Cold Patients Research Articles

Are patients with Parkinson's disease at a lower risk of catching the common cold? Propensity score matching

IntroductionAccumulating evidence indicating that inflammatory responses play crucial roles in Parkinson's disease (PD) development provided a hypothesis that physiological alpha-synuclein may contribute to inflammatory responses against infections during non-advanced stages of PD. Thus, we examined the risk of catching a common cold in patients with PD as compared to other common brain diseases. MethodsWe extracted PD (non-advanced; without dementia) and control (AD: Alzheimer's disease, migraine, epilepsy, and ischemic stroke) patient data from insurance claim data available between 2010 and 2021. After confirming the clinical PD diagnosis, we investigated factors associated with cold diagnoses and used propensity score matching to identify differences in the incidence of colds between PD and control patients. ResultsDiagnosis of colds in PD patients (n = 726) and controls (AD = 377, migraine = 1019, epilepsy = 3414, ischemic stroke = 6943) was found in 1186 (9.5%) patients, which was independently associated with being female (odds ratio: OR 1.59; 95%CI 1.41–1.79; P < 0.0001), follow-up by neurologists (OR 1.30; 95%CI 1.15–1.48; P < 0.0001), diagnosis of PD (OR 0.30; 95%CI 0.20–0.45; P < 0.0001) and COVID-19 pandemic period (OR 0.58; 95%CI 0.47–0.72; P < 0.0001). After propensity score matching, the incidence of colds was significantly lower in PD (3.4%) versus in controls; AD (9.8%; P < 0.0001), migraine (13.3%; P < 0.0001), epilepsy (11.0%; P < 0.0001), ischemic stroke (8.8%; P < 0.0001). ConclusionsPatients with PD were less likely to be diagnosed with colds. However, several confounding factors will need to be examined. Moreover, alpha-synuclein may provide protective resistance to viral infections by activating the immune system due to chronic inflammation in non-advanced PD patients.

Cardiovascular responses to dynamic and static upper-body exercise in a cold environment in coronary artery disease patients

PurposeUpper-body exercise performed in a cold environment may increase cardiovascular strain, which could be detrimental to patients with coronary artery disease (CAD). This study compared cardiovascular responses of CAD patients during graded upper-body dynamic and static exercise in cold and neutral environments.Methods20 patients with stable CAD performed 30 min of progressive dynamic (light, moderate, and heavy rating of perceived exertion) and static (10, 15, 20, 25 and 30% of maximal voluntary contraction) upper body exercise in cold (− 15 °C) and neutral (+ 22 °C) environments. Heart rate (HR), blood pressure (BP) and electrocardiographic (ECG) responses were recorded and rate pressure product (RPP) calculated.ResultsDynamic-graded upper-body exercise in the cold increased HR by 2.3–4.8% (p = 0.002–0.040), MAP by 3.9–5.9% (p = 0.038–0.454) and RPP by 18.1–24.4% (p = 0.002–0.020) when compared to the neutral environment. Static graded upper-body exercise in the cold resulted in higher MAP (6.3–9.1%; p = 0.000–0.014), lower HR (4.1–7.2%; p = 0.009–0.033), but unaltered RPP compared to a neutral environment. Heavy dynamic exercise resulted in ST depression that was not related to temperature. Otherwise, ECG was largely unaltered during exercise in either thermal condition.ConclusionsDynamic- and static-graded upper-body exercise in the cold involves higher cardiovascular strain compared with a neutral environment among patients with stable CAD. However, no marked changes in electric cardiac function were observed. The results support the use of upper-body exercise in the cold in patients with stable CAD.Trial registrationClinical trial registration NCT02855905 August 2016.

Central aortic hemodynamics following acute lower and upper-body exercise in a cold environment among patients with coronary artery disease

Exercise is beneficial to cardiovascular health, evidenced by reduced post-exercise central aortic blood pressure (BP) and wave reflection. We assessed if post-exercise central hemodynamics are modified due to an altered thermal state related to exercise in the cold in patients with coronary artery disease (CAD). CAD patients (n = 11) performed moderate-intensity lower-body exercise (walking at 65–70% of HRmax) and rested in neutral (+ 22 °C) and cold (− 15 °C) conditions. In another protocol, CAD patients (n = 15) performed static (five 1.5 min work cycles, 10–30% of maximal voluntary contraction) and dynamic (three 5 min workloads, 56–80% of HRmax) upper-body exercise at the same temperatures. Both datasets consisted of four 30-min exposures administered in random order. Central aortic BP and augmentation index (AI) were noninvasively assessed via pulse wave analyses prior to and 25 min after these interventions. Lower-body dynamic exercise decreased post-exercise central systolic BP (6–10 mmHg, p < 0.001) and AI (1–6%, p < 0.001) both after cold and neutral and conditions. Dynamic upper-body exercise lowered central systolic BP (2–4 mmHg, p < 0.001) after exposure to both temperatures. In contrast, static upper-body exercise increased central systolic BP after exposure to cold (7 ± 6 mmHg, p < 0.001). Acute dynamic lower and upper-body exercise mainly lowers post-exercise central BP in CAD patients irrespective of the environmental temperature. In contrast, central systolic BP was elevated after static exercise in cold. CAD patients likely benefit from year-round dynamic exercise, but hemodynamic responses following static exercise in a cold environment should be examined further.Clinical trials.gov: NCT02855905 04/08/2016.

Endothelial function in response to exercise in the cold in patients with coronary artery disease.

Regular long-term physical exercise has favourable effects on endothelial function in patients with coronary artery disease (CAD). However, the effects of an acute exercise bout in the cold on endothelial function are not known. At first, the effects of moderate-intensity aerobic lower-body exercise were assessed in CAD patients (n=16) in a neutral [+22°C] and cold [-15°C] environment. Secondly, responses to static and dynamic upper-body exercise in a neutral [+22°C] and cold [-15°C] environment were investigated in CAD patients (n=15). All experiments were performed in a random order. Endothelial function was measured by flow-mediated dilation (FMD) of the brachial artery in response to reactive hyperaemia, before and after the exposures in a neutral environment. No significant temperature*exercise*condition (pre-post) interaction was observed in FMD% when comparing rest versus aerobic exercise or static versus dynamic upper-body exercise. Relative reactive hyperaemia during FMD protocol, measured by changes in shear rate, was elevated after rest compared to aerobic exercise (p=.001) and after static compared to dynamic upper-body exercise (p<.001). However, no significant temperature*exercise*condition interaction was observed when FMD% was normalizedfor shear rate. Endothelial function to an acute bout of exercise among CAD patients was not modified by the environmental temperature where the exercise was performed. The present findings argue against the hypothesis that exercise in cold environmental conditions impairs endothelial function in patients with CAD.

Anti-inflammatory effects of Samsoeum, a Korean medicine for health insurance, on chronic bronchitis caused by lipopolysaccharide in rats.

Samsoeum (SSE), a Korean medicine, has been used to treat upper respiratory infection including residual coughs after catching a cold, and colds in patients with gastrointestinal disorder. In this study, we investigated the inhibitory effect of SSE against lipopolysaccharide (LPS)-induced bronchitis and characterized its optimal dosing range based on the improvement of SSE concentrations. Male Sprague Dawley rats were intra-nasally administered LPS on day 0, 3 and 6. 2 g kg-1 dose of SSE for rat was determined by the human equivalent dose formula and orally administered once a day from day 3 to day 6. To clarify the optimal administration dose of SSE, various doses including 0.5 (1/4 fold), 1 (1/2 fold), 6 (3 fold), 12 (6 fold), 24 (12 fold) and 36 g kg-1 (18 fold) were also orally administered. In addition, the molecular mechanism of SSE in mucin hyperproduction was investigated in LPS-sensitized A549 cells. Oral administration of SSE ameliorated alveolar wall thickening and inflammatory cell infiltration of lung tissues in LPS-induced bronchitis at doses of 1/4 fold, 1/2 fold and 1 fold. The total cell and neutrophil numbers in bronchoalveolar lavage fluid (BALF) were reduced in the SSE-treated groups compared with the LPS group. In addition, 0.5, 1 and 2 g kg-1 of SSE suppressed LPS-induced mucin glycoprotein 5AC (MUC5AC) production in BALF. Furthermore, SSE treatment significantly inhibited the pro-inflammatory cytokines, resulting in the decrease of MUC5AC production by the JAK1/STAT6 signaling pathway. 1, 2 and 6 g kg-1 of SSE ameliorated chronic bronchitis by inhibiting LPS-induced neutrophil infiltration and MUC5AC release in BALF. These findings suggested that SSE with 0.5-3-fold of general daily intake dose would be a therapeutic agent for chronic bronchitis.

Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease.

Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 ± 7.0 yr, means ± SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%-70% of max heart rate (HR)] performed at +22°C and -15°C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg·beats/min) was 17% higher during exercise in the cold (18,080 ± 3540) compared with neutral (15,490 ± 2,940) conditions ( P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature ( P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients.

Vitamin D Supplementation and the Risk of Colds in Patients with Asthma.

Restoration of vitamin D sufficiency may reduce asthma exacerbations, events that are often associated with respiratory tract infections and cold symptoms. To determine whether vitamin D supplementation reduces cold symptom occurrence and severity in adults with mild to moderate asthma and vitamin D insufficiency. Colds were assessed in the AsthmaNet VIDA (Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness) trial, in which 408 adult patients were randomized to receive placebo or cholecalciferol (100,000 IU load plus 4,000 IU/d) for 28 weeks as add-on therapy. The primary outcome was cold symptom severity, which was assessed using daily scores on the 21-item Wisconsin Upper Respiratory Symptom Survey. A total of 203 participants experienced at least one cold. Despite achieving 25-hydroxyvitamin D levels of 41.9 ng/ml (95% confidence interval [CI], 40.1-43.7 ng/ml) by 12 weeks, vitamin D supplementation had no effect on the primary outcome: the average peak WURSS-21 scores (62.0 [95% CI, 55.1-68.9; placebo] and 58.7 [95% CI, 52.4-65.0; vitamin D]; P = 0.39). The rate of colds did not differ between groups (rate ratio [RR], 1.2; 95% CI, 0.9-1.5); however, among African Americans, those receiving vitamin D versus placebo had an increased rate of colds (RR, 1.7; 95% CI, 1.1-2.7; P = 0.02). This was also observed in a responder analysis of all subjects achieving vitamin D sufficiency, regardless of treatment assignment (RR, 1.4; 95% CI, 1.1-1.7; P = 0.009). Our findings in patients with mild to moderate asthma undergoing an inhaled corticosteroid dose reduction do not support the use of vitamin D supplementation for the purpose of reducing cold severity or frequency.

Vitamin D Supplementation and the Risk of Colds in Patients with Asthma

Vitamin D Supplementation and the Risk of Colds in Patients with Asthma

The economic efficiency of timely diagnosis and early treatment of type 2 diabetes

Туре 2 diabetes (T2D) is frequently detected too late just after development of complications requiring expensive treatment. The costs of drugs used for the treatment of diabetic complications are much greater than the funds allocated for diabetes management. The purpose of the study was to assess the impact of timely diagnosis and early initiated treatment of T2D on the total costs of the treatment. Direct and indirect costs of the treatment of the disease and its complications, using the Atakarov model with 5% annual allowance, were estimated. It was determined that with well-timed diagnosis of T2D), the total costs per patient cold be reduced by 1736 Litas or about 503 Eros (1 Euro = 3.452S Litas) over 5 years and over 10 years it would be saved even 1712 Euros. Not only indirect costs would be reduced. A total of 700 Euros would be saved per patient over 5 years and 2045 Euros over years. With the improved diagnosis of T2D and the well-timed diagnosis in at least 50% of cases of diabetes mellitus could save 10.05 million Euros over 5 years and even 34.23 million Euros over 10 years. The timely diagnosis of the disease and its proper management would prolong the life of a patient with T2D by 2.67 months over 10 years. That of T2D saves the costs of its treatment and care and can prolong the patient's life.

Hochu‐ekki‐to inhibits rhinovirus infection in human tracheal epithelial cells

A traditional Japanese herbal medicine, hochu-ekki-to, has been used for the symptomatic treatment of the common cold and to reduce the frequency of colds in patients with chronic obstructive pulmonary disease. However, the inhibitory effects of hochu-ekki-to on infection by rhinovirus (RV), the major cause of common colds, have not been studied. Human tracheal epithelial cells in culture were infected with a major group rhinovirus-RV14. Virus output and viral RNA were measured along with interleukin (IL)-1beta, IL-6, IL-8 and tumor necrosis factor (TNF)-alpha), mRNA for intercellular adhesion molecule (ICAM)-1 and acidic endosomes in cells. RV14 infection increased virus titers, the content of cytokines in supernatants and RV14 RNA in the cells. Hochu-ekki-to decreased virus output, RV14 RNA in the cells, susceptibility to RV infection and supernatant cytokine concentrations after RV14 infection. Hochu-ekki-to reduced mRNA for ICAM-1, the receptor for RV14, the concentration of the soluble form of ICAM-1 and the number and fluorescence intensity of acidic endosomes in the cells, from which RV RNA enters into the cytoplasm, at RV14 infection. Glycyrrhizin, one of the chemical constituents of hochu-ekki-to, reduced supernatant virus titers dose-dependently. Hochu-ekki-to inhibited RV14 infection by decreasing ICAM-1 and by blocking entry of viral RNA into the cytoplasm from the endosomes, in airway epithelial cells. Glycyrrhizin may be partly responsible for inhibition of RV infection by hochu-ekki-to. Hochu-ekki-to could modulate airway inflammation by reducing production of cytokines in RV infections.

A high prevalence of new onset otitis media during parent diagnosed common colds

Past studies suggest that the majority of new otitis media (OM) diagnoses is a complication of a colds/flu. A prospective format was used to determine the coincidence of otitis media and parent diagnosed cold/flu episodes in young children followed over a typical cold/flu season. Eighteen families with children aged 1-8 years were followed from October 1 to April 30 using parent-completed daily diaries focused on cold/flu signs and weekly examinations using pneumatic otoscopy for diagnosis of the presence/absence of otitis media. Overall, 108 cold episodes were documented in 36 enrolled children with 20 colds (19%) occurring during a pre-existing OM episode and 40 colds (37%) complicated by a new OM episode. Conversely, there were 82 new OM episodes, 40 (49%) were associated with a cold in the individual child and 18 (22%) with a concurrent cold in a family member. The median duration of the OM episodes was approximately 2 weeks but this was longer for OM episodes where earache was reported. The results confirm past observation relating new OM episodes to a concurrent cold/flu but show these episodes to usually be of short duration. Two sources of potential bias were identified for point prevalence study formats: the presence of a pre-existing OM for a new onset cold/flu and the possibility of subclinical colds in patients with new OM episodes. These biases reinforce the need for longitudinal study formats to address this important relationship.

A Complex Homeopathic Preparation for the Symptomatic Treatment of Upper Respiratory Infections Associated With the Common Cold: An Observational Study

The use of complementary medicines is large and growing in both the United States and Europe. To compare the effects of a complex homeopathic preparation (Engystol; Heel GmbH, Baden-Baden, Germany) with those of conventional therapies with antihistamines, antitussives, and nonsteroidal antiinflammatory drugs on upper respiratory symptoms of the common cold in a setting closely related to everyday clinical practice. Nonrandomized, observational study over a treatment period of maximally two weeks. Eighty-five general and homeopathic practices in Germany. Three hundred ninety-seven patients with upper respiratory symptoms of the common cold. Engystol-based therapy or common over-the-counter treatments for the common cold. Patients receiving this homeopathic treatment were allowed other short-term medications, but long-term use of analgesics, antibiotics, and antiinflammatory agents was not permitted. Patients were allowed nonpharmacological therapies such as vitamins, thermotherapies, and others. The effects of treatment were evaluated on the variables fatigue, sensation of illness, chill/tremor, aching joints, overall severity of illness, sum of all clinical variables, temperature, and time to symptomatic improvement. Both treatment regimens provided significant symptomatic relief, and this homeopathic treatment was noninferior in a noninferiority analysis. Significantly more patients (P < .05) using Engystol-based therapy reported improvement within 3 days (77.1% vs 61.7% for the control group). No adverse events were reported in any of the treatment groups. This homeopathic treatment may be a useful component of an integrated symptomatic therapy for the common cold in patients and practitioners choosing an integrative approach to medical care.

Effects of cilostazol in patients with Raynaud's syndrome

Raynaud's syndrome (RS), which is characterized by recurrent episodes of vasospasm with exposure to cold, may occur alone (primary RS) or in association with connective tissue diseases or other underlying conditions (secondary RS). We investigated the effect of cilostazol on vessel wall responses in RS. Patients were diagnosed (primary or secondary RS associated with connective tissue diseases) and randomized to placebo or cilostazol 100 mg twice daily for 6 weeks in a double-blind manner. Brachial artery vasoreactivity, laser Doppler fluxmetry, and cold pressor testing (CPT) were performed at study initiation and completion. Symptoms were assessed using standardized questionnaires. Forty subjects completed the study (19 with primary RS and 21 with secondary RS). Cilostazol significantly increased the mean brachial artery diameter at 6 weeks (primary RS, p = 0.006; secondary RS, p = 0.06). There was no change in median flow-mediated dilation (FMD) with cilostazol in primary RS (25th, 75th percentiles) (4.06% [2.5, 6.1] to −0.77% [−2.4, 3.4] or secondary RS (2.2% [0.05, 6.3] to 2.95% [1.7, 7.4]). There were no changes in nitroglycerin-mediated dilation or microvascular flow indexes in either cohort. In patients with primary RS, cilostazol treatment yielded a positive change in the slope of brachial responsiveness to CPT (increase of 0.32 mm/min; p = 0.002 vs placebo). Cilostazol treatment remained significantly associated with increased brachial artery diameter when controlling for baseline values (p = 0.018). Cilostazol increased conduit vessel diameter in patients with primary and secondary RS, with a favorable impact on conduit vessel responsiveness to cold in patients with primary RS without affecting microvascular flow or symptoms.

振動障害患者の寒冷に対する自律神経反応

振動障害患者の寒冷に対する自律神経反応

Heat and cold in the management of rheumatoid arthritis.

AbstractHeat and cold are used often in the management of patients with rheumatoid arthritis (RA). The primary uses of heat have been to relieve pain and improve the extensibility of periarticular tissuesprior to mobility exercises. Cold is also used as a means of reducing pain prior to exercise and functional activities and to reduce the effects of inflammation. The effects that occur with these agents may be beneficial symptomatically and may also have an effect on the pathological process. In spite of the fact that they are often used by both patients and health care providers with apparent success, there is not a substantial body of evidence attesting to the efficacy of heat or cold in patients with RA. The purposes of this review are to examine that evidence and summarize the effectiveness of heat and cold in the management of joint complaints of patients with RA.

Inhibition of an anti‐Pr1d cold agglutinin by citrate present in commercial red cell preservative solutions

A patient with known cold autoimmune hemolyticanemia was admitted for surgery. Routine cold agglutinin evaluations, using commercial red cells (RBCs) in modified Alsever's preservative solution, revealed a cold agglutinin titer of 4 to 16. However, using RBCs washed four times with saline, a high-titer (greater than 2000 at 4 degrees C) cold autoagglutinin was demonstrated. The cold agglutinin was shown to be an IgM kappa paraprotein with anti-Pr1d specificity. The addition of Alsever's solution to washed RBCs inhibited the cold agglutinin. Each major component of Alsever's solution (neomycin, chloramphenicol, inosine, dextrose, and citrate) was tested individually; only citrate inhibited the patient's cold agglutinin. Various compounds structurally related to citrate were tested and found to cause various degrees of inhibition. The strongest inhibition correlated with the presence of either three carboxyl groups on molecules devoid of double-bonded carbon atoms or two carboxyl groups in cis configuration. A panel of 54 cold agglutinins, including 7 with anti-Pr specificity, was analyzed. None was significantly inhibited by Alsever's solution, although one with anti-Pr2 specificity was weakly inhibited. In summary, these studies describe an anti-Pr1d cold autoagglutinin that was inhibited by citrate in RBC preservative solutions. The failure to detect such a cold agglutinin can result from not washing RBCs free of citrate before testing.

Regional coronary hemodynamic responses to cold stimulation in patients without variant angina

The responses to cold in patients with exertional chest pain were studied by measuring coronary sinus and great cardiac vein flows, aortic and left ventricular pressure and diameters of epicardial and small (0.4 to 1.0 mm) intramyocardial coronary arteries before and after the left hand of 18 such patients was immersed in ice water. Coronary sinus and great cardiac vein flows were used as indexes of total and anterior left ventricular flows. Coronary sinus flow minus great cardiac vein flow was used as an index of inferior left ventricular flow. Perfusion of left ventricular regions was considered potentially “normal” or “abnormal” according to the presence or absence of 50 percent or greater stenosis of luminal diameter in the coronary artery supplying a given region. With cold stimulation, increases occurred in heart rate (6 beats/min), mean aortic pressure (22 mm Hg) and left ventricular end-diastolic pressure (8 mm Hg) (all p < 0.05). Left ventricular flow in normally perfused regions increased as resistance decreased. Left ventricular flow in abnormally perfused regions increased slightly and resistance increased. Regional left ventricular flow increased more, and changes in resistance differed in normally and abnormally perfused regions. Coronary arterial diameter decreased only minimally (6 percent) in both normal and abnormal left ventricular regions. These data show that cold stimulation increases coronary resistance in abnormally perfused left ventricular regions. Cold stimulation-related increases in coronary resistance do not appear to be caused by coronary arterial “spasm”.

Mast Cell in Disease and its Pharmacologic Regulation

The factors regulating the magnitude of histamine-mediated reactions in the skin need to be elucidated if we are to devise a rational therapy for urticaria. Attempts to prevent biosynthesis of histamine in vivo have proved unrewarding. Depletion of histamine stores in skin by repeated provocation of release until a state of tolerance has been reached has proved a useful procedure in patients with cold urticaria, but because of its inconvenience it requires a high degree of motivation. Attempts to moderate histamine secretion by mast cells, for example, by drugs that increase cyclic AMP, including isoproterenol and theophylline, have not met with success. Doxantrazole, a systemically administered compound with actions resembling the better known disodium cromoglycate, has been effective in suppressing histamine release evoked by cold in patients with cold urticaria, but there has been a puzzling discrepancy between clinical response and reduction in histamine release. Rate of enzymic histamine degradation may be an important factor in determining the magnitude of histamine-mediated reactions in skin. Degradation of histamine in human skin takes place by N-methylation, catalyzed by N-methyl transferase. Blockade of histamine degradation in the guinea pig leads to amplification of the histamine-mediated passive cutaneous anaphylaxis reaction in this species. Histamine-mediated skin reactions can be modulated by blockade of vascular histamine receptors. Recently the presence of 2 sub-classes of histamine receptors, H 1 and H 2 , on human skin blood vessels, has been established. Combined treatment by classical H 1 antihistamines and H 2 antihistamines offers a possibility of more effective antihistamine treatment.

Lymphocytes Forming Red Cell Rosettes in the Cold in Patients With Chronic Cold Agglutinin Disease

Abstract Lymphocytes that formed rosettes with human red cells in the cold were observed in the peripheral blood of four patients with chronic cold agglutinin disease. Similar rosettes were not observed in normals or other controls studied. Specificity for I and i red cells was demonstrated which paralleled that of the serum macroglobulins. The rosettes were inhibited by soluble I and i antigens in accordance with the specificity of the serum antibodies. Lymphocytotoxicity assays with idiotypic antisera made to the serum macroglobulins detected the same proteins on the lymphocyte surface. Evidence was obtained that the rosette test underestimated the number of cells bearing the specific cold agglutinin protein. Antisera against cold agglutinins as well as anti-IgM antibodies blocked the rosette formation. By all of these criteria, the surface lymphocyte receptors were indistinguishable from the serum antibodies of these patients.

Cold air and ventilatory function

The effect of abrupt exposure to cold air at −20°C on the F.E.V.1 of five normal and ten asthmatic subjects has been studied. There was no significant change in the normal subjects but two asthmatic subjects were affected at once and showed a fall in F.E.V.1, another two showed a later fall after return to normal room temperature. We consider that a history of sensitivity to cold in patients with respiratory disability should be taken seriously since this phenomenon can be confirmed objectively in experimental conditions.