An anonymous reader quotes a report from Ars Technica: Earlier this year, news broke of the first experimental xenotransplantation: A human patient with heart disease received a heart from a pig that had been genetically engineered to avoid rejection. While initially successful, the experiment ended two months later when the transplant failed, leading to the death of the patient. At the time, the team didn't disclose any details regarding what went wrong. But this week saw the publication of a research paper that goes through everything that happened to prepare for the transplant and the weeks following. Critically, this includes the eventual failure of the transplant, which was triggered by the death of many of the muscle cells in the transplanted heart. But the reason for that death isn't clear, and the typical signs of rejection by the immune system weren't present. So, we're going to have to wait a while to understand what went wrong.
[...]
After death, the team performed an autopsy on the transplanted heart. They found that it had nearly doubled in weight, largely because of fluid (and some red blood cells) leaking out of blood vessels in the absence of clotting. There was significant death of heart muscle cells, but that was scattered across the heart, rather than being a general phenomenon. Critically, most of the indications of a strong immune rejection were missing. The presence of an apparent pig cytomegalovirus was worrying, but the researchers indicate there's some question about whether the tests that picked it up might have been recognizing a closely related human virus -- one that's often associated with organ transplant problems.

So, for now, it's not clear what happened with this transplant or what the significance of the apparent viral infection is. Obviously, the team has lots of material to work with to try to figure out what went on, and there's a long, long list of potential experiments to do with it. And there are also additional xenotransplant trials in the works, so it may not be long before we have a better sense of whether this was something specific to this transplant or a general risk of xenotransplantation.

Long-time Slashdot reader Mr_Blank shares a report from Gerona: China has enacted new regulation for the live-streaming industry, listing 31 prohibited conducts and raising the bar for influencers to speak out on specific topics, in the government's latest effort to regulate the booming digital economy. The 18-point guideline, released Wednesday by the National Radio and Television Administration and the Department of Culture and Tourism, requires influencers to have relevant qualifications to cover some subjects, including law, finance, medicine and education discuss, although the authorities have not specified the necessary qualifications.

The 31 prohibited conducts during live-streaming sessions include posting content that weakens or distorts the leadership of the Chinese Communist Party, the socialist system, or the country's reform and opening-up. Other prohibited behaviors include using deepfake technologies to manipulate the images of party or state leaders and intentionally 'building up' sensitive issues and attracting public attention. Live streamers are also prohibited from showing an extravagant lifestyle, such as showing luxury products and cash, the policy said. This article originally appeared in the South China Morning Post.

Google is still useful for many, but the harder question is why its results feel more sterile than they did five years ago. From a report: SEO expert Marie Haynes's theory is that this is the result of Google trying to crack down on misinformation and low-quality content -- especially around consequential search topics. In 2017, the company started talking publicly about a Search initiative called EAT, which stands for "expertise, authoritativeness, and trustworthiness." The company has rolled out numerous quality rater guidelines, which help judge content to determine authenticity. One such effort, titled Your Money or Your Life, applies rigorous standards to any pages that show up when users search for medical or financial information.

"Take crypto," Haynes explained. "It's an area with a lot of fraud, so unless a site has a big presence around the web and Google gets the sense they're known for expertise on that topic, it'll be difficult to get them to rank." What this means, though, is that Google's results on any topic deemed sensitive enough will likely be from established sources. Medical queries are far more likely to return WebMD or Mayo Clinic pages, instead of personal testimonials. This, Haynes said, is especially challenging for people looking for homeopathic or alternative-medicine remedies.

There's a strange irony to all of this. For years, researchers, technologists, politicians, and journalists have agonized and cautioned against the wildness of the internet and its penchant for amplifying conspiracy theories, divisive subject matter, and flat-out false information. Many people, myself included, have argued for platforms to surface quality, authoritative information above all else, even at the expense of profit. And it's possible that Google has, in some sense, listened (albeit after far too much inaction) and, maybe, partly succeeded in showing higher-quality results in a number of contentious categories. But instead of ushering in an era of perfect information, the changes might be behind the complainers' sense that Google Search has stopped delivering interesting results.

The Guardian reports: Scientists have successfully developed a revolutionary cancer treatment that lights up and wipes out microscopic cancer cells, in a breakthrough that could enable surgeons to more effectively target and destroy the disease in patients.

A European team of engineers, physicists, neurosurgeons, biologists and immunologists from the UK, Poland and Sweden joined forces to design the new form of photoimmunotherapy. Experts believe it is destined to become the world's fifth major cancer treatment after surgery, chemotherapy, radiotherapy and immunotherapy. The light-activated therapy forces cancer cells to glow in the dark, helping surgeons remove more of the tumours compared with existing techniques — and then kills off remaining cells within minutes once the surgery is complete. In a world-first trial in mice with glioblastoma, one of the most common and aggressive types of brain cancer, scans revealed the novel treatment lit up even the tiniest cancer cells to help surgeons remove them — and then wiped out those left over. Trials of the new form of photoimmunotherapy, led by the Institute of Cancer Research, London, also showed the treatment triggered an immune response that could prime the immune system to target cancer cells in future, suggesting it could prevent glioblastoma coming back after surgery....

The therapy combines a special fluorescent dye with a cancer-targeting compound. In the trial in mice, the combination was shown to dramatically improve the visibility of cancer cells during surgery and, when later activated by near-infrared light, to trigger an anti-tumour effect.

Chinese bank depositors planning a protest about their frozen funds saw their health code mysteriously turn red and were stopped from traveling to the site of a rally, confirming fears that China's vast COVID-tracking system could be weaponized as a powerful tool to stifle dissent. Motherboard reports: A red health code designated the would-be protesters as suspected or confirmed COVID-19 patients, limiting their movement and access to public transportation. Their rallies in the central Henan province this week were thwarted as some were forced into quarantine and others detained by police. A 38-year-old software engineer was among hundreds who could not access their savings at four rural banks since mid-April. She had planned to travel from her home in Jiangxi province to Zhengzhou, Henan's capital city, to join a group petition this week to demand her money back. But her health code turned from green to red shortly after she bought a train ticket on Sunday. She said a nucleic test for COVID she took the night before came back negative and her hometown has not reported any infection recently.

"Henan authorities targeted the health code of bank depositors in order to stop us from defending our rights," she told VICE World News, speaking on condition of anonymity to avoid government reprisal. She eventually managed to reach Zhengzhou using her green health code on a different app, but was daunted by the sight of police officers out in force. More than 200 bank depositors from all over the country saw their health codes turned red over the past week, which effectively foiled a planned protest outside the Henan branch of China's banking regulator. Chinese activists and dissidents have reported similar experiences in the past, but the latest crackdown appears to be the most brazen example of how the authorities could exploit the supposed COVID-19 measure for political purposes.

The member countries of the World Trade Organization agreed Friday on a narrow measure aimed at boosting the supplies of Covid-19 vaccines in developing countries, wrapping up a bitter fight over corporate patent rights governing critical medical products during a pandemic. WSJ: The compromise measure on intellectual property rights will make it easier for companies in developing nations such as South Africa to manufacture and export a patented Covid-19 vaccine -- under limited circumstances -- without a consent from the patent holder if they have the approval of their own governments. Meeting for the first time in nearly five years, trade ministers from more than 100 countries also agreed on measures to reduce fisheries subsidies to protect fish stocks and pledged to minimize export restrictions on food items amid shortages triggered by the war in Ukraine. An existing ban on the collection of customs duty on digitally-transmitted products like music and movies was continued, to the relief of U.S. officials who had feared a possible change in the status quo would harm U.S. businesses.

A small NYC-led cancer trial has achieved a result reportedly never before seen - the total remission of cancer in all of its patients. From a report: To be sure, the trial -- led by doctors at Memorial Sloan Kettering and backed by drug maker GlaxoSmithKline -- has only completed treatment of 12 patients, with a specific cancer in its early stages and with a rare mutation as well. But the results, reported Sunday in the New England Journal of Medicine and the New York Times, were still striking enough to prompt multiple physicians to tell the paper they were believed to be unprecedented. One cancer specialist told the Times it was an "unheard-of" result. According to the NEJM paper and the Times report, all 12 patients had rectal cancer that had not spread beyond the local area, and their tumors all exhibited a mutation affecting the ability of cells to repair damage to DNA.

British researchers have developed a biodegradable gel to repair damage caused by a heart attack in a breakthrough that could improve the health of millions of survivors worldwide. The Guardian reports: Now after years of efforts searching for solutions to help the heart repair itself, researchers at the University of Manchester have created a gel that can be injected directly into the beating heart -- effectively working as a scaffold to help injected cells grow new tissue. Until now, when cells have been injected into the heart to reduce the risk of heart failure, only 1% have stayed in place and survived. But the gel can hold them in place as they graft on to the heart.

To prove the technology could work, researchers showed the gel can support growth of normal heart muscle tissue. When they added human cells reprogrammed to become heart muscle cells into the gel, they were able to grow in a dish for three weeks and the cells started to spontaneously beat. Echocardiograms (ultrasounds of the heart) and electrocardiograms (ECGs, which measure the electrical activity of the heart) on mice confirmed the safety of the gel. To gain more knowledge, researchers will test the gel after mice have a heart attack to show they develop new muscle tissue. The study is being presented at the British Cardiovascular Society conference in Manchester.

"In molecular biologist David Sinclair's lab at Harvard Medical School, old mice are growing young again," reports CNN: Using proteins that can turn an adult cell into a stem cell, Sinclair and his team have reset aging cells in mice to earlier versions of themselves. In his team's first breakthrough, published in late 2020, old mice with poor eyesight and damaged retinas could suddenly see again, with vision that at times rivaled their offspring's.

"It's a permanent reset, as far as we can tell, and we think it may be a universal process that could be applied across the body to reset our age," said Sinclair, who has spent the last 20 years studying ways to reverse the ravages of time.

"If we reverse aging, these diseases should not happen. We have the technology today to be able to go into your hundreds without worrying about getting cancer in your 70s, heart disease in your 80s and Alzheimer's in your 90s." Sinclair told an audience at Life Itself, a health and wellness event presented in partnership with CNN.

"This is the world that is coming. It's literally a question of when and for most of us, it's going to happen in our lifetimes," Sinclair told the audience.... Sinclair said his lab has reversed aging in the muscles and brains of mice and is now working on rejuvenating a mouse's entire body.
The article points out that he's building on research by Japan's Dr. Shinya Yamanaka (which in 2007 won a Nobel prize).

But one key caveat: "Studies on whether the genetic intervention that revitalized mice will do the same for people are in early stages, Sinclair said. It will be years before human trials are finished, analyzed and, if safe and successful, scaled to the mass needed for a federal stamp of approval."

An anonymous reader quotes a report from the New York Times: A 20-year-old woman who was born with a small and misshapen right ear has received a 3-D printed ear implant made from her own cells, the manufacturer announced on Thursday. Independent experts said that the transplant, part of the first clinical trial of a successful medical application of this technology, was a stunning advance in the field of tissue engineering. The new ear was printed in a shape that precisely matched the woman's left ear, according to 3DBio Therapeutics, a regenerative medicine company based in Queens. The new ear, transplanted in March, will continue to regenerate cartilage tissue, giving it the look and feel of a natural ear, the company said.

The results of the woman's reconstructive surgery were announced by 3DBio in a news release. Citing proprietary concerns, the company has not publicly disclosed the technical details of the process, making it more difficult for outside experts to evaluate. The company said that federal regulators had reviewed the trial design and set strict manufacturing standards, and that the data would be published in a medical journal when the study was complete. The clinical trial, which includes 11 patients, is still ongoing, and it's possible that the transplants could fail or bring unanticipated health complications. But since the cells originated from the patient's own tissue, the new ear is not likely to be rejected by the body, doctors and company officials said.

According to a new study, dogs were able to better detect COVID-19 than PCR antigenic tests in both symptomatic and asymptomatic people. Slashdot Falconhell shares the report via The Guardian: In the study, trained dogs were able to detect Covid in 97% of symptomatic cases and nearly 100% of asymptomatic cases. The study featured 335 participants from Covid screening centers in Paris. Of the participants, 109 were positive with Covid, including 31 who were asymptomatic. The detection dogs, provided by French fire stations and the United Arab Emirates, received three to six weeks of training, depending on if a dog was previously trained for odor detection. The dogs sniffed samples of human sweat placed in an olfaction cone. If a dog detected Covid, it sat down in front of the cone.

Ultimately, the trained dogs were more sensitive to positive cases. Nasal PCR tests were better able to better detect negative cases. In two false positive cases, dogs falsely identified other coronavirus respiratory illness strains that were not Covid. While there have been previous studies on the capability of dogs to detect Covid, this is believed to be the first to compare the accuracy of dogs to antigenic tests. The study has been published in the journal Plos One.

That morning cup of coffee may be linked to a lower risk of dying, researchers from a study published Monday in The Annals of Internal Medicine concluded. From a report: Those who drank 1.5 to 3.5 cups of coffee per day, even with a teaspoon of sugar, were up to 30 percent less likely to die during the study period than those who didn't drink coffee. Those who drank unsweetened coffee were 16 to 21 percent less likely to die during the study period, with those drinking about three cups per day having the lowest risk of death when compared with noncoffee drinkers.

Researchers analyzed coffee consumption data collected from the U.K. Biobank, a large medical database with health information from people across Britain. They analyzed demographic, lifestyle and dietary information collected from more than 170,000 people between the ages of 37 and 73 over a median follow-up period of seven years. The mortality risk remained lower for people who drank both decaffeinated and caffeinated coffee. The data was inconclusive for those who drank coffee with artificial sweeteners. "It's huge. There are very few things that reduce your mortality by 30 percent," said Dr. Christina Wee, an associate professor of medicine at Harvard Medical School and a deputy editor of the scientific journal where the study was published. Dr. Wee edited the study and published a corresponding editorial in the same journal.

Scientists from the University of Michigan have "fabricated a nanoparticle to deliver an inhibitor to brain tumor in mouse models, where the drug successfully turned on the immune system to eliminate the cancer," reports ScienceDaily. "The process also triggered immune memory so that a reintroduced tumor was eliminated -- a sign that this potential new approach could not only treat brain tumors but prevent or delay recurrences." From the report: The small molecule inhibitor AMD3100 was developed to block the action of CXCR12, a cytokine released by the glioma cells that builds up a shield around the immune system, preventing it from firing up against the invading tumor. Researchers showed in mouse models of glioma that AMD3100 prevented CXCR12 from binding with immune-suppressive myeloid cells. By disarming these cells, the immune system remains intact and can attack the tumor cells. But AMD3100 was having trouble getting to the tumor. The drug did not travel well through the bloodstream, and it did not pass the blood brain barrier, a key issue with getting drugs into the brain.

The Castro-Lowenstein lab collaborated with Joerg Lahann, Ph.D., Wolfgang Pauli Collegiate Professor of Chemical Engineering at the U-M College of Engineering, to create protein-based nanoparticles to encapsulate the inhibitor, in the hopes of helping it pass through the bloodstream. Castro also connected with Anuska V. Andjelkovic, M.D., Ph.D., professor of pathology and research professor of neurosurgery at Michigan Medicine, whose research focuses on the blood brain barrier. They noted that glioma tumors create abnormal blood vessels, interfering with normal blood flow.

The researchers injected AMD3100-loaded nanoparticles into mice with gliomas. The nanoparticles contained a peptide on the surface that binds to a protein found mostly on the brain tumor cells. As the nanoparticles traveled through the bloodstream toward the tumor, they released AMD3100, which restored the integrity of the blood vessels. The nanoparticles could then reach their target, where they released the drug, thus blocking the entry of the immune-suppressive myeloid cells into the tumor mass. This allowed the immune cells to kill the tumor and delay its progression. [...] Among the mice whose tumors were eliminated, the researchers then reintroduced the tumor, simulating a recurrence. Without any additional therapy, 60% of mice remained cancer-free. The research has been published in the journal ACS Nano.

An anonymous reader writes: A team of scientists created a novel type of temporary pacemaker -- one that dissolves on its own, without requiring any removal. In their latest research, they've paired the pacemaker with a series of wireless sensors on the skin, which should allow it to smartly monitor a patient's vital signs and adjust its pacing autonomously. Should the device continue to show promise, it could one day be used in patients undergoing cardiac surgery or who otherwise only need a pacemaker for a short while.

Last year, researchers at Northwestern University and George Washington University debuted the first version of the pacemaker. [...] In their new study, published Thursday in Science, the group has added more features to their pacemaker. According to author Igor Efimov, a professor of biomedical engineering and professor of medicine at Northwestern University, the pacemaker now comes with a "fully integrated network of wearable devices" attached to a patient's skin, four in total.

These devices not only monitor a person's heartbeat and other vital signs like body temperature -- they also wirelessly power the pacemaker and control its pacing automatically as needed. Doctors can remotely monitor the data collected by the device via a computer network. And in experiments with living rodents and dogs, as well as human hearts in the lab, the pacemaker and its closed loop system seemed to work as intended.

CVS Health will stop filling prescriptions for controlled substances ordered by clinicians working for telehealth startups Cerebral and Done Health starting Thursday, a move that will impact thousands of patients. From a report: A CVS spokesman confirmed the change in a statement, citing concerns CVS has with the two companies following a review it conducted. Cerebral had earlier disclosed the change in a statement to The Wall Street Journal. Cerebral called CVS's decision unfortunate, adding that it was "doing everything possible to ensure these patients get access to medications that their healthcare providers have determined they need." Some pharmacies had already blocked or delayed certain prescriptions from Cerebral and Done prescribers over concerns that clinicians were writing too many stimulant prescriptions, The Journal reported in April. Cerebral had said prescription delays occurred because of confusion around telehealth policies. Done declined to comment at the time.

Cerebral and Done between them treat tens of thousands of patients for attention-deficit hyperactivity disorder, prescribing stimulants such as Adderall. Psychiatrists say stimulants can have significant benefits for people properly diagnosed with ADHD. But they are classified as schedule 2 controlled substances by the federal government due to their potential for abuse, the same category as OxyContin and Vicodin. Cerebral and Done grew very quickly from the onset of the Covid-19 pandemic, attracting patients with social-media ads that offered an ADHD diagnosis and prescriptions to treat the condition. Previously, clinicians were prohibited from prescribing stimulants without an in-person visit. The U.S. relaxed those rules in March 2020 for all schedule 2 substances due to the coronavirus public-health emergency.

More than one in 10 cases of coronary heart disease could be prevented if people reduced their TV viewing to less than an hour a day, research suggests. From a report: Coronary heart disease occurs when fatty material builds up inside the coronary arteries causing them to narrow, reducing the heart's blood supply. Researchers say cutting down on time spent in front of the TV could lower the risk of developing the disease. "Reducing time spent watching TV should be recognised as a key behavioural target for prevention of coronary heart disease, irrespective of genetic susceptibility and traditional risk markers," said Dr Youngwon Kim, an assistant professor at the University of Hong Kong and an author of the research.

While the team did not look at what was behind the association, Kim said previous studies had found excessive TV viewing time is associated with adverse levels of cholesterol and glucose in the body. "Unfavourable levels of these cardiometabolic risk markers may then lead to increased risk of developing coronary heart disease," he said. Writing in the journal BMC Medicine, Kim and colleagues report how they used data from 373,026 white British people aged 40-69 who were part of an endeavour known as the UK Biobank study.

An anonymous reader quotes a report from The Guardian: Researchers in China revealed they have developed a contact lens that can sense an increase in pressure within the eye and release an anti-glaucoma drug should the pressure exceed a certain level. Writing in the journal Nature Communications, the team describe how they created the device using an upper and lower lens, with a snowflake-shaped pressure sensor and wireless power transfer device sandwiched between them around the rim of the lenses. The arrangement appears to give the effect of the wearer having golden irises. However, the team say the design allows the necessary components to be included in the device without blocking the wearer's view or irritating the eye.

When the pressure inside the eye increases, the gap between the upper and lower lenses decreases. This is detected by the pressure sensor by means of a cantilever. The sensor then sends a signal to the wireless system which subsequently triggers the release of an anti-glaucoma drug, from a hydrogel attached to an electrode, and enables it to cross the cornea of the eye. The drug, brimonidine, acts to reduce the pressure within the eye. The study reveals that the contact lenses have so far been tested on pigs' eyes and on the eyes of living rabbits -- albeit with smaller-sized lenses -- although trials have yet to be carried out in humans. The researchers note the lenses are not only soft and minimally invasive but are also battery-free, adding that the approach could be expanded to help tackle other eye diseases. "We can now imagine that a glaucoma sufferer wearing these contact lenses will not only receive real-time information about the pressures within the eye, since the contact lens has built-in wireless capacity and can easily communicate with an app on your smartphone, but also receive, for example, pressure-relieving drugs when needed," said Prof Zubair Ahmed from the Institute of Inflammation and Aging at the University of Birmingham. "The materials required to create such contact lenses are inexpensive and soon could be mass-produced," he added.

After scandals in which doctors let unsupervised assistants operate on patients, South Korea is becoming one of the first to require cameras in operating rooms. The New York Times reports: Ethicists and medical officials, including those at the American College of Surgeons, have cautioned that surveilling surgeons to deter malpractice may undermine trust in doctors, hurt morale, violate patient privacy and discourage physicians from taking risks to save lives. The Korea Medical Association, which is opposed to the new mandate, has lobbied to limit its impact. But supporters of the law said the move would help protect patients, build the public's trust in doctors and provide victims of medical malpractice with evidence to use in court.

"People are dying in operating rooms," said An Gi-jong, an advocate for patients. "We can't rely on doctors to solve problems on their own anymore." About five patients have died from ghost surgeries in the past eight years, he said. They include Kwon Dae-hee, a college student in Seoul who died of a hemorrhage in 2016 after jawline surgery. His mother, Lee Na-geum, who obtained footage of his operation and reviewed it hundreds of times, found evidence that the operation had been botched because parts of it had been conducted by an unsupervised nursing assistant. Ms. Lee, 62, who has held a public vigil denouncing ghost surgeries since her son's death, said in an interview: "Once the cameras are installed, your lies will be exposed if you're a ghost doctor. Cameras reveal truth." [...]

Under the new law, hospitals performing surgeries on unconscious patients must install video cameras in their operating rooms. If a patient or a relative requests that a surgery be filmed, the hospital must comply. Doctors can refuse for certain reasons, such as if a delay in the operation would put the patient's life at risk, or if the filming would significantly impede residents' training. The recorded footage can be viewed for criminal investigations, prosecutions, trials, medical disputes or mediation.

Biopharmaceutical company MindMed has announced the first topline data from a novel Phase 2 trial testing high doses of LSD as a treatment for anxiety. The results indicate one to two LSD sessions can generate rapid and sustained reductions to anxiety, however, significantly larger trials will be needed to validate these findings. New Atlas reports: This new trial was conducted at University Hospital Basel in Switzerland. The trial was randomized, and placebo-controlled with a crossover design enrolling 46 participants. The participants completed two high-dose (200-microgram) LSD sessions, six weeks apart. The primary endpoint was a reduction in anxiety 16 weeks after the second LSD session, as measured on a scale called STAI (State-Trait Anxiety Inventory), a common test used to quantify anxiety.

The data revealed by MindMed indicates 65 percent (13 out of 20) patients in the LSD group demonstrated a clinically significant reduction in STAI scores of more than 30 percent. Only nine percent of the placebo group (two out of 22) showed similar clinical improvements. The results indicate the treatment was generally safe with only mild adverse effects reported by most subjects. The announcement did report one serious adverse treatment event during an LSD session described as "acute transient anxiety and delusions." This subject required sedatives but no long-term adverse effects were noted. [...] MindMed is now beginning a Phase 2b trial to expand on these findings and further explore LSD as a treatment for anxiety disorders.

Using anti-inflammatory drugs and steroids to relieve pain could increase the chances of developing chronic pain, according to researchers from McGill University and colleagues in Italy. Neuroscience News reports: Their research puts into question conventional practices used to alleviate pain. Normal recovery from a painful injury involves inflammation and blocking that inflammation with drugs could lead to harder-to-treat pain. [...] In the study published in Science Translational Medicine, the researchers examined the mechanisms of pain in both humans and mice. They found that neutrophils -- a type of white blood cell that helps the body fight infection -- play a key role in resolving pain. Experimentally blocking neutrophils in mice prolonged the pain up to ten times the normal duration. Treating the pain with anti-inflammatory drugs and steroids like dexamethasone and diclofenac also produced the same result, although they were effective against pain early on.

These findings are also supported by a separate analysis of 500,000 people in the United Kingdom that showed that those taking anti-inflammatory drugs to treat their pain were more likely to have pain two to ten years later, an effect not seen in people taking acetaminophen or anti-depressants. "Our findings suggest it may be time to reconsider the way we treat acute pain. Luckily pain can be killed in other ways that don't involve interfering with inflammation," says Massimo Allegri, a Physician at the Policlinico of Monza Hospital in Italy and Ensemble Hospitalier de la Cote in Switzerland.