/kg/min) randomly performed a discontinuous maximal incremental test to exhaustion on a motorized treadmill under four environmental conditions: Normothermic-Normoxia (N), Normothermic-Hypoxia (H), Cold-Normoxia (C) and Cold-Hypoxia (CH). Performance and physiological and perceptual responses throughout exercise were evaluated.

RESULTS

Maximal WorkLoad (WL) and WL at lactate threshold (LT) were reduced in C (- 2.3% and - 3.5%) and H (- 18.0% and - 21.7%) compared to N, with no interactive (p = 0.25 and 0.81) but additive effect in CH (- 21.5% and - 24.6%). Similarly, HRmax and Vemax were reduced in C (- 3.2% and - 14.6%) and H (- 5.0% and - 7%), showing additive effects in CH (- 7.7% and - 16.6%). At LT, additive effect of C (- 2.8%) and H (- 3.8%) on HR reduction in CH (- 5.7%) was maintained, whereas an interactive effect (p = 0.007) of the two stressors combined was noted on Ve (C: - 3.1%, H: + 5.5%, CH: - 10.9%). [La] curve shifted on the left in CH, displaying an interaction effect between the 2 stressors on this parameter. Finally, RPE at LT was exclusively reduced by hypoxia (p < 0.001), whereas TSmax is synergistically reduced by cold and hypoxia (interaction p = 0.047).

CONCLUSION

If compared to single stress exposure, exercise performance and physiological and perceptual variables undergo additive or synergistic effects when cold and hypoxia are combined. These results provide new insight into human physiological responses to extreme environments.

Advanced Diagnostic Tools in Hypothermia-Related Fatalities-A Pathological Perspective

BACKGROUND AND OBJECTIVES

Although classical gross features are known in hypothermia victims, they lack specific diagnosis features. The aim of our study was to reveal specific brain and lung pathological features in a group of hypothermia-related fatalities.

MATERIALS AND METHODS

The study group comprised 107 cases from our files associated with hypothermia. Routine hematoxylin-eosin (H&E) staining and postmortem immunohistochemistry were performed.

RESULTS

The microscopic cerebral exam revealed diffuse perineuronal and perivascular edema, gliosis, mononuclear cell infiltration, acute brain injuries, focal neuronal ischemia, lacunar infarction, and variable hemorrhages. Variable alveolar edema, pulmonary emphysema, intra-alveolar and/or pleural hemorrhage, and bronchopneumonia, as well as other pre-existing lesions, were identified in lung tissue samples. Glial cells displayed S100β expression, while neurons showed moderate Hsp70 immunopositivity. Alveolar basal membranes exhibited diffuse ICAM-1 positive expression, while ICAM-1 and AQP-1 positivity was observed in the alveolar septum vascular endothelium. Statistical analysis revealed a significant correlation between S100β and Hps70 immunoexpression and cerebral pathological features, between ICAM-1 immunoexpression and alveolar edema and pulmonary emphysema, and between AQP-1 immunoexpression and pulmonary emphysema.

CONCLUSIONS

Our results add supplementary data to brain and lung pathological findings in hypothermia-related fatalities, with potential therapeutic value in hypothermia patients.

The zebrafish heart harbors a thermogenic beige fat depot analog of human epicardial adipose tissue

Epicardial adipose tissue (eAT) is a metabolically active fat depot that has been associated with a wide array of cardiac homeostatic functions and cardiometabolic diseases. A full understanding of its diverse physiological and pathological roles is hindered by the dearth of animal models. Here, we show, in the heart of an ectothermic teleost, the zebrafish, the existence of a fat depot localized underneath the epicardium, originating from the epicardium and exhibiting the molecular signature of beige adipocytes. Moreover, a subset of adipocytes within this cardiac fat tissue exhibits primitive thermogenic potential. Transcriptomic profiling and cross-species analysis revealed elevated glycolytic and cardiac homeostatic gene expression with downregulated obesity and inflammatory hallmarks in the teleost eAT compared to that of lean aged humans. Our findings unveil epicardium-derived beige fat in the heart of an ectotherm considered to possess solely white adipocytes for energy storage and identify pathways that may underlie age-driven remodeling of human eAT.

Effects of temperature anomaly on sperm quality: A multi-center study of 33,234 men

Backgrounds

Global fertility rates continue to decline and sperm quality is a prime factor affecting male fertility. Both extreme cold and heat have been demonstrated to be associated with decreased sperm quality, but no epidemiological studies have considered human adaptation to long-term temperature. Our aim was to conduct a multi-center retrospective cohort study to investigate exposure-response relationship between temperature anomaly (TA) that deviate from long-term climate patterns and sperm quality.

Methods

A total of 78,952 semen samples measured in 33,234 donors from 6 provincial human sperm banks in China were collected. This study considered heat and cold acclimatization to prolonged exposure in humans and explored the exposure-response relationship between TAs and sperm quality parameters (sperm concentrations, sperm count, progressive motility, progressive sperm count, total motility and total motile sperm count) during the hot and cold seasons, respectively. Linear mixed models and generalized linear models were built separately for specific centers to pool in a meta-analysis to obtain the pooled effect of TA on sperm quality, considering repeated measurements data structure and spatial heterogeneity.

Results

We identified an inverted U-shaped exposure-response relationship between TA and sperm quality during the hot season. Significant negative effect of anomalous cold on sperm quality during the hot season was found after additional adjustment for Body mass index, marital status and childbearing history. The heat-related TA in hot season was significantly negatively associated with sperm concentration, progressive sperm count and total motile sperm count (all P-values<0.05). After adjusting the relative humidity, the cold-related TA in cold season was negatively associated with the sperm total motility (P-values<0.05).

Conclusions

Our results suggest both heat-related and cold-related TAs are associated with decreased sperm quality. The findings highlight the importance of reducing exposure to anomalous temperatures to protect male fertility.

Cold exposure, gut microbiota and health implications: A narrative review

Temperature has been recognized as an important environmental factor affecting the composition and function of gut microbiota (GM). Although research on high-temperature impacts has been well studied, knowledge about the effect of cold exposure on GM remains limited. This narrative review aims to synthesize the latest scientific findings on the impact of cold exposure on mammalian GM, and its potential health implications. Chronic cold exposure could disrupt the α-diversity and the composition of GM in both experimental animals and wild-living hosts. Meanwhile, cold exposure could impact gut microbial metabolites, such as short-chain fatty acids. We also discussed plausible biological pathways and mechanisms by which cold-induced changes may impact host health, including metabolic homeostasis, fitness and thermogenesis, through the microbiota-gut-brain axis. Intriguingly, alterations in GM may provide a tool for favorably modulating the host response to the cold temperature. Finally, current challenges and future perspectives are discussed, emphasizing the need for translational research in humans. GM could be manipulated by utilizing nutritional strategies, such as probiotics and prebiotics, to deal with cold-related health issues and enhance well-being in populations living or working in cold environments.

Physiological evidence of stress reduction during a summer Antarctic expedition with a significant influence of previous experience and vigor

Antarctica provides a unique environment for studying human adaptability, characterized by controlled conditions, limited sensory stimulation, and significant challenges in logistics and communication. This longitudinal study investigates the relationship between stress indicators, with a specific focus on mean sleep heart rate, during a COVID-19 quarantine and subsequent 83 days long summer Antarctic expedition at the J. G. Mendel Czech Antarctic Station. Our novel approach includes daily recordings of sleep heart rate and weekly assessments of emotions, stress, and sleep quality. Associations between variables were analyzed using the generalized least squares method, providing unique insights into nuances of adaptation. The results support previous findings by providing empirical evidence on the stress reducing effect of Antarctic summer expedition and highlight the importance of previous experience and positive emotions, with the novel contribution of utilizing physiological data in addition to psychological measures. High-frequency sampling and combination of psychological and physiological data addresses a crucial gap in the research of stress. This study contributes valuable knowledge to the field of psychophysiology and has implications for expedition planners, research organizations, teams in action settings, pandemic prevention protocols, global crises, and long-duration spaceflight missions. Comprehensive insights promote the well-being and success of individuals in extreme conditions.

Multimode adaptive logic gates based on temperature-responsive DNA strand displacement

Living organisms switch their intrinsic biological states to survive environmental turbulence, in which temperature changes are prevalent in nature. Most artificial temperature-responsive DNA nanosystems work as switch modules that transit between "ON-OFF" states, making it difficult to construct nanosystems with diverse functions. In this study, we present a general strategy to build multimode nanosystems based on a temperature-responsive DNA strand displacement reaction. The temperature-responsive DNA strand displacement was controlled by tuning the sequence of the substrate hairpin strands and the invading strands. The nanosystems were demonstrated as logic gates that performed a set of Boolean logical functions at specific temperatures. In addition, an adaptive logic gate was fabricated that could exhibit different logic functions when placed in different temperatures. Specifically, upon the same input strands, the logic gate worked as an XOR gate at 10 °C, an OR gate at 35 °C, an AND gate at 46 °C, and was reset at 55 °C. The design and fabrication of the multifunctional nanosystems would help construct advanced temperature-responsive systems that may be used for temperature-controlled multi-stage drug delivery and thermally-controlled multi-step assembly of nanostructures.

Partial and Complete Fluid Replacement Maintains Exercise Performance in a Warm Environment Following Prolonged Cold-Water Immersion

ABSTRACT

Wheelock, CE, Stooks, J, Schwob, J, Hess, HW, Pryor, RR, and Hostler, D. Partial and complete fluid replacement maintains exercise performance in a warm environment following prolonged cold-water immersion. J Strength Cond Res 38(2): 290-296, 2024-Special warfare operators may be exposed to prolonged immersion before beginning a land-based mission. This immersion will result in substantial hypohydration because of diuresis. This study tested the hypothesis that both partial and full postimmersion rehydration would maintain performance during exercise in the heat. Seven men (23 ± 2 years; V̇o2max: 50.8 ± 5.3 ml·kg-1·min-1) completed a control trial (CON) without prior immersion and 3 immersion (18.0°C) trials without rehydration (NO) or with partial (HALF) or full (FULL) rehydration. After immersion, subjects completed a 60-minute weighted ruck march (20.4 kg; 5.6 kph) and a 15-minute intermittent exercise protocol (iEPT) in a warm environment (30.0°C and 50.0% relative humidity). The primary outcome was distance (km) covered during the iEPT. A priori statistical significance was set to p ≤ 0.05. Immersion resulted in 2.3 ± 0.4% loss of body mass in all immersion trials (p < 0.01). Distance covered during the first 13-minute interval run portion of iEPT was reduced in the NO rehydration trial (1.59 ± 0.18 km) compared with all other conditions (CON: 1.88 ± 0.18 km, p = 0.03; HALF: 1.80 ± 0.18 km, p < 0.01; FULL: 1.86 ± 0.28 km, p = 0.01). During the final 2 minutes of the iEPT, distance in the NO rehydration trial (0.31 ± 0.07 km) was reduced compared with the FULL rehydration trial (0.37 ± 0.07 km; p < 0.01) but not compared with CON (0.35 ± 0.07 km; p = 0.09) or HALF (0.35 ± 0.07 km; p = 0.08). Both partial and full postimmersion fluid replacement maintained intermittent exercise performance and should be applied as rehydration strategies.

Global, regional, and national burden of mortality associated with cold spells during 2000-19: a three-stage modelling study

BACKGROUND

Exposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells.

METHODS

A three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000-19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths), and excess death rate (excess deaths per 100 000 population) due to cold spells for each grid across the world.

FINDINGS

Globally, 205 932 (95% empirical CI [eCI] 162 692-250 337) excess deaths, representing 3·81 (95% eCI 2·93-4·71) excess deaths per 1000 deaths (excess death ratio), and 3·03 (2·33-3·75) excess deaths per 100 000 population (excess death rate) were associated with cold spells per year between 2000 and 2019. The annual average global excess death ratio in 2016-19 increased by 0·12 percentage points and the excess death rate in 2016-19 increased by 0·18 percentage points, compared with those in 2000-03. The mortality burden varied geographically. The excess death ratio and rate were highest in Europe, whereas these indicators were lowest in Africa. Temperate climates had higher excess death ratio and rate associated with cold spells than other climate zones.

INTERPRETATION

Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells.

FUNDING

Australian Research Council, Australian National Health and Medical Research Council, EU's Horizon 2020 Project Exhaustion.

Cross-adaptation from heat stress to hypoxia: A systematic review and exploratory meta-analysis

Cross-adaptation (CA) refers to the successful induction of physiological adaptation under one environmental stressor (e.g., heat), to enable subsequent benefit in another (e.g., hypoxia). This systematic review and exploratory meta-analysis investigated the effect of heat acclimation (HA) on physiological, perceptual and physical performance outcome measures during rest, and submaximal and maximal intensity exercise in hypoxia. Database searches in Scopus and MEDLINE were performed. Studies were included when they met the Population, Intervention, Comparison, and Outcome criteria, were of English-language, peer-reviewed, full-text original articles, using human participants. Risk of bias and study quality were assessed using the COnsensus based Standards for the selection of health status Measurement INstruments checklist. Nine studies were included, totalling 79 participants (100 % recreationally trained males). The most common method of HA included fixed-intensity exercise comprising 9 ± 3 sessions, 89 ± 24-min in duration and occurred within 39 ± 2 °C and 32 ± 13 % relative humidity. CA induced a moderate, beneficial effect on physiological measures at rest (oxygen saturation: g = 0.60) and during submaximal exercise (heart rate: g = -0.65, core temperature: g = -0.68 and skin temperature: g = -0.72). A small effect was found for ventilation (g = 0.24) and performance measures (peak power: g = 0.32 and time trial time: g = -0.43) during maximal intensity exercise. No effect was observed for perceptual outcome measures. CA may be appropriate for individuals, such as occupational or military workers, whose access to altitude exposure prior to undertaking submaximal activity in hypoxic conditions is restricted. Methodological variances exist within the current literature, and females and well-trained individuals have yet to be investigated. Future research should focus on these cohorts and explore the mechanistic underpinnings of CA.

A Comparison of Normalization Techniques for Individual Baseline-Free Estimation of Absolute Hypovolemic Status Using a Porcine Model

Hypovolemic shock is one of the leading causes of death in the military. The current methods of assessing hypovolemia in field settings rely on a clinician assessment of vital signs, which is an unreliable assessment of hypovolemia severity. These methods often detect hypovolemia when interventional methods are ineffective. Therefore, there is a need to develop real-time sensing methods for the early detection of hypovolemia. Previously, our group developed a random-forest model that successfully estimated absolute blood-volume status (ABVS) from noninvasive wearable sensor data for a porcine model (n = 6). However, this model required normalizing ABVS data using individual baseline data, which may not be present in crisis situations where a wearable sensor might be placed on a patient by the attending clinician. We address this barrier by examining seven individual baseline-free normalization techniques. Using a feature-specific global mean from the ABVS and an external dataset for normalization demonstrated similar performance metrics compared to no normalization (normalization: R2 = 0.82 ± 0.025|0.80 ± 0.032, AUC = 0.86 ± 5.5 × 10-3|0.86 ± 0.013, RMSE = 28.30 ± 0.63%|27.68 ± 0.80%; no normalization: R2 = 0.81 ± 0.045, AUC = 0.86 ± 8.9 × 10-3, RMSE = 28.89 ± 0.84%). This demonstrates that normalization may not be required and develops a foundation for individual baseline-free ABVS prediction.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 4: evolution, thermal adaptation and unsupported theories of thermoregulation

This review is the final contribution to a four-part, historical series on human exercise physiology in thermally stressful conditions. The series opened with reminders of the principles governing heat exchange and an overview of our contemporary understanding of thermoregulation (Part 1). We then reviewed the development of physiological measurements (Part 2) used to reveal the autonomic processes at work during heat and cold stresses. Next, we re-examined thermal-stress tolerance and intolerance, and critiqued the indices of thermal stress and strain (Part 3). Herein, we describe the evolutionary steps that endowed humans with a unique potential to tolerate endurance activity in the heat, and we examine how those attributes can be enhanced during thermal adaptation. The first of our ancestors to qualify as an athlete was Homo erectus, who were hairless, sweating specialists with eccrine sweat glands covering almost their entire body surface. Homo sapiens were skilful behavioural thermoregulators, which preserved their resource-wasteful, autonomic thermoeffectors (shivering and sweating) for more stressful encounters. Following emigration, they regularly experienced heat and cold stress, to which they acclimatised and developed less powerful (habituated) effector responses when those stresses were re-encountered. We critique hypotheses that linked thermoregulatory differences to ancestry. By exploring short-term heat and cold acclimation, we reveal sweat hypersecretion and powerful shivering to be protective, transitional stages en route to more complete thermal adaptation (habituation). To conclude this historical series, we examine some of the concepts and hypotheses of thermoregulation during exercise that did not withstand the tests of time.

Infusion-Related Reactions Induced by Cadonilimab (PD-1/CTLA-4 Bispecific Antibody): Seven Case Reports

Introduction

Cadonilimab (AK104) is an innovative human programmed cell death-1 (PD-1)/cytotoxic T lymphocyte antigen-4 (CTLA-4) bispecific antibody. Compared with the combination therapy of PD-1 and CTLA-4 blockers, less cellular toxicity of cadonilimab was significantly manifested. As one of the characteristic adverse effects of cadonilimab, infusion-related reactions (IRRs) represent fever, chills, rash, decreased blood pressure, and other symptoms.

Case Presentation

Here, we documented seven cases of IRRs after the administration of cadonilimab. The symptoms of IRRs were relieved after the discontinuation of cadonilimab and the administration of diphenhydramine, dexamethasone, and cimetidine. Notably, 3 patients were able to tolerate the subsequent cadonilimab therapy under the pretreatment.

Conclusion

In this study, we discovered that cadonilimab-related IRRs might be lessened or prevented by administering medication and the proper pretreatment and lowering the infusion rate.

Habituation of the cold shock response: A systematic review and meta-analysis

Cold water immersion (CWI) evokes the life-threatening reflex cold shock response (CSR), inducing hyperventilation, increasing cardiac arrhythmias, and increasing drowning risk by impairing safety behaviour. Repeated CWI induces CSR habituation (i.e., diminishing response with same stimulus magnitude) after ∼4 immersions, with variation between studies. We quantified the magnitude and coefficient of variation (CoV) in the CSR in a systematic review and meta-analysis with search terms entered to Medline, SportDiscus, PsychINFO, Pubmed, and Cochrane Central Register. Random effects meta-analyses, including effect sizes (Cohen's d) from 17 eligible groups (k), were conducted for heart rate (HR, n = 145, k = 17), respiratory frequency (fR, n = 73, k = 12), minute ventilation (Ve, n = 106, k = 10) and tidal volume (Vt, n = 46, k=6). All CSR variables habituated (p < 0.001) with large or moderate pooled effect sizes: ΔHR -14 (10) bt. min-1 (d: -1.19); ΔfR -8 (7) br. min-1 (d: -0.78); ΔVe, -21.3 (9.8) L. min-1 (d: -1.64); ΔVt -0.4 (0.3) L -1. Variation was greatest in Ve (control vs comparator immersion: 32.5&24.7%) compared to Vt (11.8&12.1%). Repeated CWI induces CSR habituation potentially reducing drowning risk. We consider the neurophysiological and behavioural consequences.

Pollutant-meteorological factors and cardio-respiratory mortality in Portugal: Seasonal variability and associations

Seasonal variations in cardiorespiratory diseases may be influenced by air pollution and meteorological factors. This work aims to highlight the relevance of a complete seasonal characterization of the pollutant-meteorological factors and cardio-respiratory mortality in Portugal and the relationships between health outcomes and environmental risk factors. To this end, air pollution and meteorological variables along with health outcomes were analyzed at national level and on a monthly basis for the period of 2011-2020. It was found that cardiorespiratory mortality rates during winter were 44% higher than during the summer. Furthermore, particulate matter with aerodynamic diameters of 10 and 2.5 μm (μm) or smaller (PM10 and PM2.5), carbon monoxide (CO) and nitrogen dioxide (NO2) showed a seasonal variability with the highest concentrations during winter while ozone (O3) presented higher concentrations during spring and summer. PM10, PM2.5 and NO2, showed a positive correlation between seasons, indicating similar patterns of behavior. Canonical correlation analysis (CCA) applied to pollutant-meteorological and cardiorespiratory mortality data indicates a strong linear correlation between pollutant-meteorological factors and health outcomes. The first canonical correlation was 0.889, and the second was 0.545, both statistically significant (p-value < 0.001). The CCA results suggest that there is a strong association between near-surface temperature, relative humidity, PM10, PM2.5, CO and NO2 and health outcomes. The results of this study provide important information of the seasonal variability of air pollutants and meteorological factors in Portugal and their associations with cardiorespiratory mortality.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise

In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.

The Effects of Intermittent Cold Exposure on Adipose Tissue

Intermittent cold exposure (ICE) has garnered increased attention in popular culture, largely for its proposed effects on mood and immune function, but there are also suggestions that the energy-wasting mechanisms associated with thermogenesis may decrease body weight and fat mass. Considering the continued and worsening prevalence of obesity and type II diabetes, any protocol that can reduce body weight and/or improve metabolic health would be a substantial boon. Here, we present a narrative review exploring the research related to ICE and adipose tissue. Any publicly available original research examining the effects of repeated bouts of ICE on adipose-related outcomes was included. While ICE does not consistently lower body weight or fat mass, there does seem to be evidence for ICE as a positive modulator of the metabolic consequences of obesity, such as glucose tolerance and insulin signaling. Further, ICE consistently increases the activity of brown adipose tissue (BAT) and transitions white adipose tissue to a phenotype more in line with BAT. Lastly, the combined effects of ICE and exercise do not seem to provide any additional benefit, at least when exercising during ICE bouts. The majority of the current literature on ICE is based on rodent models where animals are housed in cold rooms, which does not reflect protocols likely to be implemented in humans such as cold water immersion. Future research could specifically characterize ICE via cold water immersion in combination with controlled calorie intake to clearly determine the effects of ICE as it would be implemented in humans looking to lower their body weight via reductions in fat mass.

Temperature fluctuation and acute myocardial infarction in Beijing: an extended analysis of temperature ranges and differences

Purpose

Few studies examined the relationship between temperature fluctuation metrics and acute myocardial infarction (AMI) hospitalizations within a single cohort. We aimed to expand knowledge on two basic measures: temperature range and difference.

Methods

We conducted a time-series analysis on the correlations between temperature range (TR), daily mean temperature differences (DTDmean), and daily mean-maximum/minimum temperature differences (TDmax/min) and AMI hospitalizations, using data between 2013 and 2016 in Beijing, China. The effects of TRn and DTDmeann over n-day intervals were compared, respectively. Subgroup analysis by age and sex was performed.

Results

A total of 81,029 AMI hospitalizations were included. TR1, TDmax, and TDmin were associated with AMI in J-shaped patterns. DTDmean1 was related to AMI in a U-shaped pattern. These correlations weakened for TR and DTDmean with longer exposure intervals. Extremely low (1st percentile) and high (5°C) DTDmean1 generated cumulative relative risk (CRR) of 2.73 (95% CI: 1.56-4.79) and 2.15 (95% CI: 1.54-3.01). Extremely high TR1, TDmax, and TDmin (99th percentile) correlated with CRR of 2.00 (95% CI: 1.73-2.85), 1.71 (95% CI: 1.40-2.09), and 2.73 (95% CI: 2.04-3.66), respectively. Those aged 20-64 had higher risks with large TR1, TDmax, and TDmin, while older individuals were more affected by negative DTDmean1. DTDmean1 was associated with a higher AMI risk in females.

Conclusion

Temperature fluctuations were linked to increased AMI hospitalizations, with low-temperature extremes having a more pronounced effect. Females and the older adult were more susceptible to daily mean temperature variations, while younger individuals were more affected by larger temperature ranges.

Association between ambient temperature exposure and pregnancy outcomes in patients undergoing in vitro fertilization in Shanghai, China: a retrospective cohort study

STUDY QUESTION

Does ambient temperature exposure affect outcomes including clinical pregnancy and live birth in women undergoing IVF?

SUMMARY ANSWER

Both extreme cold and hot ambient temperatures were significantly associated with adverse pregnancy outcomes of IVF cycles.

WHAT IS KNOWN ALREADY

Heat exposure has been linked to adverse pregnancy outcomes worldwide. However, the effect of ambient temperature on infertile women undergoing IVF treatment is unclear.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study was conducted from a database of 3452 infertile women who underwent their first fresh or frozen embryo transfer in the Shanghai First Maternity and Infant Hospital from April 2016 to December 2020.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Daily mean ambient temperature exposure for each patient was obtained based on their residential address. Temperature-stratified multiple logistic regression analysis was performed to investigate associations between temperature exposure and pregnancy outcomes after controlling for confounders. Vulnerable sub-groups were identified using forest plots.

MAIN RESULTS AND THE ROLE OF CHANCE

The clinical pregnancy rate and live birth rate were 45.7% and 37.1%, respectively. Regarding clinical pregnancy, a higher temperature during cold weather was significantly associated with a higher pregnancy rate in the period about 11 weeks before ovarian stimulation (adjusted odds ratio (aOR) = 1.102, 95% CI: 1.012-1.201). Regarding live birth, an increased temperature during cold weather was significantly related to a higher live birth rate in the period after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs of 6.299 (95% CI: 3.949-10.047) or 10.486 (95% CI: 5.609-19.620), respectively. However, a higher temperature during hot weather was negatively associated with the live birth rate in the periods after confirmation of clinical pregnancy or biochemical pregnancy, with the aORs at 0.186 (95% CI: 0.121-0.285) or 0.302 (95% CI: 0.224-0.406), respectively. Moreover, the decline in live birth rates during cold and hot weather was accompanied by increased rates of early miscarriage (P < 0.05). Stratified analyses identified susceptibility characteristics among the participants.

LIMITATIONS, REASONS FOR CAUTION

Climate monitoring data were used to represent individual temperature exposure levels according to the patient's residential address in the study. We were not able to obtain information of personal outdoor activity and use of indoor air conditioners in this retrospective study, which may affect actual temperature exposure.

WIDER IMPLICATIONS OF THE FINDINGS

This study highlights that the ambient temperature exposure should be taken into account during IVF treatment and afterwards. There is a need to be alert to extremes in cold and hot ambient temperatures, especially during the period of follicle development and pregnancy. With this knowledge, clinicians can scientifically determine the timing of IVF treatment and reinforce patients' awareness of self-protection to minimize adverse pregnancy outcomes associated with extreme temperatures.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by a grant from the Clinical Research Plan of Shanghai Hospital Development Center [SHDC2020CR4080], a grant from the Science and Technology Commission of Shanghai Municipality [19411960500], and two grants from the National Natural Science Foundation of China [81871213, 81671468]. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437). B.W.M. reports consultancy for ObsEva, and research grants from Merck KGaA, Ferring and Guerbet. The other authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.