关键词： alternative therapies   corneal nerve   dry eye   lacrimal   meibomian  

摘要： Purpose of review Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. Recent findings Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.

关键词： Liquefied petroleum gas vehicle   Electric vehicle   Hydrogen fuel cell vehicle   Consumer preference   Discrete choice experiment   Reference-dependent model  

摘要： Given the growing severity of particulate matter (PM) and greenhouse gas pollution, the Korean government recently began supporting the use of eco-friendly vehicles, such as electric vehicles and hydrogen fuel cell vehicles. However, the uptake of these vehicles has been slower than anticipated because of the high purchase price and lack of infrastructure. Therefore, the Korean government has eased restrictions on liquefied petroleum gas (LPG) vehicles to encourage the vast majority of consumers to purchase LPG vehicles, expecting that they will serve as a stepping stone to switch from internal combustion engine vehicles to their eco-friendly counterparts. However, there have been only a few studies on consumer preferences for LPG vehicles in consideration of this amendment. To analyze consumer preferences for all fuel types, including LPG, this study used a discrete choice experiment combined with a reference-dependent model. The results showed a loss aversion tendency and asymmetric preferences among consumers with regard to vehicle choice. Based on these results, a simulation analysis was conducted to predict the future market share and PM pollution level. The findings indicated that the government's LPG vehicle deregulation policy could achieve positive PM reduction effects in the short term but none in the long term.

关键词： Supportive care   Complementary and alternative medicine (CAM)   Decision aid   Quality of life (QoL)  

摘要： Purpose Complementary and alternative medicine (CAM) is often used by cancer patients and is concerning as concomitant oral CAM and chemotherapy use may result in adverse interactions and toxicities. We hypothesise that a decision aid (DA) may promote informed and rational use of oral CAM during chemotherapy, and increase patients' discussion with their oncologists on CAM use. Methods We randomised 240 patients initiating chemotherapy to receive DA or none. Questionnaires were administered at randomisation (visit 1), 1 month (visit 2) and 3 months (visit 3). The primary endpoint was the decisional conflict score (DCS) for decision made on CAM use during chemotherapy. Secondary endpoints include patients' decision regret score (DRS) on CAM use, CAM uptake, discussion with oncologists on CAM usage, and difference in quality of life (QoL) score between CAM and non-CAM users at visit 3. Results There was no difference in the mean DCS (mean difference 2.7 [95 CI - 2.9 to 8.3, p = 0.345]) and DRS (mean difference - 0.3 [95% CI - 6.3 to 5.8, p = 0.926]) between the two arms. There was a reduction in odds of CAM usage in the intervention arm compared to control arm (OR = 0.36, 95% CI 0.17 to 0.78, p = 0.009), but there was no difference in discussion with oncologists on CAM usage (OR = 0.46, 95% CI 0.07 to 3.01, p = 0.419), or in the QoL between CAM and non-CAM users. Conclusion Our DA did not reduce DCS among cancer patients on chemotherapy. DA that provides more evidence-based information on CAM, and non-judgemental discussion initiated by oncologists to discuss CAM, may improve its effectiveness.

关键词： Composite distal bypass   Critical limb ischemia   Redo perpheral surgery   Case report  

摘要： Introduction: Peripheral Arterial Disease (PAD) in diabetic patients is a significant cause of Morbility. Long arterial occlusion in patient previously treated can require unusual and complex solution. Herein we report a case of complicated bypass in diabetic patient with history of bypass for bilateral popliteal aneurysm. Presentation of case: A 51-year-old male, smoker, with hypertension and diabetes mellitus was referred to our hospital for rest pain in left limb and peripheral cyanosis. Ultrasound doppler (US) showed an occlusion after common femoral artery with patency of Anterior-tibial artery (ATA) two centimeters after the origin. The unavailability of adequate autologous conduit necessitated an alternative solution and was chosen a composite femoro-anterior tibial artery bypass with successive ATA angioplasty to ensure the patency of graft. Discussion: The autogenous vein is the preferred conduit in below-knee vascular reconstructions but in redo-procedures in the absence of vein, synthetic or biologic vascular prostheses must be considered as graft material. In these cases tibial angioplasty can improve the outflow and the patency. Conclusion: Composite Femora-ATA bypass with tibial angioplasty is an alternative technique for critically ischemic legs with limited autologous vein material. In our experience this approach was safe and effective.

关键词： anticoagulation   COVID-19   MIS-C   thrombosis  

摘要： Thrombosis within the microvasculature and medium to large vessels is a serious and common complication among critically ill individuals with coronavirus disease 2019 (COVID-19). While children are markedly less likely to develop severe disease than adults, they remain at risk for thrombosis during acute infection and with the post-acute inflammatory illness termed multisystem inflammatory syndrome in children. Significant knowledge deficits in understanding COVID-19-associated coagulopathy and thrombotic risk pose clinical challenges for pediatric providers who must incorporate expert opinion and personal experience to manage individual patients. We discuss clinical scenarios to provide framework for characterizing thrombosis risk and thromboprophylaxis in children with COVID-19.

摘要： While being one of the world's most important crops, maize (Zea mays L.) is still relatively difficult to regenerate in tissue culture, which severely limits its improvement by genetic engineering. Currently, immature zygotic embryos provide the predominant material for transformation and regeneration. However, the procedures involved are often laborious and season-dependent. Therefore, new explants to replace or complement immature embryos are desirable. Here, we exploited root tips and young leaves isolated from 3-day-old dark-grown seedlings as alternative explant sources for establishing plant regeneration. As novel explants, the root tips could generate embryogenic calli similar to that from the young leaves. The rate of primary callus induction from root tips reached 97.2% and almost as high as 98.8% from immature embryos. The difference in callus induction rates among these explants may be closely related to the differences in expression level of stem cell-related genes in callus tissue. Moreover, the alternative explants are easy to obtain in large quantities. These combined results indicate that explants from seedling-derived root tips and leaf tissue have the potential to replace immature embryos for plant regeneration and transformation.

关键词： Nuclear astrophysics   Primordial nucleosynthesis   Thermal and astrophysical energies   n(12)B cluster system   Radiative capture   Total cross section  

摘要： The total cross sections of the neutron radiative capture on B-12 at astrophysical energies to the ground state of B-13, have been calculated in the energy range of 10(-8) to 10 MeV within the framework of a modified potential cluster model with the classification of orbital states according to Young diagrams. Reaction rates in the temperature range of 0.01 to 10 T-9, and their analytical parameterizations were obtained. The calculated rates of B-12(n, gamma)B-13 excess the previous results obtained by other approaches by approximately to one order of magnitude. Cross sections and reaction rates of C-12(n, gamma(0)+1+2+3)C-13 are calculated and compared to the n(10)B, n(11)B, n(12)B and p(12)C reaction rates. It is proposed that the obtained rates of the B-12(n, gamma)B-13 reaction may be suggested for the discussion of novel scenarios of stable isotope C-13 synthesis when p-captures on C-12 are not present. (C) 2021 Elsevier B.V. All rights reserved.

关键词： Renewable energy   Environmental sustainability   Trade   Income   Pollutant emissions   European union  

摘要： The role of low-carbon energy and trade on the environment has drawn several studies that have looked at issues from different perspectives, thus yielding differing conclusions. Considering the current emphasis on the COP25 conference and the commitment to cut down carbon emissions level, this study also draws strength from the United Nations Sustainable development Goals (UNSDGs) that comprises of positive strides for access to clean and responsible energy consumption (SDGs 7, 12) and climate change mitigation issues (SDG-13). To this end, this study is a timely outlook that underpins the case of the European Union (EU) countries as well as the root cause of anthropogenic activities on clean trajectory of global environment. Hence, we investigate the connection between alternative and sustainable energy source, trade, income and emissions in 27 selected European Union economies by utilizing data covering the period 1990-2017 on an annual frequency. We used second-generation panel model estimators to analyze the relationship between the variables in the long-run. Specifically, the long run results from the MG (Mean Group), AMG (Augmented Mean Group), and CCEMG (Common Correlated Effects Mean Group) estimators reveal that sustainable and alternative energy sources have a negative significant impact on pollutant emissions while trade and income have a positive impact on carbon emissions except that the impact of trade is insignificant. Although the positive impact of openness in trade on carbon emission is insignificant, the positive impact suggests that the free-trade policy that is currently in place in the EU should further incorporate sustainable development goals (SDGs) to avoid the outsourcing of carbon emissions among the member countries. Causality tests reveal a feedback hypothesis between renewable energy, income, trade, and carbon emanations. The investigation proposes expanded utilization of sustainable power source to mitigate carbon emissions in the Euro

摘要： BACKGROUND Esmolol is a beta-1 selective blocker that has been shown to reduce postoperative pain. Its antinociceptive effects have not been tested following mastectomy. OBJECTIVE To evaluate the safety, efficacy and antinociception of intra-operative esmolol infusion after mastectomy. DESIGN Randomised, double-blinded, placebo-controlled trial. SETTING Tertiary referral centre, Brasilia, Brazil. Recruitment: July 2015 to July 2017. PATIENTS Seventy women scheduled for mastectomy, ASA I to III, aged 18 to 75 years. Four were excluded. INTERVENTIONS All underwent general anaesthesia. The intervention group received a bolus of 0.5 mg kg(-1) of esmolol over 10 min followed by a continuous infusion of 100 mu g kg(-1) min(-1). The placebo group received saline. MAIN OUTCOME MEASURES The primary outcome was pain at rest 24 h after mastectomy as measured by a 0 to 10 numeric rating scale. RESULTS Pain scores at rest 24 h after mastectomy were lower in esmolol-treated patients compared with placebo (mean difference = -1.51, 95% confidence interval (CI), -2.36 to -0.65, P = 0.001). On arrival in the postanaesthesia care unit (PACU), the occurrence of pain was also lower in the esmolol group, at rest and on effort (P = 0.009 and P = 0.013, respectively), on discharge from PACU (P = 0.009 and P = 0.015), 12 h (P = 0.01 and P = 0.007) and on effort in the 24 postoperative hours (P = 0.003). Mean morphine consumption was reduced by 77% in the esmolol group compared with the placebo group (mean difference = -2.52 mg, 95% CI = -3.67 to -1.38, P < 0.001). The length of hospital stay was shorter for the esmolol group (mean difference = -6.9 h, 95% CI, -13.4 to -0.31, P = 0.040). CONCLUSION Esmolol was well tolerated, allowed a notable reduction in the dose of rescue analgesics and demonstrated superior efficacy compared to placebo for pain management after mastectomy.