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Introduction: Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease (PAD). Up to a third of CLTI patients are not eligible to receive first-line treatments such as bypass surgery or endovascular interventions. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculatory blood flow and relieve ischemic pain in CTLI patients. The aim of the study was to evaluate limb salvage, ulcer closure, and clinical changes of SCS implanted CTLI patients at 1-year follow-up. Methods: Eligible patients had end-stage lower limb PAD unresponsive to medical therapy and not amenable to surgical reconstruction. Patients were candidates for amputation, but limb loss was not inevitable (Fontaine stage III and IV). Pain intensity and skin temperature in the ischemic area (visual analogue scale), quality of life (WHOQoL-BREF), and ankle/brachial blood pressure index (ABI) were recorded at routine follow-up visits. Data were analyzed retrospectively. Results: 29 patients underwent SCS implantation at one vascular center. The minimum follow-up period was 30 months. Limb survival at 1-year follow-up was 97% (28/29) and 73% (11/15) had complete closure of limb ulcers. Pain intensity, skin temperature, and quality of life progressively improved up to 12 months after implant, with Fontaine stage III patients improving more substantially than Fontaine stage IV patients. SCS therapy did not affect ABI measurement. No complications related to the device or procedure occurred. Conclusions: SCS is a valid alternative in patients unsuitable for revascularization. The quality of results depends on both a strict selection of patients by vascular specialists and the frequency of follow-up controls. The therapy may be more beneficial in patients classified as Fontaine stage III.

The article presents the results of three studies conducted by the author concerning the preferences of retail outlet customers with regard to the days of the week on which they most frequently purchase general food and non-food merchandise. This issue has become relevant within the context of the enactment of the Act of 10 January 2018 on limiting trade on Sundays, holidays and certain other days. Previous customer shopping styles as regards weekly shopping schedules must have changed. The aim of the article is to identify consumers’ habits and their changes concerning the weekly shopping schedules before and after the Act implementation. The results are based on direct surveys conducted in 2014, 2016 and 2018 among customers in Podkarpackie Province. A descriptive analysis of the results is supported by the statistical test chi square usage. It may be concluded that both in relation to food and non-food merchandise, the implementation of the Act resulted in a decrease in the number of customers engaging in shopping on Sundays. In the case of food items, the shopping activity moved to Mondays and Tuesdays of the following week, the purpose being to resupply. No increase was identified in the number of customers purchasing food on Fridays or Saturdays preceding non-trading Sundays. The opposite was true for non-food merchandise, where non-trading Sundays resulted primarily in increased sales on Saturdays, with minor increases on Mondays, Tuesdays and Wednesdays as well. The differences in weekly shopping schedules observed between every edition of the study also proved to be more significant than those identified in the individual respondent classification groups used for the purpose of the article.

Patients with chronic wounds are significantly impaired in their health-related quality of life (HRQoL). The validated Wound-QoL questionnaire allows assessing the impact of chronic wounds on different aspects of HRQoL including physical, psychological, and everyday life-related impairments. The aim of our study was to investigate associations of these HRQoL dimensions with age, sex, and particularly wound genesis. In this retrospective, cross-sectional, multicentre study, Wound-QoL questionnaires from clinical routine of patients with venous leg ulcers, arterial leg ulcers, mixed leg ulcers, and diabetic foot ulcers (DFU) were evaluated. Effects of wound genesis, sex, and age were assessed with analysis of variance as well as correlation and multiple linear regression analyses. The completed questionnaires of 381 patients (f = 152/m = 229; mean age 68.9) were included. The wound genesis groups showed significantly different distributions of age and sex. We also found significant differences between those groups in everyday life-related QoL, with the greatest impairments in patients with DFU. Physical QoL scores showed significant differences between men and women depending on diagnosis group: in patients with venous leg ulcers, women had greater impairment of physical QoL than men. Independent of the underlying diagnosis, women had significantly higher scores in the psychological subscale as well as in the Wound-QoL sum scale. Within the subgroup of arterial leg ulcer patients, overall HRQoL sum score was significantly worse in older patients. Regression analyses supported negative effects of DFU diagnosis and female sex on HRQoL. Our data offer evidence that HRQoL shows clinically relevant differences between patients with chronic wounds of different genesis. Moreover, our data revealed that HRQoL is associated with age and sex, which should be considered when treating the patient groups. In order to be able to capture these important aspects and to offer individualised and patient-oriented treatments, the Wound-QoL should be implemented as a quick and uncomplicated standard instrument in daily routine. Patients with chronic wounds are significantly impaired in their health-related quality of life. Validated Wound-QoL questionnaire is a quick and easy-to-use instrument for daily practice. Wound-related quality of life shows clinically relevant differences between patients with chronic wounds of different genesis. Wound-related quality of life is associated with age and sex, which should be considered when treating these patient groups. Health-related quality of life should be regularly objectified in all patients with chronic wounds with a validated measuring instrument. OA Förderung 2021

Background:The autologous arteriovenous fistula is the primary choice to establish hemodialysis access without high failure rates. Intraoperative ultrasound flow measurements of newly created autologous arteriovenous fistulas represent a possibility of quality control and may therefore be a tool to assess their functionality. The aim of our study was to correlate intraoperative blood flow with access patency.Methods:Between March 2012 and March 2015, intraoperative transit time flow measurements were collected on 89 patients. Measurements were performed 5–10 min after the creation of a standardized anastomosis using 3–6 mm flow probes. To examine the correlation between intraoperative blood flow and access patency, groups of patients with high (> 200 mL/min) versus low flow (Results:In the current short-term follow-up, including 89 patients (age 62 ± 3 years), 61 (68.5%) of the autologous arteriovenous fistulas were currently being used in an observation period ranging from 3 months to 3 years (mean observation period 546 ± 95 days) postoperatively. The intraoperative blood flow in patients with functioning autologous arteriovenous fistula (78) was significantly higher than that of patients without functioning autologous arteriovenous fistulas (407 ± 25 vs 252 ± 42 mL/min, respectively; p Conclusion:The intraoperative measurement of blood flow is a useful tool to predict the outcome of maturation in autologous arteriovenous fistula. With this method, technical problems can be detected and corrected intraoperatively. Routine implementation of intraoperative flow measurements has to be examined by prospective controlled trials.

Measuring sustainable development requires multidimensional attitude as the process is characterised by compound relationships between social, economic and environmental spheres. The paper aims at assessing selected effects of sectoral employment for the three dimensions of developmental processes. We examine employment efficiency in 25 EU countries concerning four sectors: agriculture, industry, market services, and non-market services. We use a non-radial DEA input-oriented model, which allows the assessment of the general efficiency of labour resources, as well as the evaluation of in-depth efficiency in the three dimensions of the economies under study. The novelty of the research lays in both multidimensional attitudes to the effects of labour engagement as well as intersectoral comparisons of the employment results. We categorise the EU countries according to efficiency in gaining the sustainable development and its three dimensions. Generally, the “old” EU members are of higher efficiency than the “new” states. Our research shows desirable movements of labour force that are necessary to improve efficiency and thus offers some advice for a rational development policy. It appears that it is necessary to limit agricultural employment in favour of non-market and market services and, to a lower extent, of industry. We conclude that the structural changes in employment specified by patterns observed in the highly developed EU countries are favourable for realising the aims of sustainable development.

ZusammenfassungModerne Zusatzbehandlungen zur herkömmlichen Wundtherapie werden häufig notwendig, da ein großer Anteil chronischer Wunden unter der Standardbehandlung nicht vollständig abheilen bzw. auch häufig rezidivieren. Die Omega3-Wundmatrix (Kerecis®) stellt eine alternative Wundauflage dar, die aus der Haut des Kabeljaus durch entsprechende Verfahren wie z.B. die Dezellularisierung gewonnen wird.Wir berichten über eine 86-jährige Patientin, die über schmerzhafte, chronische und rezidivierende Ulzeration im Bereich des rechten Unterschenkels klagte. Vorausgegangen war eine operative Behandlung der venösen Insuffizienz mit Debridement, Vakuumtherapie und Spalthauttransplantation, wonach es im Verlauf zur deutlichen Vergrößerung und Schmerzhaftigkeit der Wunde kam. Nach anschließender lokaler Wundtherapie mit Omega3- Wundmatrix (Kerecis®) kam es zu einer rasch progredienten Wundheilung mit vollständiger Abheilung der Ulzerationen innerhalb von 14 Wochen.

The analysis presented in the study concerns the scale of productive inequality between EU member states. Disparities in the level of gross value added per capita reflect both the level of productive efficiency and the level of welfare produced by an economy. They could constitute a basis for an assessment of socio-economic cohesion in the EU and convergence processes. Estimations of the level of differences in international distribution of production are based mainly on the Gini coefficient. The analyses allow the author to assess integration processes in the EU in the years 2004-2013. Changes in the level of the Gini coefficient indicate that productive inequality has decreased since 2004. However, they indicate a breakdown in convergence tendencies during the crisis. Special attention is paid to productive inequality in particular branches. Presented analyses make it possible to identify the economic branches that are characterized by the highest international disparities, as well as those in which productive differences are the lowest. The former group comprises: finances, professional services, and information, while the latter: agriculture, industry, and traditional services. Additionally, a research thesis that the highest productive inequality exists in the most dynamically developing branches with the features of growth poles is positively verified. Quite strong relations can be observed between the growth dynamics of gross value added per capita and the scale of production disparities measured by the Gini coefficient in the studied branches. Developmental processes in the EU assume, therefore, a polarizing and diffusive character. To achieve consistent development, it is necessary to promote conditions for absorption of modern solutions in catching-up countries.

The study deals with a problem of changes in demand for human capital, that are caused by structural changes in Polish economy in the context of its convergence with the EU structures. There was assumed that structural features that are observed nowadays in the EU as a whole constitute a model for development of these countries that limit their development gap. Thus, a direction of transformation in branch relationships leads to convergence of Poland with other EU members and changes in branch relationships determine demand for human capital. The research was aimed at identification of the realised demand for human capital, concerning a level and a character of the resources. Considering the first aspect there was assumed that an indicator of a level of human capital engaged in economic processes is education of the employees. There were made comparisons of a share of highly educated employees in Poland and the EU, a structure of education in branches, as well as a share of employment in knowledge-intensive activities. The identified development tendencies showed decreasing development gap of Polish economy, connected with creation of a knowledge-based economy. The essential barrier of human capital absorption in Poland appears to be unfavorable structure of branches. The second aspect of the analysis was connected with a character of the engaged human capital, that was specified as basing on general or specific knowledge. To identify the character of knowledge there was assessed a concentration of occupations between branches and a share of professional groups in the specified branches. Disparities between Polish economy and the EU countries are described by a lower share of occupations and branches basing on a general knowledge in Poland. Meanwhile development trends show an increase of such kind of knowledge. A barrier to achieve cohesion within EU in this dimension also appeared to be the unfavorable branch relationships in Poland.

Background:To evaluate the technical results of the arterial repair, a variety of intraoperative imaging and assessment techniques can be used during carotid endarterectomy. The aim of the study wa...

The analysis in the paper is focused on a problem of differences in a level of wages and salaries between EU countries in a sectoral dimension. We try to diagnose a scale of the differentiation and a direction of changes in a period of 2004-2013 years. In a search for the reasons of wage inequality between countries we pay our attention to structural differences in remunerations. We try to specify which branches are the most and which are the least diversified across EU countries in terms of a level of wages and salaries. As modern development is connected with servicisation of economies we try to specify a character of a service sector considering its ability to equalize remunerations. We verify a hypothesis if it covers branches with the lowest level of wage inequality across EU countries. Structure of the paper leads us from a diagnosis of a relative wage level across branches into assessment of wage inequality in different branches across EU countries. In conclusion we confirm the initial thesis and point out at information and communication as well as financial and insurance activities as the ones of the lowest wage inequality

SummaryWe describe a 65-year-old male with severe soft tissue infection of both lower legs. He had infected ulcer after stripping of small saphenous vein in tumescent anaesthesia and excision of side branches, and was referred from a foreign clinic. Intraarterial angiography of the pelvic and legs vessels showed severe stenosis in the left deep femoral artery and a tandem stenosis of superficial artery. A hybrid procedure with intraoperative percutaneus angioplasty combined with femoral xenogenic patch as well as local wound treatment with negative pressure wound therapy and subsequent mesh graft transplantation were carried out. We observed complete healing of ulcers within four weeks.

Celem autorki artykułu jest charakterystyka, w kontekście kultury cyfrowej, zjawisk zachodzących w mediach interaktywnych: czarnego humoru oraz odwrażliwienia społecznego. Autorka zadaje pytanie, czy dominujące w mediach przedstawienia grozy i absurdu są wynikiem desensytyzacji, czy też pełnią funkcję kompensacyjną. Udzielenie jednoznacznej odpowiedzi byłoby diagnozą kondycji człowieka ponowoczesnego. Wydaje się jednak, że nauki o mediach nie dysponują narzędziami, które taką odpowiedź pozwolą uzyskać. The aim of the author of this article is to characterize phenomena occurring in interactive media: black humour and social desensitization, in the context of digital culture. The author asks the question of whether the awe and absurdities prevailing in the media are the result of desensitization or if they play a compensating function. Providing a definite answer would be a diagnosis of the postmodern human condition. It seems, however, that the media studies do not have tools to allow such an answer.

Research background: Regions that are able to use their resources in the most efficient way could be perceived as valuable benchmarks when shaping socio-economic policy. The concept of efficiency, however, may be related not only to pure economic categories but to social goals as well. The economic and social spheres overlap and often have some common origins, among which, the sectoral structure of employment seems to be an important one. Purpose of the article: The aim of the study was to compare the social efficiency of employment in three sectors in Polish voivodeships. Not only were we evaluating the relative performance of each region, but we were also paying attention to the efficiency of engagement of human resources in the agricultural, industrial and service sectors. Methods: We adopted the DEA method to assess the social efficiency of Polish regions. We have evaluated social cohesion concerning its two output dimensions: positive, which may be described by social activity, and negative, which may be reflected in the form of social exclusion stemming from material sources. We took into account the level of employment in agricultural, industrial and service sectors as inputs in the model and thus focused our attention on the three sectoral structure of the regional economies. Our model assumed non-radial developmental paths and was input oriented (NR-CCR). The data described the 16 Polish voivodeships in the year 2015, and were extracted from the Central Statistical Office of Poland’s databases. Findings & value added: The research conducted indicates that Polish regions which were the most efficient in terms of social integration were simultaneously those with the best economic results in terms of GDP per capita. The highest social efficiency level was characteristic for employment in the service sector, while agriculture was placed at the lowest level. The same pattern was revealed when social activity and the danger of poverty were considered separately. Thus, structural development appears to be favourable for regional economies also in terms of social cohesion, which is a factor often neglected in the literature.

The analysis of regional differences in a share of service sector in employment was conducted in the study. The aim of research was to identify the most important intra-sectoral determinants of labour engagement in the service sector at a level of voivodeships. Statistical methods such as analysis of variability, correlation, regression and factor analysis were used to realize the task of research. After identification of the most important factors determining regional scale of employment in the service sector and their structuralization, there were indicated specific sets of factors influencing situation in each voivodeship.

Postoperativ auftretende Lymphfisteln der Leistenregion stellen eine ernstzunehmende Komplikation dar. Diese Fisteln fuhren zu einer Steigerung der Morbiditat und konnen lokale sowie auch aufsteigende Infektionen unterhalten. Die Therapie dieser Komplikation reicht von konservativen Masnahmen wie Kompressionsverband und Bettruhe bis zur operativen Therapie mittels Lymphfisteldetektion und Ligatur, VAC-Pumpentherapie bis hin zur Muskellappenplastik. Diese Arbeit gibt eine Ubersicht uber eine Auswahl an Therapiemoglichkeiten. Anhand aktueller Literaturrecherche mittels Pubmed wurde eine Auswahl an etwaigen Therapieverfahren identifiziert und beschrieben. Die vorgestellten konservativen Masnahmen haben nach wie vor ihren Stellenwert. Es wird eine Auswahl sicherer und effektiver interventioneller und operativer Therapieverfahren vorgestellt. Bei der Indikation zur interventionellen bzw. operativen Therapie steht eine Auswahl sicherer und effektiver Therapiealternativen zur Verfugung, die den Krankenhausaufenthalt signifikant verkurzen konnen. Die Therapie mittels lokaler Muskellappenplastiken hat ihren Stellenwert als Ultima Ratio in der Versorgung von Protheseninfekten in der Leiste vom Typ Szilagyi III und sollte bei Bedarf angewandt werden.

The article explains the iconographic scheme of symbolic representations of Christ, which were present in the Russian and Byzantine art. In comparison to the first characters used on the early these icons have theological content. They represent the whole process of salvation for mankind, and many of them associated with the liturgy. For example, images of Christ as a “Watchful eye” or as the Lamb of God refer to the rites performed during the initial part of the Liturgy. Also important are the images of Christ in the performances of the whole Trinity. The type of the Old Testament Trinity He is shown as one of the three angels, and New Testament Trinity in the form of a man in robes of blue and red. Distinct type of representation is the Son of God in the form of an angel. There is here such topics as: Christ the Holy Silence, Christ Crucified Seraph and Sophia-Wisdom of God.

We report on a 57-year-old female liver transplanted patient who underwent endovascular aneurysm repair because of an infrarenal abdominal aortic aneurysm. Two months later, she developed an infection, and positron emission tomography computed tomography detected a paraprosthetic abscess. Explantation of the endoprosthesis and aortic reconstruction with a Y-shaped silver graft was made. The patient was discharged on the 12th postoperative day and shows up regularly in our outpatients department in a good clinical condition. After meticulous research of the current literature, this is the first published case of the successful management of an infected endovascular aortic stent in a liver transplanted patient.

Der Einsatz der chemischen Sympathektomie (CS) zur Sympathikolyse bei arterieller Verschlusskrankheit wird nach wie vor kontrovers diskutiert. In den aktuellen Leitlinien der Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC II) wird diese Masnahme nicht erwahnt. Ein Grund hierfur ist, dass die CS eine Zunahme von arteriovenosen Shunts bedingen konnte und eine Verbesserung der Sauerstoffgewebesattigung durch die CS bisher nicht belegt werden konnte. Zudem war ex ante schwer festzustellen, welcher Patient von der CS profitieren konnte. „Oxygen to see“ (O2C) erlaubt die nichtinvasive Messung der mikrovaskularen Gewebeperfusion unter statischen Bedingungen und durch funktionelle Tests eine Abschatzung der endothelialen Integritat. Die vorliegende Untersuchung uberpruft den Einsatz von O2C bei CS. Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) in den Stadien III und IV nach Fontaine wurden einer CS zugefuhrt. Die Indikation zu dieser Masnahme wurde interdisziplinar gestellt. Zusatzlich wurden im Rahmen der klinischen Routine nach einem standardisierten Messprotokoll vor und nach der CS mikrozirkulatorische Untersuchungen (O2C) durchgefuhrt. An der Studie nahmen 8 Patienten mit chronischer Extremitatenischamie ohne Moglichkeit der chirurgischen oder interventionellen Revaskularisierung teil. Mithilfe des O2C-Verfahrens sollten Veranderungen der Mikrozirkulation vor und nach der CS im Rahmen der klinischen Routineuntersuchung gezeigt werden, um potenzielle pathophysiologische Mechanismen auch bei Diabetespatienten zu charakterisieren. Ein klinisches Ansprechen auf die CS zeigten 7 von 8 Patienten. Das O2C-Verfahren konnte zwischen der klinisch fuhrenden Extremitat und der kontralateralen Seite diskriminieren. Funktionelle Messungen mit definierter Hochlagerung der Extremitat (65 cm entsprechend 50 mmHg) erwiesen sich besser geeignet als statische Messungen, um Veranderungen der Mikrozirkulation wiederzugeben. Da messbare Effekte der CS auf die Mikrozirkulation deutlich wurden, die mit dem klinischen Ansprechen korrelierten, konnte die Mikrozirkulationsmessung mit O2C bei groseren kontrollierten klinischen Studien zur Charakterisierung der Veranderungen durch CS zum Einsatz kommen. Dies gilt insbesondere fur Patienten, die anhand klinischer Parameter schwer beurteilbar sind (z. B. bei diabetischer Polyneuropathie).

The article describes the icons, where Christ is presented in the whole form and in frontal pose. On icons: “The Transfiguration”, “Ascension”, “Descent in to the Abyss”, “Saviour in Majesty” comes in many forms. In the “Descent into hell” in addition to our first parents there are also angels, prophets, demons and Satan. Pantocrator is presented in the Majesty in the midst of the heavenly powers in a row and on the sides deesis accompanied by Mother of God and John the Baptist who intercede for the people.On these ideas Saviour stands or sits on the throne, which emphasizes His majesty. Christ did not kneeling or profile, or turns his back to the person standing before the image. It is important that the Byzantine-Ruthenian icons are common features such as static characters, serious and dignified face.

One of the principal functions of the ESM/ELINT system is gathering basic information from entire electromagnetic spectrum and its analysis. In most cases, based only on primary features of incoming radar signals, the modern electronic intelligence system cannot recognize the different devices of the same type or class. A very important role is played by Measurement and Signature Intelligence (MASINT). The process of Specific Emitter Identification (SEI) based on extraction of distinctive radiated emission features and final emitter identification based on ldquothe knowledge-based approachrdquo [1, 2], generally is not enough to identify detectable radar emission.

The main aspect of nearly all forms of economic activity is a sphere of provisioning. It plays an essential role in retail enterprises, the main task of which is to transform production assortment into a commodity searched by buyers. Efficient provision constitutes necessary condition to realize the task. Results of the own research which was aimed to specify factors of choice of a source of provision by food retailers in podkarpackie voivodeships were presented in the paper. A self-esteem of level of provision of the reviewed companies was compared with assessment made by clients. Additionally, the evaluations were compared with results concerning real purchases realized out of a shop in which it was planned to buy commodities and resulted from lack of assortment in the shop.