Anatomic variations in the surgical anatomy of the thoracic esophagus and its surrounding structures

BACKGROUND: Esophagectomy is a challenging procedure due to: a) it is a complex operation; b) it is linked to very high morbidity and mortality rates; c) surgical anatomy of the esophagus is very peculiar. The anatomic variations that can be unexpectedly found during an operation may cause complications and influence the outcome. AIM: To review the anatomic basis for esophagectomy focusing on anatomic variations found in the mediastinal structures based on literature review and cadaver dissection. METHODS: Literature related to the surgical anatomy of the esophagus and mediastinal structures was reviewed. Also, a total of 20 fresh (non-embalmed, non-preserved, time of death under 12 h) human cadavers were dissected. There were 16 male and mean age was 53 ± 23 years. RESULTS: Anatomic variations for aorta, azygos system, pleura, vagus nerve, lymph nodes and thoracic duct were documented. CONCLUSIONS: The organs and structures of the mediastinum may frequently present anatomic variations. Some of these may be clinically significant during an esophagectomy. Because only a part of them may be identified before the operation with the current imaging tools, surgeons must be aware of these anatomic variations.RACIONAL: A esofagectomia é procedimento difícil, devido a: a) ser operação complexa; b) apresentar alta morbidade e mortalidade; c) a anatomia cirúrgica do esôfago é muito peculiar. As variações anatômicas que podem ser encontradas inesperadamente durante uma operação podem causar complicações e influenciar os resultados. OBJETIVO: Revisar a base anatômica para esofagectomia destacando as variações encontradas nas estruturas mediastinais através de revisão de literatura e dissecção de cadáveres. MÉTODOS: A literatura relacionada com a anatomia cirúrgica das estruturas esôfago e mediastino foi revista. Além disso, um total de 20 cadáveres humanos frescos (não embalsamados, não preservados e com tempo de morte com menos de 12 h) foram dissecados. Dezesseis eram do sexo masculino com idade média de 53±23 anos. RESULTADOS: Variações anatômicas de aorta, sistema ázigos, pleura, nervo vago, linfonodos e ducto torácico foram documentadas. CONCLUSÕES: Os órgãos e estruturas do mediastino podem, frequentemente, apresentar variações anatômicas. Algumas delas podem ser clinicamente significativas durante esofagectomia. Devido a que apenas uma parte dessas variações são identificadas antes da operação com os meios de imagens atuais, os cirurgiões devem estar cientes da possibilidade dessas variações anatômicas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de CirurgiaUniversity of Chicago Pritzker School of Medicine Department of SurgeryUNIFESP, EPM, Depto. de CirurgiaSciEL

Gastroesophageal reflux disease in surgical versus clinical literature: clinicians do not read surgical journals

BACKGROUND: Several diseases may be treated either medically or surgically; however, clinical and surgical therapies are often not treated as different options for the same patient but rather as different medical philosophies. AIM: To assess whether the main surgical and medical journals make references to their counterparts, with gastroesophageal reflux as a model of clinical/surgical disease. METHOD: It was reviewed the leading medical journals in order to verify if surgeons and clinicians make references to their counterparts on their work using gastroesophageal reflux disease as a model of a clinical/surgical disease. It was reviewed the five top-ranked journals in the field of gastroenterology, general surgery and general medicine and a neutral journal. The issues of the year 2008 of the selected journals were searched for papers dealing with gastroesophageal reflux disease. RESULTS: The search in the selected journals retrieved 49 papers, 36 (74%) in clinical journals, 5 (10%) in surgical journals, 2 (4%) in general medicine journals, and 6 (12%) in the neutral journal. Thirty one (63%) had a clinical origin, 13 (26%) a surgical origin, and 5 (10%) a neutral origin. Surgical journals published only surgical papers and general medicine journals published only clinical papers. Clinical journals and general medicine journals showed a higher proportion of clinical/surgical references compared to surgical journals (p<0.001) and the neutral journal (p<0.001). There was no differences in the proportion of clinical/surgical references when surgical and the neutral journal were compared (p=0.06). Clinical journals and general medicine journals showed a similar proportion of clinical/surgical references (p=0.06). CONCLUSION: Clinicians make significantly less references to surgical journals than surgeons do to clinical journals.RACIONAL: Várias doenças podem ser tratadas médica ou cirurgicamente; no entanto, a terapêutica clínica ou cirúrgica não é muitas vezes usada como diferente opção para o mesmo paciente, mas sim como diferente filosofia médica na abordagem. OBJETIVO: Verificar se os principais periódicos cirúrgicos e clínicos fazem referências aos seus congêneres, tendo a doença do refluxo gastroesofágico como um modelo de doença clínico/cirúrgica. MÉTODO: Foram revistos os cinco primeiros periódicos classificados na área de gastroenterologia, cirurgia geral e medicina geral e um jornal neutro. Os números do ano 2008 dos periódicos selecionados foram pesquisados no como lidar com a doença do refluxo gastroesofágico. RESULTADOS: Foram selecionados 49 trabalhos, 36 (74%) em revistas clínicas, 5 (10%) em revistas de cirurgia, 2 (4%) em revistas de medicina geral e 6 (12%) no jornal neutro. Trinta e um (63%) tiveram origem clínica, 13 (26%) cirúrgica, e 5 (10%) a origem foi neutra. Revistas cirúrgicas publicaram apenas artigos cirúrgicos e revistas de medicina geral, publicaram apenas trabalhos clínicos. Revistas e jornais de medicina clínica geral mostraram maior proporção de referências clínico/cirúrgicas em relação às revistas de cirurgia (p<0,001) e do jornal neutro (p<0,001). Não houve diferenças na proporção de referências clínico/cirúrgicas quando revistas cirúrgicas e a neutra foram comparadas (p= 0,06). Revistas clínicas e de medicina geral mostraram semelhante proporção de referências clínico/cirúrgicas (p=0,06). CONCLUSÃO: Os clínicos fazem referências significativamente menores para revistas cirúrgicas do que os cirurgiões fazem para as revistas clínicas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departmento de CirurgiaUniversity of Chicago Department of SurgeryUNIFESP, EPM, Departmento de CirurgiaSciEL

Neuro-Fuzzy prediction of alumina-supported cobalt vanadate catalyst behavior in the Fischer-Tropsch process

Alumina-supported cobalt vanadate multitransition-metal catalyst was prepared by impregnation method. The catalyst was characterized using X-ray diffraction, Fourier transform infrared spectroscopy, Brunauer-Emmett-Teller, X-ray fluorescence and Transmission electron microscopy. The cobalt/vanadium catalyst was employed for Fischer-Tropsch process in an autoclave reactor. The evaluation of this catalyst occurred at different temperature (423-623 K), over a pressure range of 10-50 bars with the Syngas H2/CO ratio varying from 2 to 6. The catalyst gave a high and selective conversion of syngas into methane. The degree of syngas conversion increased with increasing temperature and pressure. The adaptive Neuro-Fuzzy inference system (ANFIS) model has been applied for the training of the fuzzy system and the test set was applied to evaluate the performance of the system including moving average error (MAE), mean square error (MSE), root mean square error (RMSE) and mean absolute percentage error (MAPE). The results exposed that the predicted values from the model were in good agreement with the experimental data

Experimental investigation into l-Arg and l-Cys eco-friendly surfactants in enhanced oil recovery by considering IFT reduction and wettability alteration

Surfactant flooding is an important technique used to improve oil recovery from mature oil reservoirs due to minimizing the interfacial tension (IFT) between oil and water and/or altering the rock wettability toward water-wet using various surfactant agents including cationic, anionic, non-ionic, and amphoteric varieties. In this study, two amino-acid based surfactants, named lauroyl arginine (l-Arg) and lauroyl cysteine (l-Cys), were synthesized and used to reduce the IFT of oil–water systems and alter the wettability of carbonate rocks, thus improving oil recovery from oil-wet carbonate reservoirs. The synthesized surfactants were characterized using Fourier transform infrared spectroscopy and nuclear magnetic resonance analyses, and the critical micelle concentration (CMC) of surfactant solutions was determined using conductivity, pH, and turbidity techniques. Experimental results showed that the CMCs of l-Arg and l-Cys solutions were 2000 and 4500 ppm, respectively. It was found that using l-Arg and l-Cys solutions at their CMCs, the IFT and contact angle were reduced from 34.5 to 18.0 and 15.4 mN/m, and from 144° to 78° and 75°, respectively. Thus, the l-Arg and l-Cys solutions enabled approximately 11.9% and 8.9% additional recovery of OOIP (original oil in place). It was identified that both amino-acid surfactants can be used to improve oil recovery due to their desirable effects on the EOR mechanisms at their CMC ranges

Effect of environment-friendly non-ionic surfactant on interfacial tension reduction and wettability alteration; Implications for enhanced oil recovery

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Production from mature oil reservoirs can be optimized by using the surfactant flooding technique. This can be achieved by reducing oil and water interfacial tension (IFT) and modifying wettability to hydrophilic conditions. In this study, a novel green non-ionic surfactant (dodecanoyl-glucosamine surfactant) was synthesized and used to modify the wettability of carbonate reservoirs to hydrophilic conditions as well as to decrease the IFT of hydrophobic oil-water systems. The synthesized non-ionic surfactant was characterized by Fourier transform infrared spectroscopy (FTIR) and chemical shift nuclear magnetic resonance (HNMR) analyses. Further pH, turbidity, density, and conductivity were investigated to measure the critical micelle concentration (CMC) of surfactant solutions. The result shows that this surfactant alters wettability from 148.93° to 65.54° and IFT from 30 to 14 dynes/cm. Core-flooding results have shown that oil recovery was increased from 40% (by water flooding) to 59% (by surfactant flooding). In addition, it is identified that this novel non-ionic surfactant can be used in CO2 storage applications due to its ability to alter the hydrophobicity into hydrophilicity of the reservoir rocks

Usage et vulnérabilité de la flore de la Forêt Communautaire de Ando-Akpuivé au Togo

This study constitutes a contribution to the sustainable management of the Ando-Akpuivé community forest (FCAA) in the Avé prefecture of Togo. It specifically assessed the importance of the uses of the flora species of the FCAA and their level of vulnerability. The analysis drew on floristic inventory data, along with information on the uses of the plants, the harvested organs, the method of organ collection and the plant stage at which the organ parts were harvested. A total of 65 utilitarian plants were documented out of a total of 188 species present in the vegetation, highlighting the need for further research into the diversity of utilitarian flora in this ecosystem. The importance value index reveals that the most significant species are the introduced species, including Azadirachta indica, Senna siamea, Gliricidia sepium and Mangifera indica. The most prevalent plant families are Fabaceae (24.8%), Rutaceae (14.2%) and Meliaceae (11.0%). The most commonly reported used plant parts are leaves (40.7%), stems (29.4%) and flowers (9.4%), which are used for medicinal purposes, as fuel (23.3%) and food (11.0%). The harvesting methods that have been identified as most common include leaf removal (34.7%), cutting (22.5%) and gathering (20.1%). The study identified 14 highly vulnerable plant species, including Anogeissus leiocarpa, Bridelia ferruginea, Gliricidia sepium, Lonchocarpus sericeus, Nephrolepis biserrata and Senna siamea. It is recommended that greater consideration be given to the preferences of users and to vulnerable species in order to contribute to sustainable resource management in the face of increasing population needs. Keywords: Plant use, availability, community forestry, TogoLa présente étude est une contribution à la gestion durable de la forêt communautaire de Ando-Akpuivé (FCAA) dans la préfecture l’Avé au Togo. Plus spécifiquement, elle a évalué l’importance d'usages et le niveau de vulnérabilité de la flore da la FCAA. L’analyse s’est basée sur les données d’inventaires floristiques, les usages des plantes, les organes prélevés, le mode de collectes des organes et le stade de développements de la plante lors de la récolte des parties d’organes. Au total 65 plantes utilitaires ont été rapportées sur un ensemble de 188 espèces présentes dans la végétation. L’indice de valeur d’importance montre que les espèces les plus importantes sont les espèces introduites dont Azadirachta indica, Senna siamea, Gliricidia sepium et Mangifera indica. Les familles les plus représentées de la flore utilitaire sont les Fabaceae (24,8 %), les Rutaceae (14,2 %) et les Meliaceae (11,0 %). Les feuilles (40,7 %), les tiges (29,4 %) et les fleurs (9,4 %) sont les parties de plantes les plus citées en usages. Ces parties des plantes sont utilisées à des fins médicinales, de bois-énergie (23,3 %) et d’alimentation (11,0 %). Le mode de prélèvement des parties des plantes le plus pratiqué est le défeuillage (34,7 %), suivi de la coupe (22,5 %) et de la cueillette (20,1 %). L’étude a ressorti 14 plantes très vulnérables dont Anogeissus leiocarpa, Bridelia ferruginea, Gliricidia sepium, Lonchocarpus sericeus, Nephrolepis biserrata et Senna siamea. Une meilleure prise en compte des préférences des utilisateurs et des espèces vulnérables contribuerait à une gestion durable des ressources face à l’augmentation des besoins des populations. Mots clés: Usage des plantes, disponibilité, foresterie communautaire, Tog

Syndrome De Guillain-Barré Chez L’enfant Dans Un Contexte A Ressources Limitées : A Propos De Deux Observations Au CHU Sylvanus Olympio De Lomé - TOGO

Guillain-Barré syndrome is rare in children. With polyvalent immunoglobulins the management and prognosis has been significantly improved with complete recovery rate exceeding 80%. We report the cases of two children who completely recovered after Guillain-Barré syndrome in the absence of immune globulin. He was a 12 year old daughter and an infant of 17 months male who presented a progressive ascending motor deficit, dysphonia with difficulty swallowing, difficulty breathing, areflexia. A albumino-cytological dissociation was found in the study of cerebrospinal fluid in both cases. Electromyography in the girl had confirmed a axono-form myelin. Retroviral serology was negative in both cases. Other serology (Campylobacter jejuni, Cytomegalovirus, Epstein Barr, ZIKA), the dosage of anti-ganglioside antibodies and brain imaging had not been made. The immunoglobulins are not available in our work context, we conducted a symptomatic management. Complete healing was achieved with a 4-month decline

Mortalité Néonatale dans le Service de Pédiatrie du Centre Hospitalier Universitaire de Kara de 2016 à 2020

Objectif : décrire la mortalité néonatale dans le service de pédiatrie du CHU-Kara Matériel et méthode : il s’agit d’une étude descriptive transversale portant sur les nouveau-nés décédés durant l’hospitalisation du 1er Janvier 2016 au 31 Décembre 2020 au CHU-Kara. Les principaux paramètres étudiés étaient les renseignements généraux, les caractéristiques de la mère, l’histoire et l’évolution de la grossesse, les données liées à l’accouchement, l’état du nouveau-né, la pathologie diagnostiquée et le traitement reçu avant le décès. Résultats : le taux de mortalité néonatale était de 158,4 ‰ dont 87,8% dans la première semaine de vie. Les facteurs maternels associés aux décès néonataux étaient : l’âge maternel compris entre 18-35 ans, le lieu de provenance et le niveau bas d’instruction. Les facteurs obstétricaux et néonataux associés au décès néonatals étaient : le mauvais suivi de la grossesse, le sexe masculin, l’accouchement par voie basse, l’asphyxie périnatale, la primiparité, la prématurité et la détresse respiratoire néonatale. Conclusion : la mortalité néonatale constitue un véritable fléau dans notre société. Le renforcement du suivi des femmes enceintes et de la prise en charge précoce du nouveau-né permettra de réduire cette mortalité. Objective: describe neonatal mortality in the pediatric department of the CHU-Kara. Material and method: It was a cross-sectional descriptive study on newborns who died during hospitalization from January 1st, 2016 to December 31th, 2020. The main parameters studied were general information, mother’s characteristics of the mother, pregnancy’s history, data related to childbirth, conditions/status of the newborn, diagnosed pathology and treatment received before death. Results: the neonatal mortality rate was 158.4 ‰ with 87.8% in the first week of life. Maternal associated factors for neonate’s death were: age between 18-35 years, place of origin and low level of education. The obstetric and neonatal factors associated with neonatal death were: weak pregnancy follow-up, male sex, vaginal delivery, perinatal asphyxia, primiparity, prematurity and neonatal respiratory distress. Conclusion: neonatal mortality is a real scourge in our society. Strengthening the follow-up of pregnant women and early care of the newborn will contribute to reducing this mortality

Pregnancy and burns: experience of a university hospital burn unit

Introduction: The incidence of burns involving pregnant women is not well established in the literature, but is estimated to be between 3% and 7%. The management of burns in pregnancy represents a great challenge with significant impact on outcomes and maternal-fetal prognosis. Case Report: In the present study, we report two cases of pregnant burn victims who were treated in the burn unit in the Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP). One patient was treated in the first trimester and the other in the third trimester. Conclusion: In both cases, the pregnant women received specialized treatment for burns in conjunction with clinical follow-up by the obstetrics team, with good maternal-fetal outcomes

Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

BACKGROUND: Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. METHODS: In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d'Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention. RESULTS: Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d'Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767). CONCLUSIONS: This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. TRIAL REGISTRATION: PACTR202001816232398 , June 01, 2020, retrospectively registered