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Background: Enhanced Recovery After Surgery (ERAS) protocols for bariatric surgery improve clinical outcomes. However, the impact of ERAS protocols on patient satisfaction is unknown. Virtual reality has been implemented as an effective adjunct to standard analgesic regimens. This study seeks to find out if immersive virtual reality in the immediate postoperative period could improve the subjective quality of recovery and further reduce opioid requirements for bariatric surgery patients compared with ERAS care alone. Methods: This is a single-centre, randomised clinical trial of patients recovering from laparoscopic bariatric surgery. Once in the post-anaesthesia care unit (PACU), participants will receive either an immersive virtual reality plus ERAS protocol or ERAS protocol alone. The primary outcome will be the Quality of Recovery-15 (QoR-15) score at PACU discharge. Secondary outcomes include PACU opioid requirements, length of PACU stay, PACU pain scores, QoR-15 score on postoperative day 1, hospital length of stay, opioid requirements, and opioid-related adverse effects until hospital discharge. Conclusions: Positive findings from this study could introduce virtual reality as a non-pharmacological adjunct during PACU care that improves subjective recovery for patients undergoing bariatric surgery. Clinical trial registration: NCT04754165.

In the Southern Volcanic Zone of Chile (SVZ, 33–46°S) the interaction between regional fault systems and volcanic centers forms high enthalpy geothermal systems. This study aims to understand the hydrogeochemical processes (e.g., water mixing and water-rock interaction) that control the sources and distribution of Li, B and Sr in geothermal conditions. We selected two high-enthalpy hydrothermal systems that host diverse geothermal features, including boiling springs, fumaroles and geysers: Alpehue and Puyehue-Cordón Caulle. We used a combination of geochemical and isotopic methods, including stable isotopes of lithium (δ7Li), boron (δ11B) and strontium (87Sr/86Sr) in a set of samples from thermal emissions, river waters and volcanic rocks. We analyze the potential sources of dissolved boron, lithium and strontium, and the hydrogeochemical processes that control their behavior in the systems. At Alpehue, geothermal fluids showed isotopic compositions (δ7Li ≈ +0.5‰, δ11B ≈ −3.3‰) similar to those in volcanic rocks (δ7Li = +1.39‰, δ11B = −2.2‰), suggesting high-temperature water-rock interaction. At Puyehue-Cordón Caulle, the isotopic signal varies inside the large-scale volcanic system: at the steam-heated zone, composed of high temperature features (fumaroles and mud pools) and affected by argillic alteration, waters have boron isotopic signals similar to altered rocks (δ11B ≈ +15‰), while lithium matched the signal of magmatic fluids (δ7Li ≈ −2.0‰). In contrast, peripheral bicarbonate springs (T ∼ 50 °C) indicate equilibrium with a deep neutral geothermal reservoir, showing the signal of fresh volcanic rocks (δ7Li ≈ +5.9‰; δ11B ≈ −2.2‰) but with very low Li and B concentrations due to mixing with cold surficial waters. The results support a model where geothermal water acquires the isotopic signal from the host rocks, with a variable contribution of magmatic fluids, which is enhanced in steam-heated water conditions. The multi-isotopic analysis conducted in this study identified three main processes controlling the distribution of Li, B and Sr: (1) heat-fluid-rock interaction, controlled by the isotopic signature of each hosting rock, (2) mixing with magmatic fluids, presumably influenced by regional fault systems, and (3) hydrothermal alteration, influencing rock leaching and imprinting its isotopic signature on thermal water. • Li-B-Sr are mainly controlled by water-rock interaction in geothermal conditions. • Magmatic influence can be traced using integrated Li and B isotopes in thermal fluids. • Hydrothermal alteration influence fluid-rock dynamics by fractionating Li B isotopes. [ABSTRACT FROM AUTHOR]