A Global Perspective on PDA Management in the Extremely Premature: Shifting Trend Toward Transcatheter Closure.

Patent ductus arteriosus (PDA) is a frequently encountered defect in infants born extremely premature (≤26 weeks gestation). Historically, closure of the PDA was performed using cyclooxygenase inhibitor medications or by surgical ligations. However, the benefits of PDA closure using these therapies have never been demonstrated, albeit studies have previously not focused on the extremely premature infants. Therefore, there was a worldwide trend toward conservative management of the PDA. With improved survival of extremely premature infants, comorbidities associated with the PDA has increased, resulting in finding alternate treatments such as transcatheter patent ductus arteriosus closure (TCPC) for this population. Currently, there is a renewed interest toward selective treatment of the PDA in this high-risk cohort of small infants. This Comprehensive Review article inspects the globally changing trends in the management of the PDA in premature infants, with a special focus on the rising adoption of TCPC. Moreover, this article compiles data from several neonatal networks worldwide to help understand the problem at hand. Understanding the current management of premature infants and their outcomes is fundamentally essential if pediatric cardiologists are to offer TCPC as a viable therapeutic option for this population. This article aims to serve as a guide for pediatric cardiologists on this topic by compiling the results on landmark clinical trials on PDA management and the controversies that arise from these trials. Comparative outcomes from several countries are presented, including interpretations and opinions of the data from experts globally. This is a step toward coming to a global consensus in PDA management in premature infants

Capitale européenne de la culture. Varna 2019

De titre honorifique, le terme « Capitale européenne de la culture » est en train de se transformer depuis une dizaine d'années en véritable « label culturel », signe d'un ancrage fort de ce programme dans le secteur culturel européen. S'intéresser à ce programme revient donc à s'immerger dans les politiques culturelles européennes, en œuvre depuis une trentaine d'années. Ce mémoire analyse la candidature de Varna au programme européen « Capitale européenne de la culture en 2019 », replacée dans le contexte des exigences posées par la Commission européenne concernant l'initiative et aussi dans le contexte de la grande importance que ce projet a pour le développement de la ville de Varna en tant que centre culturel et touristique bulgare

Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome.

We aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients.All patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed.Compared with group 1, patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.50), and needed less volume (p=0.01). In group 2, the unstable patients were not ventilated for longer durations (p=0.19), but had higher re-intubation rates (p=0.03) than the stable patients. Compared with the unstable patients from group 1, the unstable patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.66), and needed less volume (p=0.006). There was a significant acute and sustained increase in mean arterial pressure with extubation and a parallel reduction in volume requirements and inotrope scores in the unstable patients from group 2.Timely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics

THEORETICAL ANALYSIS FOR THE OPTIMISATION OF THE BELT CONVEYOR TENSIONING STATION OF AN SRs 2000 EXCAVATOR

ABSTRACT. In the present work, the rubber belt conveyor (RBC) of an SRs 2000 excavator is made on the basis of the main technical parameters influencing the dynamic performance of a conveyor belt for the transportation of opencast working in the conditions of “Maritsa-East Mines” Ltd. The analysis includes the most important parameters, such as: theoretical performance of the conveyor; power consumption of the electric motors (kW) at dénivеllation of the conveyor; starting torque (% Nmpl); running torque (kN); braking time (sec); braking torque (N-m); drift time (sec). When the belt conveyor is dénivellated, a number of changes occur in the main technical parameters which directly affect: yield; tension drum stroke; conveyor belt braking time; power required to drive the conveyor belt; weight required to tension the belt, etc. Downloading and reading of the basic technical parameters is necessary to determine the required tensioning force applied to the tensioning drum of the RBC. On the basis of these indicators, various conceptual variants have been developed of tensioning stations for integration to the RBC of the SRs 2000 excavator operating in the conditions of “Maritsa-East Mines” EAD

NUTRITIONAL COMPOSITION AND HEAVY METAL CONTAMINATION IN FISH FROM KARDZHALI DAM, BULGARIA

This study aimed to determine the nutritional value, heavy metals, and micro and macro elements in four species of fish from the Kardzhali dam (Carassius gibelio, Perca fluviatilis, Vimba melanops and Rutilus rutilus). Data on the content of proteins, lipids, heavy metals, and micro and macro elements were obtained, and the energy value in kcal/100g and kJ/100 g fresh weight was calculated. The analyzed species can be divided into two groups: with low lipid content (up to 2.0%) - perch (1 g/100g fresh weight); and with medium lipid content (2.0-8.0%) - Prussian carp, malamida, and roach ( 2.0 to 2.7 g/100g fresh weight). All freshwater fish examined from the Kardzhali dam belonged to the category of foods with medium and high energy content (more than 170 kJ/100g) and were a good source of protein (21.52-24.54%). All four fish studied are essential magnesium, potassium, and sodium sources. Zinc, iron, phosphorus, and calcium predominate in Prussian carp and roach, while copper and manganese in malamida. The content of heavy metals mercury, lead, cadmium, and zinc in all fish examined was below the maximum allowable concentration (MAC). All four tested fish can be recommended for consumption by the population in the area