BackgroundTransient lower-limb swelling may occur in healthy young women during daily life. This study examined whether wearing graduated compression tights during sleep enhanced overnight reductions in lower-limb circumference and affected subjective sleep quality or morning fatigue.MethodsIn this randomized, open-label, two-period crossover trial, female university students aged 18-28 years with subjective lower-limb swelling were assigned 1:1 to compression-first or no-compression-first sequences. Each 14-day period was separated by a 7-day washout. With compression, participants wore graduated compression tights during sleep after daytime acclimation. Co-primary outcomes were between-condition differences in overnight circumference change at the ankle, calf, and thigh. Secondary outcomes were subjective sleep quality and morning fatigue. Self-reported morning leg swelling was assessed at each time point. Mixed-effects models were used, with Holm adjustment for three primary outcomes.ResultsForty-six participants were randomized and 44 completed both periods. Compared with no compression, compression resulted in greater overnight reductions at the ankle (least squares mean difference, -0.23 cm; 95% confidence interval, -0.33 to -0.13; adjusted p = 0.0001), calf (-0.35 cm; -0.52 to -0.18; adjusted p = 0.0004), and thigh (-0.28 cm; -0.47 to -0.08; adjusted p = 0.0066). Perceived morning leg swelling was less likely with compression (30.6% vs. 58.4%). The OSA-MA sleep-length factor was lower at Time3 (nominal p = 0.03), but no other sleep-related outcome or morning fatigue differed significantly. No adverse events were reported.ConclusionsWearing graduated compression tights during sleep enhanced overnight reductions in lower-limb circumference. Although the differences were modest (approximately 2-4 mm) and their clinical importance remains uncertain, the accompanying reduction in perceived morning swelling suggests that these changes may have perceptible relevance to participants. Nighttime compression may facilitate the overnight reduction of transient lower-limb swelling under everyday living conditions.

Resilience is an established concept in family-caregiver research, where it is used to describe how caregivers maintain functioning and adapt to sustained adversity. In long-term family care for older adults with disabilities, however, resilience is ethically ambiguous. Continued care may reflect adaptive capacity, relational commitment and caregiving competence, but it may also be shaped by dependency, moral obligation, cultural expectations and limited alternatives. This article critically examines the ethical implications of caregiver resilience and develops the concept of constrained endurance to rethink resilience in long-term family caregiving. The article advances an ethical critique of resilience discourse by showing how resilience, when uncritically celebrated, may psychologise caregiver distress, individualise structural problems and attach moral value to endurance. Fatigue, ambivalence, complaint and the wish for relief may then be interpreted as signs of inadequate coping, insufficient responsibility or failure of care, rather than as signals that care arrangements have exceeded what can be sustainably borne. Rethinking resilience through the concept of constrained endurance shifts the ethical focus from asking how caregivers can endure more to examining the conditions under which continued caregiving becomes necessary, costly or unsustainable. For nursing ethics, resilience should function not as a moral standard but as an ethical signal: a prompt to recognise caregivers' limits, acknowledge ambivalence, make hidden costs visible and develop forms of support that make care sustainable rather than merely endurable.

Metabolic dysfunction-associated steatotic liver disease (MASLD) afflicts more than one-third of adults globally, contributing significantly to an increased cardiovascular disease risk. Further, patients with severe liver disease experience muscle weakness and fatigue. Hypoxia-inducible factor 2α (HIF2α) accumulates in the livers of MASLD patients. Here we sought to understand the role of hepatic HIF2α in mediating hepatic and extra-hepatic features of MASLD. Using an obese mouse model of MASLD, we investigated the impact of hepatocyte-specific HIF2α deletion (hHIF2α-/-) on hepatic, cardiac and skeletal muscle metabolism, and cardiac function. Over 28 weeks, mice were exposed to a high-fat, high-fructose, high-cholesterol (GAN) diet, which induced obesity, hepatic steatosis, fibrosis and inflammation. hHIF2α-/- was associated with greater hepatic NADH-supported mitochondrial respiration, higher sphingomyelin levels and protection against MASLD induced hyperinsulinaemia, but not against hepatic manifestations of MASLD. Instead, in the hearts of GAN-fed mice, hHIF2α-/- caused diacylglycerol and long-chain acyl-carnitine accumulation and exacerbated diet-induced ceramide accumulation. Langendorff-perfused hearts from hHIF2α-/- mice showed systolic and diastolic dysfunction, including 24% lower left ventricular developed pressure and 34% lower maximal rate of relaxation (dP/dtmin). However, isolated hearts from hHIF2α-/- mice were protected against MASLD-associated sympathetic dominance, determined using autonomic receptor agonist stimulation. Both GAN-feeding and hHIF2α-/- were associated with lower lean mass (14% and 5.4% lower than respective controls), whilst hHIF2α-/- enhanced OXPHOS-associated protein levels in gastrocnemius muscle. Overall, hHIF2α-/- resulted in detrimental extra-hepatic effects, including myocardial lipid accumulation, impaired cardiac function, and loss of whole-body lean mass, thereby worsening the systemic presentation of MASLD-associated pathological features.

Blastomycosis is a systemic fungal infection that is caused by Blastomyces dermatitidis or Blastomyces gilchristii. Although the lungs are the primary site of infection, blastomycosis can disseminate to the skin, bones, genitourinary system, and, rarely, visceral organs such as the spleen. Occupational exposure to soil and decaying matter, particularly in construction workers, increases the risk of blastomycosis infection. A 40-year-old male presented with a progressively enlarging right facial lesion, which initially appeared as a small papule. The lesion had gradually increased in size and pain over several months and failed to respond to antibiotics. Notable symptoms include generalized fatigue, low mood, intermittent morning headaches, confusion, poor appetite with weight loss, intermittent night sweats, and joint pain. The diagnostic workup included imaging findings of an exophytic skin lesion arising from the right cheek, pulmonary micronodules and consolidation, and splenic changes. Serum Blastomyces antigen testing was positive, fungal culture of tissue from the facial lesion grew Blastomyces dermatitidis, and histopathologic examination demonstrated granulomatous inflammation with broad-based budding yeast within the dermis, supporting the diagnosis of disseminated blastomycosis. Liposomal amphotericin B induction therapy was initiated, and the facial lesion improved. The patient was discharged home with a transition to oral itraconazole. This report presents a case of disseminated blastomycosis involving the lungs, skin, and spleen in an immunocompetent individual. High index of suspicion and recognition of cutaneous lesions in the context of occupational and environmental risk factors for blastomycosis enable early diagnosis and treatment.

In this case study, we present a 31-year-old female, a homemaker, who developed persistent symptoms of anxiousness, fatigue, weakness, irritation, anger issues, and difficulty concentrating for nearly 12 months following recovery from COVID-19. She was diagnosed by a consulting psychiatrist with post-COVID anxiety with depression, and had been on anxiolytic and antidepressant medications for the past ten months. She underwent Shirodhara (dripping of medicated oil on the forehead) using Balashwagandhadi taila for 14 days as an add-on therapy, while continuing her conventional medications. Assessments at baseline, 8th day, 15th day, and 30th day showed progressive improvements: Hamilton Anxiety Rating Scale (HAM-A) scores reduced from 42 to 10, Hamilton Depression Rating Scale (HDRS) from 23 to 6, Patient Health Questionnaire-9 (PHQ-9) from 24 to 1, and Flanagan Quality of Life Scale (QOLS) improved from 59 to 79 by the 30th day. Serum cortisol was 3.09 μg/dL at baseline, below the normal range, and returned to the normal physiological range (11.76 μg/dL) on the 15th day, reflecting improved stress adaptation. C-Reactive Protein remained stable, while Systemic Immune-Inflammation Index showed a transient, non-pathological rise within normal limits. Also, based on the evaluation and recommendation of the psychiatrist, the dosage of conventional medications was reduced: Propranolol was tapered from 20 mg twice daily to once daily, Clonazepam 0.5 mg at bedtime was shifted to as-needed use, and Omeprazole was discontinued. This case highlights the potential role of Shirodhara as an adjunctive therapy in post-COVID anxiety, along with depression. These findings require validation through larger studies with long-term follow-up.

Introduction Due to limited digital health literacy (DHL), stroke survivors frequently face barriers in using digital health tools essential for post-stroke rehabilitation and self-management. DHL is a multidimensional construct, encompassing several distinct skill domains. Although sociodemographic and clinical characteristics may influence overall DHL, their associations with specific DHL domains remain poorly understood. This study therefore explores how individual DHL domains relate to patient characteristics in stroke survivors. Methods In this cross-sectional NORFAST study, stroke survivors aged 18-80 years with a first-ever stroke in 2021 or 2022 were recruited through the Norwegian Stroke Registry. Registry data included diagnosis, stroke type, aphasia, and scores on the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index for Activities of Daily Living. Cognitive function was assessed before inclusion using the Mini/5min MoCA, a brief telephone-administered cognitive screening tool. Participants also completed self-report questionnaires (telephone or electronic), assessing sociodemographics, self-rated health status (EQ-VAS) and fatigue interference (Fatigue Severity Scale, FSS-7). The primary outcomes were DHL dimensions, assessed with the 7-domain eHealth Literacy Questionnaire (eHLQ). Linear regression models examined unadjusted and adjusted associations between patient characteristics and each DHL domain. Results Among 177 stroke survivors (mean age 69), most had experienced minor strokes and cerebral infarction. Patients scored highest on the domain "feel safe and in control", and lowest on "digital services that suit individual needs". In multivariable regression models, older age was associated with lower scores on Using technology, Engage, Motivation, and Needs; female sex with lower scores on Motivation and Needs; college/university education with higher scores on Understanding, Engage, Motivation and Needs; and better health status with higher scores on domains Using technology, Understanding, Motivation, Access and Needs. Living alone, aphasia, cognitive function, and fatigue interference were not significantly associated with any DHL domain after multivariable adjustment. Conclusion This study demonstrates considerable variation in DHL across domains among stroke survivors. After adjustment, age, education level, and self-rated health status were the factors most consistently associated with DHL dimensions. These findings suggest that older stroke survivors, those without college or university education, and those with lower self-rated health may warrant particular attention when designing, implementing, and evaluating digital health interventions. Co-creation with stroke survivors, healthcare professionals, and technology designers may support the development of accessible and clinically meaningful digital solutions.