Design and application of a central venous pressure measurement tool / 中华危重病急救医学

Central venous pressure (CVP) reflects the comprehensive condition of effective blood volume, cardiac function and vascular tone. Clinical monitoring of CVP can indirectly understand and evaluate the dynamic changes of blood volume in patients, and provide a reference for patients to venous fluid. At present, the traditional manual measurement method is widely used for measurement, which has some shortcomings such as zero shift, cumbersome operation (requires two health care workers to cooperate). In order to overcome the above problems, the author invented a new fixable CVP measurement tool and obtained the national utility model patent (ZL 2021 2 1451705.7). The tool is mainly composed of a base plate, a movable frame and a measuring department, etc. When used, the base plate is placed into the back of the patient and pressed and fixed, the movable frame is adjusted, the zero point is found, and the measurement data is read from the measuring department. It has the advantages of simple and convenient operation, small measurement error, wide applicability (different body types) and so on, which is suitable for clinical promotion.

Discussion on the zero-calibration and the zero line in the measurement of central venous pressure and invasive arterial blood pressure / 中华危重病急救医学

Objective:To figure out the timing of zeroing and the location of the zero line in the central venous pressure (CVP) monitoring and invasive arterial blood pressure (IBP) monitoring, and to provide scientific and accurate data for patients management.Methods:The liquid vessel models were used to simulate the pressure measurement process of the continuous pressure monitoring system. Based on the theory of fluid mechanics and the knowledge of blood pressure physiology and cardiovascular anatomy, the composition and influencing factors of the pressure in the fluid-filled catheter system during the zeroing and placing the transducer in the zero line of CVP and IBP, were analyzed.Results:The pressure in the liquid-filled catheter system was composed of atmospheric pressure, the pressure of pumping bag, the gravity of the water column (the vertical distance between the liquid level of Murphy's dropper and pressure transducer, ΔH), and the resistance of tube wall. This pressure value is set as a pressure of 0 mmHg (1 mmHg ≈ 0.133 kPa). In the process of pressure measurement, when the pressure transducer was placed at a horizontal position of 10 cm below the highest liquid level of the vessel, the pressure measured at different catheter tip positions was all 10 cmH 2O (1 cmH 2O ≈ 0.098 kPa); When the pressure transducer was placed at the horizontal position of the highest liquid level of the vessel, the measured pressure is 0 mmHg. Conclusion:Zeroing should repeatedly be performed only when one or more conditions (atmospheric pressure, pressure of pumping bag, gravity of ΔH water column and resistance of tube wall) are changed. In the measurement process, the pressure transducer should be placed at the zero line position at any time to eliminate the influence of hydrostatic pressure and to ensure the objective and accurate value.

Trajectory of the development of caries in the permanent dentition of 12- to 16-year-old students based on a latent class growth model analysis in Liuyang / 口腔疾病防治

Objective@# To explore the trajectory of the development of permanent caries in 12- to 16-year-old students in Liuyang and to provide a reference for the prevention and management of caries.@*Methods@#Primary and secondary school students who were registered within the Liuyang jurisdiction were screened for caries from September to November by the Liuyang Center for Disease Control and Prevention. A total of 7 297 students between the ages of 12 and 16 years with complete permanent dentition caries monitoring records and traceable deciduous dentition caries monitoring records were selected from 2013 to 2019, and a zero-inflated negative binomial-latent class growth model (ZINB-LCGM) was established to describe the trajectory of the development of individual caries using the decayed missing filled teeth (DMFT) indicators. @*Results@# DMFT of 12- to 16-year-old students in Liuyang were mainly decayed teeth (DT), with the majority occurring in the first permanent molar. According to the ZINB-LCGM model, the students were classified into three latent categories, "slow growth pattern" (28.55%), "rapid growth pattern" (6.59%), and "stable pattern" (64.86%), which followed different nonlinear caries growth trajectories. Females with deciduous teeth caries were more likely to have trajectories showing a “rapid growth pattern” and a “slow growth pattern”. There were significant differences in the trajectories between men and women, as well as between those with and without primary dentition caries. @*Conclusion @# The trajectory of the development of caries in 12-16-year-old students shows heterogeneity in terms of different developmental patterns of latent categories, suggesting that females with deciduous dental caries should receive more attention.

Creating Peru's patient zero: pandemic narratives through traditional and social media / Creando el paciente cero de Perú: narrativas sobre la pandemia a través de los medios de comunicación tradicionales y sociales

Abstract During the covid-19 pandemic, authorities, journalists, and the public used the term patient zero to refer to the first diagnosed patient. However, experts describe the term as imprecise because it equates the first infected patient with the first identified one. Although the term's inaccuracy, patients zero became relevant actors and sources of information during the pandemic. This was the case with the Peruvian patient zero, who had public media participation and opened his Instagram to establish a communication channel with the public. Despite knowing the term's inaccuracy, he felt responsible for the audience and sought to give his testimony. The Peruvian case shows how patients zero respond to the public interest and establish their agency through traditional and social media.

Resumen El coronavirus hizo que autoridades, periodistas y público designaran "paciente cero" al primer diagnosticado, aunque los especialistas calificaran al término como impreciso por equiparar el primer paciente infectado con el primero identificado. A pesar de esa inexactitud, pacientes cero se tornaron actores y fuentes de información relevante durante la pandemia. Fue el caso del paciente cero peruano, que participó en los medios de comunicación y abrió su Instagram para establecer un canal con el público. Conociendo la inexactitud del término, asimismo trató de dar su testimonio para aclarar la audiencia. El caso peruano muestra cómo pacientes cero responden al interés público y establecen sus acciones mediante los medios tradicionales y sociales.

Tends of "Zero-dose" children aged 12-23 months in Togo from 2000 to 2017 and predictions for 2030

Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children

Zero Phaco: A new technique for dealing with soft cataracts

Phacoemulsification in soft cataracts can be challenging due to the lack of rigid cleavage planes and the inability to crack. We describe a new phacoemulsification technique for dealing with soft cataracts using high vacuum and zero energy. Following capsulorhexis and hydrodissection, we introduced the phacoemulsification probe, keeping the torsional and longitudinal power at zero. A central groove was created in sculpting mode. We held the nucleus with adequate vacuum in chop mode and divided the nucleus. Then, we rotated and chopped the nucleus similarly into small pieces without using any power. For emulsification, we increased the vacuum to 600 mmHg and then shredded and stuffed the pieces into the phaco probe by the chopper. A newer generation phaco machine with active fluidic system and monitored pressurized infusion helps the surgeon control the intraocular pressure (IOP) and hold the nucleus with vacuum alone, allowing chopping and emulsifying of the pieces without any energy.

The principles of ultra-low contrast percutaneous coronary intervention

Ultra-low contrast percutaneous coronary intervention (ULCPCI) can be performed electively in advanced chronic kidney disease. Engage guide catheter and advance guidewire into the coronary artery without using contrast. IVUS-guided PCI can reduce the contrast load. Perform co-registration of distal and proximal radio-opaque marker bands of intravascular ultrasound (IVUS) catheter. Deploy the stent at the target lesion under fluoroscopic guidance of these co-registered position of the IVUS-marking images. Complete the ULCPCI procedure with a final angiography using minimal contrast. Newer contrast sparing techniques and intravascular imaging technologies provide opportunities to perform ULCPCI efficiently with good results and the least complications

Gerenciamento de resíduos sólidos urbanos de Feira de Santana: demanda energética e pegada de carbono / Management of solid urban waste in Feira de Santana: energy demand and carbon footprint

RESUMO O gerenciamento de resíduos sólidos urbanos, com a disposição do material em aterro sanitário, é uma prática amplamente adotada no Brasil. A quantificação do desempenho ambiental do gerenciamento de resíduos sólidos urbanos apoia a proposição de práticas otimizadas. A avaliação do ciclo de vida foi aplicada para avaliar o gerenciamento de resíduos sólidos urbanos de 1 tonelada de material em Feira de Santana, estado da Bahia, Brasil. A fronteira do sistema do gerenciamento de resíduos sólidos urbanos deste estudo incluiu o material gerenciado nas etapas de coleta, transporte, tratamento, disposição e manejo do lixiviado. Foi avaliada a disposição do material em aterro sanitário no cenário base de gerenciamento de resíduos sólidos urbanos e opções de recuperação de recurso para o aproveitamento de material (reciclagem e compostagem) e energia (aterro sanitário e digestão anaeróbia com coleta de biogás) nos cenários propostos de gerenciamento de resíduos sólidos urbanos. O inventário de primeiro plano utilizou dados representativos para os cenários avaliados, enquanto o inventário de segundo plano utilizou a base de dados ecoinvent™ no software Simapro®, com os métodos de demanda de energia acumulada e Intergovernmental Panel On Climate Change 2013, com potencial de aquecimento global de cem anos. A demanda de energia acumulada foi 215 MJ·t-1 e as emissões de gases de efeito estufa foram 449 kg CO2eq·t-1 no cenário base. A maior contribuição da demanda de energia acumulada do cenário base foi oriunda da etapa de coleta e transporte, enquanto aquela de gases de efeito estufa foi oriunda do aterro sanitário. Os cenários propostos com a recuperação dos recursos apresentaram potenciais de redução da demanda de energia acumulada e das emissões de gases de efeito estufa do gerenciamento de resíduos sólidos urbanos, assim como apoiam a transição para uma economia circular.

ABSTRACT Municipal Solid Waste Management with the material disposal in landfills is a widely adopted practice in Brazil. The environmental performance quantification in MSWM supports the proposition of optimized practices. The Life Cycle Assessment was applied to evaluate 1 ton of material in the Municipal Solid Waste Management of Feira de Santana, state of Bahia, Brazil. The system boundary of the Municipal Solid Waste Management in this study included the material managed in collection, transportation, treatment, disposal and leachate handling stages. The material disposal in sanitary landfill was evaluated in the base scenario of Municipal Solid Waste Management and the resource recovery options for material (recycling and composting) and energy (sanitary landfill and anaerobic digestion with biogas collection) in the proposed scenarios of Municipal Solid Waste Management. The foreground inventory used representative data for the evaluated scenarios, while the background inventory used the ecoinvent™ database in the Simapro® software with the Cumulative Energy Demand and Intergovernmental Panel on Climate Change 2013 with 100 years global warming potential methods. Cumulative Energy Demand was 215 MJ·t-1 and Greenhouse Gas emissions were 449 kg CO2eq·t-1 in the base scenario. The largest contribution in the base scenario was the collection and transportation stage in Cumulative Energy Demand and the sanitary landfill in Greenhouse Gas. The proposed scenarios with resource recovery showed a potential to reduce the Cumulative Energy Demand and Greenhouse Gas emissions in Municipal Solid Waste Management, along with supporting the transition to a circular economy.

Gastric preparation with Sprite Zero ? for magnetically controlled capsule endoscopy / 中华消化内镜杂志

Objective:To explore the feasibility of 400 mL Sprite Zero ? in gastric preparation for magnetically controlled capsule endoscopy (MCE) . Methods:A randomized controlled trial at the Department of Gastroenterology of Changhai Hospital, Naval Medical University from December 16th, 2019 to January 15th, 2020 was conducted. The patients and healthy volunteers who intended to receive MCE were randomly divided into the Sprite Zero ? (S) group and the water (W) group at 1∶1. For subjects in the W group, 800 mL water was taken 10 minutes before swallowing the capsule. And for subjects in the S group, 400 mL Sprite Zero ? was taken. The primary endpoint was gastric filling score and the secondary endpoint included the fullness score, gastric transit time (GTT), small bowel transit time (SBTT), completion rate (CR) for small bowel examination and the diagnostic yield. Results:A total of 102 subjects were enrolled, 52 subjects in the S group and 50 subjects in the W group. The median score of gastric filling was 4 at 0-5 min, >5-10 min and >10-15 min after taking the capsule in both groups, with less median liquid consumption in the S group than the W group (500 mL VS 950 mL, P<0.001). The S group showed lower median fullness score (7.0 scores VS 7.5 scores, P=0.030) and higher proportion of patients with GTT less than 30 minutes [69.57% (16/52) VS 27.59% (8/29), P=0.030] compared with the W group. The CR of small bowel examination in the S group was 100.00%, higher than that of the W group (89.66%, P=0.245). Conclusion:Compared with 800 mL water, 400 mL Sprite Zero ? can fully fill the stomach with more comfort. It has the potential to accelerate gastric emptying and improve the CR of small bowel examination, which is feasible for the gastric preparation.

Reasons and achievement of Chinese dynamic zero-COVID-19 strategy’s consistency / 上海预防医学

COVID-19 has caused more than 600 million cases， more than 6 million death and mortality of 1.24% worldwide. One out of every six people caught COVID-19 at the 5th wave of expansion， having a mortality of 15 per 10 thousand. China mainland with the dynamic zero-COVID-19 strategy have decreased 699 million cases and 6.26 million deaths from dynamic zero-COVID-19 strategy in 3 years in case of yearly outbreak of COVID-19， according to the situation of Omicron variant in Hongkong with incidence of one out of every six people and 0.76% of mortality. With the stronger contagious and variation of the virus， there is less long-term latency. The Chinese governments have more efficient control of epidemic of dynamic zero-COVID-19 strategy caused by imported cases with local diffusion by physical separation and isolation as measure of quarantines； have quick and effective results with zero new cases， which kept the health and safety for people in China. The paper analyzes the efficient measures and achievement of dynamic zero-COVID-19 strategy in Beihai and Chongzuo of Guangxi under the outbreaks of COVID-19 Omicron variant on July of 2022， after the calculation of expanding latency as ≤4 days， ≤7 days or ≥ 8 days’ different latency of primary strains， of expanding latency of Delta variant in part of cases in Yangzhou City of Jiangsu， and of expanding latency of Omicron coming out from chain-expanding cases from Xiaojinge clothing store of Beijing.

Women autonomy and demand for maternal health services in Nigeria: Evidence from the Nigeria Demographic and Health Survey

mproving women autonomy can be vital in determining the uptake of healthcare services, especially in a patriarchal society with gender rights concerns. Using the 2013 Nigeria Demographic and Health Survey and employing Zero Inflated Negative Binomial regression, the effect of household decision-making power with considerations to women autonomy on the demand for maternal health services in Nigeria was examined. The result of the analysis suggests that women autonomy in deciding expenditures on household healthcare services, and autonomy in deciding their income expenditures significantly increases the likelihood of demand for maternal healthcare services. On the other hand, when the husband/partner makes sole decision, as well as joint decision making concerning expenditure on household healthcare services and expenditure of woman's income reduces the likelihood of demand for maternal healthcare services in the country. This reduction was however much more when husband alone takes the decision than when decisions were taken jointly. Other socioeconomic variables like higher maternal education, and household wealth, also increased the demand for maternal healthcare services. We recommend that government should put in place policies that will help increase women's participation in household decision-making through the sensitization and capacity building initiatives such as improved educational quality for women. (Afr J Reprod Health 2022; 26[4]: 65-74).

Optimization of Diltiazem hydrochloride osmotic formulation using QBD approach

Abstract Diltiazem hydrochloride (DLH) is a calcium channel blocker useful for the treatment of angina pectoris, arrhythmia, and hypertension. DLH having a short half-life needs frequent administration for successful treatment but this poses a problem of poor patient compliance. These requirements are served by elementary osmotic pump tablets (EOP) based controlled-release (CR) systems. Quality by design (QbD) approach assists in screening various factors with subsequent assessment of critical parameters that can have a major impact on the scalability of EOP. Tablets were formulated using wet granulation method followed by osmotic coating. Factorial design based QbD strategy aided in defining the risk assessment of influential variables such as hydrophilic polymers and osmotic coat component on the in-vitro release kinetics of the designed EOP tablets. These formulated EOP systems followed zero-order kinetics, a characteristic feature of EOPs. EOP tablets were formulated applying a systematic QbD statistical approach. The formulated DLH EOP systems with improved concentration-independent behavior helped to address the challenges of IR formulation. Application of QbD strategy in ascertaining the scalability of DLH EOP formulation would help pharmaceutical industries in the translation of EOP based drug delivery systems from R&D to market.

Application of path quality inspection and "zero defect" service management in nursing quality management of orthopedic ward / 中国实用护理杂志

Objective:To analyze the application of path quality inspection combined with "zero defect" service management in nursing quality management of orthopedic ward.Methods:From January 2018 to December 2019,196 patients admitted to the Department of Orthopaedics of Panzhihua Central Hospital, Sichuan Province. Ninety-eight patients from January to December 2018 were as control group, 98 patients from January to September 2019 were as observation group. The control group adopted the routine nursing management mode, while the observation group adopted the path type quality inspection combined with the "zero defect" service management mode. The differences in the incidence of nursing adverse events, quality of life scores and nursing satisfaction were compared between the two groups.Results:The incidence of nursing adverse events during hospitalization in observation group and control group was 6.12% (6/98) and 15.31% (15/98), the difference was statistically significant ( χ 2 value was 4.320, P<0.05). Mental score, sleep score, diet score, mental health score, total score were (94.38±8.36), (93.28±8.33), (95.37±8.43), (91.89±10.48), (377.12±20.08) points in observation group, significantly higher than (85.65±10.74), (81.01±9.48), (87.69±7.97), (85.47±12.02), (331.09±13.39) points in the control group, the difference between the two groups was statistically significant ( t value was 3.118-18.880, P<0.01). The nursing satisfaction of observation group and control group was 92.86% (91/98), 82.65% (81/98), the difference was statistically significant ( χ 2 value was 4.749, P<0.05). Conclusion:The application of path quality inspection combined with "zero defect" service management in the nursing quality management of orthopedic ward is conducive to reducing the incidence of nursing adverse events, improving the quality of life of patients after surgery, and improving patients' satisfaction with nursing services.

Utilization of the evidence from studies with no events in meta-analyses of adverse events: An empirical investigation (Chinese translation) / 中国胸心血管外科临床杂志

@#Objective    Zero-events studies frequently occur in systematic reviews of adverse events, which consist of an important source of evidence. We aimed to examine how evidence of zero-events studies was utilized in the meta-analyses of systematic reviews of adverse events. Methods    We conducted a survey of systematic reviews published in two periods: January 1, 2015 to January 1, 2020 and January 1, 2008, to April 25, 2011. Databases were searched for systematic reviews that conducted at least one meta-analysis of any healthcare intervention and used adverse events as the exclusive outcome. An adverse event was defined as any untoward medical occurrence in a patient or subject in healthcare practice. We summarized the frequency of occurrence of zero-events studies in eligible systematic reviews and how these studies were dealt with in the meta-analyses of these systematic reviews. Results    We included 640 eligible systematic reviews. There were 406 (63.45%) systematic reviews involving zero-events studies in their meta-analyses, among which 389 (95.11%) involved single-arm-zero-events studies and 223 (54.93%) involved double-arm-zero-events studies. The majority (98.71%) of these systematic reviews incorporated single-arm-zero-events studies into the meta-analyses. On the other hand, the majority (76.23%) of them excluded double-arm-zero-events studies from the meta-analyses, of which the majority (87.06%) did not discuss the potential impact of excluding such studies. Systematic reviews published at present (2015-2020) tended to incorporate zero-events studies in meta-analyses than those published in the past (2008-2011), but the difference was not significant [proportion difference=–0.09, 95%CI (–0.21, 0.03), P=0.12]. Conclusion    Systematic review authors routinely treated studies with zero-events in both arms as "non-informative" carriers and excluded them from their reviews. Whether studies with no events are "informative" or not, largely depends on the methods and assumptions applied, thus sensitivity analyses using different methods should be considered in future meta-analyses.

Effect of Zero-valent Iron Nanoparticles and Melatonin on Yield and Quality of Fritillaria przewalskii in Domesticated Cultivation Conditions / 中国实验方剂学杂志

Objective:To investigate the effect of iron nanoparticles and melatonin on yield and quality of <italic>Fritillaria przewalskii</italic> and provide technical support for its domesticated cultivation. Method:Hundred grain weight was measured by conventional method；alkaloid content was detected according to protocols of the edition of 2020 <italic>Chinese Pharmacopoeia</italic>，chlorophyll，hydrogen peroxide，malondialdehyde，superoxide dismutase （SOD），peroxidase （POD） and catalase （CAT） were detected by spectrophotometric analysis，auxins，cytokinins，gibberellins，salicylic acid，jasmonic acid and abscisic acid were detected by ultra performance liquid chromatography tandem mass spectrometry analysis. Result:Zero-valent iron nanoparticles and melatonin significantly increased the hundred grain weight without affecting the quality. The effect of the two treatments on physiological and biochemical indexes in different stages were quite different，but the effects on content of endogenous hormones were basically the same. Correlation analysis showed that hundred grain weight was negatively correlated with malondialdehyde content，SOD activity and jasmonic acid content，but positively correlated with POD activity，salicylic acid content，gibberellins content，auxin content and abscisic acid content. The two treatments were separated effectively by principal component analysis，indicating that there were some differences in the mechanisms of growth promoting. The treatment of zero-valent iron nanoparticles mainly affected auxins，salicylic acid and abscisic acid. The treatment of melatonin mainly affected SOD，malondialdehyde and gibberellins. Conclusion:Zero-valent iron nanoparticles and melatonin can be used as a simple and practical technology to improve the stress resistance and yields of <italic>F. przewalskii</italic> in domesticated cultivation conditions.

Escape from abluminal LRP1-mediated clearance for boosted nanoparticle brain delivery and brain metastasis treatment

Breast cancer brain metastases (BCBMs) are one of the most difficult malignancies to treat due to the intracranial location and multifocal growth. Chemotherapy and molecular targeted therapy are extremely ineffective for BCBMs due to the inept brain accumulation because of the formidable blood‒brain barrier (BBB). Accumulation studies prove that low density lipoprotein receptor-related protein 1 (LRP1) is promising target for BBB transcytosis. However, as the primary clearance receptor for amyloid beta and tissue plasminogen activator, LRP1 at abluminal side of BBB can clear LRP1-targeting therapeutics. Matrix metalloproteinase-1 (MMP1) is highly enriched in metastatic niche to promote growth of BCBMs. Herein, it is reported that nanoparticles (NPs-K-s-A) tethered with MMP1-sensitive fusion peptide containing HER2-targeting K and LRP1-targeting angiopep-2 (A), can surmount the BBB and escape LRP1-mediated clearance in metastatic niche. NPs-K-s-A revealed infinitely superior brain accumulation to angiopep-2-decorated NPs-A in BCBMs bearing mice, while comparable brain accumulation in normal mice. The delivered doxorubicin and lapatinib synergistically inhibit BCBMs growth and prolongs survival of mice bearing BCBMs. Due to the efficient BBB penetration, special and remarkable clearance escape, and facilitated therapeutic outcome, the fusion peptide-based drug delivery strategy may serve as a potential approach for clinical management of BCBMs.

Cause Analysis of “Not Cost-effective at a Zero Price ”Results in Pharmacoeconomic Evaluation / 中国药房

OBJECTIVE：To pr ovide reference for the future pharmacoeconomic evaluation. METHODS ：Four typical cases of pharmacoeconomic evaluation showed the special situation that “not cost-effective at a zero price ”，defined the concept of “net value”to assist in theoretical analysis ，and summarized the possible causes of this situation . RESULTS & CONCLUSIONS ：The system（ATPS）：an overview and advances in its applica background treatment cost other than the target drug was too high ，the patient ’s quality of life during survival was too low ，the threshold of willingness to pay of incremental cost-effectiveness ratio was too low ，the cost of risk events during extended survival was too high or the health loss was too high ，and the price of the control scheme was too low ，which might affect the results of economic evaluation ，and even le d to the dilemma of pharmacoeconomic evaluation of “not cost-effective at a zero price ”. Pharmacoeconomic evaluation discusses the economy of intervention programs rather than the economy of drugs. The uneconomic results caused by various reasons need to be treated objectively ；theoretically，all“relevant”and“irrelevant”costs should be included in the calculation category in pharmacoeconomic evaluation ；pharmacoeconomics mainly solves the problem of “cost performance”comparison among several treatment schemes ，and the medical and health field often needs to face problems such as ethics and fairness. Therefore ，researchers may need to jump out of the framework of pharmacoeconomics analysis and conduct in-depth discussion from a higher and broader perspective.

Avaliação do desempenho de oleogéis estruturados com ceras vegetais como base lipídica reduzida em ácidos graxos saturados aplicados em cream cheeses / Performance evaluation of structured oleogels with vegetable waxes as a reduced lipid base in saturated fatty acids applied in cream cheeses

Diante das exigências crescentes das agências regulatórias do mundo todo quanto à redução/eliminação de ácidos graxos trans nos alimentos industrializados, bem como da conscientização do consumidor sobre a relação entre alimentação e saúde, o desenvolvimento de alternativas mais saudáveis aos óleos parcialmente hidrogenados e a outras fontes lipídicas com alto grau de saturaçã o se faz necessário. O oleogel, um sistema composto por um óleo preso em uma rede tridimensional formada por um agente estruturante, se apresenta como uma solução promissora. Dentre os diversos agentes estruturantes, as ceras vegetais se destacam por sua excelente capacidade de gelificação de óleos. Contudo, apresentam uma desvantagem sob o aspecto sensorial, pois podem conferir cerosidade e sabor residual desagradável aos alimentos. Com o objetivo de viabilizar o uso das ceras como agentes estruturantes em oleogéis face ao seu excelente desempenho tecnológico, este projeto propõe o estudo e a aplicação de oleogéis à base de óleo de soja (SBO) estruturado com ceras de farelo de arroz (RBW) a 2 e 4 % (m/m) ou carnaúba (CBW) a 3 e 6% (m/m), isoladamente. As matérias-primas foram caracterizadas e o comportamento de gelificação de cada cera foi avaliado por análises de textura por penetração de cone, estabilidade à perda de óleo por centrifugação, energia coesiva por parâmetro de solubilidade de Hansen (HSP) e comportamento de cristalização e fusão por calorimetria exploratória diferencial (DSC). Os resultados mostraram que ambas as ceras são capazes de formar oleogéis estruturalmente estáveis, contudo, o oleogel com 2% de RBW apresentou maior firmeza a 20 °C (190,4 gf/cm2) do que o oleogel com 6% de CBW a 5 °C (186,1 gf/cm2). Ao final de 5 dias, a capacidade de retenção de óleo do oleogel preparado com RBW foi de 100% às concentrações de 2 e 4% (m/m), contra 61 e 99,3% do oleogel elaborado com CBW às concentrações de 3 e 6% (m/m), respectivamente. Esses resultados podem ser explicados pela diferença entre as energias coesivas, ou seja, do grau de interação molecular entre o solvente e o soluto de cada oleogel. De acordo com os resultados de distância, que prevê se o gel formado será forte, fraco ou se não haverá formação de gel, o soluto CBW apresentou menor interação com o óleo (3,3 MPa1/2) do que o soluto RBW (3,7 MPa1/2). Os oleogéis foram aplicados como ingredientes em diferentes formulações de cream cheese, que foram analisados quanto a diferentes parâmetros de textura e esses resultados foram comparados a uma referência comercial. Nenhuma das amostras produzidas obteve resultados de textura estatisticamente iguais aos do cream cheese comercial (CC), o que pode ser explicado pelas diferenças de formulação e processamento dos produtos. Face aos resultados para textura e estabilidade à perda de óleo dos oleogéis de RBW, este agente estruturante apresenta ria maior potencial de aplicação, porém o oleogel CBW6 obteve alta capacidade de retenção de óleo (99,3%) e quando aplicado na formulação de cream cheese (CCBW6) apresentou resultados de firmeza e espalhabilidade mais próximos da amostra de referência, feita com gordura do leite (CMF)

Given the growing demands of regulatory agencies around the world regarding the reduction/elimination of trans fatty acids in processed foods, as well as consumer awareness about the relationship between food and health, the development of healthier alternatives to partially hydrogenated oils and others lipid sources with a high degree of saturation are necessary. Oleogel, a system composed of an oil trapped in a three-dimensional network formed by a structuring agent, presents itself as a promising solution. Among the various structuring agents, vegetable waxes stand out for their excellent oil gelling capacity. However, they have a sensory disadvantage, as they can give waxy and unpleasant aftertaste to foods. Aiming at enabling the use of waxes as structuring agents in oleogels in view of their excellent technological performance, this study proposes the evaluation and application of oleogels based on soybean oil (SBO) structured with rice bran wax (RBW) at 2 and 4% (m/m) or carnauba (CBW) at 3 and 6% (m/m). The raw materials were characterized and the gelling behavior of each wax was evaluated by analysis of texture by cone penetration, stability to oil loss by centrifugation, cohesive energy by Hansen solubility parameter (HSP) and crystallization and melting behavior. by differential scanning calorimetry (DSC). The results showed that both waxes are able to form structurally stable oleogels, however, oleogel with 2% RBW showed greater firmness at 20 °C (190.4 gf/cm2) than oleogel with 6% CBW at 5° C (186.1 gf/cm2). At the end of 5 days, the oil retention capacity of oleogel prepared with RBW was 100% at concentrations of 2 and 4% (m/m), against 61 and 99.3% of oleogel prepared with CBW at concentrations of 3 and 6% (m/m), respectively. These results can be explained by the difference between the cohesive energies, that is, the degree of molecular interaction between the solvent and the solute of each oleogel. According to the distance results, which predicts if the formed gel will be strong, weak or if there will be no gel formation, the CBW solute showed less interaction with the oil (3.3 MPa1/2) than the RBW solute (3 ,7 MPa1/2). Oleogels were applied as ingredients in different cream cheese formulations, which were analyzed for different texture parameters and these results were compared to a commercial reference. None of the samples produced had texture results statistically equal to those of commercial cream cheese (CC), which can be explained by the differences in formulation and processing of the products. Given the results for texture and oil binding capacity of RBW oleogels, this structuring agent would present greater application potential, but CBW6 oleogel obtained high oil biding capacity (99.3%) and when applied in cream cheese formulation (CCBW6) showed firmness and spreadability results closer to the reference sample, made with milk fat (CMF)

Zero Budget Natural Farming in India: Aiming Back to the Basics

Crisis of Indian agriculture is very pertinent at this moment as green revolution is gradually losing its hope. Excessive, pointless exploitation of broods of green revolution has left bad footprints on country’s food security and environmental safety. With the motto to ensure food security by reviving Indian agriculture in environmentally safe way as well as to release farmers from debt cycle and suicides, zero budget natural farming (ZBNF) has come in the picture, which discards uses of all the chemical farming inputs and relies on natural way of farming i.e. rejuvenating soil and crop health through its own practices (Jivamrita, Bijamrita, mulching, soil aeration, intercropping, crop diversification, bunds, bio-pesticides etc.). ZBNF movement right now is the most popular agrarian movement which begun in 2002 in Karnataka and later successfully spread in many states (specially, of South India) of the nation through numbers of trainings, demonstrations and various promotional activities. Successful outcomes from farmers’ fields of south Indian states like Andhra Pradesh, Karnataka etc. are encouraging and grabbing attention of farmers, public and private organisations towards ZBNF in recent times. Yet, various controversies regarding its transparency, inadequate information, efficacy, practices, idealisms, even the term ‘zero budget’ etc. have agglutinated around ZBNF over the years since it debuted. Critics in fact have cited several references of drastic yield reductions with ZBNF practices in many places. Adequate scientific evaluation or monitoring of ZBNF’s successes or failures through multi-locational trials is now therefore the needful before allowing or restraining its run in Indian agriculture.

A New Validated Third Order Derivative Spectroscopic Method For Simultaneous Estimation Of Metoprolol Succinate And Ramipril In Tablet Dosage Form

Objective: The objective of the present work is to develop and validate a new UV derivative spectrophotometric method for simultaneous estimation of metoprolol succinate and ramipril in methanol: water (50:50v/v). Methods: “Zero crossing technique” was chosen for quantitative determination. The zero-crossing points (ZCP’s) were found to be 209 nm where metoprolol succinate was quantified and 211 nm where ramipril was quantified. This method was then subjected to accuracy, linearity, sensitivity and reproducibility according to ICH guidelines to ensure and confirm its validity. Results: The method was found to be obeying Beer’s law in the range of 10-50 µg/ml and 5-25 µg/ml for metoprolol succinate and ramipril, respectively. The % recoveries were observed between the range of 99.2-100.2 for metoprolol succinate and 99.57-99.86 for ramipril. The intra-day and inter-day results showed reproducibility. Conclusion: It can be concluded that the developed third-order UV derivative spectroscopic method for the simultaneous determination of metoprolol succinate and ramiprilcan be recommended for routine quantitative analysis.