Optimal approaches and criteria to treat-and-extend regimen implementation for Neovascular age-related macular degeneration: experts consensus in Taiwan

The management of neovascular age-related macular degeneration (nAMD) has taken a major stride forward with the advent of anti-VEGF agents. The treat-and-extend (T&E) approach is a refined management strategy, tailoring to the individual patient’s disease course and treatment outcome. To provide guidance to implementing anti-VEGF T&E regimens for nAMD in resource-limited health care systems, an advisory board was held to discuss and generate expert consensus, based on local and international guidelines, current evidence, as well as local experience and reimbursement policies. In the experts’ opinion, treatment of nAMD should aim to maximize and maintain visual acuity benefits while minimizing treatment burden. Based on current evidence, treatment could be initiated with 3 consecutive monthly injections. After the initial period, treatment interval may be extended by 2 or 4 weeks each time for the qualified patients (i.e. no BCVA loss ≥5 ETDRS letters and dry retina), and a maximum interval of 16 weeks is permitted. For patients meeting the shortening criteria (i.e. any increased fluid with BCVA loss ≥5 ETDRS letters, or presence of new macular hemorrhage or new neovascularization), the treatment interval should be reduced by 2 or 4 weeks each time, with a minimal interval of 4 weeks. Discontinuation of anti-VEGF may be considered for those who have received 2–3 consecutive injections spaced 16 weeks apart and present with stable disease. For these individuals, regular monitoring (e.g. 3–4 months) is recommended and monthly injections should be reinstated upon signs of disease recurrence.

The financial and prudential performance of Chinese banks and Fintech lenders in the era of digitalization

The years 2013 to 2019 marked an explosion in Fintech in China. We analyze the financial and prudential performance of 40 exchange-traded banks and 25 listed Fintech lenders in China during this watershed period. Among other things, traditional banks experienced rising operating costs, declining profit margins and softening loan quality. Consistent with a process of adaptation, traditional bank performance stabilized in the latter part of the study period (2018-19) after an initial period of decline. Study findings also highlight rising business and regulatory costs for Fintech providers over the course of the study frame. A marked deterioration in online lenders’ Special Mention and Non-Performing Loan (SML & NPL) positions arose during the period. Within the traditional bank group, smaller entities with fewer growth options and greater foreign ownership fared worst in prudential terms. Traditional banks’ financial and prudential performance also declines with time since IPO. Relative to joint stock commercial, city and rural banks, state-owned lenders registered more resilient performance, especially in relation to asset quality. In a final area, we construct a categorical Fintech proficiency variable for China's established banks. Our preliminary evidence suggests such proficiencies help stabilize SML and NPL rates and support financial returns. Overall, we offer major contribution to the banking literature by analyzing the financial and prudential performance of both incumbent and emerging lenders in one of the world’s most dynamic Fintech settings.

Russian Foreign Policy

Russian foreign policy has undergone substantial shifts in the post–Cold War period. Scholarly attention toward the topic has also experienced ebbs and flows as the breakup of the Soviet Union drastically decreased general interest toward a newly emerged Russia. The initial period of Russian foreign policy in the early 1990s was to a large degree a continuation of Soviet foreign policy, with its focus on cooperative relations with the West. This, in turn, combined with the general weakness of the Russian state, resulted in the relative disregard of other foreign policy directions. The deepening domestic power struggle led to a growing opposition toward the pro-Western course and paved the way for a number of domestic players to influence Russia’s foreign policy course. Vladimir Putin’s arrival to power in 2000 and the domestic changes he introduced freed foreign policy from most of its domestic constraints, at least temporarily. During his first presidential term (2000–2004), Russian foreign policy oscillated between competition with the West (the United States in particular) and attempts to integrate Russia as the West’s equal partner. The consolidation of the regime, which accelerated in Putin’s second presidential term (2004–2008), left its mark on foreign policy. Russia’s engagement with the external world underwent substantial changes, which turned out to be durable for the next decade and a half. Material resurgence, the strengthening of the state, and the domestic political consolidation fueled Russia’s assertiveness in international politics. These processes culminated in Putin’s 2007 Munich speech and the 2008 war with Georgia. The following period of the so-called tandemocracy (2008–2012), with Putin becoming prime minister and Dmitri Medvedev serving as president, led to a partial warming in relations with the West, though Russia continued its assertive policy. Russia also deepened its cooperation with a rising China. Putin’s return to power in 2012 initiated the conservative-nationalist turn in domestic politics, which was reflected in foreign policy. Russia increasingly positioned itself not only as a geopolitical challenger to the West, but also a normative one. The annexation of Crimea (2014), followed by the military intervention in Syria (2015), opened a new phase in Russian foreign policy. Moscow became bolder in using military force abroad and enlarged its presence in such regions as sub-Saharan Africa. The explanations of change and continuity in Russian foreign policy can be grouped in several camps, with scholars emphasizing power politics and external constraints, domestic politics, and the role of ideas and identity. The emerging trend is the growing popularity of pluralist explanations of Russian foreign policy.

The Rise in Norovirus-Related Acute Gastroenteritis During the Fight Against the COVID-19 Pandemic in Southern China

Background: There has been a significant decline in the morbidity of almost all infectious diseases during the COVID-19 pandemic. However, while the incidence of norovirus-related acute gastroenteritis declined in Guangzhou, China during the initial period of the pandemic, incidence increased significantly once the new school year began in September 2020.Methods: Norovirus-related acute gastroenteritis clusters and outbreaks were assessed in Guangzhou from 2015 to 2020. Medians and interquartile ranges were compared between groups using the Mann–Whitney U-test, and attack rates were calculated.Results: While 78,579 cases of infectious diarrhea were reported from 2015 to 2019, with an average of 15,716 cases per year, only 12,065 cases of infectious diarrhea were reported in 2020. The numbers of sporadic cases and outbreaks reported from January to August 2020 were lower than the average numbers reported during the same time period each year from 2015 to 2019 but began to increase in September 2020. The number of cases in each reported cluster ranged from 10 to 70 in 2020, with a total of 1,280 cases and an average attack rate of 5.85%. The median number of reported cases, the cumulative number of cases, and the attack rate were higher than the average number reported each year from 2015 to 2019. The intervention time in 2020 was also higher than the average intervention time reported during 2015–2019. The main norovirus genotypes circulating in Guangzhou during 2015–2020 included genogroup 2 type 2 (GII.2) (n = 79, 26.69%), GII.17 (n = 36, 12.16%), GII.3 (n = 27, 9.12%), GII.6 (n = 8, 2.7%), GII.4 Sydney_2012 (n = 7, 2.36%), and GII.4 (n = 6, 2.03%).Conclusions: Our findings illustrate the importance of maintaining epidemiological surveillance for viral gastroenteritis during the COVID-19 pandemic. Local disease prevention and control institutions need to devote sufficient human resources to control norovirus clusters.

Staying Physically Active Is Associated with Better Mental Health and Sleep Health Outcomes during the Initial Period of COVID-19 Induced Nation-Wide Lockdown in Jordan

Jordan, a Middle Eastern country, initially responded to an outbreak of COVID-19 cases within its own borders by imposing a 7-week strict lockdown and closure of international and domestic travel. Such measures drastically influenced lifestyle behaviors of the population. This study aimed to investigate the prevalence of physical activity, and its association with mental and sleep health outcomes among Jordanians during a period of COVID-19 induced lockdown. Validated questionnaires were administered using a web-based platform to evaluate moderate-to-vigorous physical activity (MVPA), anxiety and depressive symptoms, sleep health, and sociodemographic characteristics. A modified Poisson regression model with robust error variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Compared to participants who met the guidelines, those who did not had significantly higher prevalence of moderate or severe anxiety symptoms than that of minimal or mild anxiety symptoms and increased depressive symptoms. Insufficient MVPA was associated with higher prevalence of poor sleep quality, short sleep duration (<7 h) and sleep problems. Overall, sufficient MVPA was associated with better mental and sleep health during the COVID-19 induced nation-wide lockdown in Jordan. While further research is necessary, promoting physical activity during the lockdown could potentially improve mental and sleep health outcomes among the population.

Edukasi Kesehatan Reproduksi Remaja Di Karangtaruna Pendowohardjo

Adolescence is the initial period of maturity of the reproductive organs in humans or the so-calledpuberty. Based on previous preliminary studies, adolescents prefer sources of reproductive health informationobtained from peers and parents, but if this is not given an explanation from health workers directly it will causedifferent perceptions from each teenager which can cause gaps. Based on the preliminary study, researchers areinterested in doing community service with the title "Adolescent Reproductive Health Education in KarangtarunaPendowohardjo". The purpose of this research is to increase the knowledge of adolescents about the importanceof reproductive health from a physical and psychological perspective. Adolescent Reproductive Health EducationActivities at Karangtaruna Pendowohardjo were carried out using counseling and demonstration methods, themedia used using teaching aids. The target audience in this community service is Youth, especially YouthOrganizations in Pendowohardjo Sewon Bantul with a target number of 48 Youth Youth Organizations. The resultsof this research are that adolescents gain knowledge and skills regarding Reproductive Health through counselingand demonstrations.

New features of the pulsar B0950+08 radiation at the frequency of 111 MHz

Results of long time observations of the pulsar B0950+08 are given. These observations were carried out at the LPA radio telescope at the frequency of 111 MHz from January of 2016 to May of 2019 (450 days). A strong variability in emission of this pulsar has been detected with changes of signal to noise ratios hundreds of times. Part of long-time flux density variability can be explained by the refractive scintillations in the interstellar medium. The existence of radiation between the interpulse (IP) and main pulse (MP) was confirmed. It was more powerful than at high frequencies. We detected the unusual interpulse and precursor (Pr) radiation on August 1, 2017. On the base of strong 65 interpulses we found the correlations between energies of IP and Pr and between the phase of IP and the distance Pr-IP. It is shown that the observed peculiarities of this pulsar can be explained in the frame of the aligned rotator model. We estimated distances of radiation levels from the center of the neutron star. The calculated value of the initial period of 0.2 sec means that not all pulsars are born with millisecond periods. The large age of the pulsar (6.8 millions of years) and the small angle between its magnetic moment and the rotation axis (less than 20°) confirm the suggestion on the pulsar evolution to an alignment.

Extreme sleep fragmentation for 11 consecutive days and nights does not significantly alter total sleep time, and sleep stage distribution, during the continuous alpine downhill skiing world record

Introduction: Extreme levels of sleep deprivation, fragmentation and management, are major problems in many sportive disciplines, ultramarathons, polar or extreme altitude expeditions, and in space operations. Material and methods: Polysomnographic (PSG) data was continuously recorded (total sleep time and sleep stage distribution) in a 34-year-old male whilst performing the new world record in long-term downhill skiing. He napped only during the short ski lift rides for 11 days and nights. Results: After an initial period of complete sleep deprivation for 24 hours, total sleep time and the total times of non-REM and REM achieved during the lift rides returned to standard values on the second day. PSG data revealed an average sleep time per 24 hours of 6 hours and 6 minutes. During daylight sleep was rarely registered. The subject experienced only two minor falls without injury and immediately resumed skiing. Conclusion: In a healthy, trained, elite male athlete, sleep fragmentation over 11 consecutive days did not significantly impair the sleep, motor or cognitive skills required to perform a continuous downhill skiing world record after an initial adaptation phase.

Features and patterns of changes in neurochemical parameters at different stages of chronic mercury intoxication

Introduction. At present, the features of the clinical picture and pathogenesis of the formation and progression of chronic intoxication under the influence of mercury remain insufficiently studied. Purpose. To study the features and patterns of changes in the neurotransmitters and neurotrophic factors concentration at different stages of chronic mercury intoxication (CMI). Materials and methods. A cohort examination of 69 workers (group 1) exposed to mercury, 18 individuals in the initial period of CMI (group 2), and 55 patients in the long-term period (group 3) were carried out. The content of neurotransmitters and neurotrophic factors was determined by enzyme immunoassay. The statistical processing included Wilcoxon, Kruskal-Wallis and Mann-Whitney tests. Results. Higher levels of histamine were found in group 2, low levels of metanephrine in group 1, and normetanephrine in group 3. An increase in the BDNF concentration was revealed in group 2 compared with groups 1 and 3. The content of neurotrophin-3 in group 3 was statistically significantly lower than in group 2. Conclusion. The general pattern for all stages is an increase in the norepinephrine and CNTF concentration. Mercury neurointoxication at all stages is characterized by high serotonin levels. A distinctive feature for trained workers is a compensatory increase in the normetanephrine level and a low BDNF and NT-3. For the initial period of CMI, an increase in the histamine, BDNF and NT-3 content is characteristic. The long-term period is characterized by an imbalance in the concentration of the studied neurotransmitters and neurotrophic factors.

Organization of Medical Care for Prisoners of Tobolsk Prison Castle: End of XVIII — First Half of XIX Century

The article examines the initial period of the formation of penitentiary medicine on the example of the prison hospital of the Tobolsk prison castle (ostrog). The article is the first work on the history of penitentiary medicine in the Tobolsk province. The study was based on a wide range of sources, the most significant are documents from central and regional archives, introduced into scientific circulation for the first time. In the first half of the XIX century. The legal framework of penitentiary medicine is being formed, the execution of legislative and subordinate acts can be traced in the activities of the prison administration, its interaction with the West Siberian Governor-General, civil governors, and state institutions. Attention is drawn to the peculiarities of the organization of medical care for prisoners. The development of the hospital’s material base depended not only on the amount of state funds allocated, but to a greater extent on the contributions of the charitable foundation of the provincial prison trust committee, as well as private charity. The management of the hospital was carried out by doctors of the civil medical service, only in 1854, by the decision of the Governing Senate, the position of a doctor was introduced into the prison staff. The causes of morbidity and mortality of prisoners are analyzed, the sacrificial feat of prison doctors during the cholera epidemic of 1848 is noted.