Cold Skin Research Articles

Aridity‐Dependent Land Surface Skin Temperature Biases in CMIP5/6

AbstractLand surface skin temperature, a critical indicator of climate change, connects the water and energy cycles between the land and the atmosphere. Here, we evaluate the simulations of land surface skin temperature from the Coupled Model Intercomparison Project Phase 5 (CMIP5) and CMIP6 models with satellite‐based datasets and reanalysis. We find systematic cold skin temperature biases over arid regions in CMIP5/CMIP6 simulations. Over arid and semi‐arid regions, latent heat biases drive skin temperature biases by evaporative cooling. Over humid regions, surface downward shortwave and albedo biases are relatively more critical. Spatial patterns of biases remain similar in the latest CMIP6 simulations, suggesting systematic biases in land‐atmosphere interactions. These biases need to be corrected or considered while using models for future projections.

DIAGNOSTIC AND MANAGEMENT PROBLEMS IN PULMONARY ASPERGILLOSIS

TYPE: Late Breaking Abstract TOPIC: Chest Infections INTRODUCTION: The gold standard for the definite diagnosis of opportunistic infections in the respiratory system is represented by the bronchial biopsy accompanied by the histopathological examination, thus eliminating the suspicion of other diseases at this level. CASE PRESENTATION: In January of this year, a 59-year-old patient presented to the pulmonology department, accusing the sensation of suffocation in supine position, accentuated during the evening, retrosternal embarrassment and epigastric pain. From the patient’s history we remember SARS-COV2 infection, sarcoidosis and cardiac pathology, with outpatient backgroung treatment. The objective examination shows pale, cold skin, sound chest, no bronchial rales. From laboratory data we note slight inflammation, mild neutropenia and anemia. Functional respiratory tests are normal. The sputum examination doesn’t show the pathogenic flora, the Galactomannan antigen is negative. Thus, fibrobronchoscopy with biopsy is performed, the cytohistological result highlighting septate hyphae with sharp-angled branches, conidia and metules of the genus Aspergillus Spp. The evolution during the hospitalization period is favorable under the antibiotic and symptomatic treatment, subsequently following the outpatient antifungal treatment. DISCUSSION: We are facing a case in which establishing an early diagnosis of pulmonary aspergillosis is a challenge, being known that a proper therapy can prevent further complications. CONCLUSIONS: Patients with pre-existing lung disease may contract various infections and the response of the immune system depends on the degree of damage. DISCLOSURE: No significant relationships. KEYWORD: pulmonary aspergillosis

Influence of different polysaccharides and wobbling processing on the quality of steamed noodles with wheat starch (Niangpi)

ABSTRACT Niangpi (cold skin noodles) with northwestern characteristics is one of the traditional foods in China. To promote the development of traditional food, the current study was designed to improve the formulation and production process of Niangpi. A single factor, Box-Behnken design of response surface methodology (RSM) was employed to investigate the appropriate amount of polysaccharides (including potato starch, konjac flour, and sodium alginate) and their influence on instrumental texture profile analysis (TPA) and sensory evaluation of Niangpi. The effect of different wobbling times (0s, 70s, 140s, 220s) on sensory evaluation, microstructure, face rate, and TPA of Niangpi was explored. The optimum level of potato starch, konjac flour, and sodium alginate determined by the single factor test and RSM was 1.0, 0.15, and 0.03% and 1.24, 0.16, and 0.03%, respectively. The quality of Niangpi was the best at 220 s wobbling time. The wobbling time increased the pore structure and hierarchy of Niangpi, and presented a strongly positive correlation with the hardness, gumminess, and a strongly negative correlation with adhesiveness, chewiness, and cohesiveness. The obtained results revealed that both the optimized formulation and production process not only simplified the preparation but also improved the quality and sensory characteristics of Niangpi.

P163 The cytokine horror: Kawasaki disease shock syndrome complicated with macrophage activation syndrome

Abstract Background/Aims Kawasaki disease (KD) is an acute febrile systemic vasculitis of unknown aetiology, affecting medium-sized vessels. It often occurs in children less than 5 years old. During the acute phase of the disease, less than 5% of children develop hypotension and shock. This severe form is called Kawasaki Disease Shock Syndrome (KDSS). Macrophage activation syndrome (MAS) is a heterogenous syndrome complex encompassing a broad spectrum of clinical features. MAS associated with KDSS is an extremely rare life threatening entity that warrants a high index of clinical suspicion, prompt and proper management. Methods We present our experience in the dilemmas and challenges faced in the diagnosis and management of KDSS complicated with MAS in a poor resource setting. It is our first experience of encountering MAS in KDSS. Results A 9-month-old baby with fever and a maculopapular rash involving palms and soles for 5 days duration was transferred from a peripheral hospital. A preliminary diagnosis of acute Kawasaki disease was made with the classical features that included the rash, cracked lips, pedal oedema, BCG scar inflammation, perianal excoriation and irritability. The fever did not settle following standard therapy that included three doses of intravenous immunoglobulins 2g/kg, aspirin and low dose dexamethasone. The child quickly began to decompensate. She developed cold clammy skin with hypotension on the 8th day of the illness. There was evidence of hepatosplenomegaly with transaminitis. 2D Echo revealed normal coronary vasculature without any dilatations or strictures. However, there was evidence of myocarditis supported by diffuse T inversions in the anterolateral leads and a highly positive troponin titre. Investigations revealed aa leucocytosis (22,100/dl), an abrupt drop in platelet count (350,000/dl to 80,000/dl), red blood cells, haemoglobin (11g/dl to 8g/dl) and erythrocyte sedimentation rate 95mm/hr to 50mm/hr. Hyperferritinemia, hypertriglyceridemia and hypofibrinogenemia supported the diagnosis of MAS. Blood culture was sterile. Initial bone marrow biopsy was inconclusive. High dose dexamethasone 10mg/m2/day and cyclosporine 2mg/kg/day was initiated. The circulatory collapse was managed with fluid boluses and a low dose adrenaline infusion. Subsequently there was dramatic clinical improvement and her cell counts and transaminases normalised on day 15. Conclusion We emphasise the importance of early recognition of refractory MAS in pediatric populations with rheumatic diseases and we suggest early initiation of cyclosporin as a rapid and effective treatment option in the poor resource settings where the ideal management with anakinra is beyond the realms of possibility. Disclosure L. Rajagopala: None. J. Jagoda: None. M.L. Gunatilaka: None.

Design and optimization of a novel herbosomal-loaded PEG-poloxamer topical formulation for the treatment of cold injuries: a quality-by-design approach.

The spectrum of cold injuries ranges from frostnip, chilblains to severe frostbite. Cold injuries occur upon prolonged exposure to freezing temperature and are pathologically a combination of ice crystal formation in the tissue resulting ininflammation, thrombosis and ischemia in the extremities, often necessitating limb amputation in extreme cases due to tissue necrosis. Severe forms of frostbite are a cause of major concern to patients as well as the treating physician. Due to the lack of effective treatment modalities and paucity of research onprophylaxis and therapeutics of cold injuries, we developed a novel herbosomal-loaded PEG-poloxamer topical formulation (n-HPTF) employing quality-by-design (QBD) approach. Natural compounds exhibitingpotent therapeutic potential forthe management of cold injuries were incorporated in novel lipid vesicles (herbosomes) loaded in PEG-poloxamer polymers. The herbosomal formulation effectively createsan occlusion barrier that promotes epithelial regeneration, desmosome scale-up and angiogenesis and thus promotes rapid healing, indicating controlled release of herbosomes. Optimized novel herbosomes showed entrapment efficiency > 90% and < 300nm mean particle size and in vitro drug permeation of about 2µg/cm2 followed Higuchi's release kinetics. Skin irritancy study on female Sprague-Dawley rats showed no edema or erythema. In vivo bio-efficacy study revealed significant efficacy (p < 0.05)when compared to the standard treatment groups. Graphical abstract presenting the designing and optimization of novel herbosomal-loaded PEG-poloxamer topical formulation (n-HPTF) and predictive model for the in vivo study of the developed n-HPTF on cold injury rat skin model.

Transpedal and Tibiopedal Retrograde Revascularization for Peripheral Vascular Disease

Peripheral vascular disease, or peripheral artery disease (PAD), is a chronic and debilitating disease that affects millions of people worldwide. PAD is associated with abnormal arterial narrowing, specifically outside of the heart and brain. PAD is primarily observed in the legs, but it can also affect the kidneys, arms, and neck. Patients with PAD often complain of acute leg pain that occurs when walking. However, the pain resolves with rest. The phenomenon of acute pain due to narrowed arteries is known as intermittent claudication. Common symptoms of PAD include abnormal hair and nail growth, bluish skin, skin ulcers, and cold skin. Untreated and unmanaged PAD can lead to serious complications such as tissue infection or necrosis, which in turn could lead to amputation. In rare cases, PAD may cause a stroke or coronary artery disease.Among all the management options available, the endovascular approach remains the recommended and the gold standard nowadays. In this paper, we examine and analyze the transpedal and tibiopedal retrograde revascularization in PAD patients in which the conventional antegrade approach is not successful intra-operatively with emphasis on the challenges and postoperative complications. It also correlates the different studies and its outcomes with an up-to-date worldwide results.

Investigation of the impact of a particle foam insulation on frost buildup on the aircraft structure

The aircraft insulation separates the thermally comfortable cabin interior environment from the extremely cold outside condition. However, the fabrication and installation of the insulation in the aircraft is a labour intensive task. Tailored, rigid particle foam parts could be a solution to speed up installation process. The presented study investigates the feasibility of such a concept from a hygrothermal point of view. Due to the temperature difference between the cold air trapped between aircraft skin and insulation on one side and the warm cabin air on the other side, a buoyancy induced pressure difference forms. This effect drives the warmer air through leakages in the insulation system towards the cold skin. Here, moisture contained in the air condenses on the cold surfaces, increasing the risk for uncontrolled dripping (“rain in the plane”) when it melts. Therefore, this study compares the frost build-up of different installations of a rigid particle foam frame insulation with the classical glass fiber capstrip. Tests are hosted in the Fraunhofer Lining and Insulation Test Environment chamber.

Effects of eri silkworm (Samia ricini) pupae inclusion in broiler diets on growth performances, health, carcass characteristics and meat quality.

ObjectiveThe objective of this study was to determine the appropriate amount of eri silkworm pupae meal (Samia ricini) to add to the broiler diet.MethodsTwo hundred 1-day-old male chicks with initial weight at 50.03±0.56 g/chick were divided into four groups (five replicates per group and ten chicks per replicate): a control group fed a corn-soybean diet and experimental groups supplemented with 5%, 10%, or 15% eri silkworm pupae meal. All experimental diets were isocaloric and isonitrogenous and formulated respecting nutrient requirements. Growth performances were collected during the experimental period and other parameters were collected at the end of experiment when broilers reached thirty-eight days old.ResultsA higher cold carcass weight and skin yellowness in the broilers fed 10% eri silkworm pupae meal compared with the other groups (p<0.05). Therefore, supplementation with 10% eri silkworm pupae meal is suggested for the broiler diet formulation because it did not cause any serious negative consequences on growth performance, health status, carcass characteristics and meat quality. However, the usage of eri silkworm pupae meal at 15% is not recommend because it led to negative outcomesConclusionThe addition of eri silkworm pupae at 10% can be used as an alternative protein sources for broiler chickens which provided benefits on cold carcass weight and skin yellowness without adverse effects.

FOOD POISONING: CAUSES, ITS EFFECTS AND CONTROL

Food poisoning is also known as a foodborne illness caused by the consumption of contaminated food or water containing various bacteria, viruses, protozoa, non-microbial agents like vegetable origin or animal origin, and also toxins of biochemical or chemical nature. The primary source of foodborne illness is bacteria (66%), chemicals (26%), parasites (4%), and viruses (4%). Nowadays more people have died from diarrheal diseases caused by the consumption of contaminated food and water. The symptoms that occur through food poisoning are headache, giddiness, colicky pain, cold and clammy skin, intense thirst, acute vomiting, diarrhea, slow pulse, rigors, abdominal pain, hepatic, and cramps. To avoid food poisoning we should consume healthy food, fresh vegetables, fresh fruits, purified water and avoid junk food which is easily available in the market. Viruses that are present on water or surfaces can be removed through using an ultraviolet light.

FOOD POISONING: CAUSES, ITS EFFECTS AND CONTROL

Food poisoning is also known as a foodborne illness caused by the consumption of contaminated food or water containing various bacteria, viruses, protozoa, non-microbial agents like vegetable origin or animal origin, and also toxins of biochemical or chemical nature. The primary source of foodborne illness is bacteria (66%), chemicals (26%), parasites (4%), and viruses (4%). Nowadays more people have died from diarrheal diseases caused by the consumption of contaminated food and water. The symptoms that occur through food poisoning are headache, giddiness, colicky pain, cold and clammy skin, intense thirst, acute vomiting, diarrhea, slow pulse, rigors, abdominal pain, hepatic, and cramps. To avoid food poisoning we should consume healthy food, fresh vegetables, fresh fruits, purified water and avoid junk food which is easily available in the market. Viruses that are present on water or surfaces can be removed through using an ultraviolet light.

Investigation of the Impact of a Particle Foam Insulation on Airflow, Temperature Distribution, Pressure Profile and Frost Buildup on the Aircraft Structure

Aircraft insulation separates the thermally comfortable cabin interior environment from the extremely cold outside conditions. However, the fabrication and installation of the insulation in the aircraft is a labor-intensive task. Tailored, rigid particle foam parts could be a solution to speed up the installation process. The presented study investigates the feasibility of such a concept from a hygrothermal point of view. Due to the temperature difference between the cold air trapped between aircraft skin and insulation on one side and the warm cabin air on the other side, a buoyancy-induced pressure difference forms. This effect drives the warmer air through leakages in the insulation system towards the cold skin. Here, moisture contained in the air condenses on the cold surfaces, increasing the risk for uncontrolled dripping (“rain in the plane”) when it melts. Therefore, this study compares the condensate build-up of different installations of a rigid particle foam frame insulation with the classical glass fiber capstrip. Tests are hosted in the Fraunhofer Lining and Insulation Test Environment chamber. It is shown that careful installation of the particle foam frame insulation provides similar level of moisture protection as the current state of the art insulation, and that the condensate amount does not depend on the amount of airflow directly behind the sidewall.

Risk Factors and Clinical Characteristics of Congenital Primary Hypothyroidism: A Case-control Study in Ulaanbaatar, Mongolia

Objective: The study aimed to identify the risk factors and clinical features of congenital primary hypothyroidism (CPH). Methods: A matched case-control study recruited all children diagnosed with congenital primary hypothyroidism and children without disease as a control between 2012 and 2020. Controls were matched on their gender and age. We collected information on demographic, clinical, and laboratory characteristics from patient’s medical records. Results: The birth weight (OR = 1.1; p = 0.001), gestational age (OR = 2.24; p &lt; 0.001), maternal age (OR = 1.21; p &lt; 0.001), additional congenital disabilities (OR = 1.1; p = 0.015) and maternal hyperthyroidism (OR = 1.21; p &lt; 0.011) were significant factors for CPH. The baby’s height (OR = 0.2; p = 0.012), maternal gestational diabetes (OR = 0.2; p = 0.002) and being a twin (OR = 0.91; p = 0.010) were significant protective factors for CPH. In terms of clinical symptoms of CPH, 70.2% had shown no clinical signs at births in our study. The most commonly identified clinical signs were: umbilical hernia, open posterior fontanel, feeding difficulty, hypothermia, abdominal stiffness, cold or mottled skin, prolonged jaundice, and low muscle tone. Conclusion: Children with CPH are often symptom-free at birth, and several risk factors contribute to CPH.

Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure.

Physical examination remains the cornerstone in the assessment of acute heart failure. There is a lack of adequately powered studies assessing the combined impact of both systolic blood pressure (SBP) and hypoperfusion on short-term mortality. Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in 3 time periods between 2011 and 2016. Logistic regression models were used to assess the association of 30-day mortality with SBP (<90, 90-109, 110-129, and ≥130 mm Hg) and with manifestations of hypoperfusion (cold skin, cutaneous pallor, delayed capillary refill, livedo reticularis, and mental confusion) at admission. Among 10 979 patients, 1143 died within the first 30 days (10.2%). There was an inverse association between 30-day mortality and initial SBP (35.4%, 18.9%, 12.4%, and 7.5% for SBP<90, SBP 90-109, SBP 110-129, and SBP≥130 mm Hg, respectively; P<0.001) and a positive association with hypoperfusion (8.0%, 14.8%, and 27.6% for those with none, 1, ≥2 signs/symptoms of hypoperfusion, respectively; P<0.001). After adjustment for 11 risk factors, the prognostic impact of hypoperfusion on 30-day mortality varied across SBP categories: SBP≥130 mm Hg (odds ratio [OR]=1.03 [95% CI, 0.77-1.36] and OR=1.18 [95% CI, 0.86-1.62] for 1 and ≥2 compared with 0 manifestations of hypoperfusion), SBP 110 to 129 mm Hg (OR=1.23 [95% CI, 0.86-1.77] and OR=2.18 [95% CI, 1.44-3.31], respectively), SBP 90 to 109 mm Hg (OR=1.29 [95% CI, 0.79-2.10] and OR=2.24 [95% CI, 1.36-3.66], respectively), and SBP<90 mm Hg (OR=1.34 [95% CI, 0.45-4.01] and OR=3.22 [95% CI, 1.30-7.97], respectively); P-for-interaction =0.043. Hypoperfusion confers an incremental risk of 30-day all-cause mortality not only in patients with low SBP but also in normotensive patients. On admission, physical examination plays a major role in determining prognosis in patients with acute heart failure.

Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status.

Measures of peripheral perfusion can be used to assess the hemodynamic status of critically ill patients. By monitoring peripheral perfusion status, clinicians can promptly initiate life-saving therapy and reduce the likelihood of shock-associated death. Historically, abnormal perfusion has been indicated by the observation of pale, cold, and clammy skin with increased capillary refill time. The utility of these assessments has been debated given that clinicians may vary in their clinical interpretation of body temperature and refill time. Considering these constraints, current sepsis bundles suggest the need to revise resuscitation guidelines. New technologies have been developed to calculate capillary refill time in the hopes of identifying a new gold standard for clinical care. These devices measure either light reflected at the surface of the fingertip (reflected light), or light transmitted through the inside of the fingertip (transmitted light). These new technologies may enable clinicians to monitor peripheral perfusion status more accurately and may increase the potential for ubiquitous hemodynamic monitoring across different clinical settings. This review will summarize the different methods available for peripheral perfusion monitoring and will discuss the advantages and disadvantages of each approach.

Effect of extract of cryopreserved piglets skin fragments and aqueous colloidal solution of fullerene C60 on epidermis morphology in cold skin wound

Effect of extract of cryopreserved piglets skin fragments and aqueous colloidal solution of fullerene C60 on epidermis morphology in cold skin wound

Hemipelvectomia esquerda traumática em paciente com fratura complexa de quadril: estudo de caso

Objetivo: Descrever a abordagem a um paciente politraumatizado com fratura do osso pélvico submetido a hemipelvectomia esquerda no Hospital de Referência em uma cidade do Tocantins. Relato de caso: Paciente de 27 anos, sexo feminino, vítima de colisão entre caminhonete e motocicleta em via pública, em uso de capacete. Foi admitida na sala de emergência com a escala de coma de Glasgow 13, fratura exposta de fêmur, pulsos ausentes, pele fria, instabilidade pélvica e choque hipovolêmico. Foi submetida à hemipelvectomia mista esquerda, à desarticulação do quadril, colostomia, traqueostomia e cirurgia plástica, apresentou boa evolução pós-operatória. Após estabilidade clínica, realizou-se fechamento da colostomia e traqueostomia. Atualmente a paciente segue em acompanhamento ambulatorial, aguardando prótese oferecida pelo SUS. Considerações finais: A hemipelvectomia é um procedimento pouco usual e causador de importantes limitações funcionais e comorbidades. No caso relatado, a evolução do paciente foi satisfatória e como há poucos casos de pelvectomia traumática na literatura. Os resultados obtidos com a pesquisa serviram como experiência para uma futura condução segura no atendimento de vítimas de politrauma.

Climate Change Research in the Arctic Must Include Polar Native Communities

Background: Concern about the melting of polar ice has tended to highlight wildlife, but not humans. However, research on Arctic climate change is crucial for developing effective public health policies for native communities who reside in the polar region. These include Inuit, Alaskan Natives, and Sami in Norway. Because there has been a dramatic rise in sea levels and a loss of sea ice in the Arctic, our intent is to share the needed epidemiology to address this issue. We aim encourage collaborative research from climate change among the indigenous communities of Canada, US, Norway, Sweden, Russia, Denmark, Iceland, and Greenland. Methods: We examined the epidemiology literature suggesting where climate change might have the most impact on native health. We considered the research methods needed to conduct polar health studies.Findings: Arctic climate change appears to be linked with snowmobile trauma and hunting injuries, village relocation and adolescent mental health impacts, zoonotic infections, especially from sled dogs, tuberculosis and other environmental infections, housing deterioration and cold injury, skin cancer and immunocompromise, mosquito and tick-born infections, food-born botulinum outbreaks, contamination and alterations in diet, alcoholism, diabetes, and asthma. Because many workers in northern mining and oil extraction industries include native employees, we must assess whether climate modification and workplace exposures interact. Measuring the amounts of exposure to an altered environment and appropriate comparison groups are research challenges to valid health studies. Including native children in any study will require utmost sensitivity.Synthesis/conclusions: We will emphasize effective communication with native communities and northern governments leading to ethical public health studies. We hope to encourage the development of new epidemiology research and curricula for international Arctic health in order to measure impacts of climate change on indigenous residents.

Profile of Anaphylactic Reaction in Surabaya from January 2014 to May 2018

Introduction: Anaphylactic reaction is systemic hypersensitivity reaction. It is type 1 hypersensitivity reaction. The incidence can be mild to severe due to the sudden release of mediators by effector cells. This research aimed to examine the prevalence of anaphylactic reaction in Dr. Soetomo General Hospital in January 2014 until May 2018.Methods: This study was a cross-sectional and retrospective study by assessing patients’ medical records and was analyzed descriptively.Results: 22 patients were identified as anaphylactic reaction. The prevalence of anaphylactic reaction from year to year cannot be identified surely because of underdiagnose and underreporting. The most common cause of anaphylactic reaction in Dr. Soetomo General Hsopital was drugs (50%). The most drugs were antibiotics (22.73%) and the most antibiotics were groups of penicillin (40%) and cephalosporin (40%). The most common clinical manifestation was skin-related (77.27%), which includes urticaria (4.55%), angioedem (27.27%), pruritus (27.27%) cold skin (0.09%), pallor (4.55%), and cyanosis (4.55%). Most patients became better (45.54%) after getting treatment from the doctor.Conclusion: The most common cause of anaphylactic reaction was drugs, the most drugs were antibiotics and the most antibiotics were groups of penicillin and cephalosporin. The most clinical manifestation was skin-related. Most of anaphylactic reaction’s patients became better after getting treatment from the doctor. Underdiagnose and underreporting are the problem often encountered in cases of anaphylactic reaction.

SAT-487 Untreated Primary Hypothyroidism Presenting as Pica with Concurrent Hyponatremia and Rhabdomyolysis

Background:Psychosis is a rare but known presentation of hypothyroidism, whereas other mental health disorders are less commonly associated. Pica, the consumption of non-nutritive, non-food substances, has not been reported to be associated with hypothyroidism. We describe a case of untreated severe hypothyroidism in which the patient presented with pica that reversed with treatment with levothyroxine.Clinical case:A 65-year-old female with a history of cigarette smoking and chronic marijuana use was brought to the emergency department by family after she was found attempting to eat non-food objects such as pens and a toothbrush. She reported new onset unsteady gait and having frequent falls over the past several months in addition to being increasingly forgetful. She complained of fatigue and reported recent unintentional weight loss, but denied cold intolerance, skin or hair changes, or constipation. On admission, she was noted to be hypothermic with body temperature between 94-95 degrees Fahrenheit. Physical examination was essentially unremarkable with normal thyroid size and reflexes. No pretibial edema was noted. Admission labs showed hemoglobin of 14.0 g/dL with a white cell count of 8000 cells/uL, without evidence of anemia or infection. Sodium was low at 123 mmol/l and creatinine kinase was elevated at 989 U/L which peaked at 1356 U/L during her admission. CT of the head was negative for any acute intracranial process. Further workup was significant for TSH 85.6 mIU/L (0.27-4.20 mIU/L), free T4 <0.1 ng/dL (0.80-1.90 ng/dL), total T4 0.7 mcg/dL (5.1-11.9 mcg/dL), total T3 < 25 ng/dL (76-181 ng/dL), and TPO antibody 416 IU/ml (<9 IU/ml). AM cortisol was 27.0 ug/dL (6.2-19.4 ug/dL) at 8 AM, ruling out hypocortisolemia. The patient had not seen a medical provider in 10 years, had no recent health maintenance, and had no prior known history of thyroid disease. She was given IV fluids and started on oral levothyroxine 100 mcg daily due to the severity of hypothyroidism. Her sodium improved to 130 mmol/l over the next 4-5 days. Mental status returned to baseline with improvement in memory function and in gait and balance. Creatinine kinase trended down to 688 U/L over the next 2 days. She did not exhibit any additional behavior of eating non-food objects during the hospital stay. Patient was diagnosed to have severe hypothyroidism presenting as pica along with hyponatremia and rhabdomyolysis. Patient was discharged on levothyroxine 75 mcg daily.Clinical lessons/conclusions:Hyponatremia, rhabdomyolysis, and psychosis are relatively uncommon but known reported complications of untreated primary hypothyroidism. Acute psychosis has been reported as a presenting feature of undiagnosed hypothyroidism, but hypothyroidism presenting as pica as seen in our patient is extremely rare. This case highlights the importance of screening for hypothyroidism in patients presenting with unexplained pica.

Enzyme-digested Colla Corii Asini (E'jiao) prevents hydrogen peroxide-induced cell death and accelerates amyloid beta clearance in neuronal-like PC12 cells.

As an aging-associated degenerative disease, Alzheimer’s disease is characterized by the deposition of amyloid beta (Aβ), oxidative stress, inflammation, dysfunction and loss of cholinergic neurons. Colla Corii Asini (CCA) is a traditional Chinese medicine which has been used for feebleness-related diseases and anti-aging. CCA might delay aging-induced degenerative changes in neurons. In the present study, we evaluated antioxidant activity, cytoprotective effects, and Aβ removability of enzyme-digested Colla Corii Asini (CCAD). Oxygen radical absorbance capacity (ORAC) activity assay showed that, as compared to gelatins from the skin of porcine, bovine and cold water fish, CCA exhibited the highest ORAC activity. The ORAC activity of CCA and CCAD was increased gradually by the length of time in storage. Ultrastructure analysis by scanning electron microscopy showed that among CCA manufactured in 2008, 2013, 2017 and gelatin from cold water fish skin, CCA manufactured in 2008 presented the smoothest surface structure. We further tested the protective effects of CCAD (manufactured in 2008) and enzyme-digested gelatin from cold water fish skin (FGD) on hydrogen peroxide (H2O2)-induced cell death in nerve growth factor-differentiated neuronal-like PC12 cells. Presto blue assay showed that both FGD and CCAD at 0.5 mg/mL increased cell viability in H2O2-treated neuronal-like PC12 cells. The protection of CCAD was significantly superior to that of FGD. Acetylcholinesterase (AchE) assay showed that both FGD and CCAD inhibited AchE activity in nerve growth factor-differentiated neuronal-like PC12 cells to 89.1% and 74.5% of that in non-treated cells, respectively. The data suggest that CCAD might be able to increase the neurotransmitter acetylcholine. Although CCAD inhibited AchE activity in neuronal-like PC12 cells, CCAD prevented H2O2-induced abnormal deterioration of AchE. ELISA and neprilysin activity assay results indicated that CCAD reduced amyloid beta accumulation and increased neprilysin activity in Aβ1–42-treated neuronal-like PC12 cells, suggesting that CCAD can enhance Aβ clearance. Our results suggest that CCA might be useful for preventing and treating Alzheimer’s disease.