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Multi-omics reveals that burdock seed aglycone alleviates renal fibrosis by restoring mitochondrial oxidative phosphorylation function.

Renal fibrosis (RF), a common pathological process driving chronic kidney disease (CKD) progression to end-stage renal failure, is closely associated with oxidative phosphorylation (OXPHOS). Arctigenin (ATG), the main active component of burdock seed, exhibits anti-inflammatory and anti-fibrotic activities, but its mechanisms in RF treatment remain unclear. Here, we performed integrated transcriptomic and proteomic analyses to identify key targets and pathways of ATG in a unilateral ureteral obstruction-induced rat RF model. Multi-omics enrichment analysis revealed that NDUFS8 and NDUFS2 were the core targets of ATG, with the OXPHOS pathway as the central intersecting pathway. Our results suggest that ATG exerts anti-renal fibrosis effects by targeting the OXPHOS pathway to inhibit excessive reactive oxygen species production and oxidative stress. SIGNIFICANCE: Chronic kidney disease (CKD) continues to impose an escalating global health and socioeconomic burden, while renal fibrosis (RF), as the convergent pathological endpoint of virtually all progressive nephropathies, remains the principal determinant of irreversible renal failure and adverse clinical outcomes. Despite extensive efforts to develop antifibrotic therapies, effective clinical interventions remain elusive, largely due to the complex and multifactorial nature of RF pathogenesis. In this study, we employed an integrated multi-omics framework encompassing transcriptomics, proteomics, and metabolomics to systematically decipher the antifibrotic mechanism of arctigenin (ATG), a bioactive natural compound derived from traditional Chinese medicine. Our findings identify mitochondrial oxidative phosphorylation as the pivotal regulatory axis underlying the renoprotective effects of ATG and further establish key catalytic subunits of mitochondrial complex I as its direct molecular targets. Mechanistically, ATG not only restores complex I activity and reprograms mitochondrial energy metabolism but also preserves the intracellular stability and localization of these subunits, thereby preventing their aberrant release-mediated inflammatory activation and disrupting the self-perpetuating cycle linking metabolic dysfunction, inflammation, and fibrosis progression. Beyond revealing a previously unrecognized dual mechanism integrating metabolic and inflammatory regulation, this study provides compelling evidence that mitochondrial dysfunction is not merely a secondary consequence of tissue injury but a fundamental driver of fibrotic remodeling. Importantly, our work highlights the translational potential of natural product-based mitochondrial interventions for CKD treatment and supports a broader conceptual shift toward metabolism-centered therapeutic strategies for chronic fibrotic diseases. Given the central role of mitochondrial dysfunction across multiple organs, these findings may also have far-reaching implications for the treatment of systemic fibrosis-related disorders beyond the kidney.

Animals

[Study of pressor drops during continuous peridural analgesia in gerontologic surgery].

A statistical study bearing upon othe fall of blood pressure concomitant with the setting of peridural anaesthesia was carried out upon an homogeneous series of patients over 75 belonging to groups III and IV of the A S A classification for interventions seating below the IXth metamere. From this study, it seems to follow that: - for starting maximum arterial tensions over 180 mm/Hg, pressure falls are virtually constant in absolute value; - the most important variations in pressure falls are to be found in abdominal surgery; - the lowest figure in blood pressure which accompanies the achievement of surgical analgesia takes place about the 24 th minute whatever the type of surgery can be; - no significant link can be evidence between the importance of the fall in blood pressure and the consumption of the mixture required for surgical analgesia.

Abdomen

Comparative Evaluation of Virtual Reality versus Standard Nursing Care in Managing Pain and Fear during Lumbar Puncture Procedures: A Randomised Controlled Trial.

BACKGROUND: Meningitis is a serious infectious disease that can cause significant morbidity and long-term neurological problems. Although a lumbar puncture is a necessary diagnostic procedure, it is often accompanied by discomfort, anxiety, and fear, which can severely impact the patient's experience. Although there is few data on its application prior to lumbar puncture in adult patients with meningitis, immersive virtual reality (VR) has become a promising non-pharmacological technique for lowering procedural distress. Thus, among individuals undergoing lumbar punctures, this randomized controlled research assessed how well pre-procedural VR reduced pain, anxiety, and fear while enhancing patient satisfaction. OBJECTIVE: This study aims to evaluate the effectiveness of virtual reality (VR) in reducing pain and fear among adults undergoing lumbar puncture (LP) compared with standard care protocol. METHODS: A randomised clinical trial was conducted from May to October 2025, using a single-blind, true experimental design. A total of 85 patients were randomly assigned to either the VR intervention group ( n = 41) or the control group receiving standard care ( n = 44). Pain levels were assessed using a visual analogue scale. Fear was assessed using the Multidimensional Fear-of-Injection Scale. Data were analysed using SPSS version 26. RESULTS: According to the study, the findings revealed a significant reduction in pain levels among the study group following the VR intervention, with mean pain scores dropping from 7.54 ± 1.925 to 2.49 ± 0.675. In contrast, the control group showed increased pain intensity, with mean scores rising from 6.84 ± 1.842 to 8.36 ± 1.348. The VR group showed a significant reduction in fear scores across all domains, whereas no significant changes were observed in the control group. Direct fear decreased from 20.12 ± 1.71 to 9.44 ± 2.00, indirect fear from 17.24 ± 1.46 to 8.66 ± 2.24, physiological response improved from 0.34 ± 0.66 to 3.00 ± 1.00 and avoidance behaviour decreased from 16.71 ± 1.49 to 7.80 ± 1.85. CONCLUSIONS: The research shows that the use of VR prior to LP significantly reduces level of pain and fear compared to standard care. These results support VR as a non-pharmacological intervention for fear and pain to improve patient experience during invasive procedures. In contrast, the control group experienced no improvement.Trial Registration: The IRCT code for the trial was IRCT ID 20250803066743N1.

Humans

Effectiveness of digital health technologies for post-discharge follow-up and management in older adults: a systematic review.

Older adults (≥65 years) are a rapidly growing population that are experiencing a higher number of hospitalisation admissions, longer hospital stays, and greater hospitalisation-related costs than younger adults. There is an important gap in post-discharge care for older adults, and digital technologies, such as video visits, mobile health apps, and remote patient monitoring, may support follow-up and management after hospital discharge. This systematic review examined the effectiveness, feasibility, acceptability, and impact (ie, effects on rehospitalisation, quality of life, mental health, adherence, and patient satisfaction) of technology-based interventions used for the follow-up and management of older adults after hospital discharge. MEDLINE (via PubMed), Scopus, and Web of Science were searched from database inception to January, 2026. The search identified 1972 records, of which 46 studies met the inclusion criteria: older adult populations (aged ≥65 years), a technology-based intervention, post-discharge follow-up or management, and empirical data. Overall, digital post-discharge interventions were reported to be feasible, with good engagement, adherence, compliance, and retention; low dropout rates; and positive patient satisfaction. However, mixed findings were reported regarding rehospitalisation rates and mental health outcomes for virtual care compared with those for traditional care. Digital health technologies might represent a promising step towards improving post-discharge health care and continuity of care for older adults.

Journal Article

Long duration subarachnoid anaesthesia with continuous epidural block.

UNLABELLED: A method of spinal anaesthesia with Dixidextracaine-70 (a mixture of xylocaine 40.0 mg + percaine, 10.0 mg+ Dextran-70, 60,0 mg+ distiled water ad 2.0 ml) with continuous epidural block has been tested in 150 patients. The advantages of this association are: the possibility of obtaining a high quality conduction anaesthesia, virtually unlimited in time, the ability to extend over several anatomical regions the surgical field, minimal toxicity, the absence of postoperative pulmonary complications, and the economy. Drawbacks are: the need for two vertebral punctures, the longer induction time of anaesthesia and some difficulty in finding the subarachnoid space after catheterisation of the epidural space. The indications of the method include subdiaphragmatic surgery, interventions on more than one anatomical region, surgery in aging patients, patients with full stomach, and those with anaesthetic and surgical risk, as well as socioeconomic factors which may prevent application of a differentiated and safe narcosis. CONTRAINDICATIONS: those of subarachnoid and epidural block. The incidents and accidents are minimal and specific to both techniques. The fear of producing total subarachnoid anaesthesia by injection of the anaesthetic solution in the epidural space after puncture of the subarachnoid space is virtually unfounded.

Adolescent

Implementing Prolonged Exposure Therapy in a Community Substance Use Treatment Program: A Qualitative Study.

INTRODUCTION: Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUD), yet few community-based SUD programs incorporate evidence-based trauma-focused. Prolonged exposure (PE), including its massed format (M-PE) with session frequency of 3-4 times per week, is a gold standard intervention for PTSD; however, concerns about client readiness, logistical demands and relapse risk have limited its adoption within SUD settings. This study examined staff perspectives on the feasibility and acceptability of integrating M-PE into a community-based SUD program. METHODS: Prior to launching a Hybrid Type 1 effectiveness-implementation trial (Project COMET), we conducted semi-structured virtual interviews with 15 community clinic staff: providers (n = 8), administrators (n = 2) and peer specialists (n = 5). Interviews were recorded, transcribed and analysed using a rapid qualitative analysis framework with matrix techniques to compare themes across roles. RESULTS: Four overarching themes captured staff perspectives on integrating M-PE: (Theme 1) Prior Knowledge and Experiences: Most staff were familiar with EMDR, while direct knowledge of PE/M-PE was limited. (Theme 2) Perceptions of M-PE: M-PE was widely viewed as a promising, structured intervention that fits the pacing and duration of SUD care. (Theme 3) Symptom Reduction and Client Impact: Staff anticipated improvements in PTSD and SUD symptoms through trauma-focused treatment. (Theme 4) Barriers and Constraints: Participants identified several potential implementation challenges, including logistical barriers and client readiness. DISCUSSION AND CONCLUSIONS: Findings suggest that staff generally viewed M-PE favourably but emphasised the importance of ensuring client readiness and organisational support. Enhancing feasibility and long-term sustainability may require expanded psychoeducation, targeted provider training and flexible delivery models. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06968832.

Adult

Diet and cholesteremia.

The statistical correlation between elevated serum cholesterol levels and increased risk of coronary heart disease has channeled thinking towards regarding dietary fat and cholesterol as the principal causes of hypercholesteremia. Since 1909 there have been a number of changes in nutrient availability in the United States. Protein availability is unchanged but the ratio of animal to vegetable protein rose from 1.06 in 1909 to 2.37 in 1972. Fat availability has risen by 26% with the ratio of animal to vegetable fat falling from 4.88 in 1909 to 1.64 in 1972. A review of available data indicates that amount and type of protein may affect cholesteremia and atherosclerosis in experimental animals. Soy protein is less cholesteremic than casein but the extent of difference can be affected by the type of carbohydrate. In a semipurified, cholesterol-free diet, saturated fat exerts an atherogenic effect but unsaturated fat does not. No atherogenicity is evident when saturated fat is added to laboratory ration. In the semipurified diet, fructose is more atherogenic than glucose, and casein is more atherogenic then soy protein. The latter difference can be virtually eliminated if alfalfa replaces cellulose as the dietary fiber. The data suggest that all elements of the diet interact and can affect cholesteremia and atherosclerosis. These effects must be considered in the planning of dietary intervention trials.

Animals

Medicine and patriarchal violence: the social construction of a "private" event.

Our objectives are to describe the pattern of abuse associated with battering and to evaluate the contribution of the medical system and of broader social forces to its emergence. A pilot study of 481 women who used the emergency service of a large metropolitan hospital in the U.S. shows that battering includes a history of self-abuse and psychosocial problems, as well as repeated and escalating physical injury. In addition, although the number of battered women using the service is 10 times higher than medical personnel identify, the pattern of abuse that constitutes battering emerges only after its initial effects are presented and in conjunction with specific medical intervnetions and referrals. Examination of intervention and referral patterns suggests a staging process by which battering is socially constructed. At first, the physical trauma associated with abuse is medicated symptomatically. But the patient's persistence, the failure of the cure, and the incongruity between her problems and available medical explanations lead the provider to label the abused woman in ways that suggest she is personally responsible for her victimization. Although secondary problems such as depression, drug abuse, suicide attempts, or alcoholism derive as much from the intervention strategy adopted as from physical assault or psychopathology, they are treated as the primary problems at psychiatric and social service referral points where family maintenance is often the therapeutic goal. One consequence of this referral strategy is the stabilization of "violent families" in ways that virtually insure women will be abused in systematic and arbitrary ways. The use of patriarchal logic by medical providers ostensibly responding to physical trauma has less to do with individual "sexism" than with the political and economic constraints under which medicine operates as part of an "extended patriarchy." Medicine's role in battering suggests that the services function to reconstitute the "private" world of patriarchal authority, with violence if necessary, against demands to socialize the labors of love.

Emergency Service, Hospital

Applications and outcomes of virtual reality in inpatient psychiatry: A systematic review.

BACKGROUND: Virtual reality (VR) has been widely used in outpatient psychiatric services and has demonstrated benefits across several clinical diagnoses, but its use and effects in inpatient settings remain to be explored. This systematic review aimed to examine the use of VR during psychiatric hospitalization, including types of VR applications, barriers and facilitators of implementation, and effects on various outcomes. METHODS: The review was registered in PROSPERO (#CRD42023446524). Following PRISMA guidelines, databases (Ovid, SciVerse, Web of Science, Cochrane Library, ProQuest, and WorldCat) were searched from 1983 to 2025 using keywords related to VR and psychiatric disorders. Studies involving the use of VR with psychiatric inpatients (≥85%) were included. Descriptive statistics and narrative syntheses were used to summarize findings. Study quality was assessed with the Mixed Methods Appraisal Tool. RESULTS: After full-text screening, 37 studies (N = 1,004) met inclusion criteria. VR was used for both assessment and intervention, with cognitive-behavioral therapy/exposure (35%) and assessment (24%) being the most frequently used. VR use in inpatient units appeared feasible, acceptable, and safe for inpatients and clinicians, though findings remain preliminary. Several facilitators (e.g. adequate staff training and supervision) and common barriers (e.g. technical difficulties and limited resources) were identified. The most consistent improvements were observed in clinical symptoms (e.g. anxiety) compared with psychosocial, cognitive, and physiological outcomes. CONCLUSIONS: These findings suggest that inpatient settings represent a promising, yet understudied context for VR-based assessments and interventions. High-quality trials and systematic reporting of implementation are needed in future studies to inform research and clinical practice.

Humans

Game changer? Cognitive-motor effects of VR exergaming compared to video-based training.

BACKGROUND/OBJECTIVE: Virtual reality (VR) exergaming enhances several cognitive domains through multisensory engagement. Acute cognitive benefits of VR are established, but evidence for direct comparisons with non-immersive controls is limited. This study aimed to determine whether VR exercise provides additional cognitive and cognitive-motor benefits beyond a matched non-immersive active stick-fight video (SFV) intervention, and whether effects persist after training. METHODS: In this randomized quasi-experimental study, N&#x2009;=&#x2009;55 healthy adults (VR: n&#x2009;=&#x2009;30; SFV: n&#x2009;=&#x2009;25; 25.5&#x2009;&#xb1;&#x2009;7.1&#x2009;years; 41.8% female) completed an 8-week program (2&#x2009;&#xd7;&#x2009;30&#x2009;min/week), of VR or SFV matched in movement patterns, frequency, intensity and duration. Measurements included reaction time (RT), Stroop Test (versions 1-3), Letter Cancellation Test (LCT), Trail Making Test (TMT), Trail Walking Test (TWT) and Fitts task (difficulty level 1-4). Data were analyzed using mixed-design ANOVAs. RESULTS: Improvements were observed in Stroop reading (F(1,53) = 14.84, p < .001, &#x3b7;2 = 0.219), Stroop inhibition (F(1,53) = 10.99, p = .002, &#x3b7;2 = 0.172), and LCT (F(1,53) = 4.57, p = .037, &#x3b7;2 = 0.079). A time&#x2009;&#xd7;&#x2009;group interaction was found for TMT (F(1,53) = 6.55, p = .031, &#x3b7;2 = 0.110), indicating greater changes following VR training. Both groups improved cognitive-motor performance (TWT: F(1,25) = 55.32, p < .001, &#x3b7;2 = 0.689; Fitts3: F(1,53) = 44.97, p < .001, &#x3b7;2 = 0.459), with greater gains for VR in Fitts3 (p = .006). CONCLUSION(S): Eight weeks of VR and SFV enhanced cognitive and cognitive-motor performance. VR provided domain-specific advantages in executive function, but these effects were not uniformly persistent. SFV sustained more improvements in real-world-relevant cognitive-motor tasks.

Humans

Effectiveness of artificial intelligence in nursing simulation education: A systematic review, meta-analysis and bibliometric visualization analysis.

OBJECTIVES: To synthesize the roles and core functions of AI in nursing simulation education for nursing students via systematic review, quantitatively evaluate its effects on students' knowledge and skill outcomes through meta-analysis, and map the research landscape and development trends of this field through bibliometric visualization analysis. DESIGN: Systematic review, meta-analysis and bibliometric visualization analysis. DATA SOURCES: Eight electronic databases: PubMed, Web of Science, MEDLINE, ERIC, Academic Search Complete, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Science and Technology Journal Database (VIP) were employed to search studies from the time of construction to 16 December 2025. REVIEW METHODS: Studies meeting the inclusion criteria were screened. The revised Cochrane Risk of Bias tool (ROB 2) and Joanna Briggs Institute (JBI) critical appraisal checklists were used for quality assessment. Meta-analysis was performed with Review Manager 5.4, and bibliometric visualization analysis was conducted using VOSviewer 1.6.20 and Bibliometrix (based on R4.4.3). RESULTS: A total of 61 studies were included. AI primarily played two roles in nursing simulation education: peer-type new subject (n&#xa0;=&#xa0;24) and direct mediator (n&#xa0;=&#xa0;22). Meta-analysis showed that AI interventions significantly improved nursing students' knowledge (SMD&#xa0;=&#xa0;1.49, 95% CI [0.55,2.43], p&#xa0;=&#xa0;0.002) and skills (SMD&#xa0;=&#xa0;0.66, 95% CI [0.02,1.31], p&#xa0;=&#xa0;0.04). Bibliometric analysis identified that the United States of America and China were the two main contributing countries in this field, and the key motor themes included generative artificial intelligence, virtual patients, and geriatric care. CONCLUSIONS: AI exerts positive effects on nursing students' knowledge acquisition and skill enhancement in simulation education, with peer-type new subject and direct mediator as the dominant roles. Future research should focus on expanding AI applications in multi-specialty simulation scenarios, activating the data-driven value of machine learning, and strengthening international collaboration and standardization construction, so as to promote the sustainable development of AI-integrated nursing simulation education.

Humans

Myocardial substrate utilization and hemodynamics following repeated coronary flow reduction in pigs.

The effect of repeated local ischemia and reperfusion on myocardial metabolism and ventricular performance was studied in 12 open-chested pigs fasted overnight. Myocardial ischemia was induced by reduction of the flow in the left anterior descending coronary artery to 40% of control during 30 min. After 35 min of reperfusion a second 30-min occlusion period was started, again followed by a 35-min reperfusion period. At the end of both reperfusion periods coronary flow and coronary resistance had returned to control values. During control there was lactate uptake, but no significant uptake of glucose, free fatty acids (FFA), triglycerdies, glycerol and inosine. During the first occlusion period the heart released lactate and inosine, and used glucose and FFA. At the end of the first reperfusion period lactate uptake approached control values, but inosine was still released by 10 of the 12 animals. In the second ischemic period, glucose and FFA were again taken up. Lactate and inosine were released, but the production was much smaller than during the first occlusion period. Depletion of myocardial glycogen and high-energy phosphates could be responsible for this quantitatively different response. Necrosis may have played a role, although enzyme release was minimal and only observed after the second occlusion period. Heart rate, peripheral resistance and ventricular filling pressure were virtually unchanged throughout the course of the experiments. Maximum rate of fall of left ventricular pressure (min LVdP/dt) decreased during ischemia and did not recover during reperfusion. Changes in min LVdP/dt and cardiac output were more closely related than changes in max LVdP/dt and cardiac output. This model cannot be used for the study of interventions during myocardial ischemia in which the animal serves as its own control.

Animals

[Microwave therapy in outpatient oral surgery].

The biological action of microwave therapy is due to the conversion of high-frequency electromagnetic waves to heat that is produced directly in the tissue at the radiation area. It is a deep heating procedure of limited range with low-level exposure to the subcutaneous fatty tissue; it may be used in subacute and chronic infectious inflammatory conditions, after surgical interventions, in affections of the salivary glands and of the maxillary sinuses, and also in temporo-mandibular joint disorders and facial neuralgias. As a rule, irradiation by microwaves is only a supporting treatment. Its advantages are above all: easy application; great economy; versatility; uniform, locally limited distribution of heat with low-level exposure to the fatty tissue; virtual safety.

Adolescent

Educational approaches to enhance genomics competencies among health sciences students: A scoping review with implications for nursing education.

INTRODUCTION: Genomics is increasingly recognized as essential for precision health, yet its integration into undergraduate nursing and other health sciences curricula remains limited. Persistent gaps in genomics literacy and confidence among students and professionals indicate that current educational approaches may not adequately prepare graduates for genomics-informed care and precision health. The aim of this review is to map educational approaches and methods used to enhance genomic competencies among undergraduate health sciences students and discuss implications for nursing education. METHODS: Scoping review, reported in accordance with PRISMA-ScR recommendations. Systematic search in CINAHL Ultimate, ERIC, and MEDLINE for studies published in English between January 2015 and December 2024 was undertaken. Data were charted using a standardized extraction form and synthesized descriptively and narratively, grouping interventions by educational approach, methods, strategies, techniques, and tools. RESULTS: Thirty-one studies were included, mostly from the United States, involving primarily medical and nursing students. Educational approaches centered on experiential and practice-based learning, simulation, case- and problem-based learning, flipped classrooms, collaborative or interprofessional learning, narrative and arts-based methods, and technology-enhanced strategies such as virtual labs, online modules, and digital storytelling. These approaches were associated with improvements in genomic knowledge, application to clinical scenarios, ethical awareness, engagement, and self-reported confidence, although outcomes were predominantly short-term. CONCLUSIONS: Genomics education for health sciences students is characterized by diverse, largely experiential and student-centered approaches. Integration into curricula remains fragmented and often focused on genetics rather than broader genomics and precision health. Nurse educators should prioritize integrated, authentic, and ethically informed genomics education, supported by educator development and digital technologies, including generative AI, to prepare graduates for precision nursing care.

Genomics

Extended Reality Interventions for Osteoarthritis of the Knee and Recovery After Total Knee Arthroplasty: Systematic Review and Meta-Analyses.

BACKGROUND: Nonpharmacologic interventions are important for treating knee pain due to osteoarthritis or after total knee arthroplasty (TKA), and extended reality (XR) technology may enhance treatments for these indications. OBJECTIVE: This systematic review aimed to evaluate XR interventions for pain due to knee osteoarthritis (KOA) or for recovery after TKA. METHODS: Databases were searched through May 2023 and updated in December 2025. Eligible trials evaluated XR interventions to treat KOA pain or after TKA. We classified interventions by depth of immersion and clinical mechanism. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria to determine the certainty of evidence for prioritized outcomes. Meta-analyses were performed when &#x2265;3 studies evaluated similar comparisons, outcomes, and time points. RESULTS: Eligible trials addressed KOA (k=12) or recovery after TKA (k=9). Sample sizes ranged from 36 to 306 participants, and most studies had a follow-up of &#x2264;3 months. Nineteen studies assessed pain-related functioning and pain intensity, and 5 assessed adverse events (AEs). For KOA, 10 studies examined interactive digital rehabilitation (IDR), and 2 examined virtual reality (VR)-digitally augmented exercise (DAE). IDR for KOA may result in better pain-related functioning (low certainty of evidence [COE]; pooled standardized mean difference [SMD] -0.59, 95% CI -1.11 to -0.06; prediction interval [PI] -1.72 to 0.55; k=5) and lower pain intensity at 6-8 weeks (low COE; pooled SMD -0.46, 95% CI -0.92 to 0.00; PI -1.39 to 0.47; k=4). VR-DAE for KOA (k=2) produced inconsistent results (very low COE). For post-TKA studies, 5 examined IDR, 2 examined VR-DAE, 1 examined VR-distraction, and 1 examined VR-psychoeducation. Post-TKA IDR may result in better pain-related functioning (low [k=4] and moderate COE [k=1]) but little to no difference in pain intensity (low-moderate COE; pooled SMD at 3-4 months -0.12, 95% CI -0.75 to 0.52; PI -1.63 to 1.27; k=3). VR-psychoeducation probably results in lower pain at 4 weeks (moderate COE; k=1), and VR-distraction may result in 6 months (low COE; k=1), whereas VR-DAE produced mixed findings (k=2; very low COE). IDR was not associated with AEs, and VR may not be associated with AEs for KOA (high and low COE), though AE reporting was uncommon (k=5) and evidence was very uncertain for post-TKA. CONCLUSIONS: IDR may augment treatment for KOA and post-TKA recovery, and VR may benefit post-TKA rehabilitation. This review is the first to stratify by level of immersion, clinical mechanism, and follow-up duration and to systematically evaluate AEs. IDR may be ready for integration into KOA care, while use after TKA needs more evidence. Randomized controlled trials with implementation outcomes could determine how XR interventions can be used for KOA, whereas trials evaluating efficacy and AEs are needed before their use for post-TKA.

Humans

Active and inactive thyroid hormone levels in elective and acute surgery.

The changes in the plasma or serum concentration of thyrotrophin (TSH), thyroxine (T4), 3,5,3'-triiodothyronine (T3), 3,3',5-triiodothyronine (reverse T3, rT3) and cortisol were examined in patients undergoing elective cholecystectomy (n = 10) or acute laparotomy due to peritonitis (n = 11). TSH and T4 showed no essential changes in either group. T3 was reduced already during initiation of anaesthesia and continued to fall during and after surgery in both groups. In the peritonitis group, T3 was reduced already before medical intervention. rT3 displayed changes opposite to those of T3. An increase in cortisol peceded the changes in T3 and rT3 in both groups. T3 and rT3 returned towards normal levels when the patients recovered and resumed oral nutrition. It seems likely that both elective and acute uncomplicated surgery is accompanied by a transient reduction in the extrathyroidal production of the most active hormone, T3, and by a reciprocal increase in the levels of the virtually inactive rT3. The underlying mechanism behind this metabolic adaptation is unclear but may be related to adrenocortical activation and/or to changes in the mode of nutrition.

Aged

The medicolegal investigation of operating room associated deaths.

For those medicolegal investigative systems charged by statute with the responsibility of investigating and examining known or suspected iatrogenic deaths--whether in a perioperative or operative situation, or in some other relationship to medical intervention--there is usually little doubt that these types of investigations constitute the most difficult, often perplexing, and far-reaching investigation, examination, and reporting problems of any of the types of cases referred. Much of this difficulty derives from the changing attitude of the public at large, including the medical and the legal community. In the United States, as recently as 15 years ago, the loss of life or injury subsequent to a therapeutic or operative procedure, with rare exception, was accepted virtually as an act of God.

Anesthesia

Cancer of the breast. Staging methods, primary treatment options and end results.

A totally satisfying concept of treatment is not easy to formulate from the complex and often conflicting results of local therapeutic interventions for breast cancer. It seems evident that clinically occult cancer is often beyond the pale of both resection and irradiation at primary treatment, particularly when cancer is found in regional lymph nodes. Despite all combinations of local treatment, the ultimate risk of failure correlates more closely with the stage of the disease at the time of treatment than with the particular form of treatment. Thus the extent of disease must be considered the major, perhaps the ultimate determinant of prognosis. Because, under controlled conditions, several therapeutic alternatives have appeared to provide virtually identical end results in terms of survival and ultimate dissemination of the disease, the adequacy of control within the field of treatment may, in fact, be the most meaningful end result of local treatment. The experience that has accumulated with treatment of breast cancer supports the thesis that removal of the breast accomplishes all that can be achieved in terms of curing the disease, and wider treatment with surgery or irradiation serves only to improve the prospects for local control. Halsted demonstrated this principle with his radical mastectomy and it still seems to be the case. This fact provides further impetus for detecting and treating cancer while it is still localized to the breast. With these generalizations in mind some empirical observations can be added. An anatomic fact is that multiple microscopic foci of cancer that are not evident clinically are often present in the mammary parenchyma. Undisturbed, at least some, and perhaps eventually all, of these foci of cancer progress to become clinical cancers. Thorough removal of the entire breast (the entire mammary parenchyma) eliminates this particular hazard and, one may presume, terminates the disease if it is still limited to the breast. Removal of the underlying pectoralis major muscle provides additional margin around the tissues primarily involved, but sacrific of the muscle is apparently needless unless it is directly invaded by cancer. Microscopic metastases are also often present in regional lymph nodes without being clinically detectable and, left untreated, have the capacity to enlarge and become clinically apparent. Routine wide removal of regional lymph nodes improves the control of cancer at these sites when metastases are present, but whether it improves the chances for cure is doubtful. The fact is that approximately 25 per cent of patients with axillary metastases enjoy prolonged survival free of recurrence, some remaining well even after thirty years (Adair et al., 1974). Whether they would survive as well without removal of the metastases is uncertain. Desease-free survival is highest if metastases are removed while still microscopic, but this phenomenon may simply reflect treatment at an earlier phase in the evolution of the disease...

Bone and Bones