Effect of hyperthermia on radiation pneumonitis in elderly patients with esophageal cancer receiving intensity-modulated radiation therapy / 中华放射肿瘤学杂志

Objective:To evaluate the effect of hyperthermia on radiation pneumonitis (RP) in elderly patients with esophageal cancer undergoing intensity-modulated radiotherapy (IMRT).Methods:Clinical data of 177 elderly esophageal cancer patients (aged ≥60 years) receiving IMRT in the First Affiliated Hospital of Soochow University and Yixing Cancer Hospital from August 1, 2017 to February 6, 2023 were retrospectively analyzed. Patients were divided into the hyperthermia and non-hyperthermia groups based on whether they received hyperthermia treatment. Patients in two groups received IMRT with 6 MV X-rays. Patients in the hyperthermia group underwent high-frequency hyperthermia within 1 h before radiation using the external thermotherapy device HG-2000Ⅲ (heating temperature: 41-43 ℃ for 40 min, twice a week). After adjusting for confounding factors between two groups using propensity score matching (PSM), the short-term effective rates between two groups were compared using Chi-square test. Univariate analysis and logistic multivariate analysis were employed to compare the incidence of RP between two groups. Results:After applying PSM, 42 pairs were successfully matched, and the baseline data and radiotherapy parameters showed no statistically significant differences between two groups (all P>0.05). The objective response rate (ORR) in the hyperthermia group was significantly higher than that in the non-hyperthermia group (83.3% vs. 64.3%, P=0.047). Univariate analysis revealed that the incidence of RP and symptomatic RP (≥ grade 2) in the hyperthermia group was significantly lower than that in the non-hyperthermia group (61.9% vs. 85.7%, P=0.013; 21.4% vs. 47.6%, P=0.012). Logistic multivariate analysis indicated that hyperthermia was an independent protective factor for symptomatic RP ( P=0.011). Conclusions:The incidence and severity of RP in elderly esophageal cancer patients receiving IMRT can be reduced by hyperthermia. Hyperthermia, as a clinically beneficial green treatment, improves efficacy and reduces toxicity for patients with esophageal cancer.

Coil design and simulation analysis of magnetic induction hyperthermia in rats / 中国医学物理学杂志

A Helmholtz coil is selected to generate the alternating magnetic field,and the relevant model is established with a rat brain tumor as the research object.Based on the Pennes bioheat transfer equation,the electromagnetic field distribution and temperature field distribution are calculated in COMSOL simulation software,and the factors affecting the outcome of magnetic induction hyperthermia are analyzed.The results show that both magnetic field distribution and temperature field distribution meet the requirements for magnetic induction hyperthermia.The magnetic field distribution in the tumor treatment area is uniform,and the central magnetic induction strength is 12.847 mT.The temperature rise in the tumor area is significant,and the temperature at the tumor center is 46℃or above,basically reaching the treatment temperature.The therapeutic efficacy of magnetic induction hyperthermia is affected by the number of turns,current,radius and spacing,magnetic field frequency and other parameters.The study provides reference for the clinical application of magnetic induction hyperthermia and the coil design.

Effects of maternal hyperthermia on neurodevelopment: a literature review

Maternal hyperthermia, defined as a body temperature above 38°C (100.4°F) is due to various etiologies during pregnancy, and has been a subject of growing research interest. This phenomenon is considered a potential environmental teratogen contributing to the development of neural tube defects (NTDs) and other neurodevelopmental disorders. NTDs such as anencephaly and spina bifida, are known to be multifactorial in origin, resulting from a complex interplay between genetic and environmental factors. In this review, we aim to comprehensively analyze the effect of maternal hyperthermia on neurodevelopmental disorders and associated congenital anomalies. In addition, we will highlight both the infectious and noninfectious causes of maternal hyperthermia, as well as any risks and potential preventive measures. The literature search identified studies reporting associations between maternal hyperthermia and adverse fetal outcomes. We have evaluated the link between maternal fever due to infections during pregnancy and the increased likelihood of NTDs, particularly anencephaly and spina bifida, as well as Neurodevelopmental disorders. ??In addition, the effects of non-infectious causes of maternal hyperthermia, including exercise and exposure to heat sources like saunas and hot tubs, on neurodevelopment have also been studied with varying degrees of evidence. Maternal hyperthermia elevates the risk of NTDs and neurodevelopmental disorders in infants, with folic acid offering partial protection, while other factors elevate this risk. However, further research is needed to define the precious association of these factors.

Hipertermia maligna en paciente sometida a mastectomía radical tipo Madden / Malignant hyperthermia in a patient undergoing Madden type radical mastectomy

Resumen: El objetivo del presente estudio es dar a conocer el manejo anestésico que se proporcionó ante un evento crítico hipertermia maligna (HM) en una mastectomía radical Madden programada de manera electiva, la cual fue manejada con lo que se contaba en ese momento por no tener el fármaco específico (dantroleno) para este tipo de evento HM. El cáncer de mama es una enfermedad compleja, es la primera causa de muerte en la mujer a nivel mundial, ocurre en 70% en países desarrollados. México se encuentra en un nivel intermedio, representa un problema de salud con tendencia a la alta debido al envejecimiento de la población y a mayor prevalencia en factores de riesgo. La HM es un trastorno farmacogenético desencadenado por anestésicos que liberan una masiva acumulación de calcio en el sarcoplasma, que conduce a un metabolismo acelerado y a un incremento en la actividad contráctil del musculoesquelético, llevando a un estado hipermetabólico que genera un incremento en la temperatura corporal llegando a tener secuelas importantes y una alta mortalidad. Se trató de paciente femenino 40 años sin antecedentes relevantes para procedimientos anestésicos, se aplicó anestesia general balanceada, a los 60 minutos presentó datos clínicos que nos sugerían hipertermia maligna, fue manejada con los medios disponibles y se obtuvo un resultado favorable desde el punto de vista de morbimortalidad.

Abstract: The objective of the present is to present the anesthetic management that occurred before a critical event malignant hyperthermia HM) in an electively scheduled Madden radical mastectomy and which was managed with what was available at that time for not having the drug specific (dantrolene) for this type of event HM. Breast cancer is a complex disease, being the leading cause of death in women worldwide, with 70% occurring in developed countries. Mexico is at an intermediate level, being a health problem with a tendency to rise due to the aging of the population. population and higher prevalence of risk factors. Malignant hyperthermia (MH) is an anesthetic-triggered pharmacogenetic disorder that triggers a massive accumulation of calcium in the sarcoplasm, leading to accelerated metabolism and increased skeletal muscle contractile activity. Leading to a hypermetabolic state showing an increase in body temperature, leading to significant sequelae and high mortality. It was a 40-year-old female with no relevant history for anesthetic procedures, being managed with balanced general anesthesia at 60 minutes present data clinicians that they suggested malignant hyperthermia, being managed. With the available means, obtaining a favorable result from the point of view of morbidity and mortality.

La terapia electroconvulsiva en el síndrome neuroléptico maligno / Electroconvulsive therapy in neuroleptic malignant syndrome

Resumen: Uno de los efectos adversos más importantes de los neurolépticos es la posibilidad de desencadenar el síndrome neuroléptico maligno (NMS). El diagnóstico se determina por exclusión y el manejo terapéutico inicial será retirado por neurolépticos por la administración de benzodiacepinas y, en casos extremos, el uso de la terapia electroconvulsiva (ECT). La ECT es una opción terapéutica eficaz en estos pacientes y en esos casos se obtiene una mala respuesta a la administración con fármacos antipsicóticos. Basándonos en el caso del artículo «Rocuronium-sugammadex for electroconvulsive therapy management in neuroleptic malignant síndrome. A case report¼ donde se describe el manejo exitoso del uso de relajantes no despolarizantes y su reversor específico en terapias electroconvulsivas en pacientes diagnosticados de síndrome neuroléptico maligno, comentamos la fisiopatología e implicaciones anestésicas además de similitudes con otras entidades hipertérmicas, como es la hipertermia maligna.

Abstract: One of the most important adverse effects of neuroleptics is the possibility of triggering neuroleptic malignant syndrome (NMS). The diagnosis is determined by exclusion and the initial therapeutic management will be withdrawn by neuroleptics by the administration of benzodiazepines and, in extreme cases, the use of electroconvulsive therapy (ECT). ECT is an effective therapeutic option in these patients and in these cases a poor response to administration with antipsychotic drugs is obtained. Based on the case of the article «Rocuronium-sugammadex for the management of electroconvulsive therapy in neuroleptic malignant syndrome. A case report¼ where the successful management of the use of non-depolarizing relaxants and their specific reversal in electroconvulsive therapies in patients diagnosed with of malignant neuroleptic syndrome, we comment on the pathophysiology and anesthetic images as well as similarities with other hyperthermic entities, such as malignant hyperthermia.

Predictive factors of the contracture test for diagnosing malignant hyperthermia in a Brazilian population sample: a retrospective observational study

Abstract Introduction Malignant Hyperthermia (MH) is a pharmacogenetic, hereditary and autosomal dominant syndrome triggered by halogenates/succinylcholine. The In Vitro Contracture Test (IVCT) is the gold standard diagnostic test for MH, and it evaluates abnormal skeletal muscle reactions of susceptible individuals (earlier/greater contracture) when exposed to caffeine/halothane. MH susceptibility episodes and IVCT seem to be related to individual features. Objective To assess variables that correlate with IVCT in Brazilian patients referred for MH investigation due to a history of personal/family MH. Methods We examined IVCTs of 80 patients investigated for MH between 2004‒2019. We recorded clinical data (age, sex, presence of muscle weakness or myopathy with muscle biopsy showing cores, genetic evaluation, IVCT result) and IVCT features (initial and final maximum contraction, caffeine/halothane concentration triggering contracture of 0.2g, contracture at caffeine concentration of 2 and 32 mmoL and at 2% halothane, and contraction after 100 Hz stimulation). Results Mean age of the sample was 35±13.3 years, and most of the subjects were female (n=43 or 54%) and MH susceptible (60%). Of the 20 subjects undergoing genetic investigation, 65% showed variants in RYR1/CACNA1S genes. We found no difference between the positive and negative IVCT groups regarding age, sex, number of probands, presence of muscle weakness or myopathy with muscle biopsy showing cores. Regression analysis revealed that the best predictors of positive IVCT were male sex (+12%), absence of muscle weakness (+20%), and personal MH background (+17%). Conclusions Positive IVCT results have been correlated to male probands, in accordance with early publications. Furthermore, normal muscle strength has been confirmed as a significant predictor of positive IVCT while investigating suspected MH cases.

Fatigue, depression, and physical activity in patients with malignant hyperthermia: a cross-sectional observational study

Abstract Background Malignant Hyperthermia (MH) is a pharmacogenetic disorder triggered by halogenated anesthesia agents/succinylcholine and characterized by hypermetabolism crisis during anesthesia, but also by day-to-day symptoms, such as exercise intolerance, that may alert the health professional. Objective The study aimed to analyze the incidence of fatigue in MH susceptible patients and the variables that can impact perception of fatigue, such as the level of routine physical activity and depression. Methods A cross-sectional observational study was carried out with three groups - 22 patients susceptible to MH (positive in vitro muscle contracture test), 13 non-susceptible to MH (negative in vitro muscle contracture test) and 22 controls (no history of MH). Groups were assessed by a demographic/clinical questionnaire, a fatigue severity scale (intensity, specific situations, psychological consequences, rest/sleep response), and the Beck depression scale. Subgroups were re-assessed with the Baecke habitual physical exercise questionnaire (occupational physical activity, leisure physical exercise, leisure/locomotion physical activity). Results There were no significant differences among the three groups regarding fatigue intensity, fatigue related to specific situations, psychological consequences of fatigue, fatigue response to resting/sleeping, depression, number of active/sedentary participants, and the mean time and characteristics of habitual physical activity. Nevertheless, unlike the control sub-group, the physically active MH-susceptible subgroup had a higher fatigue response to resting/sleeping than the sedentary MH susceptible subgroup (respectively, 5.9 ± 1.9 vs. 3.9 ± 2, t-test unpaired, p< 0.05). Conclusion We did not detect subjective fatigue in MH susceptible patients, although we reported protracted recovery after physical activity, which may alert us to further investigation requirements.

Several challenges associated with the anesthetic management of Emery-Dreifuss muscular dystrophy patients: case report

Abstract Emery-Dreifuss Muscular Dystrophy is a very rare type of muscular dystrophy, associated with contractures, atrophy, and muscle weakness, besides cardiomyopathy with severe arrhythmias. Published studies focusing on this disorder are scarce. We describe the anesthetic management of a male patient with Emery-Dreifuss Muscular Dystrophy, to be submitted to umbilical and inguinal hernioplasty and hydrocele repair under epidural anesthesia. The anesthesia approach enabled us to circumvent the patient's susceptibility to malignant hyperthermia and his potentially difficult airway, in addition to maintaining hemodynamic stability. The day after surgery the patient resumed walking, and two days later he was discharged from the hospital.

Patient suspected susceptibility to malignant hyperthermia: impact of the disease

Abstract Introduction Malignant Hyperthermia (MH) is an inherited hypermetabolic syndrome triggered by exposure to halogenated anesthetics/succinylcholine. The lack of knowledge regarding this condition might be associated with the rare occurrence of MH reaction and symptoms. Methods This observational study evaluated 68 patients from 48 families with confirmed or suspected MH susceptibility due to medical history of MH reaction or idiopathic increase of creatine kinase or MH-related myopathies. Participants were assessed by a standardized questionnaire and submitted to physical/neurological examination to assess the characteristics of patients with MH, their knowledge about the disease, and the impact suspected MH had on their daily lives. Results Suspected MH impacted the daily life of 50% of patients, creating difficulties in performing surgical/clinical/dental treatment and problems related to their family life/working/practicing sports. The questionnaire on MH revealed a correct answer score of 62.1 ± 20.8 (mean ± standard deviation) on a scale 0 to 100. Abnormal physical/neurological examination findings were detected in 92.6% of susceptible patients. Conclusions Suspected MH had impacted the daily lives of most patients, with patients reporting problems even before MH investigation with IVCT. Patients showed a moderate level of knowledge about MH, suggesting the need to implement continuing education programs. MH susceptible patients require regular follow-up by a health team to detect abnormalities during physical and neurological examination.

Hipertermia maligna / Malignant hyperthermia

Resumen: La hipertermia maligna es un raro desorden farmacogenético potencialmente mortal, que se presenta como una respuesta hipermetabólica a los anestésicos volátiles y relajantes musculares despolarizantes en individuos susceptibles. Esta susceptibilidad se asocia a mutaciones en tres genes: RYR1, CACNA1S y STAC3. Puede manifestarse con síntomas leves o como una crisis fulminante, con rabdomiólisis severa, fibrilación ventricular e insuficiencia renal y circulatoria aguda, por lo tanto, el pronóstico depende de qué tan pronto se sospeche del diagnóstico y qué tan rápido se inicie el tratamiento. El diagnóstico definitivo se basa en una prueba de sensibilidad en biopsia muscular fresca y en pruebas genéticas. La mejor manera de prevenir un evento es la detección precoz de los pacientes susceptibles así como contar con el equipo para responder ante una crisis en cada centro donde se administren anestésicos volátiles y la capacitación del personal. Esta revisión sintetiza los conceptos actuales clínicos y biomédicos para detección, prevención, diagnóstico y manejo de la hipertermia maligna.

Abstract: Malignant hyperthermia is a rare, life-threatening pharmacogenetic disorder which presents as a hypermetabolic response to volatile anesthetics and depolarizing muscle relaxants in susceptible individuals. This susceptibility is associated with mutations in three genes: RYR1, CACNA1S and STAC3. Can manifest with mild symptoms or as a fulminant crisis, with severe rhabdomyolysis, ventricular fibrillation and acute renal and circulatory failure, therefore the prognosis depends on how soon the diagnosis is suspected and how fast treatment is started. The definitive diagnosis is based on a fresh muscle biopsy sensitivity test and genetic testing. The best way to prevent an event is the early detection of susceptible, as well as have equipment to respond to a crisis in each center where volatile anesthetics are administered and the training of staff. This review synthesizes current clinical and biomedical concepts for detection, prevention, diagnosis and management of malignant hyperthermia.

Termoterapia associada com treinamento de flexibilidade não aprimora a amplitude de movimento de joelhos em adultos saudáveis: revisão sistemática de ensaios clínicos randomizados com meta-análise / Thermotherapy associated with flexibility training does not increase the knee range of movement of healthy adults: systematic review and meta-analysis of randomized clinical trials

The stretching with thermotherapies associated have been related in the literature as a way to increase the range of motion (ROM), but still are not consensus about this efficacy and costeffectiveness. The muscle stretching is a useful technique in rehabilitation and in physical activities programs, either to gain or maintain the flexibility, as a recovery of musculoskeletal and joint injuries. Objective: To determine the effects of thermotherapies associated to flexibility training in ROM of knee extension in healthy adults. Method: The search strategy was conducted in main databases, as Cochrane Library, LILACS, PEDro, PUBMED/ Medline, Scopus and Web of Science. The searches were done in 2016, and renewed in 2023, in order to achieve new publications along this time. Were selected only randomized clinical trials that have executed a training of hamstrings stretching, associated or not with one or more thermotherapies in healthy young adults, as long as the outcome was knee extension ROM. Only papers in Portuguese or English were assessed. To evaluate risk of bias was used the Cochrane Collaboration's Risk of Bias Tool, and the methodological quality assessment was rated following the PEDro Scale. Results: Eight articles were included, totalizing 260 participants. The papers showed low methodological quality, and uncertain risk of bias. Only chronic effect of local warming and cryotherapy plus stretching showed a statistically significant difference versus control group. However, the thermotherapy action associated with stretching is still unclear, once the results suggest that even without the thermotherapy there are ROM increases. Conclusion: The stretching is effective in knee extension ROM improvement in healthy adults, with or without thermotherapy. New studies with higher methodological rigor and standardized protocols are needed

Os alongamentos com termoterapias associadas têm sido relatados na literatura como forma de aumentar a amplitude de movimento (ADM), mas ainda não há consenso sobre sua eficácia e custo-efetividade. O alongamento muscular é uma técnica útil na reabilitação e em programas de atividades físicas, tanto para ganho ou manutenção da flexibilidade, quanto para recuperação de lesões musculoesqueléticas e articulares. Objetivo: Determinar os efeitos das termoterapias associadas ao treinamento de flexibilidade na ADM de extensão do joelho em adultos saudáveis. Método: A estratégia de busca foi realizada nas principais bases de dados, como Cochrane Library, LILACS, PEDro, PUBMED/ MedLine, Scopus e Web of Science. As buscas foram realizadas em 2016, e renovadas em 2023, a fim de alcançar novas publicações ao longo deste tempo. Foram selecionados apenas ensaios clínicos randomizados que tenham executado um treinamento de alongamento de isquiotibiais, associado ou não a uma ou mais termoterapias, em adultos jovens saudáveis, desde que o desfecho fosse ADM de extensão de joelho. Apenas artigos em português ou inglês foram avaliados. Para avaliar o risco de viés foi usado o Risk of Bias Tool da Cochrane Collaboration, e a avaliação da qualidade metodológica foi classificada de acordo com a Escala PEDro. Resultados: Foram incluídos oito artigos, totalizando 260 participantes. Os artigos apresentaram baixa qualidade metodológica e risco incerto de viés. Apenas o efeito crônico de aquecimento local e crioterapia associados ao alongamento mostrou uma diferença estatisticamente significativa em relação ao grupo controle. No entanto, a ação da termoterapia associada ao alongamento ainda não está clara, uma vez que os resultados sugerem que mesmo sem a termoterapia há aumento da ADM. Conclusão: O alongamento é eficaz na melhora da ADM de extensão do joelho em adultos saudáveis, com ou sem termoterapia. Novos estudos com maior rigor metodológico e protocolos padronizados são necessários

Evaluation of two polyethylene bags in preventing admission hypothermia in preterm infants: a quasirandomized clinical trial

Abstract Objective: To compare two polyethylene bags in preventing admission hypothermia in preterm infants born at <34 weeks gestation. Method: Quasi-randomized unblinded clinical trial conducted at a level III neonatal unit between June 2018 to September 2019. The authors assign infants between 240/7 and 336/7 weeks' gestation to receive NeoHelpTM bag (intervention group) or a usual plastic bag (control group). The primary outcome was admission hypothermia, considering an axillary temperature at admission to the neonatal unit of <36.0 °C. Hyperthermia was considered if the admission temperature reached 37.5 °Cor more. Results: The authors evaluated 171 preterm infants (76, intervention group; 95, control group). The rate of admission hypothermia was significantly lower in the intervention group (2.6% vs. 14.7%, p = 0.007), with an 86% reduction in the admission hypothermia rate (OR, 0.14; 95% CI, 0.03-0.64), particularly for infants weighing >1000 g and >28 weeks gestation. The intervention group also had a higher median of temperature at admission - 36.8 °C (interquartile range 36.5-37.1) vs. 36.5 °C (interquartile range 36.1-36.9 °C), p = 0.001, and showed à higher hyperthermia rate (9.2% vs. 1.0%, p = 0.023). Birth weight was also associated to the outcome, and it represented a 30% chance reduction for every 100-g increase (OR, 0.997; 95% CI, 0.996-0.999). The in-hospital mortality rate was similar between groups. Conclusion: The intervention polyethylene bag was more effective in preventing admission hypothermia. Nonetheless, the risk of hyperthermia is a concern during its use.

Caso clínico. Golpe de calor ¿Futura pandemia? / Heat stroke, future pandemic? Case report

The clinical case of a patient admitted to the intensive care unit (ICU) of a tertiary university hospital with a diagnosis of heat stroke is presen- ted. Meets the definitions of this pathology with hyperthermia (41°), altered level of consciousness with ambient temperatura of more than 40°. For its management, the patient requires mechanical ventilation connection, vasoactive drugs, and an intravascular hypothermic device. During the month of July 2022, temperaturas held extraordinarily high. It is foreseeable that these phenomena will increase in intensity or frequency. A critical medical pathology directly related to this phenomenon is the heat stroke. The objective of this case is to make a description of a pathology not very frequent in intensive care units at present, but with real possibilities of increase.

Se presenta el caso clínico de un paciente ingresado en la Unidad de Cuidados Intensivos (UCI), de un hospital terciario universitario con el diagnóstico de golpe de calor. Cumple con las definiciones de este cuadro con hipertermia (41°), alteración de nivel de consciencia con temperatura ambiente de más de 40°. El paciente precisa para su manejo conexión a ventilación mecánica, fármacos vasoactivos y dispositivo intravascular de hipotermia. Durante el mes de julio de 2022, se registraron en gran parte de Europa temperaturas mantenidas extraordinariamente altas. Es previsible, que estos fenómenos aumenten en intensidad o frecuencia. Una patología médica crítica relacionada directamente con este fenómeno es el golpe calor. El objetivo del presente caso es realizar una descripción de una patología no muy frecuente en las unidades de cuidados intensivos en la actualidad, pero con posibilidades reales de aumento.

Manejo anestésico de paciente con dermatomiositis paraneoplásica en cirugía de cáncer de ovario / Anesthetic management of a patient with paraneoplastic dermatomyosis in ovarian cancer surgery

Dermatomyositis is a rare disease with important implications regarding the anesthetic management of the patient. The possibility of the development of hyperkalemic crises, malignant hyperthermia or myotonic crises forces us to know which drugs are safe and which ones should be avoided. The involvement of the respiratory and swallowing muscles makes these patients very prone to the development of post-anesthetic apnea and increases the appearance of aspiration pneumonia, arrhythmias and heart failure, so longer-term post-anesthetic surveillance in spe- cialized units is recommended. Likewise, it is essential to maintain normothermia, normovolemia avoiding anemia, adequate treatment of pain and prevention of renal failure. There is little bibliography in this regard, so more publications are needed.

La dermatomiositis es una enfermedad rara con importantes implicaciones respecto al manejo anestésico del paciente. La posibilidad del desarrollo de crisis hiperpotasémicas, hipertermia maligna o crisis miotónicas nos obliga a conocer cuales son los fármacos seguros y cuáles debemos evitar. La afectación de los músculos respiratorios y deglutorios hace que estos pacientes sean muy propensos a desarrollo de apneas posanestésicas y aumenta la aparición de neumonías aspirativas, arritmias y fallos cardíacos, por lo que la vigilancia posanestésica de mayor duración en unidades especializadas es recomendable. Así mismo, es esencial el mantenimiento de la normotermia, la normovolemia evitando la anemización, el tratamiento adecuado del dolor y la prevención de la insuficiencia renal. Existe escasa bibliografía al respecto, por lo que son necesarias más publicaciones.

Identificación y tratamiento oportuno exitoso de hipertermia maligna / Identification and successful timely treatment of malignant hyperthermia

Malignant hyperthermia (MH) is an acute hypermetabolic pharmacogenetic syndrome triggered by succinylcholine and inhaled anesthetics; the prevalence of MH episodes ranges from 1:10,000 to 1:220,000 cases per administered anesthesia; there is a deregulation in intracellular calcium homeostasis generating muscle rigidity, high energy expenditure, increased VO, without timely treatment mortality is greater than 65% due to rhabdomyolysis, hyperkalaemia, increased CPK and múltiple organ failure, with treatment specific decreases to 10%. We report the first case of malignant hyperthermia in preschool with extubation and early hospital discharge after the crisis; It is a 2-year-old female with no previous history diagnosed with syndactyly since birth. She is scheduled for correction of congenital deformity. She is performed under a balanced general anesthetic technique with sevoflorane and remifentanil. At the second hour of surgery, she presents symptoms compatible with malignant hyperthermia (tachycardia). , hypercapnia, hyperthermia) treatment was started according to the SCARE protocol with maintenance doses of dantrolene for 24 h, extubation at 24 h and discharge on the third day with follow-up in an outpatient clinic without sequelae. This case report highlights the importance of timely recognition of malignant hyperthermia crisis, the early initiation of pharmacological and non-pharmacological treatment during and after the crisis, the use of cognitive aids such as SCARE crisis protocols and the training of health personnel as a determining factor of the morbidity and mortality of these patients.

La hipertermia maligna (HM) es un síndrome farmacogenético agudo hipermetabólico, desencadenado por succinilcolina y anestésicos inhalados; la prevalencia de los episodios de HM va desde 1:10.000 hasta 1:220.000 casos por anestesia administrada; se produce una desregulación en la homeostasis del calcio intracelular generando rigidez muscular, alto gasto de energía, aumento del VO, sin un tratamiento oportuno la mortalidad es superior al 65% debido a rabdomiólisis, hiperpotasemia, aumento de CPK y falla multiorgánica, con el tratamiento específico disminuye al 10%. Reportamos el primer caso de hipertermia maligna en preescolar con extubación y egreso hospitalario temprano tras la crisis; se trata de femenina de 2 años sin antecedentes previos con diagnóstico de sindactilia desde el nacimiento se programa para corrección de deformidad congénita, se realiza bajo técnica anestésica general balanceada con sevoflorane y remifentanilo a la segunda hora de cirugía presenta sintomatología compatible con hipertermia maligna (taquicardia, hipercapnia, hipertermia) se inicia tratamiento según protocolo de la SCARE con dosis de mantenimiento de dantroleno por 24 h, extubación a las 24 h y egreso al tercer día con seguimiento en consulta externa sin secuelas. Este reporte de caso destaca la importancia de reconocer de manera oportuna la crisis de hipertermia maligna, el inicio temprano del tratamiento farmacológico y no farmacológico durante y después de la crisis, el uso de las ayudas cognitivas como son los protocolos de crisis de la SCARE y el entrenamiento del personal de salud como factor determinante de la morbimortalidad de dichos pacientes.

Experimental study on ultrasound-guided radiofrequency of hyperthermia combined with recombinant human adenovirus H101 for the treatment of hepatocellular carcinoma / 中华肝胆外科杂志

Objective:Evaluation of ultrasound-guided radiofrequency of hyperthermia combined with recombinant human adenovirus H101 for the treatment of hepatocellular carcinoma (HCC).Methods:In vitro cell therapy experiments, luciferase/red fluorescent protein/lentivirus mediated McA-RH7777 cells were conducted and divided into 4 groups. Each group was repeatedly treated for 6 times: (1) recombinant human adenovirus type 5 H101 [(multiplicity of infection, MOI)=0.2]+ RFH group, heated at 42℃ for 30 min; (2) recombinant human adenovirus type 5 H101 alone (MOI=0.2); (3) RFH alone, heated at 42℃ for 30 min; (4) control group: physiological saline group. Twenty-four nude rats weighing 180-220 g were selected to establish a nude rat model of orthotopic HCC. They were divided into 4 groups with 6 rats in each group: (1) H101+ RFH combined treatment group: RFH electrode needles were punctured to the center of the tumor in the liver of nude rats under ultrasound guidance, and H101 was directly injected through the electrode injection end. RFH was delivered to the tumor at a temperature of 42℃ for 30 min; (2) H101 treatment group: MOI=0.2; (3) RFH treatment group; (4) sham surgery group. Fluorescence microscopy imaging was used to evaluate the viability of cells in vitro experiments. For in vivo validation, ultrasound imaging was used to follow up the tumor size. Tumor gross specimens and pathological changes were also evaluated.Results:Twenty-four hours after treatment, the survival rate of cells in the H101+ RFH group was the lowest under fluorescence microscopy. The results of MTS quantitative analysis showed that the relative absorbance of mezzanine in the H101+ RFH group cells was lower than that in the H101 group alone [(25.00±2.27)% vs. (69.50±4.53)%], the RFH group alone [(25.00±2.27)% vs. (92.83±1.66)%], and the control group [(25.00±2.27)% vs. 100%], with statistical significance (all P<0.001). The number of apoptotic cells in the H101+ RFH group was higher than that in the H101 group alone [(54.5±3.1)% vs. (25.2±1.4)%], the RFH group alone [(54.5±3.1)% vs. (5.7±0.6)%], and the control group [(54.5±3.1)% vs. (3.9±0.5)%], all of which showed statistically significant differences (all P<0.001). The relative tumor volume of nude rats in the H101+ RFH combination treatment group was smaller than that in the H101 treatment group (0.776±0.127 vs. 1.312±0.188), RFH treatment group (0.776±0.127 vs. 1.893±0.571), and sham surgery group (0.776±0.127 vs. 1.977±0.590), all of which had statistical significance (all P<0.001). The number of apoptotic cells in nude rats in the H101+ RFH combination treatment group was higher than that in the H101 treatment group [(49.85±4.00%)% vs. (22.70±0.65)%], the RFH treatment group [(49.85±4.00% vs. (5.36±0.84)%], and the sham surgery group [(49.85±4.00)% vs. (5.96±0.78)%], all of which showed statistically significant differences (all P<0.001). Conclusion:Ultrasound guided RFH combined with recombinant human adenovirus H101 has a promoting effect on the treatment of HCC.

Impact of Culture Temperature Changes on the Efficacy of Growth Inhibitory Manipulation of Cancer Cell Lines / 日本温泉気候物理医学会雑誌

  We have previously reported that high-temperature (42°C) culture inhibited the proliferation of human umbilical endothelial cells (HUVECs). We described how the proliferative capacity and telomere length (TL)-related parameters of HUVECs, one of somatic cells, change with culture temperature. It was speculated that a combination of cytostatic manipulations, such as anticancer treatments, and high-temperature conditions would more effectively suppress the growth of somatic cells. Therefore, we hypothesized that increasing the core body temperature (BT) as a pretreatment for cancer treatment enhances the effectiveness of cancer treatment. In the present study, various cells (HUVECs, Jurkat cells, and SLVL) were cultured under different temperature conditions (35°C, 37°C or 39°C) combined with anticancer manipulations (X-ray irradiation or addition of 1-β-D-Arabinofuranosylcytosine [Ara-C]), which resulted in changes in the proliferation rate and TL. The degree of cell proliferation inhibitory effect depended on the combination of cell type, anticancer procedure, and temperature condition. Therefore, the best therapeutic condition might be selected in advance by checking the proliferation rate of biopsied cancer cells being cultured under combinations of anticancer manipulations at altered temperature conditions.

Impact of Culture Temperature Changes on the Efficacy of Growth Inhibitory Manipulation of Cancer Cell Lines / 日本温泉気候物理医学会雑誌

  We have previously reported that high-temperature (42°C) culture inhibited the proliferation of human umbilical endothelial cells (HUVECs). We described how the proliferative capacity and telomere length (TL)-related parameters of HUVECs, one of somatic cells, change with culture temperature. It was speculated that a combination of cytostatic manipulations, such as anticancer treatments, and high-temperature conditions would more effectively suppress the growth of somatic cells. Therefore, we hypothesized that increasing the core body temperature (BT) as a pretreatment for cancer treatment enhances the effectiveness of cancer treatment. In the present study, various cells (HUVECs, Jurkat cells, and SLVL) were cultured under different temperature conditions (35°C, 37°C or 39°C) combined with anticancer manipulations (X-ray irradiation or addition of 1-β-D-Arabinofuranosylcytosine [Ara-C]), which resulted in changes in the proliferation rate and TL. The degree of cell proliferation inhibitory effect depended on the combination of cell type, anticancer procedure, and temperature condition. Therefore, the best therapeutic condition might be selected in advance by checking the proliferation rate of biopsied cancer cells being cultured under combinations of anticancer manipulations at altered temperature conditions.

Efficacy of whole course hyperthermia on cervical metastatic lymph nodes of nasopharyngeal carcinoma and its effects on immune function / 重庆医学

Objective To study the short-term efficacy of combined cervical metastatic lymph nodes hy-perthermia during locally advanced nasopharyngeal carcinoma induction chemotherapy and concurrent chemo-radiotherapy and its effect on peripheral blood lymphocyte subsets.Methods Sixty patients with pathological-ly diagnosed nasopharyngeal carcinoma in this hospital from July 2021 to July 2022 were collected as the study subjects and divided into the observation group(induction chemotherapy+concurrent chemoradiotherapy combined with hyperthermia)and control group(induction chemotherapy+concurrent chemoradiotherapy),30 cases in each group.The general information,short term efficacy,EB virus(EBV)DNA level,adverse reac-tions occurrence,peripheral blood lymph cell subsets and hot shock protein 90α(HSP90α)were recorded and compared between the two groups.Results Compared with the control group,the objective remission rate in the observation group was higher(100.0％vs.90.0％),the EBV positive rate after induction chemotherapy was lower(20.0％vs.46.7％),the occurrence rate of ≥3 grade radiation dermatitis was higher(30.0％vs.6.7％),the level of natural killer(NK)cells after radiotherapy was increased[(25.89±5.53)％vs.(19.18±6.41)％],the HSP90α level after treatment was increased[(91.19±9.18)ng/mL vs.(67.22± 11.02)ng/mL],and the differences were statistically significant(P＜0.05).Compared with before treatment,the levels of CD3+,CD4+,CD4+/CD8+after radiotherapy in the observation group were decreased,the levels of CD3+,CD4+,CD4+/CD8+in the control group were decreased,but the differences between the two groups were not statistically significant(P＜0.05),while the proportion of peripheral blood NK cells in the experi-mental group was significantly increased compared with the control group(P＜0.05).Conclusion Hyper-thermia canimprove the local control of nasopharyngeal carcinoma cervical lymph node metastasis and improve the immune function.

Research progress of magnetic hyperthermia based on magnetic nanomaterials / 中华放射肿瘤学杂志

Thermotherapy has become another important tumor treatment after surgery, radiotherapy, chemotherapy, and targeted treatment. Magnetic hyperthermia (MH) is a new type of hyperthermia, which has attracted widespread attention due to its advantages of non-invasiveness / minimal invasiveness, high efficiency and good tissue penetration. It provides a new option for the molecular level treatment of malignant tumors with high efficacy and low toxicity, which has become a new research direction of tumor treatment. Magnetic materials and suitable magnetic fields are needed to realize MH. Iron oxide nanoparticles (IONs) are widely studied as MH agents because of their high biocompatibility and heating ability. In this article, the research progress on magnetic iron oxide nanomaterials and MH combined with antitumor therapy based on magnetic nanoparticles were analyzed, and the potential application of MH in cancer treatment was reviewed.