To explore the understanding of osteoporosis in the context of adult spinal deformity (ASD) surgery with a focus on diagnosis, surgical risks, non-operative, and operative treatment techniques. A comprehensive literature search was performed. Articles were identified using the search terms “osteoporosis,” “adult spinal deformity,” “scoliosis,” and “spine surgery.” Relevant studies were selected based on their focus on the intersection of these topics with an emphasis on utility in spine surgery. This review discusses osteoporosis diagnosis, surgical risks, and non-operative, and surgical treatments in the context of ASD surgery with a focus on clinical applications. Areas for future growth are highlighted. As adult spinal deformity (ASD) patients increase globally, the Scoliosis Research Society (SRS) formed a task force to improve understanding of osteoporosis and its impact on this vulnerable population. This review brings together the latest research on the topic and highlights this area as one of critical importance and growth in the field.
Anastomotic leakage most frequently occurs within the first postoperative week, when intrinsic tissue strength is limited. Although bioabsorbable reinforcement materials are widely used, the optimal degradation profile remains unclear. This study evaluated whether short-term bioabsorbable reinforcement improves early mechanical stability compared with medium-term reinforcement in a controlled porcine small bowel model. Ten pigs underwent laparotomy, and three standardized jejunal end-to-end anastomoses were created in each animal: control, short-term reinforcement, and medium-term reinforcement. Animals were sacrificed at 1 week (n = 5) or 3 weeks (n = 5). The primary endpoint was intraluminal bursting pressure, and rupture location was recorded. At 1 week, bursting pressures were 87 (72–98) mmHg in controls, 156 (136–182) mmHg in the medium-term group, and > 200 mmHg in the short-term group (p < 0.001). Both reinforcement groups exceeded controls, and short-term reinforcement showed the highest strength. All specimens ruptured at the anastomotic line. At 3 weeks, all groups exceeded the measurement limit (> 200 mmHg); however, rupture location differed significantly, with controls failing at the suture line and reinforced segments rupturing away from the anastomosis (p < 0.01). Histology demonstrated increased subanastomotic connective tissue thickness in reinforced groups, particularly at 1 week. Short-term bioabsorbable reinforcement markedly enhanced early mechanical stability and altered late rupture patterns, suggesting restoration of structural competence. Temporal alignment between degradation and early healing may represent a rational strategy to improve anastomotic outcomes.
Seasonal variations in blood pressure (BP) and cardiovascular risk represent one of the most consistently reproduced yet under-recognized phenomena in hypertension research. In Japan, where winter temperatures can fluctuate sharply in both outdoor and indoor environments, the burden of winter-associated cardiovascular events is strikingly visible in epidemiological data. The so-called “heat shock” phenomenon is defined as acute cardiovascular events triggered by sudden temperature changes. Recent statements by the Japanese Society of Hypertension, including the initiative “Morning BP Action in Winter,” emphasize that winter mornings constitute a uniquely hazardous physiological “heat shock” window—one in which sympathetic activation, thermal stress, and behavioral triggers converge to sharply elevate BP and precipitate acute cardiovascular events. This editorial commentary expands on the scientific rationale, clinical implications, and public health significance of this initiative, aiming to contextualize winter morning BP management as an essential preventive strategy.
Small-molecule drug candidates often encounter challenges related to physicochemical properties, such as poor solubility and stability. Modifying the crystal form of these compounds is a promising approach to overcoming these challenges. Herein, trimethoprim (TMP), a biopharmaceutics classification system (BCS) class II drug with low water solubility, and sulfathiazole (STZ), a polymorphic sulfa drug, were selected as model active pharmaceutical ingredients. A TMP-STZ complex was prepared using liquid-assisted grinding, yielding anhydrous and ethanol-solvated forms. Physicochemical analyses confirmed that the complexes formed stable salt crystals, reducing hygroscopicity and improving thermal stability. An ethanol solvate demonstrated enhanced stability but exhibited a decreased melting point due to desolvation. Single-crystal structure analysis revealed strong hydrogen-bonding interactions between TMP and STZ, contributing to the stability of the crystal. Structural analysis confirmed proton transfer between TMP and STZ, forming a stable salt. Reduced hygroscopicity and improved thermal stability indicate enhanced solid-state robustness of TMP. These results provide a structural basis for controlling the solid-state stability of TMP by salt formation.
Immersive virtual reality (VR) is increasingly used to support cognition, mobility, and emotional well‑being in older adults with mild cognitive impairment (MCI), dementia, or frailty. Evidence is expanding but fragmented across small randomized and feasibility trials. We synthesized recent studies to clarify benefits, risks, and implementation considerations. Following PRISMA 2020, we searched PubMed and CINAHL from 1 January 2019 to 15 October 2025. Eligible studies enrolled adults aged ≥ 65 years with MCI, dementia, or frailty/cognitive frailty; delivered immersive or semi‑immersive VR via head‑mounted display or large‑screen projection (interactive tasks or 360° content); and reported cognitive, mobility, or emotional/behavioral outcomes in randomized, quasi‑experimental, or pre–post designs. Two reviewers independently screened and extracted data. Risk of bias was appraised with RoB 2 (randomized trials) or JBI tools (non‑randomized). Heterogeneity precluded meta‑analysis; we conducted a structured narrative synthesis. Seventy records were identified (PubMed 28; CINAHL 42); after removing 9 duplicates, 61 records were screened, 24 full texts were assessed, and 13 studies were included (10 randomized; 3 feasibility/mixed‑methods). The most consistent improvements occurred in executive function and processing speed among participants with MCI or cognitive frailty; several trials also reported modest gains in global cognition. Multiple trials showed better Timed Up Go and Berg Balance outcomes and enhanced anticipatory postural adjustments versus comparators. In residential care, immersive reminiscence and group VR reduced anxiety and apathy and were well tolerated. Adverse events were uncommon and mild; adherence was high with supervised delivery. Most randomized trials had some concerns for bias; one was at overall low risk. Immersive and semi-immersive VR interventions appear feasible for supervised delivery in older adults with MCI or cognitive frailty and may be associated with improvements in cognitive and mobility outcomes. Evidence for emotional and behavioral outcomes in institutional settings is promising but preliminary. Programs with adequate exposure (2–3 sessions/week for 8–12 weeks; ≥ 15 total hours), adaptive challenge, and supervision were most frequently associated with positive outcomes. Larger multicenter randomized trials with standardized outcomes and embedded implementation and economic evaluations are needed.
