Enhanced Elastocaloric Effects in γ-Graphyne.

The global emphasis on sustainable technologies has become a paramount concern for nations worldwide. Specifically, numerous sustainable methods are being explored as promising alternatives to the well-established vapor-compression technologies in cooling and heating devices. One such avenue gaining traction within the scientific community is the elastocaloric (eC) effect. This phenomenon holds promise for efficient cooling and heating processes without causing environmental harm. Studies carried out at the nanoscale have demonstrated the efficiency of the eC effect, proving to be comparable to that of state-of-the-art macroscopic systems. In this study, we used classical molecular dynamics simulations to investigate the elastocaloric effect for the recently synthesized γ-graphyne. Our analysis goes beyond obtaining changes in eC temperature and the coefficient of performance (COP) for two species of γ-graphyne nanoribbons (armchair and zigzag). We also explore their dependence on various conditions, including whether they are deposited on a substrate or prestrained. Our findings reveal a substantial enhancement in the elastocaloric effect for γ-graphyne nanoribbons when subjected to prestrain, amplifying it by at least 1 order of magnitude. Under certain conditions, the changes in the eC temperature and the COP of the structures reach expressive values as high as 224 K and 14, respectively. We discuss the implications of these results by examining the shape and behavior of the carbon-carbon bond lengths within the structures.

Development of an image-based fluorometer with smartphone control for paper analytical devices.

This work describes the construction and evaluation of a fluorometer for use in paper analytical devices, using a smartphone to operate the instrument and to perform real-time image-based detection. In this approach, a circular PAD containing twenty analytical plates is rotated at 18° increments under a UV LED source, providing a sequential irradiation of plates and the detection of the luminescence with a lab-made application, capable of automatically identifying the analytical zones and collecting the RGB intensities from the selected pixels. As a proof of concept, the fluorometer performance was evaluated for the determination of quinine in beverages and riboflavin (B2 vitamin) in supplements. Quinine, which is less photoreactive, provided steady-state signals, while riboflavin, which rapidly degrades under UV photons, presented transient responses for RGB detection. For both analytes, linear calibration ranges (R2 > 0.99) were observed from 2.0 mg L-1 to 10.0 mg L-1 with limits of detection estimated at approximately 1.0 mg L-1. Nevertheless, it was demonstrated that successive additions of standard solutions to a single analytical plate of PAD could enhance the signal-to-noise ratios for less concentrated samples, acting as a pre-concentration step. In addition, suitable deviations for the signals (ca. 4.0%) and the absence of systematic errors for most samples (9 out of 11), when compared with a reference method at 95% confidence level, indicates that the proposed strategy is precise and accurate enough to be used as analytical tool for fluorescence detection in PAD.

Elastocaloric Effect in Graphene Kirigami.

Kirigami, a traditional Japanese art of paper cutting, has recently been explored for its elastocaloric effect (ECE) in kirigami-based materials (KMs), where an applied strain induces temperature changes. Importantly, the feasibility of a nanoscale graphene kirigami monolayer was experimentally demonstrated. Here, we investigate the ECE in GK representing the thinnest possible KM to better understand this phenomenon. Through molecular dynamics simulations, we analyze the temperature change and coefficient of performance (COP) of GK. Our findings reveal that while GKs lack the intricate temperature changes observed in macroscopic KMs, they exhibit a substantial temperature change of approximately 9.32 K (23 times higher than that of macroscopic KMs, which is about 0.4 K) for heating and -3.50 K for cooling. Furthermore, they demonstrate reasonable COP values of approximately 1.57 and 0.62, respectively. It is noteworthy that the one-atom-thick graphene configuration prevents the occurrence of the complex temperature distribution observed in macroscopic KMs.

Abdominal esophagocardiectomy with esophagogastric anastomosis, with vagal preservation and construction of a spiral anti reflux valve in the treatment of advanced megaesophagus.

OBJECTIVE: present a new operative technique characterized by abdominal esophagocardiectomy, with esophagogastrus anastomosis, vagal preservation and spiral anti-reflux valve construction in the treatment of advanced megaesophagus in patients with severe systemic diseases, as well as its result in an initial group of 17 patients. METHOD: We selected 17 patients with advanced megaesophagus and comorbidities submitted to new technique. The following parameters were analyzed: age, sex, length of hospital stay, early and late complications, mortality, radiological/endoscopic aspects. RESULTS: twelve male patients (70%) and five (30%) were operated on, with mean age of 51.5 years and mean hospital stay of 14.8 days. There was no mortality in the immediate intraoperative or postoperative period and there were no cases of postoperative fistula. During hospitalization there was one case of pulmonary atelectasis (5.8%), one of pleural effusion (5.8%), two of wall infection (11.7%) and one of urinary retention (5.8%). Discussion: We believe it to be an easy technique, made exclusively by the abdominal route, that is, without violating the thoracic cavity. Such a procedure would be beneficial in patients with advanced megaesophagus and important comorbidities, as well as in those with a history of previous surgeries. CONCLUSION: the technique described was easy to perform and safe, when performed by an experienced team, with low morbidity and mortality in patients with advanced megaesophagus and important comorbidities, which could increase your complications with more invasive and complex surgeries.

Managing tube thoracostomy with thoracic ultrasound: results from a randomized pilot study.

PURPOSE: Tube thoracostomy (TT) is a simple and a life-saving procedure; nevertheless, it carries morbidity, even after its removal. Currently, TT is managed and removed by chest X-ray (CXR) evaluation. There are limitations and these are directly linked to complications. The use of thoracic ultrasound (US) has already been established in the diagnosis of pneumothorax (PTX) and hemothorax (HTX); its use, in substitution of CXR can lead to improvement in care. Our aim is to evaluate the efficiency and safety of US in the management of TT. METHODS: Prospective and randomized study with patients requiring TT. They were divided in groups according to their thoracic injuries (PTX and HTX) and randomized into two groups according to TT management: US and CXR. Data collected included gender, age, mechanism of injury, days to TT removal, complications after TT removal and presence of mechanical ventilation. RESULTS: Sixty-one patients were randomized, of which 68.8% were male. The most frequent diagnosis was PTX, present in 37 cases. Median time for TT removal was 2.5 days in the US group and 4.9 in the control group (p = 0.009). The complication rate was 6.6%, with no morbidity in the US group. TT removal in patients with mechanical ventilation did not increase the incidence of complications. CONCLUSIONS: The use of US in the management is efficient and safe. It allows early TT removal regardless the cause of the thoracic injury.

Abdominal esophagocardiectomy with esophagogastric anastomosis, with vagal preservation and construction of a spiral anti reflux valve in the treatment of advanced megaesophagus / Esofagocardiectomia abdominal com esofagogastro anastomose, com preservação vagal e construção de válvula antirrefluxo em espiral no tratamento do megaesôfago avançado

ABSTRACT Objective: present a new operative technique characterized by abdominal esophagocardiectomy, with esophagogastrus anastomosis, vagal preservation and spiral anti-reflux valve construction in the treatment of advanced megaesophagus in patients with severe systemic diseases, as well as its result in an initial group of 17 patients. Method: We selected 17 patients with advanced megaesophagus and comorbidities submitted to new technique. The following parameters were analyzed: age, sex, length of hospital stay, early and late complications, mortality, radiological/endoscopic aspects. Results: twelve male patients (70%) and five (30%) were operated on, with mean age of 51.5 years and mean hospital stay of 14.8 days. There was no mortality in the immediate intraoperative or postoperative period and there were no cases of postoperative fistula. During hospitalization there was one case of pulmonary atelectasis (5.8%), one of pleural effusion (5.8%), two of wall infection (11.7%) and one of urinary retention (5.8%). Discussion: We believe it to be an easy technique, made exclusively by the abdominal route, that is, without violating the thoracic cavity. Such a procedure would be beneficial in patients with advanced megaesophagus and important comorbidities, as well as in those with a history of previous surgeries. Conclusion: the technique described was easy to perform and safe, when performed by an experienced team, with low morbidity and mortality in patients with advanced megaesophagus and important comorbidities, which could increase your complications with more invasive and complex surgeries.

RESUMO Objetivo: apresentar uma nova técnica caracterizada por esofagocardiectomia abdominal com esofagogastro anastomose, preservação vagal e construção de válvula antirrefluxo em espiral no tratamento do megaesôfago avançado de pacientes com doenças sistêmicas graves, assim como seu resultado em grupo inicial de 17 pacientes. Método: foram selecionados 17 pacientes com megaesôfago avançado e comorbidades submetidos a nova técnica. Os seguintes parâmetros analisados foram: idade, sexo, tempo de permanência hospitalar, complicações precoces e tardias, mortalidade, aspectos radiológicos/endoscópicos. Resultados: foram operados 12 (70%) pacientes do sexo masculino e 5 (30%) do sexo feminino, com idade média foi de 51,5 anos e tempo de permanência hospitalar médio de 14,8 dias. Não houve mortalidade no intraoperatório ou pós-operatório imediato e não houve casos de fìstula. Durante a internação houve um caso de atelectasia pulmonar (5,8%), um de derrame pleural (5,8%), dois de infecção de parede (11,7%) e um de retenção urinária (5,8%). Discussão: acreditamos ser uma técnica de fácil realização, feita exclusivamente por via abdominal, ou seja, sem violar a cavidade torácica. Tal procedimento seria benéfico em pacientes com megaesôfago avançado e comorbidades importantes, assim como naqueles com história de cirurgias prévias. Conclusão: a técnica descrita mostrou-se de fácil execução e segura, quando realizada por equipe experiente, com baixa morbimortalidade em pacientes com megaesôfago avançado e comorbidades importantes, o que poderia aumentar suas complicações com cirurgias mais invasivas e complexas.

A new quantitative gel electrophoresis method with image-based detection for the determination of food dyes and metallic ions.

This work describes an alternative application of gel electrophoresis for the separation and quantification of analytes with low molecular weights using an innovative and low-cost apparatus that enables the acquisition of image-based electropherograms with a webcam. As a proof of concept, the determination of Cu and Ni content in metallic alloys was evaluated by means of the separation and detection of the metallic ions, previously complexed with Eriochrome Black T. Furthermore, the determination of the food colouring agents Sunset Yellow FCF, Tartrazine, Brilliant Blue FCF and Amaranth Red in powder refreshment samples was investigated as alternative to well-stablished methods used for this purpose. For all investigated analytes, the corresponding electrophoretic peaks showed signal to noise ratios ranging from 10 to 180, suitable precision on areas (RSD < 3.5%) and linear relationships (R > 0.99) between RGB detected signals and concentrations of the standard solutions. Application of the method to the determination of Cu and Ni contents in metallic alloys provided results with no significant differences, at 95% confidence level, when compared to the results obtained with a FAAS based method. Apparent recoveries estimated for powder refreshment samples fortified with the food dyes ranged from 93% to 108% for added and found contents, suggesting the absence of matrix effects. The studies prove the feasibility of separation and quantification of coloured analytes by gel electrophoresis and image-based detection that can be useful for different samples.

Laparoscopic resection of primary retroperitoneal schwannoma: A case report.

BACKGROUND: Schwannomas are rare, often benign, tumors deriving from Schwann cells that have low incidence in the retroperitoneal region (0.5% to 5%). Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs, symptoms and imaging tests. Thus, it is necessary performing guided punch biopsy in order to identify it. Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy. CASE SUMMARY: Forty-seven years old female patient who was hospitalized for elective orthopedic procedure, without complications, evolved with severe pain in the lower limbs, thigh and gluteal region associated with neurogenic claudication. Persistent pain required magnetic resonance imaging (MRI) of the lumbar spine, which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion. The surgical team opted for draining the collection, as well as requested an MRI of the abdomen and pelvis, whose analysis showed expansive lesion in the retroperitoneum, in close contact with the inferior vena cava and with the right renal vein. A guided puncture was performed for diagnostic clarification, which showed immunohistochemical profile compatible with schwannoma. The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy. The patient was discharged and remained stable after 4-mo follow-up; she remains under follow-up to check the need of cancer investigations. CONCLUSION: Schwannoma features requires surgical treatment based on laparoscopic resection, which often presents low relapse rates and optimistic prognosis.

Expression of MMR system genes is correlated to NF-kB in patients with oral squamous cell carcinoma.

AIMS: The aim of this study was to evaluate the mismatch repair gene expression and their correlation with NF-kB in patients with oral squamous cell carcinoma (SCC). METHODS: Total RNA was isolated from 28 biopsy samples. A control group was composed of 20 volunteers. Differential expression of hMSH2, hMSH6 and NF-kB genes was accessed by quantitative PCR. RESULTS: There is increased expression of all the analysed genes when the patients were smokers and alcoholics. In addition, there is increased expression of hMSH2 when SCC was removed from the base of the tongue. There was a correlation between NF-kB and hMSH2 and hMSH6 as well as between repair genes hMSH2 and hMSH6 expression levels. There is increased expression of the hMSH2 gene in patients with SCC, especially in the alcoholics. CONCLUSIONS: There is a strong indication that NF-kB gene was expressed along with the studied repair genes, evidencing the possibility that this system can be activated by the inflammatory pathway.

Abordagem de segurança alimentar nutricional nos currículos das universidades federais brasileiras: principais enfoques / Food and nutrition security approach in Brazilian federal universities curricula: core aspects

Resumo O nutricionista é um profissional importante para a promoção da saúde individual e coletiva, tendo em vista a realização da segurança alimentar e nutricional (SAN), que focaliza o direito humano à alimentação adequada (DHAA) e se constitui estratégia de ações e políticas que pautam o próprio DHAA, a soberania alimentar e o enfoque sistêmico. Nesse sentido, a formação do nutricionista deve incluir conteúdos que subsidiem a sua tarefa de promoção da alimentação adequada e saudável, comprometida com os princípios do Sistema Único de Saúde, na perspectiva da SAN. Este estudo analisou 27 projetos pedagógicos do curso de nutrição de universidades federais das cinco regiões do país, visando identificar como a SAN aparece nos currículos e se constitui elemento para a construção do perfil profissional. A análise evidenciou que, apesar de a maioria estar em consonância com as orientações das Diretrizes Curriculares Nacionais em relação ao perfil esperado para o egresso, o tema é abordado por um número restrito de disciplinas, apontando baixa representatividade dos conteúdos de SAN em relação a outros conteúdos disciplinares. Conclui-se que o fortalecimento do tema na formação refletirá na atuação do profissional engajado e comprometido com a sua realização no cotidiano.

Abstract Nutritionists are key for individual and collective health promotion focused on achieving Food and Nutrition Security (FNS) policies, which in Brazil focuses on the human right to adequate food (HRAF) and includes guidelines for itself, for food sovereignty, and its systemic approach. The nutritionist's training must include content that promotes adequate and healthy food, following SUS principles from the perspective of FNS. This study analyzes 27 pedagogical projects of the Nutrition course from federal universities in the five regions of Brazil to identify how the FNS appears in Nutrition curricula and functions as an element for constructing a professional profile. The results showed that, although most curricula comply with the national curriculum guidelines regarding the expected profile for graduates, the subject is addressed by a restricted number of disciplines, indicating a low representativeness of FNS content regarding interdisciplinary content. Strengthening the subject during training thus reflects on these professionals' performance in daily life.

Concepções e práticas de educação e saúde da população negra: uma revisão integrativa da literatura brasileira / Conceptions and practices of education and black population health: an integrative review of Brazilian literature / Concepciones y prácticas de educación y salud de la población negra: una revisión integrativa de la literatura brasileña

A Política de Saúde Integral da População Negra reiterou a urgência de qualificação dos processos educativos no Sistema Único de Saúde (SUS) em prol da superação do racismo institucional. A revisão integrativa, apresentada neste artigo, analisou as concepções teóricas e as práticas educativas em estudos dirigidos à saúde da população negra. Foram utilizadas as bases de dados da Biblioteca Virtual em Saúde (BVS); a Scientific Eletronic Library Online (SciELO); a ferramenta de pesquisa na web Google Scholar e o acervo darevista da Associação Brasileira de Pesquisadores/as Negros/as, a Revista da ABPN. A produção na temática é heterogênea, dispersa entre periódicos das áreas da educação, educação em saúde e interdisciplinar. Há vanguardismo da enfermagem e forte presença de estudos com povos e comunidades tradicionais. Nota-se dificuldade de interpenetração de referenciais teóricos e pedagógicos do campo da educação na sustentação das práticas educativas de saúde. Sugerem-se a cooperação e a integração científica entre esses campos visando ao protagonismo do sujeito negro nos processos de cuidado.

The Política de Saúde Integral da População Negra (Integral Health Policy of the Black Population) reiterated the urgency of qualifying educational processes in the Unified Health System (SUS ­ Sistema Único de Saúde) in order to overcome institutional racism. The integrative review presented in this article analyzed the theoretical conceptions and the educational practices in studies directed to the health of the black population. The databases of the Virtual Health Library (VHL); the Scientific Electronic Library Online (SciELO); the web search engine Google Scholar and the collection of the Revista da ABPN that is the magazine of the Associação Brasileira de Pesquisadores/as Negros/as (Brazilian Association of Black Researchers) were examined. The production in this thematic is heterogeneous, dispersed in periodicals of the areas of education, health education and interdisciplinary. When the matter is the health of black population, the nursing is an avantgarde profession carrying out a number of studies with traditional peoples and communities. It was noted the difficulty of interpenetration of theoretical and pedagogical references of the field of education in support of educational health practices. We suggest the cooperation and the scientific integration between these fields aiming at the protagonism of the black population in the process of care.

La Política de Saúde Integral da População Negra (Política de Salud Integral de la Población Negra) reiteró la urgencia de calificación de los procesos educativos en el Sistema Único de Salud (SUS ­ Sistema Único de Saúde) en pro de la superación del racismo institucional. La revisión integrativa, presentada en este artículo, analizó las concepciones teóricas y las prácticas educativas en estudios dirigidos a la salud de la población negra. Se utilizaron las bases de datos de la Biblioteca Virtual en Salud (BVS); la Scientific Eletronic Library Online (SciELO); el motor de búsqueda web Google Scholar y el acervo de la Revista da ABPN, la cual es la revista de la Associação Brasileira de Pesquisadores/as Negros/as (Asociación Brasileña de Investigadores/ as Negros/as. La producción en la temática es heterogénea, dispersa entre periódicos del área de la educación, educación en salud y interdisciplinaria. La enfermería se destaca en la literatura acerca de la salud de la población negra en la cual hay fuerte presencia de estudios con pueblos y comunidades tradicionales. Se observa dificultad de interpenetración de referenciales teóricos y pedagógicos del campo de la educación en la sustentación de las prácticas educativas de salud. Proponemos la cooperación y la integración científica entre esos campos visando el protagonismo del sujeto negro en los procesos de cuidado.

Involvement of repair genes in oral cancer: A systematic review.

Among the types of cancers that may occur in the oral cavity, squamous cell carcinomas (SCC) of the mouth have a higher incidence and are associated with increased rates of morbidity and mortality. Among steps from the beginning to the progression of the tumour, DNA Repair System is highlighted. The present study aims to conduct a systematic review of the literature on the expression of the repair genes hMSH2 and hMSH6 in patients with SCC in the mouth and oropharyngeal region. The search was performed in databases such as PubMed, Lilacs, and Scielo and included articles published in English from 1999 until 2015. The search in the above-mentioned databases initially yielded 15 scientific articles related to the proposed objective. After a detailed analysis of each of them, only 8 were included in the present review, precisely because they met the inclusion criteria determined in the method. All the reviewed works were unanimous in recognizing the veracity and complexity of the Genomic Repair System, also called Mismatch Repair System, confirming the participation of repair gene proteins (such as hMSH2 and hMSH6) in patients with oral cancer and even of lesions that are susceptible to malignization. SIGNIFICANCE OF THE STUDY: Worldwide, there are an estimated 300 thousand new cases of oral cancer per year. Studies have shown a greater risk in individuals who are smokers and alcohol consumers in developing mouth cancer. Many steps are observed from the beginning to the progression of the tumour, highlighted among them is the moment in which genetic, and epigenetic alterations will interfere in the functioning of the DNA Repair System. This work presents a survey of current knowledge about the involvement of repair genes, especially those of the MutSα system, in the development and progression of oral cancer.

The structure of graphene on graphene/C60/Cu interfaces: a molecular dynamics study.

Two experimental studies reported the spontaneous formation of amorphous and crystalline structures of C60 molecules intercalated between graphene and a surface. The findings observed included interesting phenomena ranging from reaction between fullerene C60s ('C60s' stands for plural of C60) under graphene to graphene sheets sagging between C60s and control of strain in these sheets. Motivated by this work, we performed fully atomistic reactive molecular dynamics simulations to investigate the formation and thermal stability of graphene sheet wrinkles as well as graphene attachment to and detachment from a surface when the sheet is laid over a previously distributed array of C60 molecules on a copper surface at different temperatures. As graphene compresses the C60s against the surface, and graphene attachment to the surface in between C60s depends on the height of the wrinkles in the graphene sheet, configurations with both frozen and non-frozen fullerenes were investigated in the simulations in order to examine the experimental result of stable, sagged graphene sheets when the distance between C60s is about 4 nm and the height of the wrinkles in the sheet is about 0.8 nm. Below a distance of 4 nm between fullerenes, the graphene is predicted to become locally suspended and less strained. The simulations predict that this happens when the fullerenes can deform under the compressive action of the graphene sheet. If the fullerenes are kept frozen, spontaneous 'blanketing' of graphene is predicted only when the distance between neighbouring C60s is equal to or great than about 7 nm. These predictions agree with a mechanical model relating the rigidity of a graphene sheet to the energy of graphene-surface adhesion. This work further reveals the structure of intercalated molecules and the role of stability and sheet wrinkling on the preferred configuration of graphene. This study thus might assist in the development of two-dimensional confined nanoreactors for chemical reactions.

Influence of vascularized lymph node transfer (VLNT) flap positioning on the response to breast cancer-related lymphedema treatment. / Influência do posicionamento do retalho linfonodal vascularizado na resposta ao tratamento cirúrgico do linfedema secundário ao câncer de mama.

OBJECTIVE: to evaluate the initial therapeutic experience of transplantation of vascularized lymph nodes in patients with lymphedema of the upper limbs secondary to the treatment of breast cancer, and to verify if the positioning of the transplant influences the surgical result. METHODS: we conducted a prospective, comparative test of two therapeutic modalities, with 24 patients with lymphedema of the upper limb after breast cancer treatment, classified as grades 2 and 3, according to the International Lymphedema Society. The two types of procedures performed were: 1) total breast reconstruction with - deep inferior epigastric perforator (DIEP) flap associated with lymph node flap, in patients with no previous breast reconstruction or loss of previous reconstruction (axillary positioning); 2) isolated inguinal lymph node flap performed in patients with completed breast reconstruction or without the desire to perform the breast reconstruction (wrist positioning). RESULTS: the reduction percentage of the affected limb volume was 20.1% (p=0.0370). The number of infectious episodes (cellulites) also decreased significantly, from 41% in the preoperative period to 12.5% in the postoperative one (p=0.004). There were no differences between the proximal and distal groups. CONCLUSION: the transplantation of lymph nodes positively affected the postoperative evolution of patients with lymphedema secondary to breast cancer. We observed no differences in relation to flap positioning.

OBJETIVO: analisar a experiência terapêutica inicial do transplante de linfonodos vascularizados em pacientes portadoras de linfedema de membros superiores secundário ao tratamento do câncer de mama e verificar se o posicionamento do transplante influencia o resultado cirúrgico. MÉTODOS: ensaio prospectivo, comparativo, de duas modalidades terapêuticas em 24 pacientes portadoras de linfedema de membro superior após tratamento de câncer mamário, classificados como graus 2 e 3, segundo a Sociedade Internacional de Linfedema. Os dois tipos de procedimentos realizados foram: 1) reconstrução total da mama com retalho de perfurante da artéria epigástrica inferior (DIEP- deep inferior epigastric perforator flap) associado ao retalho linfonodal, em pacientes sem reconstrução mamária prévia ou com histórico de perda da reconstrução (posicionamento axilar); 2) retalho linfonodal inguinal isolado foi realizado em pacientes com reconstrução mamária finalizada ou sem o desejo de realizar a reconstrução da mama (posicionamento no punho). RESULTADOS: a porcentagem de redução do volume do membro afetado foi de 20,1% (p=0,0370). O número de episódios infecciosos (celulites) também sofreu redução significativa, de 41% no período pré-operatório para 12,5% no pós-operatório (p=0,004). Não foram observadas diferenças entre os grupos proximal e distal. CONCLUSÃO: o transplante de linfonodos afetou positivamente a evolução pós-operatória de pacientes portadoras de linfedema secundário ao câncer de mama. Não foram observadas diferenças em relação ao posicionamento do retalho.

Neonatal mortality in Luanda, Angola: what can be done to reduce it? / Mortalidade neonatal em Luanda, Angola: o que pode ser feito para sua redução?

INTRODUCTION: One of the main health indicators is infant mortality rate, which is a metric of living conditions and population development. The goal of reducing neonatal mortality requires an adequate knowledge of the real factors at each level of health care so that maternal and human resources are efficiently channeled to the constraint. Countries that have paid special attention to improving health services for the entire pregnancy-puerperal cycle have attained the reduction of infant mortality, especially early neonatal mortality. OBJECTIVE: The present study aims to describe the profile and analyze the risk factors associated with neonatal mortality in the Angolan context at a tertiary level public maternity hospital, located in Luanda. METHODS: This is a retrospective cross-sectional study with a quantitative approach, using secondary data, of provincial base in hospital and ministerial registry instruments from January to December 2012. RESULTS: The results show that the neonatal deaths are not mere occurrences, since they indicate failures of the political powers, professionals of the health system and of the families. CONCLUSIONS: This study suggests that the major risk factor for birth mortality in Luanda is the type of delivery (c-section) and that this data is not related to the age of the mother or to premature birth. We also found that there was higher mortality between May and July, during the period of lower rainfall index in the region. However, further studies are needed that may provide a logical framework and arguments for realistic policies to mitigate neonatal mortality.

INTRODUÇÃO: Um dos principais indicadores de saúde é a taxa de mortalidade infantil, que é uma métrica de condições de vida e desenvolvimento populacional. A redução da mortalidade neonatal requer um conhecimento adequado dos fatores reais em cada nível de atenção à saúde, de modo que os recursos maternos e humanos sejam eficientemente avaliados. Os países que deram atenção especial à melhoria dos serviços de saúde para todo o ciclo gravídico-puerperal atingiram a redução da mortalidade infantil, especialmente a mortalidade neonatal precoce. OBJETIVO: O presente estudo tem como objetivo descrever o perfil e analisar os fatores de risco associados à mortalidade neonatal em uma maternidade pública de nível terciário localizada em Luanda, Angola. MÉTODO: Trata-se de um estudo retrospectivo de corte transversal com abordagem quantitativa, utilizando dados secundários de base provincial em instrumentos de registro hospitalar e ministerial de janeiro a dezembro de 2012. RESULTADOS: Os resultados mostram que os óbitos neonatais não são meras ocorrências, pois indicam falhas dos poderes políticos, de profissionais do sistema de saúde e das famílias. CONSLUSÃO: Este estudo sugere que o maior fator de risco para mortalidade ao nascimento em Luanda é o tipo de parto (c-section) e que este dado não está relacionado com a idade da mãe ou com o nascimento prematuro. Identificamos também que houve maior mortalidade entre os meses de maio a julho, durante o período de menor índice de chuvas na região. No entanto, são necessários mais estudos que possam fornecer um quadro lógico e argumentos para políticas realistas para mitigar a mortalidade neonatal.

Influência do posicionamento do retalho linfonodal vascularizado na resposta ao tratamento cirúrgico do linfedema secundário ao câncer de mama / Influence of vascularized lymph node transfer (VLNT) flap positioning on the response to breast cancer-related lymphedema treatment

RESUMO Objetivo: analisar a experiência terapêutica inicial do transplante de linfonodos vascularizados em pacientes portadoras de linfedema de membros superiores secundário ao tratamento do câncer de mama e verificar se o posicionamento do transplante influencia o resultado cirúrgico. Métodos: ensaio prospectivo, comparativo, de duas modalidades terapêuticas em 24 pacientes portadoras de linfedema de membro superior após tratamento de câncer mamário, classificados como graus 2 e 3, segundo a Sociedade Internacional de Linfedema. Os dois tipos de procedimentos realizados foram: 1) reconstrução total da mama com retalho de perfurante da artéria epigástrica inferior (DIEP- deep inferior epigastric perforator flap) associado ao retalho linfonodal, em pacientes sem reconstrução mamária prévia ou com histórico de perda da reconstrução (posicionamento axilar); 2) retalho linfonodal inguinal isolado foi realizado em pacientes com reconstrução mamária finalizada ou sem o desejo de realizar a reconstrução da mama (posicionamento no punho). Resultados: a porcentagem de redução do volume do membro afetado foi de 20,1% (p=0,0370). O número de episódios infecciosos (celulites) também sofreu redução significativa, de 41% no período pré-operatório para 12,5% no pós-operatório (p=0,004). Não foram observadas diferenças entre os grupos proximal e distal. Conclusão: o transplante de linfonodos afetou positivamente a evolução pós-operatória de pacientes portadoras de linfedema secundário ao câncer de mama. Não foram observadas diferenças em relação ao posicionamento do retalho.

ABSTRACT Objective: to evaluate the initial therapeutic experience of transplantation of vascularized lymph nodes in patients with lymphedema of the upper limbs secondary to the treatment of breast cancer, and to verify if the positioning of the transplant influences the surgical result. Methods: we conducted a prospective, comparative test of two therapeutic modalities, with 24 patients with lymphedema of the upper limb after breast cancer treatment, classified as grades 2 and 3, according to the International Lymphedema Society. The two types of procedures performed were: 1) total breast reconstruction with - deep inferior epigastric perforator (DIEP) flap associated with lymph node flap, in patients with no previous breast reconstruction or loss of previous reconstruction (axillary positioning); 2) isolated inguinal lymph node flap performed in patients with completed breast reconstruction or without the desire to perform the breast reconstruction (wrist positioning). Results: the reduction percentage of the affected limb volume was 20.1% (p=0.0370). The number of infectious episodes (cellulites) also decreased significantly, from 41% in the preoperative period to 12.5% in the postoperative one (p=0.004). There were no differences between the proximal and distal groups. Conclusion: the transplantation of lymph nodes positively affected the postoperative evolution of patients with lymphedema secondary to breast cancer. We observed no differences in relation to flap positioning.

Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases.

OBJECTIVE: to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. METHODS: we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruction data, postoperative complications, including loss of reconstruction and complications of surgical wound. We divided the patients into two groups, according to the classification of the Brazilian National Elderly Policy and the Statute of the Elderly: young (age <60 years) and elderly (60 years or more). We also grouped them according to the World Health Organization classification: young people (age <44 years), middle age (45-59 years); elderly (age 60-89 years) and extreme advanced age (90 years or older). We applied the surgical risk classification of the American Society of Anesthesiologists to investigate the role of the preoperative physical state as a possible predictor of complications. RESULTS: of the 560 patients operated on, 94 (16.8%) were 60 years of age or older. We observed a local complication rate of 49.8%, the majority being self-limited. The incidences of necrosis, infection and dehiscence were 15.5%, 10.9% and 9.3%, respectively. Patients older than 60 years presented a chance of complication 1.606 times greater than the younger ones. Forty-five (8%) patients had loss of the reconstruction; there was no statistically significant difference in the mean age of the patients who presented this result or not (p=0.321). CONCLUSION: in selected patients, breast reconstruction can be considered safe; most documented complications were limited and could be treated conservatively.

Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases / Influência da idade avançada sobre a evolução pós-operatória e a perda total da reconstrução mamária: análise crítica de 560 reconstruções

ABSTRACT Objective: to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. Methods: we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruction data, postoperative complications, including loss of reconstruction and complications of surgical wound. We divided the patients into two groups, according to the classification of the Brazilian National Elderly Policy and the Statute of the Elderly: young (age <60 years) and elderly (60 years or more). We also grouped them according to the World Health Organization classification: young people (age <44 years), middle age (45-59 years); elderly (age 60-89 years) and extreme advanced age (90 years or older). We applied the surgical risk classification of the American Society of Anesthesiologists to investigate the role of the preoperative physical state as a possible predictor of complications. Results: of the 560 patients operated on, 94 (16.8%) were 60 years of age or older. We observed a local complication rate of 49.8%, the majority being self-limited. The incidences of necrosis, infection and dehiscence were 15.5%, 10.9% and 9.3%, respectively. Patients older than 60 years presented a chance of complication 1.606 times greater than the younger ones. Forty-five (8%) patients had loss of the reconstruction; there was no statistically significant difference in the mean age of the patients who presented this result or not (p=0.321). Conclusion: in selected patients, breast reconstruction can be considered safe; most documented complications were limited and could be treated conservatively.

RESUMO Objetivo: avaliar o papel da idade no risco de complicações pós-operatórias de pacientes submetidas à reconstrução mamária unilateral pós-mastectomia, com ênfase na perda total da reconstrução. Métodos: estudo retrospectivo de pacientes submetidas à reconstrução mamária, cujas variáveis incluídas foram: dados oncológicos e da técnica de reconstrução, complicações pós-operatórias, incluindo perda da reconstrução e complicações da ferida operatória. As pacientes foram divididas de acordo com a classificação da Política Nacional do Idoso e Estatuto do Idoso em dois grupos: jovens (idade <60 anos) e idosas (60 anos ou mais). Também foram agrupadas de acordo com a classificação da Organização Mundial da Saúde: jovens (idade <44 anos); meia-idade (idade 45-59 anos); idosas (idade 60-89 anos) e velhice extrema (90 anos ou mais). A classificação do risco cirúrgico da Sociedade Americana de Anestesiologistas foi aplicada para investigar o papel do estado físico pré-operatório como possível preditor de complicações. Resultados: das 560 pacientes operadas, 94 (16,8%) apresentavam 60 anos ou mais. Observou-se taxa de complicações locais de 49,8%, a maioria, limitadas. As incidências de necrose, infecção e deiscência foram de 15,5%, 10,9% e 9,3%, respectivamente. Pacientes com 60 anos ou mais apresentaram chance de complicação 1,606 vezes maior do que as jovens. Quarenta e cinco (8%) pacientes apresentaram perda da reconstrução e não houve diferença estatisticamente significante na média de idade das pacientes que apresentaram ou não esse desfecho (p=0,321). Conclusão: em pacientes selecionadas, a reconstrução mamária pode ser considerada segura; a maioria das complicações documentadas foi limitada e pode ser tratada conservadoramente.

Colostomy closure: risk factors for complications / Fechamento de colostomia: fatores de risco para complicações

ABSTRACT Background : The restoration of intestinal continuity is an elective procedure that is not free of complications; on the contrary, many studies have proven a high level of morbidity and mortality. It is multifactorial, and has factors inherent to the patients and to the surgical technique. Aim : To identify epidemiological features of patients that underwent ostomy closure analyzing the information about the surgical procedure and its arising complications. Method : It was realized a retrospective analysis of medical records of patients who underwent ostomy closure over a period of seven years (2009-2015). Results : A total of 39 patients were included, 53.8% male and 46.2% female, with mean age of 52.4 years. Hartmann´s procedure and ileostomy were the mainly reasons for restoration of intestinal continuity, representing together 87%. Termino-terminal anastomosis was performed in 71.8% of cases, by using mainly the manual technique. 25.6% developed complications, highlighting anastomotic leakage; there were three deaths (7.6%). The surgical time, the necessity of ICU and blood transfusion significantly related to post-operative complications. Conclusion : It was found that the majority of the patients were male, with an average age of 52 years. It was observed that the surgical time, the necessity of blood transfusion and ICU were factors significantly associated with complications.

RESUMO Racional: A reconstrução de trânsito intestinal é procedimento realizado eletivamente que não é isento de complicações, pelo contrário, muitos estudos evidenciam alto grau de morbimortalidade, dependendo de fatores inerentes ao paciente, bem como da própria técnica operatória. Objetivo: Identificar as características epidemiológicas dos pacientes submetidos à reconstrução intestinal, além de analisar as informações a respeito do procedimento cirúrgico e as complicações decorrentes. Método: Foi realizado análise retrospectiva dos prontuários dos pacientes submetidos à reconstrução intestinal no período de sete anos (2009-2015). Resultado: Foram incluídos 39 pacientes, sendo 53,8% homens e 46,2% mulheres, com idade média de 52 anos. As operações tipo Hartmann e ileostomia foram os motivos para a reconstrução do trânsito intestinal, representando juntas 87% dos pacientes. A anastomose terminoterminal foi realizada em 71,8% dos casos, utilizando principalmente a técnica manual. 25,6% dos pacientes apresentaram complicações, destacando-se a fístula de anastomose. Três (7,6%) morreram. O tempo operatório, necessidade de UTI e transfusão sanguínea apresentaram significância estatística com as complicações pós-operatórias. Conclusão: Verificou-se que a maioria foi de homens, com média de idade de 52 anos. Entre as variáveis estudadas, observou-se que a duração da operação, a necessidade de transfusão sanguínea e de UTI foram fatores complicadores com significância estatística.

Graphene-Titanium Interfaces from Molecular Dynamics Simulations.

Unraveling the physical and chemical properties of graphene-metal contacts is a key step toward the development of graphitic electronic nanodevices. Although many studies have revealed the way that various metals interact with graphene, few have described the structure and behavior of large pieces of graphene-metal nanostructures under different conditions. Here, we present the first classical molecular dynamics study of graphene-titanium (G-Ti) structures, with and without substrates. Physical and chemical properties of equilibrium structures of G-Ti interfaces with different amounts of titanium coverage are investigated. Adhesion of Ti films on graphene is shown to be enhanced by the vacancies in graphene or the electrostatic influence of substrates. The dynamics of pristine G-Ti structures at different temperatures on planar and nonplanar substrates are investigated, and the results show that G-Ti interfaces are thermally stable, that is, not prone to any reaction toward the formation of titanium carbide.