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Background and Aims: Postoperative pain can impede functional recovery and delay hospital discharge after functional endoscopic sinus surgery (FESS). The study aimed to assess the efficacy of ultrasound (USG)-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain in FESS. Methods: Forty-eight adult patients between 18 and 65 years of age with American Society of Anesthesiologists physical status I and II and scheduled to undergo FESS were enroled in this randomised controlled study. Patients were randomly allocated to either receive USG-guided SZMNB with general anaesthesia (n = 24) or general anaesthesia alone (n = 24). The numerical rating scale (NRS) pain score in the immediate postoperative period was recorded as the primary outcome. A total of 24 h postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative haemodynamics, and postoperative complications were noted as secondary outcomes. Results: The median (interquartile range) of the NRS pain score in the immediate postoperative period was 0 (0-0.25)[95% confidence interval (CI): 0, 0.08] in the block group compared to 2 (1.75-3) [95% CI: 1.60, 2.40] in the control group, P < 0.001]. Pain scores were significantly reduced at all time intervals till 24 h after surgery (P < 0.001). None of the patients required rescue analgesia in the block group. In contrast, eight patients required diclofenac 75 mg intravenous as rescue analgesia within 1 h of surgery and ten patients within 1–6 h of surgery in the control group. Other secondary outcomes were comparable between groups (P > 0.05). Conclusion: The USG-guided SZMNB provides excellent postoperative analgesia for patients undergoing FESS without significant side effects.

Objectives: Hepatic CEACAM1 expression declines with advanced hepatic fibrosis stage in patients with metabolic dysfunction-associated steatohepatitis (MASH). Global and hepatocyte-specific deletions of Ceacam1 impair insulin clearance to cause hepatic insulin resistance and steatosis. They also cause hepatic inflammation and fibrosis, a condition characterized by excessive collagen production from activated hepatic stellate cells (HSCs). Given the positive effect of PPARγ on CEACAM1 transcription and on HSCs quiescence, the current studies investigated whether CEACAM1 loss from HSCs causes their activation. Methods: We examined whether lentiviral shRNA-mediated CEACAM1 donwregulation (KD-LX2) activates cultured human LX2 stellate cells. We also generated LratCre + Cc1fl/fl mutants with conditional Ceacam1 deletion in HSCs and characterized their MASH phenotype. Media transfer experiments were employed to examine whether media from mutant human and murine HSCs activate their wild-type counterparts. Results: LratCre + Cc1fl/fl mutants displayed hepatic inflammation and fibrosis but without insulin resistance or hepatic steatosis. Their HSCs, like KD-LX2 cells, underwent myofibroblastic transformation and their media activated wild-type HSCs. This was inhibited by nicotinic acid treatment which blunted the release of IL-6 and fatty acids, both of which activate the epidermal growth factor receptor (EGFR) tyrosine kinase. Gefitinib inhibition of EGFR and its downstream NF-κB/IL-6/STAT3 inflammatory and MAPK-proliferation pathways also blunted HSCs activation in the absence of CEACAM1. Conclusions: Loss of CEACAM1 in HSCs provoked their myofibroblastic transformation in the absence of insulin resistance and hepatic steatosis. This response is mediated by autocrine HSCs activation of the EGFR pathway that amplifies inflammation and proliferation.

Background and Aims: Post-discharge nausea and vomiting (PDNV) is a pertinent problem in patients undergoing ambulatory surgery. The objective of this study was to assess the efficacy of the novel drug olanzapine, which has proved its efficiency in patients undergoing highly emetogenic chemotherapy for PDNV prevention. Methods: This randomised controlled trial recruited 106 adult patients (18–65 years) undergoing highly emetogenic daycare surgeries with propofol-based general anaesthesia (GA). Group O received preoperative oral olanzapine 10 mg, and Group C, acting as a control, received 8 mg of intravenous dexamethasone and 4 mg of ondansetron intraoperatively. The primary outcome was nausea (numeric rating scale >3) and/or vomiting 24 h after discharge. Secondary outcomes included nausea and vomiting in the post-anaesthesia care unit (PACU), severe nausea, vomiting and side effects. Normality was assessed using the Shapiro–Wilk test, and the independent samples t-test or the Mann–Whitney U test was used to compare continuous variables. Fisher’s exact test was used to assess any non-random associations between the categorical variables. Results: The incidence and severity of postoperative nausea and vomiting were similar in both groups within PACU (four patients experienced nausea and vomiting, three had severe symptoms in Group O, P = 0.057) and in the post-discharge period (three patients in Group O had nausea and vomiting compared to five patients in Group C, of which four were severe, P = 0.484). The side effects (sedation, dizziness, and light-headedness) were comparable between the two groups. Conclusion: A single preoperative oral olanzapine can be an effective alternative to standard antiemetic prophylaxis involving dexamethasone and ondansetron for preventing PDNV in highly emetogenic daycare surgeries with propofol-based GA.

The present study explores the intersection between green finance (GF) and environmental sustainability (ES) with the help of comprehensive bibliometric and content analysis techniques, unveiling new perspectives on this synergy and contributing novel insights to the field. By synthesizing a wide range of literature, this study provides an important understanding of the dynamics of GF and its implications for ES. The bibliometric analysis helps identify key trends, emerging themes, influential contributors, prominent journals, and institutions contributing to the field of GF. For analyzing the co-citations of authors, publications, journals, and generation of keywords VOSviewer software has been used. Based on an extensive exploration of past research, this study synthesizes the academic literature and offers a comprehensive overview of the emerging field of GF. The findings of our study reveal that GF fosters ES through green innovation, public spending, private participation, and digital finance. These results broaden the current state of GF and provide significant implications for policymakers, researchers, practitioners, and other stakeholders in navigating the complexities of GF and its role in promoting sustainable growth. Through its interdisciplinary approach and rigorous analysis, this manuscript enriches the growing body of knowledge on GF and its role in fostering a sustainable future. Furthermore, the study points out several limitations and knowledge gaps, suggesting avenues for future research to address these gaps.

Summary: Background: There is uncertainty regarding how best to support patients with anorexia nervosa following inpatient or day care treatment. This study evaluated the impact of augmenting intensive treatment with a digital, guided, self-management intervention (ECHOMANTRA) for patients with anorexia nervosa and their carers. Methods: In this pragmatic multicentre randomised controlled trial and economic evaluation, patients with a diagnosis of anorexia nervosa or atypical anorexia nervosa, aged 16+ and attending one of the 31 inpatient or day-patient services in the UK were randomised with one of their carers to receive ECHOMANTRA plus treatment as usual (TAU), or TAU alone. ECHOMANTRA was hosted on a digital platform and included a workbook, recovery-oriented video-clips and online facilitated groups (patients only, carers only, joint patient-carer). Participants were randomised on a 1:1 ratio using a minimisation algorithm to stratify by site (N = 31) and severity (defined by BMI

Hypersensitivity to aspirin is rare disorder occurring in 1.88% of the patients. Aspirin-hypersensitive patients requiring single antiplatelet agent may be treated with clopidogrel, an alternative antiplatelet agent. However, aspirin desensitization is more cost-effective than the usage of clopidogrel in these patients. Furthermore, aspirin desensitization is of greater value in patients requiring dual antiplatelet therapy, for example following procedures like percutaneous transluminal coronary angioplasty (PTCA) instead of using non-aspirin-based combinations. Herein, we report a 74-year-old hypertensive male presented with features of acute coronary syndrome and planned for percutaneous transluminal coronary angioplasty of RCA followed by dual antiplatelet therapy. Since he had aspirin allergy, desensitization was done using rapid desensitization protocol for which he responded well. This case highlights the importance of aspirin-desensitization in patients with aspirin allergy instead of choosing non-aspirin based antiplatelet agents.

Abstract Millions of households globally rely on uncultivated ecosystems for their livelihoods. However, much of the understanding about the broader contribution of uncultivated ecosystems to human wellbeing is still based on a series of small-scale studies due to limited availability of large-scale datasets. We pooled together 11 comparable datasets comprising 232 settlements and 10,971 households in ten low-and middle-income countries, representing forest, savanna and coastal ecosystems to analyse how uncultivated nature contributes to multi-dimensional wellbeing and how benefits from nature are distributed between households. The resulting dataset integrates secondary data on rural livelihoods, multidimensional human wellbeing, household demographics, resource tenure and social-ecological context, primarily drawing on nine existing household surveys and their associated contextual information together with selected variables, such as travel time to cities, population density, local area GDP and land use and land cover from existing global datasets. This integrated dataset has been archived with ReShare (UK Data Service) and will be useful for further analyses on nature-wellbeing relationships on its own or in combination with similar datasets.

Introduction: Total Intravenous Anaesthesia (TIVA) with propofol is gaining acceptance for day care surgeries due to its advantages over inhalational agents. Opioids administered as premedication are known to enhance the hypnotic effect of propofol and provide intraoperative and postoperative analgesia. Aim: To compare the effectiveness of Nalbuphine and Fentanyl for postoperative analgesia in short surgical procedures. Materials and Methods: In present double-blinded randomised controlled trail conducted in the Department of Anaesthesia at the Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, 60 patients aged 18 to 60 years, classified as American Soceity of Anaesthesiologists (ASA) Grade-I or II, and scheduled for elective short surgical procedures under TIVA were randomly assigned to two groups. Group N received Nalbuphine 0.05 mg/kg, and control Group F received 0.001 mg/ kg Fentanyl intravenously before induction. Parameters studied included pain scores, first rescue analgesia, haemodynamics, and side effects. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 19.0 for Windows). Parametric data were analysed using paired and unpaired t-tests. Results: Data from a total of 60 patients (Group N mean age: 46.9±9.96 years and Group F mean age: 46.6±10.44 years) were collected and analysed. Both groups were comparable in terms of age, Body Mass Index (BMI), mean duration of surgery, and type of surgery (p > 0.05). Pain scores on the Visual Analogue Scale (VAS) were not significant upto 15 minutes after surgery, but thereafter, the VAS score was significantly lower in the Nalbuphine group (p-value < 0.05). Intraoperative episodes of significant hypotension were observed only in the Fentanyl group (p-value < 0.05). The total dose of propofol required was significantly lower in the Fentanyl group (p-value < 0.001). The time to the first rescue analgesia requirement (in minutes) was significantly shorter in the Fentanyl group (32.83±28.43) compared to the Nalbuphine group (56.37±25.31). Side effects such as postoperative sedation, nausea, and vomiting were observed in the Fentanyl group (p-value >0.05). Conclusion: Nalbuphine provided superior postoperative analgesic effects compared to Fentanyl when used as an analgesic component in TIVA. Postoperatively, pain scores were lower, and the time to the first rescue analgesia was longer in the Nalbuphine group.

Purpose The current study was conducted to examine the role of consolidation chemotherapy after neoadjuvant radiation therapy (NART) in decreasing the involvement of the mesorectal fascia (MRF) in high-risk locally advanced rectal cancers (LARCs). Methods In total, 46 patients who received consolidation chemotherapy after NART due to persistent MRF involvement were identified from a database. A team of 2 radiologists, blinded to the clinical data, studied sequential magnetic resonance imaging (MRI) scans to assess the tumor response and then predict a surgical plan. This prediction was then correlated with the actual procedure conducted as well as histopathological details to assess the impact of consolidation chemotherapy. Results The comparison of MRI-based parameters of sequential images showed significant downstaging of T2 signal intensity, tumor height, MRF involvement, diffusion restriction, and N category between sequential MRIs (P0.3) was observed for only T2 signal intensity and diffusion restriction on diffusion-weighted imaging. No clinically relevant changes occurred in the remaining parameters; thus, no change was noted in the extent of surgery predicted by MRI. Weak agreement (Cohen κ coefficient, 0.375) and correlation (Spearman rank coefficient, 0.231) were found between MRI-predicted surgery and the actual procedure performed. The comparison of MRI-based and pathological tumor response grading also showed a poor correlation. Conclusion Evidence is lacking regarding the use of consolidation chemotherapy in reducing MRF involvement in LARCs. The benefit of additional chemotherapy after NART in decreasing the extent of planned surgery by reducing margin involvement requires prospective research.

Background Adults with anorexia nervosa experience high levels of relapse following in-patient treatment. ECHOMANTRA is a novel online aftercare intervention for patients and carers, which provides psychoeducation and support to augment usual care. Aims To explore patient and carer experiences of receiving the ECHOMANTRA intervention. Method This is part of the process evaluation of the ECHOMANTRA intervention as delivered in the TRIANGLE trial (ISRCTN: 14644379). Semi-structured interviews were conducted with 20 participants randomised to the ECHOMANTRA (ten patients and ten carers). Thematic analysis was used to analyse the interview transcripts. Results Five major themes were identified: (1) Mixed experience of the intervention; (2) tailoring the intervention to the stage of recovery; (3) involvement of carers; (4) acceptability of remote support; and (5) impact of self-monitoring and accountability. Conclusions Participants were mostly positive about the support offered. The challenges of using remote and group support were counterbalanced with ease of access to information when needed. Components of the ECHOMANTRA intervention have the potential to improve care for people with eating disorders.

Background: Diabetic striatopathy primarily is characterized by choreiform movements due to hyperglycemic injury to the basal ganglia in a type 2 diabetes mellitus (T2DM) patient. Hemi-hyperalgesia as a presenting symptom in diabetic striatopathy has not been reported previously. Case presentation: Fifty-eight-year type 2 diabetes female presented to the emergency department with complains of left-sided body pain and tingling sensation in the left upper and lower limbs for 3 days. Along with this, she gave a brief history of involuntary movements of bilateral upper limbs. On investigation, her fasting blood sugar was 28.5 mmol/l, postprandial blood sugar was 43.4 mmol/l, HbA1C was 16.8 %. Computed tomography (CT) head showed hyperdense area in the right caudate nucleus, right putamen, and right cerebral peduncle of the midbrain without perilesional edema suggestive of diabetic striatopathy. She was managed with basal bolus insulin and amitriptyline. She recovered from the symptoms after a week and was discharged on oral hypoglycemic drugs. Discussion: Radiologically diabetic striatopathy is characterized by striatal hyperdensity on CT or on T1 sequence of magnetic resonance imaging (MRI); the pathology behind which is basal ganglia injury associated with acute hyperglycemia. Our case presented with hyperalgesia and new onset tingling sensation on the background of acute hyperglycemia with T2DM. Optimal glycemic control, and management of movement disorder if present is the mainstay of treatment. Conclusion: Although rare, diabetic striatopathy is a serious complication of uncontrolled diabetes mellitus. Strict compliance with medications and diet is required for its prevention.

Research into cancer therapeutics has uncovered various potential medications based on metal-containing scaffolds after the discovery and clinical applications of cisplatin as an anti-cancer agent. This has resulted in many metallodrugs that can be put into medical applications. These metallodrugs have a wider variety of functions and mechanisms of action than pure organic molecules. Although platinum-based medicines are very efficient anti-cancer agents, they are often accompanied by significant side effects and toxicity and are limited by resistance. Some of the most studied and developed alternatives to platinum-based anti-cancer medications include metallodrugs based on ruthenium, gold, copper, iridium, and osmium, which showed effectiveness against many cancer cell lines. These metal-based medicines represent an exciting new category of potential cancer treatments and sparked a renewed interest in the search for effective anti-cancer therapies. Despite the widespread development of metal complexes touted as powerful and promising in vitro anti-cancer therapeutics, only a small percentage of these compounds have shown their worth in vivo models. Metallodrugs, which are more effective and less toxic than platinum-based drugs and can treat drug-resistant cancer cells, are the focus of this review. Here, we highlighted some of the most recently developed Pt, Ru, Au, Cu, Ir, and Os complexes that have shown significant in vivo antitumor properties between 2017 and 2023.

Key Clinical Message Immediate thrombolysis in submassive pulmonary embolism on the basis of bedside echocardiography can be a lifesaving decision in areas where computed tomography (CT) pulmonary angiogram is not readily available. Abstract Bedside echocardiography can be a rapid diagnostic and decision‐making tool for immediate thrombolysis in submassive pulmonary embolism with evidence of progressively failing ventricles. We report a case of submassive pulmonary embolism in a 26‐year‐old male under testosterone replacement therapy, who was successfully thrombolyzed based on bedside echocardiography findings.

Outpatient parenteral antimicrobial therapy (OPAT) in Australia has evolved from modest beginnings to a well-established health service with proven benefits in patient outcomes. This is a comprehensive review of the current state of art Australian OPAT with vignettes of the types of OPAT models of care, antimicrobial prescribing and antimicrobial use. In addition, we highlight the similarities and differences between OPAT to other countries and describe Australian OPAT experiences with COVID-19 and paediatrics. Australian OPAT continues to advance with OPAT antifungals, novel treatment options and upcoming high-impact research.

Abstract Background Waldenström macroglobulinemia is a rare hematological malignancy and is the most common diagnosis in patients with hyperviscosity syndrome. Bilateral central retinal vein occlusion as an initial presentation of hyperviscosity syndrome in Waldenström macroglobulinemia is rare. Case presentation A 42-year-old Nepalese male presented with sudden-onset bilateral painless blurring of vision. Fundus examination revealed bilateral, diffusely dilated, tortuous retinal veins and intraretinal deep blot hemorrhages in all four quadrants of the retina in both eyes; features of bilateral central retinal vein occlusion. Serum electrophoresis showed hypoalbuminemia with an immunoglobulin M kappa monoclonal spike. Bone marrow picture and immunohistochemistry analysis were suggestive of lymphoplasmacytic lymphoma. The patient received systemic therapy for Waldenström macroglobulinemia, along with intravitreal bevacizumab. Conclusion Adequate hydration, plasmapheresis, and a combination of bortezomib, dexamethasone, and rituximab regimen as a systemic therapy may represent an ideal choice for patients with hyperviscosity in Waldenström macroglobulinemia.

Modular proteins are regulatory proteins that carry out more than one function. These proteins upregulate or downregulate a biochemical cascade to establish homeostasis in cells. To switch the function or alter the efficiency (based on cellular needs), these proteins require different facilitators that bind to a site different from the catalytic (active/orthosteric) site, aka ‘allosteric site’, and fine-tune their function. These facilitators (or effectors) are allosteric modulators. In this Review, we have discussed the allostery, characterized them based on their mechanisms, and discussed how allostery plays an important role in the activity modulation and function fine-tuning of proteins. Recently there is an emergence in the discovery of allosteric drugs. We have also emphasized the role, significance, and future of allostery in therapeutic applications.

The current technique was developed to estimate the amount of alectinib present in spiked rabbit plasma using liquid chromatographic mass spectrometry. The liquid-liquid extraction method was used, and chromatographic separation was carried out on a C18 (4.6mm id x 50mm) analytical column with a mobile phase consisting of acetonitrile and water with 0.1% formic acid at a volume ratio of 75:25. Alectinib's product m/z +483.2 (parent) 396.1 (product) and the internal standard m/z +447.5 (parent) 380.3 (product) were both obtained using positive ion mode. The calibration curve was linear from 0.5 to 600 ng/ml. The percentage extraction recovery (98.15% → 98.86%), demonstrated excellent matrix and analyte selectivity (% interference = 0), and satisfactory stability study results in all types (% nominal 94.94% → 99.63%). The intra and interday accuracy with % nominal 97 → 98.8%, precision % CV ≤ 2% in all quality control levels. The rabbit model's pharmacokinetic parameters were examined, and alectinib's area under the curve (AUC 0—∞) was 4269 ± 8.13 hr.ng/ml. The half-life of elimination (t1/2) is 8.52 ± 6.66 hours. The currently established approach was used in rabbit blood samples for pharmacokinetic investigations of commercial formulations since it was thought to be a novel, verified bioanalytical method based on experimental results.

The ADITYA upgrade (ADITYA-U), a medium-sized $\left( {{R_0} = 75{\text{ cm}},\,\,a = 25{\text{ cm}}} \right)$ conventional tokamak facility in India, has been consistently producing experiments findings by using circular and shaped-plasmas. Recognizing the plasma parameters aligning closely with the design parameters of circular limited plasmas, ADITYA-U shifted its focus toward exploring the operational regime for experimentation on saw-tooth and MHD phenomena. Moreover, ADITYA-U has made consistent advancements toward conducting preliminary plasma shaping experiments through the activation of top and bottom divertor coils utilizing hydrogen as well as deuterium fuels. Confinement is improved by a factor of ∼1.5 in ${D_2}$ plasmas when compared to H _2 plasmas of ADITYA-U. Further, ADITYA-U operations emphasize preventing disruptions and runaway electrons (REs) to ensure safe operations for future fusion devices. Significant suppression of REs has been achieved in ADITYA-U with the application of pulsed localized vertical magnetic field (LVF) perturbation, thereby establishing the technique’s independence from the tokamak device. The successful RE mitigation requires a critical threshold of LVF pulse magnitude, which is approximately 1% of the toroidal magnetic field, and a minimum duration of ∼5 ms. Apart from this, several novel findings have been achieved in the ADITYA-U experiments, including the modification of sawtooth duration through gas-puff, the emergence of MHD-induced geodesic acoustic mode-like oscillations, the propagation of fast heat pulses induced by MHD activity, the control of RE dynamics through Gas-puffs, the propagation of pinch-driven cold-pulses, the transport and core accumulations of argon impurities, the mass dependency of plasma toroidal rotation and the detection of ‘RICE’ scaling, as well as the characterization of edge plasma using wall conditioning methods, such as glow discharge cleaning using a combination of Ar -H _2 mixture, localized wall cleaning by electron cyclotron resonant plasma, and the development of machine learning-based disruption predictions, will be discussed in this paper.

Intrinsic toroidal rotation velocity ( V _φ ) has been measured from the Doppler shift of C ^5+ carbon spectral lines (at 529.05 nm) in the edge region of the ADITYA-U tokamak without any auxiliary torque input in an ohmically heated pure hydrogen (H _2 ) plasma as well as in H _2 plasmas seeded with medium-Z (neon and argon) impurities . The toroidal rotation in the edge region is observed to reverse its direction from the counter-current to the co-current direction with an increase in plasma current beyond I _p ∼ 145–150 kA. Furthermore, a systematic decrease in the co-current V _φ has been observed with the edge density, which tends to decrease to almost zero velocity with an increase in the edge density. The injection of medium- Z (neon and argon) impurities is observed to influence the edge toroidal rotation significantly. In low I _p discharges, argon injection leads to a reversal of edge intrinsic rotation from the counter-current to the co-current direction. In high I _p discharges, both neon and argon seeding enhance the co-current rotation by about ∼5–10 km s ^−1 , at a constant I _p compared to pure H _2 discharges. Simultaneous measurements of the edge radial electric field, E _r , shows that the E _r × B _θ flow seems to be driving the edge toroidal rotation in ADITYA-U. With impurity injection, the E _r also gets modified, leading to an observed increase in the edge toroidal rotation.

Floods destroy crop production; nevertheless, the extent of their impact on farmers’ livelihoods in developing countries has been poorly investigated. This paper contributes to the growing evidence-based assessment of the impacts of shocks on communities. It assessed the post-disaster livelihood of farmers affected by the 2012 flooding in the semi-arid zone of Benin. To this end, a survey was conducted on 228 farmers in two municipalities of the flood-prone part of the semi-arid zone of Benin (Malanville, Karimama). Information on the well-being of households was collected using semi-structured interviews. Data were analyzed using income and consumption approaches focusing on poverty and on subjective assessment using happiness approach. Additionally, a probit model was used for a poverty assessment. The survey revealed that flooded farmers were amongst the poorest in the study system. Seven variables determined poverty in this study: household size, location, the percentage of the farm size that was flooded, fishing, the farmer’s gender, farm size, and “holding a secondary activity”. Regarding happiness, 99% of the flooded farmers were unhappier after the flood in 2012. The results clearly show that being subjected to floods increases the incidence of poverty. The capacity of flood risk management and governance should be strengthened in the study system.

The land use, land-use change and forestry (LULUCF) sector, as a source and a sink of greenhouse gas (GHG) emissions, is critical for achieving carbon neutrality. Many academic journals have published papers on land use carbon emission or sink (LUCES), but LUCES reviews are relatively rare, which poses great challenges in accurately understanding the research progress and future prospects. This work analyzes the research characteristics, hotspots and future perspectives of LUCES research by using a bibliometric analysis (such as DDA, VOSviewer, CiteSpace software) and a review based on the data (6115 scientific papers) during 1991–2023 from the Web of Science (WoS) platform. We found that (1) over the past 33 years, it first presented a steady growth, then fluctuating growth, and finally a rapid growth trend in the yearly number of publications in LUCES research. The USA (17.31%), China (14.96%), and the UK (7.37%) occupy a dominant position in this research field. (2) The related LUCES research is interdisciplinary, which mainly cover science and technology, meteorology and atmospheric sciences, geology, and environmental sciences and ecology disciplines. (3) The research hotspot analysis on LUCES shows that these articles mostly covered the follow three aspects: ecosystem services, climate change, and carbon neutrality. (4) A review of the past LUCES literature suggests that it is mainly focused on exploring the forefront issues in terms of the definition and boundaries, evaluation method and influencing factors, etc. This work suggests that further research could explore the main scientific problems on quantification of land-based carbon neutrality, quantitative analysis of the impact mechanisms, as well as interdisciplinary research and collaborative governance needed for carbon neutrality.

Introduction: Effective post-operative analgesia improves patient’s outcome and satisfaction. Many methods are available to provide best analgesia after major abdominal surgery. Epidural anaesthesia is “gold standard” but it is associated with its own drawbacks. Transversus Abdominis Plane (TAP) block is a comparable technique to epidural to provide reliable analgesia in lower abdominal surgeries. Aim: To compare the efficacy of Ultrasonography (USG) guided TAP block and the epidural block for the post-operative pain management in lower abdominal cancer surgery. Materials and Methods: This randomised clinical double-blinded study, conducted in 60 female patients undergoing lower abdominal cancer surgery under General Anaesthesia (GA) from July 2022 to September 2022. Patients were randomised to Group-E and Group-T. Group-E (Epidural) received injection (inj.) 0.2% Ropivacaine (10 ml) plus inj. Morphine 2 mg via epidural. Group-T (TAP) received inj. 0.2% Ropivacaine (20 ml) plus inj. Morphine 2 mg on each side via USG guided TAP block postoperatively. The Visual Analog Scale (VAS) Score, first rescue analgesia, total analgesic consumption and any side-effects in 24 hours were recorded. The Statistical Package for Social Sciences(SPSS) version 22.0 International Business Management (IBM) Corporation (NY) was used for statistical analysis. Unpaired t test, Chi-square test and Fisher’s-exact test and one-way Analysis of Variance (ANOVA) test were used as and when appropriate. Results: Data of total 60 female patients , 30 patients in each group(Group E mean age: 47.33±9.614 years and Group T mean age: 47.77±12.370 years) was collected and analysed. Both the groups were comparable with respect to age, height, weight, American Society of Anaesthesiologists (ASA) grade, mean duration of surgery and duration of anaesthesia (p>0.05). More patients in group-E had moderate pain at rest and coughing (VAS-4 to 6) at six hours and 12 hours which is statistically significant (p

Abstract Organizing pneumonia (OP) is one of the rare pulmonary manifestations of systemic lupus erythematosus (SLE) which is infrequently reported as a presenting manifestation. Early diagnosis of lupus‐related OP with the help of imaging, can drive to prompt initiation of immunosuppressive therapy leading to a better prognosis. We present a case of a 34‐year‐old young male who presented with fever, myalgia, and a dry cough for 1 month and was later diagnosed as SLE‐related organizing pneumonia.

Understanding changes in Land Use Land Cover (LULC) is essential for managing and monitoring natural resources and development, particularly where urbanization is expanding. So, this study aimed to assess the level of changes in LULC of Nepalgunj Sub-metropolitan city using temporal Landsat satellite imageries of 1996, 2008, and 2020 AD, and the key drivers of LULC change were observed through a purposive household survey (N=140) with a sampling intensity of 0.5%. LULC maps were generated using initial unsupervised and later supervised classification. LULC changes were computed using the post-change detection classification technique. LULC map of 1996 AD, 2008 AD, and 2020 AD showed accuracy of 84.44 %, 85.45%, and 83.64% with a kappa value of 0.8381, 0.8497, and 0.829 respectively. Bareland, Human buildup, and grassland were found to have increased by 13.34%, 5.07%, and 29.62% respectively while sparse vegetation, dense vegetation, and water bodies were found to have decreased by 44.10%, 17.82%, and 13.34% respectively between 1996 and 2008. Likewise, there was decrease in grassland area (-26%), dense vegetation area (-9.48%), sparse vegetation area (-5%), water bodies (-0.12%), and increase in Bareland (+20%) and Human buildup (+20.6%) in between 2008 to 2020. Eight key drivers of LULC, development of infrastructure, government policy, plans, and land market, forest encroachment, forest, and its products, political condition, economic opportunities, and hotel and tourism activities, were recognized in the study area. Further research is required to determine the specific ramifications of the aforementioned LULC change drivers, as well as the area's long-term viability.

Introduction: Non-ST elevation myocardial infarction is frequently thought to be caused by incomplete blockage of the culprit artery, whereas ST elevation myocardial infarction is frequently thought to be caused by total occlusion of the culprit artery. The objective of the study was to find out the prevalence of occluded coronary arteries among non-ST elevation myocardial infarction patients department of cardiology of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among non-ST elevation myocardial infarction patients in a tertiary care centre from 22 June 2020 to 21 June 2021 after taking ethical approval from the Institutional Review Committee [Reference number: 4271 (6-11) E2 076/077]. A total of 196 patients were included in the study by simple randomized sampling. Data on the patient’s clinical profile, angiographic findings, and in-hospital complications were recorded. Point estimate and 95% Confidence Interval were calculated. Results: Among 126 non-ST elevation myocardial infarction patients included in the study, the prevalence of occluded coronary artery was 41 (32.54%) (24.36-40.72, 95% Confidence Interval). Conclusions: The prevalence of occluded coronary arteries was similar to the studies done in similar settings.

Abstract Background AMP-activated protein kinase (AMPK) is a metabolic sensor that maintains energy homeostasis. AMPK functions as a tumor suppressor in different cancers; however, its role in regulating antitumor immunity, particularly the function of regulatory T cells (Tregs), is poorly defined. Methods AMPKα1 fl/fl Foxp3 YFP-Cre, Foxp3 YFP-Cre, Rag1 −/− , and C57BL/6 J mice were used for our research. Flow cytometry and cell sorting, western blotting, immuno-precipitation, immuno-fluorescence, glycolysis assay, and qRT-PCR were used to investigate the role of AMPK in suppressing programmed cell death 1 (PD-1) expression and for mechanistic investigation. Results The deletion of the AMPKα1 subunit in Tregs accelerates tumor growth by increasing the expression of PD-1. Metabolically, loss of AMPK in Tregs promotes glycolysis and the expression of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), a key enzyme of the mevalonate pathway. Mechanistically, AMPK activates the p38 mitogen-activated protein kinase (MAPK) that phosphorylates glycogen synthase kinase-3β (GSK-3β), inhibiting the expression of PD-1 in Tregs. Conclusion Our study identified an AMPK regulatory mechanism of PD-1 expression via the HMGCR/p38 MAPK/GSK3β signaling pathway. We propose that the AMPK activator can display synergic antitumor effect in murine tumor models, supporting their potential clinical use when combined with anti-PD-1 antibody, anti-CTLA-4 antibody, or a HMGCR inhibitor.

The 3CL protease of SARS-CoV-2 is inhibited by PF-00835231 in vitro. Here, the authors show that the prodrug PF-07304814 has broad spectrum activity, inhibiting SARS-CoV and SARS-CoV-2 in mice and its ADME and safety profile support clinical development.