This case report describes Shushkakshipaka (Non-Sjögren's Aqueous Deficient Dry Eye - Non-Sjögren's ADDE) in a patient unfit for cataract surgery due to compromised ocular surface integrity. A 73-year-old woman presented with ocular irritation, foreign body sensation, and blurred distant vision for three months. She had a six-year history of type II diabetes mellitus and hypertension, controlled. Evaluation revealed Grade 2 Nuclear Sclerotic cataract (NS) and Posterior Subcapsular cataract (PSC) (Left > Right) with Punctate Keratopathy, making immediate bilateral cataract surgery unsuitable. Schirmer's test I showed right eye <1 mm and left eye <1 mm, and tear break-up time (TBUT) was right eye (4 s) and left eye (6 s). She was diagnosed with moderate-to-severe non-Sjögren's ADDE and cataract. During ophthalmic evaluation, the patient was diagnosed with punctate keratopathy and dry eye symptoms. She was prescribed artificial tears and omega-3 fatty acid supplements. Cataract surgery was deferred, as the patient was unfit for surgery. Owing to inconsistent treatment adherence, conditions showed minimal improvement at the time of presentation to the Ayurveda hospital. She was diagnosed as Vata-Pitta Pradhana Shushkakshipaka (predominance of Vata and Pitta Doshas; in Ayurveda, Vata, Pitta and Kapha are collectively called Tridosha, the three regulatory functional factors of the body). Treatment had three phases. The first focused on systemic intervention, with Deepana (metabolism-enhancing) and Pachana (digesting), followed by Mrdu Shodhana (mild therapeutic bio-cleansing) and Marsha Nasya (high-dose errhine therapy). Following systemic cleansing and attainment of Niramavastha (a state free from accumulated metabolites achieved by either therapeutic measures or the effect of time), the second phase focused on local ocular management through Netra Kriyakalpa (localised ocular therapeutic procedures). The third involved follow-up and maintenance therapy for long-term ocular stability. Oral Ayurvedic polyherbal formulations, dietary modifications, and lifestyle changes were administered throughout the two-month Ayurveda treatment period. After two months, parameters improved, with Schirmer's values of right eye 5 mm and left eye 7 mm and TBUT of right eye 8 s and left eye 14 s, making her fit for cataract surgery. Within the Ayurvedic framework, these changes may be viewed as consistent with improved Agni (digestive/metabolic factors) and supportive of subsequent Kriyakalpa; links with ocular surface integrity or the gut-eye connection remain hypothetical. This case warrants further investigation in selected cataract surgery candidates with severe, non-responsive dry eye.

Background: Sjögren's disease (SjD) causes severe ocular surface desiccation, progressing from aqueous-deficient dry eye (ADDE) to vision-threatening corneal ulceration, stromal melting, and perforation. Recent consensus guidelines and therapeutic innovations have transformed ophthalmic diagnosis and management. Methods: A comprehensive narrative overview of PubMed and Google Scholar (July 2016-July2026) was conducted to evaluate updates in SjD diagnostics, ocular surface mechanics, topical/biological pharmacotherapies, neurostimulation, and meibomian gland interventions. Results: Diagnostic parameters have shifted towards non-invasive salivary metabolomics (lactate, alanine, malate), regulatory non-coding RNAs (H19 ICR hypomethylation), tear point-of-care MMP-9 testing, and salivary gland ultrasonography (SGUS). Large-diameter scleral lenses provide continuous corneal fluid shielding, though edge design and surface modification are required to mitigate midday fogging. Additionally, emerging therapeutics are shifting care from palliative lubrication to targeted secretomotor and biological reactivation, including cold thermosensory TRPM8 agonists (acoltremon 0.003%), water-free formulations (0.1% cyclosporine, perfluorohexyloctane), reactive aldehyde species (RASP) modulators (reproxalap), syndecan-1 receptor agonists (Lacripep), systemic B-cell depleting biotherapy (ianalumab), trigeminal neurostimulation, and combined intense pulsed light with meibomian gland expression (IPL + MGX). Conclusions: Ophthalmic SjD management has evolved from palliative lubrication toward a stepwise, mechanism-directed paradigm integrating novel diagnostics, secretomotor stimulation, mechanical protection, and biologic disease modification; dedicated SjD-specific trials remain essential to validate these emerging interventions.

Aqueous-deficient dry eye disease (ADDE) frequently results from structural and functional impairment of the lacrimal gland. Regenerative approaches require biomaterials that replicate the extracellular matrix (ECM) composition and biomechanical properties of native lacrimal gland tissue. However, quantitative data on the ECM composition and large-strain biomechanics of the human lacrimal gland remain limited. In this study, histological and immunofluorescence-based ECM analyses were combined with large-strain mechanical testing and quantitative enzyme-linked immunosorbent assay (ELISA)-based measurements to characterize the structural and mechanical properties of native human lacrimal gland tissue obtained from elderly donors. Mechanical testing included cyclic compression-tension, stress relaxation, and cyclic torsional shear tests. The lacrimal gland ECM exhibited a heterogeneous architecture dominated by collagen III-rich networks in periacinar regions, collagen IV within basement membranes, and collagen VI surrounding acini and ducts. Mechanical testing demonstrated that lacrimal gland tissue behaves as an ultra-soft viscoelastic material characterized by compression-tension asymmetry, nonlinear stress-stretch behavior, hysteresis, and moderate stress relaxation within the investigated strain range. A hyperelastic one-term Ogden model was used for inverse identification of material parameters describing tissue stiffness and nonlinear mechanical behavior, yielding a shear modulus of 0.21 kPa and a negative nonlinearity parameter during the unconditioned loading cycle. ELISA measurements identified collagen III and VI as the predominant ECM components. These results provide the first integrated characterization of ECM composition and large-strain mechanics in aging human lacrimal gland tissue and establish quantitative reference parameters that may guide the development of biomaterials and engineered scaffolds for lacrimal gland regeneration. STATEMENT OF SIGNIFICANCE: Despite the central role of the lacrimal gland in ocular surface homeostasis, the extracellular matrix (ECM) architecture and biomechanical properties of human lacrimal gland tissue remain poorly characterized. This study provides the first integrated analysis of ECM composition and large-strain mechanical behavior in the human lacrimal gland. The results define the lacrimal gland as an ultra-soft viscoelastic tissue with an ECM predominantly composed of collagens III, IV, and elastic fiber networks. By integrating structural, biochemical, and mechanical analyses, this study establishes quantitative parameters defining the native microenvironment of lacrimal gland cells. These findings establish references for aging lacrimal gland tissue that may guide the design of ECM-mimetic biomaterials and support regenerative strategies for aqueous-deficient dry eye disease.

A profound understanding of the physiology of the lacrimal gland is essential for developing regenerative therapies for aqueous deficient dry eye syndrome (ADDE). This study presents a reproducible, high-throughput method to generate functional spheroids of the lacrimal gland as building blocks for a three-dimensional (3D) in vitro model. Co-culturing primary lacrimal gland epithelial cells (EpC), mesenchymal stromal cells (MSC), and human umbilical vein endothelial cells (HUVEC) in non-adhesive agarose microwells resulted in rapid spheroid formation within 24 h. These spheroids developed a defined spatial organization, with EpC forming an outer sheath, HUVEC adopting a tube-like structure, and MSC interspersed between them. Compared to 2D-cultures, lacrimal gland spheroids exhibited lower viability but enhanced secretory function, as indicated by β-hexosaminidase activity. Embedding of lacrimal gland spheroids in decellularized lacrimal gland hydrogel (dLG-HG) or tissue-unspecific collagen-I improved both viability and secretory activity, with dLG-HG showing superior effects. Embedding led to a reorganization of the cell types so that EpC formed a central lumen resembling an acinar structure. This study demonstrates that combining 3D spheroids with a tissue-specific ECM scaffold creates a robust, physiologically relevant lacrimal gland in vitro model. Such a model provides a valuable platform for elucidating the pathomechanisms of lacrimal gland dysfunction and for screening potential regenerative therapies to restore tear secretion in patients with ADDE.

We present a new database providing spatial data to support plant ecological research and conservation throughout mainland Spain. It integrates high-resolution spatial data of four main categories: (I) plant occurrence data, (II) environmental variables, (III) species distribution models, and (IV) thematic maps for conservation and management. The occurrence dataset includes georeferenced records for 81 tree and 101 shrub native species, and atlas data for 6,456 vascular plants and 1,252 bryophytes. Environmental variables include climatic, edaphic, hydrological, and solar, factors influencing plant distribution. Species distribution models are available for all the trees and shrubs (182 species). Thematic maps include species richness for woody and protected plants, distribution of vegetation types, and forest connectivity. All climatic variables, models, and thematic maps are projected under current and four future climate scenarios (2070-2100). The database is openly available on Zenodo.

Cerebral Palsy (CP) is a prevalent motor disability in children, for which early detection can significantly improve treatment outcomes. While skeleton-based Graph Convolutional Network (GCN) models have shown promise in automatically predicting CP risk from infant videos, their "black-box" nature raises concerns about clinical explainability. To address this, we introduce a perturbation framework tailored for infant movement features and use it to compare two explainable AI (XAI) methods: Class Activation Mapping (CAM) and Gradient-weighted Class Activation Mapping (Grad-CAM). First, we identify significant and non-significant body keypoints in very low and very high risk infant video snippets based on the XAI attribution scores. We then conduct targeted velocity and angular perturbations, both individually and in combination, on these keypoints to assess how the GCN model's risk predictions change. Our results indicate that velocity-driven features of the arms, hips, and legs appear to have a dominant influence on CP risk predictions, while angular perturbations have a more modest impact. Furthermore, CAM and Grad-CAM show partial convergence in their explanations for both low and high CP risk groups. Our findings demonstrate the use of XAI-driven movement analysis for early CP prediction, and offer insights into potential movement-based biomarker discovery that warrant further clinical validation.

Area-based conservation remains the principal strategy for preserving biodiversity, yet current planning approaches inadequately consider two critical uncertainties: future trajectories of socio-environmental drivers of environmental degradation and preferences for alternate conservation objectives. This study demonstrates how spatial conservation prioritization can be integrated with scenario-based simulation modelling to systematically evaluate conservation strategies under these uncertainties. We simulated conservation area expansion strategies (e.g. timing and extent of interventions) in Switzerland (2020-2060) using a comprehensive full-factorial design testing approaches across five scenarios of climate change, land-use change, and conservation priorities, with strategy robustness assessed through impacts on ten ecosystem services (ES) characterized across both space and time. Results revealed substantial variation in ES provision under alternative futures, with pronounced spatial shifts in service delivery. Critically, only limited spatial overlap existed between regions displaying the highest ES robustness and areas prioritized for protection based on current ecological value, demonstrating the inadequacy of planning approaches that ignore future uncertainties. The most consistently robust strategy for securing ES provision involved rapidly expanding conservation areas to 30% coverage (aligned with the Kunming-Montreal Global Biodiversity Framework target), prioritizing small patches in human-dominated landscapes, and employing mixed management combining both preservation and restoration. However, strategy effectiveness varied across different ES and scenarios, indicating that optimal approaches must account for societal preferences regarding trade-offs between services. This research addresses a recognized gap in conservation planning science and provides both methodological guidance for uncertainty-informed planning and specific recommendations for Switzerland's pursuit of the 30x30 target under accelerating environmental change.

Nature's contributions to people (NCP) are essential for human wellbeing, yet most assessments still rely on land-cover indicators that overlook how biodiversity supports these contributions. We propose that species-level data, widely used in biodiversity mapping, can better inform direct NCP prediction through the development of species' contributions to people (SCP). Linking species to NCP through relational SCP databases and combining these with species distribution models and global change scenarios can yield spatial NCP predictions that can be better rooted in species' ecological characteristics. This approach fosters integrated biodiversity-NCP planning and supports conservation goals. We outline key methodological steps, identify research needs, and encourage collective progress to advance SCP knowledge for a transformative shift in how we assess and manage NCP.