Postinfarction ventricular septal defect closure

After a median full sternotomy, cardiopulmonary bypass is installed in the usual manner. Apical ventriculotomy is performed through the infarcted myocardium. Polypropylene pledgeted mattress sutures are passed from the right to the left ventricular side through the ventricular septal defect, with the pledgets remaining on the right ventricle. Great care must be taken to place the suture on healthy myocardium and away from the edge of the ventricular septal defect; otherwise the chances of a recurrent postoperative ventricular septal defect would increase. The sutures are subsequently positioned through a heterologous patch, previously prepared to be appropriate for the ventricular septal defect closure. A collar of 3 to 4 cm is left on the external side of the patch. A 4-0 polypropylene running suture is placed through this collar and the left ventricle to further reinforce the ventricular septal defect closure. The left ventricular incision is closed with polypropylene 3-0 continuous sutures. For each ventricular edge, the running suture is passed through 2 polytetrafluoroethylene felts: one on the endoventricular side and the other on the epicardial side. Finally, the suture line is reinforced with a continuous 2-0 polypropylene suture, which is passed through the polytetrafluoroethylene felts, the ventricular wall, and the heterologous patch used to close the ventricular septal defect.

Adsorption of Arsenic on Graphene Oxide, Reduced Graphene Oxide, and their Fe3O4 Doped Nanocomposites

Adsorption of arsenic on graphene oxide (GO), reduced graphene oxide (rGO), and nanocomposites with iron oxide nanoparticles were examined in an aqueous medium. All the nanoparticles and nanocomposites were synthesized and characterized in the usual manner. Water samples were collected from groundwater outlets in the Chakdaha block of West Bengal, India. The adsorption was modeled using various isotherms. The nanocomposites with iron oxides showed higher efficiency in adsorbing arsenic species vis-à-vis individual graphene-based nanoparticles. The present data shows As removal efficiency of 71.64% and 78.84% for GO and rGO, respectively, and 76.07% and 81.6% for their nanocomposites with iron oxide, respectively. While further work is needed to optimize As adsorption by the nanocomposites, the data can be used to develop low-cost water filtering kits for use in the affected areas.

Some Procedural Aspects of Deprivation of Immunity from Criminal Prosecution

The paper examines certain aspects of deprivation of immunity from criminal prosecution. Considering the procedures for bringing to criminal responsibility persons in respect of whom a special procedure for criminal proceedings has been established by law, the author concludes that the initiation of a criminal case by the head of a higher investigative body does not constitute a deprivation of immunity. In this regard, it is proposed to abandon this procedure and initiate a criminal case in the usual manner, namely by the preliminary investigation body, which has jurisdiction over the case. Analyzing the circle of participants in the procedure for the deprivation of immunity, the author argues that the subjects appealing to the highest bodies of state power (and such bodies themselves) rendering the decision on the deprivation of immunity are not ordinary participants in criminal proceedings. They rather carry out constitutional and legal activities, the results and decisions of which are implemented in the criminal procedure. Exploring the grounds for giving consent to bring a person to criminal liability, the author draws attention to the different approach of the legislator to different categories of persons and proposes to unify the regulatory framework. The public authority must establish two circumstances: the presence of elements of a crime and the absence of a connection between the criminal prosecution and the person’s public law activities.

Physicians’ Experience and Willingness to Participate in Non-Interventional Trials in Bulgaria

Summary Non-interventional studies (NIS) are conducted to obtain additional information about a medicinal product prescribed in the usual manner in compliance with the conditions determined in the marketing authorization. They are a valuable source of real-world data for the effectiveness and safety of medicines. This study aims to assess physicians‘ knowledge of non-interventional studies in Bulgaria and identify the primary factors and barriers hindering the NIS at a national level. An individual anonymous questionnaire with 16 items was distributed among physicians in inpatient and outpatient settings. The results showed that 81.3% (n=147) of the respondents have no experience with non-interventional studies. Physicians‘ willingness to participate in NIS in the future is high and independent of their previous experience. The main barriers hindering conducting NIS in Bulgaria are related to organization, the conduct and the design of the trials, and, sometimes, the investigators‘ concerns. There is a need for proper training of the researchers and expanding healthcare resources to grow the NIS sector in Bulgaria in line with the tendencies in Europe.

Tangible and Intangible Boundaries: The Case of Baoshan Port-City Interface in Shanghai

Instead of stressing that port cities are characterised by institutional fragmentations with many resulting conflicts, we claim that port cities might be highly constructive in terms of changing tangible and intangible boundaries. To capture this quality, we use the concept of ‘penumbral,’ a combination of perceptional aspects as well as tangible and intangible spatial constellations. This perspective is applied in the case of the Shanghai Baoshan port-city interface through the investigation of the changing tangible and intangible boundaries, and how planning relates to boundary changes in a context of spatial, industrial, and institutional multi-layered structures. Tangible refers to physical boundaries between the port and urban structure or district, while intangible refers to immaterial boundaries created by actors’ views on ports. Based on planning documents, direct observations, and 17 in-depth semi-structured interviews with local governments, port authority, planning departments, and companies, we find that one can indeed speak of penumbral boundaries, based on port-related values and ideas, and particularly on perceptions of the port and port businesses. Those perceptions are the initial power of changing and, following the idea of penumbral boundaries, blurring tangible and intangible boundaries. Finally, we suggest that, following the idea of penumbral boundaries, planning can play a stronger role in connecting the port and the city by first investigating how actors view the port and port businesses carefully, paying full attention to the specific relational context before formulating plans in the usual manner.

Impaction of a continuous glucose monitoring sensor

A 33-year-old man presented to the plastic surgery department for foreign body removal 1 month after the insertion of a continuous glucose monitoring (CGM) sensor (Dexcom G5) in the left upper arm. The patient had used the CGM system for 5 years, and the insertion was done in the usual manner. The entire sensor wire was visible on simple radiography and ultrasonography. In the operating room, and the sensor wire was identified in the intermuscular septum and removed. No foreign body reaction or inflammatory signs were found around the CGM, and the extracted wire measured 2.5 cm. Thus, it was assumed that the whole sensor wire was detached from the transmitter, not fractured. No remnant foreign body was observed on follow-up simple radiography.

A COMPARATIVE STUDY OF USING TWO COMMONLY APPLIED METHODS AND TO EVALUATE THE FUNCTIONAL OUTCOME OF MANAGEMENT OF COLLES FRACTURES IN ADULTS

Background:Colles fracture in adults is a common injury and considering that there is very limited knowledge about the best method of treatment, either conservative or surgical. There is insufcient evidence from comparisons tested within this study to establish the relative effectiveness of the two methods over one another but from a health policy and health care funders' perspective it seems justiable to apply least costly option for managing this common fracture in our country. Aim: To study the functional outcome following treatment of Colles fracture by using closed reduction and plaster cast application versus Kirschner wire xation and to study the effectiveness and complications of both the procedure. Materials and Methods: 50 adult patients with fracture Colles were assigned in to two groups after informed consent. Both groups were investigated in usual manner. Group A: Cases treated with plaster cast application alone (n = 25).Group B: Cases treated with K-wire and plaster cast application (n = 25). The patients were followed up every four weeks till radiological union was seen. The assessment of results were made using the demerit score system of Gartland and Werley based on objective and subjective criteria, residual deformity and complications. Results: At 6 months postoperatively, According to Gartland and Werley Group A we had 5 (10%) excellent results, 12(24%) good results, 06(12%) fair results and 2 (4%) poor results. In group B, 5(10%) excellent results, 13(26%) good results, 07 (14%) fair results and none had poor results. Conclusion: From a health policy and health care funders' perspective it seems justiable to apply least costly option for managing this common fracture in our country.

Giffen goods, backward bending supply curves, price controls and praxeology; or, who’s afraid of the big bad boogie man of giffen goods and backward bending supply curves? Not us

What is the status of claims about the effects of minimum wage laws? Empirical or praxeological? We claim the latter. How can the effect of such legislation be best analyzed under the assumption of mis-behaving supply (backward bending) and demand (positively sloped, based on positing Giffen goods) curves? In the usual manner: resource misallocation still occurs. But this is only arguendo. More radically, such curves are themselves problematic. Even more radically, this, too, applies to «well behaved» supply and demand curves as well. Key words: Backward Bending Supply Curves, Price Controls, Praxeology, Giffen Goods, Logical Positivism. JEL Classification: D0. Resumen: ¿Cuál es el status del análisis sobre los efectos de las leyes de salario mínimo? ¿Empírico o praxeológico? Nosotros defendemos lo se gundo. ¿Pueden analizarse mejor los efectos de dichas leyes suponiendo curvas de oferta y demanda anómalas (como las de los bienes Giffen)? Como en el nálisis tradicional se produce una mala asignación de recursos. En todo caso, tanto tales curvas, como las tradicionales son muy problemáticas. Palabras clave: Control de precios, praxeología, bienes de Giffen, positivismo lógico. Clasificación JEL: D0.

Epinucleus Scraping: Safe New Phacoemulsification Technique for Rock-Hard Cataracts

Introduction: Phacoemulsification of rock-hard cataracts is challenging because the leathery epinucleus at the posterior plate often found in such cataracts tends to prevent smooth dissection of the nucleus. We devised an Epinucleus scraping technique to overcome this problem. Methods: The epinucleus is initially stripped of the hard endonucleus using a new instrument. The isolated endonucleus can then be readily chopped and divided with a phaco chopper or in the usual manner. Conclusion: Phacoemulsification of rock-hard cataracts can be carried out safely and easily with epinucleus scraping technique.

Electronic document management and electronic cases in Russian arbitration courts: advantages and development prospects

An analysis of the activities of arbitration courts demonstrates the effectiveness of the implementation of electronic justice in Russia, which ensures the promptness of procedural actions by the parties to the dispute. Statistics show a constant increase in the number of lawsuits filed with the courts. The current procedural legislation provides for the possibility of filing a lawsuit in court in an electronic form. Meanwhile the bulk of appeals is carried out in the usual manner in a paper form, which entails certain problems, for example, an increase in the workload on the staff of the court apparatus, the need to form court cases in a paper form, and difficulties in storage.The author proposes to establish in the law a rule providing for filing a claim in an electronic form - as the main method, and going to court by filing in a standard paper form as an exception. The implementation of this proposal will make it possible to switch to the formation of completely electronic court cases, which fully meets modern requirements. At the same time the author points to the possibility of endowing multifunctional centers for the provision of state and municipal services with the right to file lawsuits and other documents to the courts in an electronic form. This will shorten the time for consideration of cases, as well as reduce the costs of both the courts and the participants in the trial.