High Skin Research Articles

The Establishment of a High Standard Skin Bank in Taiwan as a Burn Care Pioneer

Introduction: The establishment of skin banks is especially important in providing crucial cadaveric skin for burn treatments. Although the 2015 Formosa Fun Coast Explosion Disaster resulted in tragic casualties, it raised public awareness of the importance of having a well-functioning skin bank and led to the initiation of a skin bank development project, as well as the establishment of the first high standard skin bank in Taiwan. Methods: We standardized the size of our procured skin to avoid broken or disrupted skin graft, fit properly on a Zimmer Dermacarrier® for mesh expansion, and to be convenient for storage. We also integrated gamma radiation with the glycerol stored skin method for our skin preservation which effectively eradicates all contamination. Results: From 2016 to 2020, 453,100 cm2 of skin were procured from 62 donors and stored in the NTUH skin bank; 254,000 cm2 of which were utilized in the treatment of 75 patients. Between 2016 and 2017, 141 microbiological examinations were administered with six were positive. Since the introduction of gamma radiation, no contamination has been observed hereafter in our examinations. Conclusions: We report the success of establishing a high standard and well-functioning skin bank at NTUH that supply sufficient skin allografts in Taiwan. It is the first interhospital supply of charitable skin allografts across Taiwan. Being humanitarian, our skin bank is passing great love forward.

Phytopharmaceuticals from Andrographis paniculata: An ambrosia for immortality

Andrographis paniculata Nees. (family Acanthaceae) is the most popular medicinal plant used traditionally for the treatment of array of diseases such as high fever, inflammation, cancer, diabetes, high blood pressure, ulcer, leprosy, bronchitis, skin diseases, flatulence, colic, influenza, dysentery, dyspepsia and malaria for centuries particularly in Asian continents. Its leaves and rhizomes possess several phytochemical constituents with major as andrographolide, deoxy-andrographolide and other diterpenes with unique and interesting biological properties. The plant extracts and pure compounds have been reported for their anti-microbial, cytotoxicity, anti-protozoan, anti-inflammatory, anti-oxidant, immune-stimulant, anti-diabetic, anti-infective, anti-angiogenic, hepato-protective, liver enzymes modulation insecticidal and toxicity activities. The results of numerous evaluations of extracts and metabolites isolated from this plant did not show any significant acute toxicity in experimental animals and regarded as safe for consumption. The drawback of andrographolide is its low bioavailability that could be improved by fabricating new analogs of bioactive constituents and suitable nanoparticles. The present review describes the diversity of usage of A. paniculata with respect to the medicinal value and phytoconstituents in order to bridge the gap between the research and applications of the plant for human health in the form of phytopharmaceuticals.

Report of a Rare Case of Primary Malignant Mesothelioma of the Perineum Presenting as a Scrotal Abscess

A 57-year-old man presented with erythema and pain in the scrotum for 1 week, with pus exuding from the ruptured scrotum for 1 day. Physical examination showed an enlarged left scrotum, with a small area of ruptured skin, and yellowish-white discharge from the rupture was visible in the lower posterior part of the testes near the perineum, with slightly high local skin temperature, tenderness, and fluctuating sensation. The initial reproductive system ultrasound and pelvic CT were suggestive of inflammatory infection, which was confirmed by histology following two surgeries. The patient's condition did not show improvement for a long period of time, and repeat pelvic CT suggested multiple enlarged inguinal lymph nodes. Fine needle aspiration cytology suggested metastatic cancer. Histopathological examination and immunohistochemistry of the perineal scrotal area showed malignant mesothelioma, and whole-body PETCT suggested pulmonary metastases and invasion into the surrounding tissues, such as the organs of the reproductive system. The patient received chemotherapy and immunotherapy, but the disease progressed rapidly, and he ultimately died of respiratory failure.

Prevalence of heavy episodic drinking in the Brazilian adult population: National Health Survey 2013 and 2019.

To describe the prevalence of heavy episodic drinking in the Brazilian adult population, according to sociodemographic characteristics, in 2013 and in 2019. A cross-sectional study using data on heavy episodic drinking among adults (≥ 18 years) from the National Health Survey, analyzed descriptively. 60,202 participants were included in 2013 and 88,531 in 2019. The prevalence of heavy episodic drinking, in 2019 (17.1%; 95%CI 16.6;17.5), was higher than 2013 (13.1%; 95%CI 13.1;14.2). In the two years, there was a higher prevalence among male sex, adults 18 to 39 years old, individuals with high schooling and Black skin color. In addition, higher prevalence were found among residents in urban areas and in the Midwest and Southeast regions. The indication of the growing prevalence of alcohol abuse in Brazil and the differences in prevalence, according to sociodemographic characteristics, show the need to encourage public policies and actions to combat its use.

A clinico-epidemiological profile of scrub typhus cases admitted in a tertiary hospital in South India

Scrub typhus (ST) is a consistently underreported disease. The disease is spreading to newer areas, and an understanding of disease epidemiology is needed in the local Indian and current context. This study describes the demographic characteristics, monthly distribution, clinical and laboratory presentations, and treatment outcome of the ST cases recently identified. Case sheets of 15 ST patients diagnosed from January 2019 to December 2020 were analyzed. The majority of the patients were male. Eighty percent of the patients were from rural or suburban areas. Higher admission was observed from September to December. Fever (100%), skin rash (73.3%), body ache (53.3%), and vomiting (53.3%) were the most common clinical features. The onset of fever till the appearance of skin rash was 3 ± 1.2 days. The mean day from onset of symptoms till diagnosis was 6.8 ± 3.9 days. Eschar was found in only two patients. Nine (60%) patients already had complications at the time of admission. Most patients presented a laboratory picture of thrombocytopenia, neutrophilic leukocytosis, and anemia. Complications such as septic shock, acute kidney injury, and hepatic involvement were observed. All responded to doxycycline within 48 h. No fatalities were observed. Early clinical suspicion of ST among those with high fever, skin rash and thrombocytopenia, and transaminitis showed positive clinical outcome.

Rickettsial disease: An underestimated cause of posterior uveitis

Rickettsioses are worldwide distributed infectious disease caused by intracellular small Gram-negative bacteria transmitted to humans by the bite of contaminated arthropods, such as ticks. Systemic disease typically consists of a triad of high fever, headache, and skin rash. It usually has a self-limited course, but severe, life-threatening complications can sometimes occur. It may be clinically difficult to differentiate rickettsial diseases from other febrile illnesses. Rickettsial infection has been largely underestimated as a cause of infectious uveitis for long decades in the past. Conversely, recent data show that ocular involvement is much more common than previously thought, with retinitis, retinal vasculitis, and neuroretinitis being the most typical and frequent findings. Early clinical diagnosis of rickettsial disease, while awaiting laboratory test results, is essential for prompt initiation of appropriate antibiotic treatment to prevent systemic and ocular morbidity. The prevention remains the mainstay of rickettsial infection control.

PEDOT: PSS treated cotton-based textile dry electrode for ECG sensing

Reliable extraction of physiological signals from human skin is essential information for health monitoring, preventive care, and treatment. Wearable bioelectronics advancements that are directly placed on the epidermis surface offer a promising future biopotential sensing option. Wearable health-monitoring systems should be comfortable, stigma-free, and capable of producing high-quality data. Wearable textile electrodes for biopotential sensing are a promising candidate for long-term health monitoring to overcome the drawbacks of wet and metal electrodes. This work proposes a cotton-based textile dry electrode for ECG monitoring via the treatment of prepared conductive ink by Poly(3,4-ethylenedioxythiophene) (PEDOT): Poly (styrene sulfonate) (PSS) and DMSO. These electrodes give excellent quality ECG signals without any skin irritation. The ECG is monitored by a portable self-designed low-cost Arduino-based device and validated by a standard ECG monitoring system. The electrode offers high skin compatibility and good signal quality, which are prominent features for cardiorespiratory monitoring.

Evaluation of surface dose calculations using monaco treatment planning system in an indigenously developed head and neck phantom

Objective: The objective of this study is to evaluate the surface doses for 3-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) treatment planning techniques using an inhouse designed head and neck (HN) phantom and to compare the measured surface doses with the doses calculated using the Monaco treatment planning system (TPS). Materials and Methods: An arbitrary clinical target volume was defined with 5 mm planning target volume (PTV) expansion on computed tomography images of an in house designed heterogeneous HN phantom. 3DCRT, IMRT, and VMAT plans were created using Monaco TPS for prescribed dose of 60Gy in 30 fractions to cover 95% of PTV volume. Dose measurements were performed using EBT3 Gafchromic films at 10 selected points on the surface of HN phantom, especially inside the treatment area. Percentage mean dose differences were evaluated between the TPS calculated doses and measured dose values at these identified points. Results: The average dose difference between the TPS calculated doses and film measurements were found to be varying from 11.66% to 19.73%. It was observed that TPS overestimated the surface doses in comparison to measured doses. The results also shows that Gafchromic films can be used for surface dose measurements in patients for in vivo dosimetry in areas where high skin dose is expected during radiotherapy treatment. Conclusion: The limitations of TPS should be considered while evaluating surface doses in radiotherapy plans.

Validation of organ dose calculations with PyMCGPU-IR in realistic interventional set-ups.

Interventional radiology procedures are associated with high skin dose exposure. The 2013/59/EURATOM Directive establishes that the equipment used for interventional radiology must have a device or a feature informing the practitioner of relevant parameters for assessing patient dose at the end of the procedure. This work presents and validates PyMCGPU-IR, a patient dose monitoring tool for interventional cardiology and radiology procedures based on MC-GPU. MC-GPU is a freely available Monte Carlo (MC) code of photon transport in a voxelized geometry which uses the computational power of commodity Graphics Processing Unit cards (GPU) to accelerate calculations. PyMCGPU-IR was validated against two different experimental set-ups. The first one consisted of skin dose measurements for different beam angulations on an adult Rando Alderson anthropomorphic phantom. The second consisted of organ dose measurements in three clinical procedures using the Rando Alderson phantom. The results obtained for the skin dose measurements show differences below 6%. For the clinical procedures the differences are within 20% for most cases. PyMCGPU-IR offers both, high performance and accuracy for dose assessment when compared with skin and organ dose measurements. It also allows the calculation of dose values at specific positions and organs, the dose distribution and the location of the maximum doses per organ. In addition, PyMCGPU-IR overcomes the time limitations of CPU-based MC codes.

Design of a Long-Acting Rivastigmine Transdermal Delivery System: Based on Computational Simulation.

The purpose of our study was using a computational simulation to develop a long-acting patch of rivastigmine (RVS). A range of patch formulations were screened including pressure sensitive adhesive (PSA), pharmaceutical excipients, and controlled release membranes using transfer simulation based on a mathematical model. Diffusion dynamics parameters for simulated operations were acquired through in vitro release tests (IVRT) and in vitro skin permeation tests (IVPT). The mechanism of controlled release was studied by FTIR (Fourier transform infrared), DSC (differential scanning calorimeter) and molecular docking. Results of a rat in vitro permeation profile showed excellent correlation with the in vivo deconvolution profile (R2=0.998). Experiments testified to transfer of RVS at a relatively uniform speed with high skin permeation (2531.2±142.46 μg/cm2) in 72 h. Pharmacokinetic data obtained in vivo also confirmed stable plasma concentrations over 72 h for the optimized patch, and significant prolongation of both Tmax (11.20±1.79 h) and MRT0-t (33.91±5.33 h). Cmax was controlled with AUC0-t (267.34±24.46 h ng/ml), which was closely comparable to parameters of a commercial Exelon® Patch. The successful development of a long-acting patch of RVS thus underscores the potential of computer aided design in a context of promnesic transdermal delivery. Graphical abstract.

Toxicological and Pharmacokinetic Analysis by Insilico Bioinformatics Tools of an Ancient Medicine Compound Cantharidin Derived from Spanish fly

Background: Cantharidin, a vesicant released by spanish fly belongs to species beetles of zoological order Coleoptera. It has a long history in both folk and traditional medicine use for topical cantharidin to treat warts and molluscum and as an aphrodisiac. They are also known to cause poisoning by the presence of toxic principle.Aims and Objectives: The aims of the study were to study possible drug likeness, pharmacokinetic and toxicological profiling of known toxicological active principle cantharidin by insilico analysis and prediction tools.Materials & Methods: This study was investigated on web-based tools PubChem to extract the chemical structure, followed by authentication and validation with the chemical formula. The two-dimensional structures are further converted to three-dimensional (3D) structure with ChemSketch software; The structures are then screened for molecular properties with Simplified Molecular Input Line Entry System, followed by absorption, distribution, metabolism, elimination, and toxicity through SWISS ADME software web based tool. The reports are analyzed and predicted for drug likeness, pharmacokinetic and toxicity characters of cantharidin.Results: The compounds screened cantharidin for drug likeness had a Log P score of >4.15, Bioavailability Score of 0.55, +ve blood brain barrier +ve Intestinal penetration and -ve to Cytochrome P450 enzyme induction and inhibition. The toxic hazard classification by Cramer resulted as HIGH –CLASS III with Skin Sensitization score of 0.861Conclusion: The insilico analysis predicts cantharidin belongs to class III Toxic hazard classification but potential as drug like candidate for topical administration due to its high skin sensitivity and irritation ability as a vesicant in treatment of warts and molluscum.

ANALYSIS OF SKIN DISEASE INFECTION AFTER THE PALU EARTHQUAKE USING BINARY LOGISTIC REGRESSION

The incidence of skin disease in Indonesia is still relatively high and is a significant problem. This is evidenced by the 2010 Indonesian Health Profile data which shows that skin and subcutaneous tissue diseases are the third rank of the 10 most common diseases among outpatients in hospitals throughout Indonesia. Skin disease is growing, as evidenced by data from the Indonesian Ministry of Health, the prevalence of skin disease throughout Indonesia in 2012 was 8.46%, then increased in 2013 by 9 %. Palu City is an area that has a high skin disease problem. According to the 2016 BPS of Palu City, skin diseases are among the top 10 diseases in Palu City with a total of 11,363 sufferers. The method used in this research is binary logistic regression. Based on the analysis that has been done, it can be concluded that the best model is formed as follows:. Based on the best model, it is found that the factors that influence the transmission of skin diseases after the Palu earthquake are genetic factors.

Overview of Emulgel as Emergent Topical Delivery: Recent Applications and Advancement

Emulgel is an emerging delivery system with added advantages over other topical delivery systems which is proven to be boon for cosmetics and dermatology. Emulgels are emulsion which is converted to Gel, which will make it a non greasy and enhances patient compliance. The amalgamation of the two systems would be advantages in term of high drug loading capacity and low skin irritation, site specific targeting avoiding first-pass metabolism and increase in bioavailability. Work carried out by researchers proved that, Emulgel/ Nanoemulgel loaded with drugs has been found effective in many topical disorders and it is emerging as potential drug delivery system in area of dermatology. In the present review current research works that carried out on Emulgel and nano emulgels are discussed and also highlighted the recent applications of Emulgel in transdermal as well as dental, ocular, vaginal, and other delivery system.

Off-centered stagnation point flow of an experimental-based hybrid nanofluid impinging to a spinning disk with low to high non-alignments

PurposeThe purpose of this study is to model and solve numerically the three-dimensional off-centered stagnation point flow and heat transfer of magnesium oxide–silver/water hybrid nanofluid impinging to a spinning disk.Design/methodology/approachThe applied effective thermophysical properties of hybrid nanofluid including thermal conductivity and dynamics viscosity are according to the reported experimental relations that would be expanded by a mass-based algorithm. The single phase formulations coupled with experimental-based hybrid nanofluid model is implemented to derive the governing partial differential equations which are then transferred to a set of dimensionless ordinary differential equations (ODEs) with the use of the similarity transformation method. Afterward, the reduced ODEs are solved numerically by bvp4c function from MATLAB that is a trustworthy and efficient code according to three-stage Lobatto IIIa formula.FindingsThe effect of spinning parameter and nanoparticles masses (mMgO, mAg) on the hydrodynamics and thermal boundary layers behavior and also the quantities of engineering interest are presented in tabular and graphical forms. The recent work demonstrates that the analysis of flow and heat transfer becomes more complicated when there is a non-alignment between the impinging flow and the disk axes. From computational results demonstrate that, the radial and azimuthal velocities are, respectively, the increasing and decreasing functions of the disk spinning parameter. Further, for the greater values of the spinning parameter, an overshoot of the radial velocity owing to the centrifugal forces of the spinning disk is observed. Besides, the quantities of engineering interest gently enhance with first and second nanoparticle masses, while comparing their absolute values illustrates the fact that the effect of second nanoparticle mass (mAg) is greater. Further, it is inferred that the second nanoparticle’s mass enhancement results in the amplification of the heat transfer; although, the high skin friction and the relevant shear stress should be controlled.Originality/valueThe combination of experimental thermophysical properties with theoretical modeling of the problem can be the novelty of the present work. It is evident that the experimental relations of effective thermophysical properties can be trustable and flexible in the theoretical/mathematical modeling of hybrid nanofluids flows. Besides, to the best of the authors’ knowledge, no one has ever attempted to study the present problem through a mass-based model for hybrid nanofluid.

Patient exposure dose in interventional cardiology per clinical and technical complexity levels. Part 1: results of the VERIDIC project.

Patients can be exposed to high skin doses during complex interventional cardiology (IC) procedures. To identify which clinical and technical parameters affect patient exposure and peak skin dose (PSD) and to establish dose reference levels (DRL) per clinical complexity level in IC procedures. Validation and Estimation of Radiation skin Dose in Interventional Cardiology (VERIDIC) project analyzed prospectively collected patient data from eight European countries and 12 hospitals where percutaneous coronary intervention (PCI), chronic total occlusion PCI (CTO), and transcatheter aortic valve implantation (TAVI) procedures were performed. A total of 62 clinical complexity parameters and 31 technical parameters were collected, univariate regressions were performed to identify those parameters affecting patient exposure and define DRL accordingly. Patient exposure as well as clinical and technical parameters were collected for a total of 534 PCI, 219 CTO, and 209 TAVI. For PCI procedures, body mass index (BMI), number of stents ≥2, and total stent length >28 mm were the most prominent clinical parameters, which increased the PSD value. For CTO, these were total stent length >57 mm, BMI, and previous anterograde or retrograde technique that failed in the same session. For TAVI, these were male sex, BMI, and number of diseased vessels. DRL values for Kerma-area product (PKA), air kerma at patient entrance reference point (Ka,r), fluoroscopy time (FT), and PSD were stratified, respectively, for 14 clinical parameters in PCI, 10 in CTO, and four in TAVI. Prior knowledge of the key factors influencing the PSD will help optimize patient radiation protection in IC.

Nanoemulsions containing Garcinia mangostana L. pericarp extract for topical applications: Development, characterization, and in vitro percutaneous penetration assay.

A highly stable oil-in-water nanoemulsion for topical applications, containing mangostins extracted from the pericarp of mangosteen (Garcinia mangostana L.), is a promising strategy to protect mangostins as well as to improve penetration of these important antioxidants through the skins. Nanoemulsions consisted of virgin coconut oil as the oil phase, Tween-80 and Span-80 as surfactants, and xanthan gum as the thickening agent, were prepared using the high-energy and low-energy emulsification methods. The nanoemulsions that were stable up to 28 days had oil droplet diameter of 220 nm to 353 nm and zeta potential of -46.9 mV to -63.7 mV. The accelerated stability test showed that the most stable nanoemulsions were those prepared using the low-energy emulsification method with an estimated shelf life of eleven months, composed of 11% oil phase, 17% surfactant, and 72% aqueous phase. The in vitro percutaneous penetration test for the nanoemulsion with added xanthan gum provided high cumulative skin penetration of mangostins of up to 114 μg/cm2. The results of this study indicate that virgin coconut oil-based nanoemulsions containing mangostins, prepared using the low-energy emulsification method, stabilized by xanthan gum and mixed at 40°C can prospectively be used for topical applications.

Enhancing breakdown strength and lifetime of multilayer dielectric films by using high temperature polycarbonate skin layers

Polymer multilayer films (MLFs) hold a potential to achieve high energy density, high temperature rating, and high breakdown strength simultaneously for next-generation film capacitors. Under extreme conditions such as high AC electric fields and high temperatures, an important dielectric loss mechanism is the homocharge injection from metal electrodes and subsequent charge recombination (i.e., AC electronic conduction) at the electrode/dielectric interfaces. In this work, the mechanism of the AC electronic conduction loss is studied for high-temperature polycarbonate (HTPC)/poly(vinylidene fluoride) (PVDF) MLFs with either HTPC (MLF@HTPC) or PVDF skin layers (MLF@PVDF). Based on the DC/AC breakdown strength and lifetime measurements, it is observed that homocharge injection was more significant for MLF@PVDF than MLF@HTPC. Using the electric displacement-electric field loop analysis, dielectric losses from both AC electronic conduction and ferroelectric switching (PVDF) are quantified. A dipolar electric double layer model at the electrode/PVDF interfaces is proposed to explain the more significant ferroelectric switching and charge injection in MLF@PVDF. From these experimental results, it is concluded that enhanced breakdown strength and lifetime can be achieved for MLF@HTPC because of the reduced homocharge injection and AC electronic conduction at high electric fields and high temperatures.

Design of FSS Based Radome Wall for Airborne Radar Application

In this paper, a broad band A-sandwich radome wall structure based on band-pass FSS (frequency selective surface) is proposed for an airborne radar applications. The FSS structure having two square conducting rings, which are embedded on either side of core layer. The conventional and proposed FSS based radome wall is analyzed with different incidence angles (0°, 10°, 20° and 30°) for both TE and TM polarization. The radome wall structure consist of a low density Nomex honeycomb core layer sandwiched between two high density Quartz skin layers. The structure shows the percentage impedance bandwidth of 40.8 % in the frequency range from 7.8GHz to 11.8GHz with sharp roll-off characteristics. The proposed novel approach involves high frequency unit cell simulation, which is carried out using EM Simulation Tool. To understand the practical behavior of the proposed structure for radome application the conformal analysis has been also carried out, with respect to different radius. The superior EM performance of the proposed broadband novel radome wall structure makes it suitable for the design of airborne radome.

Lichen planus pigmentosus in a 7-year-old girl.

LPP is a rare variant of LP that is infrequently encountered in children. In a retrospective analysis of 316 pediatric patients with LP, only nine (2.8%) were diagnosed with LPP (4). Similarly, in a recent retrospective study of 76 pediatric patients with LP in South India, only one (1.3%) was diagnosed with LPP (6). It is commonly seen in middle-aged patients with high skin phototypes. LPP presents as chronic, acquired, violaceous to brownish-gray, oval macules, with poorly-defined borders (7). The lesions appear more frequently in the neck and face, but they can also affect the upper and lower extremities, and torso as well. LPP rarely affects the oral mucosa, scalp, palms, soles, and nails. Flexural involvement is seen in around 20% of cases with a concurrent photo-exposed distribution (5). LPP-inversus is a variant of LPP, limited to intertriginous and flexural areas, and sparing sun-exposed areas (3, 5). A skin biopsy will confirm the diagnosis. The histopathology findings include hyperkeratosis and vacuolar degeneration of the basal layer, dermal band-like or perivascular infiltrate, and melanophages. Superficial pigmentary incontinence can be seen (7). The main differential diagnosis of LPP is erythema dyschromicum perstans (EDP) or ashy dermatosis. EDP presents as non-pruritic, blue-gray macules and patches, with or without raised erythematous borders in photo-exposed areas and trunk. Histopathology reveals lichenoid features within the peripheral active border. A perivascular infiltrate and numerous melanophages can be seen. The clinical features and histopathology of LPP and EDP can overlap, so much so as to suggest that the two conditions can be part of the spectrum of a unique entity. Other differential diagnoses include post-inflammatory hyperpigmentation, pigmented contact dermatitis, fixed drug eruption, and urticaria pigmentosa, among others (2, 7). LPP treatment is difficult, with limited results in most cases. The available topical treatments include medium to high potency corticosteroids, calcineurin inhibitors (mostly tacrolimus 0.1% ointment) and skin lightening creams containing hydroquinone and retinoids in conjunction with an anti-inflammatory treatment (3, 7, 9). Some Authors (3) recommend that in order to prevent steroid atrophy, corticosteroids should be used for a short period (2-4 weeks). Later on they could be followed by a calcineurin inhibitor over a longer period (3-6 months). In recalcitrant or widespread cases, systemic treatments with or without topical therapy can be used. They include oral corticosteroids, dapsone, and isotretinoin (7, 9, 10). The use of narrow band ultraviolet B (NB-UVB) phototherapy in LPP has been recently reported. Complete resolution of lesions was achieved after 20 exposures and no adverse effect was observed (1).

Influence of temperature on sonographic images of the median nerve for the diagnosis of carpal tunnel syndrome: a case control study

BackgroundIn addition to nerve conduction studies (NCSs), ultrasonography has been widely used as an alternative tool for diagnosing carpal tunnel syndrome (CTS). Although the results of NCSs are influenced by local skin temperature, few studies have explored the effects of skin temperature on ultrasonography of the median nerve. Since swelling and intraneural blood flow of the median nerve might be influenced by local temperature changes, the aim of this study was to evaluate the cross-sectional area (CSA) and intraneural blood flow of the median nerve under three skin temperatures (30 °C, 32 °C, 34 °C).MethodsFifty patients with CTS and 50 healthy volunteers were consecutively recruited from a community hospital. Each participant received physical examinations and NCSs and underwent ultrasonography, including power Doppler, to evaluate intraneural vascularity.ResultsThe CSA of the median nerve in the CTS patients was significantly larger than that in the healthy controls at all three temperatures. However, significant differences in the power Doppler signals of the median nerve between the two studied groups were observed only at 30 and 32 °C, not at 34 °C.ConclusionThe significant difference in the intraneural vascularity of the median nerve between the patients with CTS and the healthy subjects was lost at higher temperatures (34 °C). Therefore, the results of power Doppler ultrasonography in diagnosing CTS should be cautiously interpreted in patients with a high skin temperature or those who reside in warm environments.