The utility of contact lens-assisted corneal cross-linking (CACXL) in progressive keratoconus patients with thin corneas

Purpose To evaluate efficacy and safety of contact lens-assisted corneal cross-linking (CACXL) among progressive keratoconus patients with thin corneas. Setting Private eye hospital Design Cross-sectional study Methods Thirty-six eyes of 36 consecutive patients with progressive keratoconus and thinnest corneal thickness of 380–400 µm after epithelium removal were included. CACXL was performed based on use of a dextran-free isotonic (>0.1%) riboflavin solution with hydroxypropyl methylcellulose (HPMC, 1.1%) after epithelial removal and placement of a riboflavin-soaked contact lens without an ultraviolet filter on the cornea and ultraviolet irradiance. Data on best distance corrected (CDVA) and uncorrected (UDVA) visual acuity, manifest sphere (D), manifest cylinder (D), K1 (D), K2 (D), mean keratometry (D) and Kmax (D) values, endothelial cell count and mean depth of demarcation line were recorded preoperatively and at the postoperative 1-year Results Post-operative 1-year data revealed significant increases in UDVA (0.23 ± 0.15 vs. 0.17 ± 0.13 D, p < 0.001) and CDVA (0.44 ± 0.18 vs. 0.36 ± 0.17 D, p < 0.001) values and a significant reduction in the mean Kmax (from 56 ± 3.3D to 55 ± 3.2 D, p < 0.001), K2 (from 49.7 ± 3.2 D to 49.52 ± 3.11 D, p = 0.049), manifest sphere (from −1.93 ± 2.21 D to −1.55 ± 2.02 D, p = 0.001) and manifest cylinder (from −2.83 ± 1.67 D to −2.39 ± 1.36 D, p < 0.001) values along with a similar endothelial cell count. The mean depth of demarcation line was mean 230 (SD17.05, range 200 to 262) at postoperative 1-month. Conclusions Our findings indicate favourable 1-year postoperative outcome of CACXL in progressive keratoconus patients with thin cornea in terms of improved visual acuity and keratectasia status as well as endothelial safety.

The Distinction Between Law qnd Morality in Legal Positivism: Socio-Philosophical Dimension

The article deals with the main conceptions of the relationship between law and morality in legal positivism. The research relevance is caused by legal positivism which is influential and dynamically developing in both domestic and foreign science. The purpose of the study is to consider the features that describe the positivist approach to the differentiation between legal and moral regulation in the context of the dialectical interaction of individual and social principles in society. It presupposes the establishment of both general and special in legal positivism’s views regarding the interaction of these social regulators. Special attention is paid to the consideration of not only positive aspects of the proposed concepts but also the difficulty that arise within legal positivism. The research methodology is based on the dialectical method, the method of analysis, comparative and historical methods. These methods allow us to analyze in a historical perspective the development of views on the relationship between law and morality in legal positivism, to analyze specific features in the visions of the most influential philosophers of this doctrine, to identify common ideas that unite the philosophers considered. As a result of the conducted research, it is argued that legal positivism is characterized by the correlation of law and morality as sovereign socio-normative systems that closely interact in the structure of society, but do not have the necessary connection that mutually determines their content. The sovereign nature of legal and moral regulation implies the search for models of their interaction. It is important to determine the demarcation line of the spheres and limits of each social regulator. As a result, it is concluded that there are three possible models of this interaction, and the consequences of their implementation in society. In particular, it is determined that law and morality within the structure of society can be either indifferent to each other or have identical content realized through both regulation forms or be in relation to a contradiction adducing to a social conflict.

Heritable human genome editing is ‘currently not permitted’, but it is no longer ‘prohibited’: so says the ISSCR

The Guidelines for Stem Cell Research and Clinical Translation, recently issued by the International Society for Stem Cell Research (ISSCR), include a number of substantive revisions. Significant changes include: (1) the bifurcation of ‘Category 3 Prohibited research activities’ in the 2016 Guidelines into ‘Category 3A Research activities currently not permitted’ and ‘Category 3B Prohibited research activities’ in the 2021 guidelines and (2) the move of heritable human genome editing research out of the ‘prohibited’ category and into the ‘currently not permitted’ category. These changes are noteworthy because of the absence of a clear demarcation line between the two categories insofar as, by definition, that which is ‘prohibited’ is ‘currently not permitted’, and vice versa. Permanence is not part of the definition of ‘prohibition’. In principle, a prohibition can be rescinded at any time. This begs the question ‘Why make a policy change that has no apparent practical effect?’ One hypothesis is that the recategorisation of specific ‘prohibited’ research activities as ‘currently not permitted’ is meant to seed intuitions about which prohibited research activities should ‘soon’ be permitted subject to specialised scientific and ethics review and approval.

The Principle of Equal Rights in the Context of the Covid-19 Pandemic as a Factor Influencing the Sustainable Development of Ukraine

The article discusses the implementation of the principle of equal rights in the context of the COVID-19 pandemic in Ukraine. The peculiarities of applying this principle in relation to human rights and the rights of companies have been investigated. The article analyzes the state of compliance with the principle of equal rights in the diagnostics (testing) and treatment of different categories of patients in territories with different legal regimes. The study revealed de jure violations of equality in the normative definition of categories of citizens entitled to free testing, as well as de facto discrimination of citizens based on their place of residence when they cross the demarcation line between the controlled and uncontrolled territory of Ukraine. The state of ensuring equal economic rights of companies and an acceptable level of competition in the event of quarantine measures have been investigated. The general parameters of the relationship between the state and business and the limits of state intervention in entrepreneurial activity in the context of the pandemic have been determined. Characteristic features of discrimination against certain categories of the population and companies due to the establishment of quarantine have been revealed.

«It’s Only a Joke!» What is an Offensive Joke among Adolescents?

All of us cannot imagine adolescents' daily communication without humor and making fun of each other. Jokes can help strengthen friendships, smooth out the awkwardness, or maintain status in the group, but sometimes jokes become a means of humiliation and bullying. Despite many studies, determining the demarcation line between comic and aggressive words is quite challenging. This border remains uncertain. This paper aims to identify characteristics in which a joke becomes offensive and can develop into bullying.The article presents the results of a qualitative analysis of 72 interviews with middle and high school students. We identify three situations when a joke is perceived as aggression. Firstly, If a fun statement emphasizes the differences between the adolescent and the group, it makes one feel "inferior" compared to peers. Secondly, the difference in statuses between a speaker and an interlocutor exists, leading to no reply to a joke using a joke. In that case, the joke ceases to be a part of the dialogue and becomes a means of reinforcing inequality. Thirdly, if not all participants are aware of "the rules of the game," they cannot understand the context of reading the joke. That means the statement is interpreted in different ways by the parties, leading to resentment. The findings can help design effective bullying prevention measures in the school environment.

Effectiveness of Sanctions in International Politics

Even though IR literature has accumulated a large amount of empirical data and knowledge in sanctions policy effectiveness, this problem remains contested: IR has failed yet to reach a consensus and elaborate the sanctions theory. The article reviews the variety of approaches to evaluating the effectiveness of the sanctions policy and explains why researchers have come to conflicting and mutually exclusive conclusions about the impact of various factors and conditions on the outcome of sanctions pressure. It argues that the disagreement is primarily rooted in different approaches to conceptualizing basic concepts – “sanctions” and “effectiveness”. This disagreement results in coding the same cases as successful and unsuccessful and presents an obstacle to obtaining similar results using statistical analysis. The main demarcation line goes between the realist and liberal understandings of sanctions as a foreign policy tool. This is reflected in the ongoing disputes between those who adhere to the idea of inflicting severe economic damage on the target country and supporters of targeted sanctions; between those who promote multilateral sanctions as capable of causing economic effects, or try to identify weaknesses of ad hoc coalitions, or see the only way to get the effect of sanctions in support from international organizations; between those who focus their research on the target country and those who are interested in pressure on the allies.

Durkheim and the Philosophy of His Time

Durkheim was trained as a philosopher, taught philosophy, and never left the philosophical field. He started his career with standard philosophical equipment but also with a growing disenchantment about the eclectic and metaphysical mainstream that had survived the establishment of the Third Republic. Philosophy was too general to deal with the growth of scientific invention. Durkheim pursued simultaneously two goals: first, he established a firm demarcation line between philosophy and sociology, guaranteeing the full autonomy of the latter. Second, he benefited from his full membership in the philosophical institution. Rationalism remained his lifetime affiliation. It was largely based on a French version of neo-Kantianism. In the last part of his life, he engaged in a strong discussion with American pragmatism, as a way of clarifying his grasp of social practice.

Critical Analysis of Corneal Cross-linking (Part-I): Formulas for Efficacy, Safety Dose, Minimum Thickness, Demarcation Line Depth and the Role of Oxygen

Purpose: To update and derive formulas for the efficacy and kinetics of corneal collagen crosslinking (CXL) including both type-I and oxygen-mediated type-II mechanisms, the role of oxygen, the initiator regeneration, safety dose, minimum corneal thickness and demarcation line depth. Study Design: Modeling the kinetics of CXL in UV light and using riboflavin as the photosensitizer. Place and Duration of Study: Taipei, Taiwan, between June, 2021 and July, 2021. Methodology: Coupled kinetic equations are derived under the quasi-steady state condition for the 2-pathway mechanisms of CXL. For type-I CXL, the riboflavin (RF) triplet state [T] may interact directly with the stroma collagen substrate [A] to form radical (R) and regenerate initiator. For type-II process, [T] interacts with oxygen to form a singlet oxygen [1O2]. Both reactive radical (R) and [1O2], can interact with the substrate [A]) for crosslinking. Based on a safety dose and a threshold dose, formulas for the minimum corneal thickness and demarcation line depth (DLD) are derived. Results: Our updated theory/modeling showed that oxygen plays a limited and transient role in the process, in consistent with that of Kamave. In contrary, Kling et al believed that type-II is the predominant mechanism, which however conflicting with the epi-on CXL results. For both type-I and type-II, a transient state conversion (crosslink) efficacy in an increasing function of light intensity (or dose), whereas, its steady state efficacy is a deceasing function of light intensity. RF depletion in type-I is compensated by the RF regeneration term (RGE) which is a decreasing function of oxygen. For the case of perfect regeneration case (or when oxygen=0), RF is a constant due to the catalytic cycle. Unlike the conventional Dresden rule of 400 um thickness, thin cornea CXL is still safe as far as the dose is under a threshold dose (E*), based on our minimum thickness formula (Z*). Our formula for thin cornea is also clinically shown by Hafez et al for ultra thin (214 nm) CXL. Conclusion: For both type-I and type-II, the transient state conversion (crosslink) efficacy in an increasing function of light intensity (or dose), whereas, its steady state efficacy is a deceasing function of light intensity. CXL for ultra thin corneas are still safe, as far as it is under a threshold dose (E*), based on our minimum thickness (Z*) formula, which has a similar tend as that of demarcation line depth (Z').

How-I-do-it: laparoscopic left medial sectionectomy utilizing a cranial approach to the middle hepatic vein and Laennec’s capsule

Background Laparoscopic anatomic liver resection is technically demanding, given the need to safely isolate the Glissonean pedicles and expose the hepatic veins (HVs) on the liver parenchyma cut surface. Laennec’s capsule is observed around the Glissonean pedicles and root of the HVs. However, its existence, particularly on the peripheral side of the HVs, remains controversial. Herein, we describe Laennec’s capsule-related histopathological findings around the HVs and a safe laparoscopic left medial sectionectomy utilizing Laennec’s capsule. Methods The extrahepatic Glissonean approach was performed by connecting Gates II and III, in accordance with Sugioka’s Gate theory. Liver parenchymal transection commenced along the demarcation line, which is between the medial and lateral sections, and the G4 was dissected during transection. Subsequently, via the outer-Laennec approach, the middle hepatic vein (MHV) was exposed from the root side in cranial view, while Laennec’s capsule was preserved. Parenchymal transection was completed while connecting the MHV with the demarcation line. We obtained the membrane surrounding the HVs and performed histopathological examinations. Results Six patients underwent laparoscopic left medial sectionectomy from February 2012 to November 2020. There were no cases involving complications (Clavien–Dindo classification; grade II or higher), open-surgery conversion, transfusion, or surgery-related death. The histopathological findings showed Laennec’s capsule surrounding both the trunk of the major HVs and the peripheral side of the HVs. Conclusions A cranial approach to the major HVs utilizing Laennec’s capsule is a feasible and advantageous procedure for laparoscopic left medial sectionectomy. We propose that Laennec’s capsule surrounds the entire length of the HVs.