A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage cancer patients

The supraclavicular island flap has been widely used in head and neck reconstruction, providing an alternative to the traditional techniques like regional or free flaps, mainly because of its thin skin island tissue and reliable vascularity. Head and neck patients who require large reconstructions usually present poor clinical and healing conditions. An early experience using this flap for late-stage head and neck tumour treatment is reported. Forty-seven supraclavicular artery flaps were used to treat head and neck oncologic defects after cutaneous, intraoral and pharyngeal tumour resections. Dissection time, complications, donor and reconstructed area outcomes were assessed. The mean time for harvesting the flaps was 50 min by the senior author. All donor sites were closed primarily. Three cases of laryngopharyngectomy reconstruction developed a small controlled (salivary) leak that was resolved with conservative measures. Small or no strictures were detected on radiologic swallowing examinations and all patients regained normal swallowing function. Five patients developed donor site dehiscence. These wounds were treated with regular dressing until healing was complete. There were four distal flap necroses in this series. These necroses were debrided and closed primarily. The supraclavicular flap is pliable for head and neck oncologic reconstruction in late-stage patients. High-risk patients and modified radical neck dissection are not contraindications for its use. The absence of the need to isolate the pedicle offers quick and reliable harvesting. The arc of rotation on the base of the neck provides adequate length for pharyngeal, oral lining and to reconstruct the middle and superior third of the face. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Nursing care time in the Intensive Care Unit: evaluation of the parameters proposed in COFEN Resolution Nº 293/04

This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in São Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.

Time lags of the kilohertz quasi-periodic oscillations in the low-mass X-ray binaries 4U 1608−52 and 4U 1636−53

We studied the energy and frequency dependence of the Fourier time lags and intrinsic coherence of the kilohertz quasi-periodic oscillations (kHz QPOs) in the neutron-star lowmass X-ray binaries 4U 1608−52 and 4U 1636−53, using a large data set obtained with the Rossi X-ray Timing Explorer. We confirmed that, in both sources, the time lags of the lower kHz QPO are soft and their magnitude increases with energy. We also found that: (i) In 4U 1636−53, the soft lags of the lower kHz QPO remain constant at∼30 μs in the QPO frequency range 500–850 Hz, and decrease to ∼10 μs when the QPO frequency increases further. In 4U 1608−52, the soft lags of the lower kHz QPO remain constant at 40 μs up to 800 Hz, the highest frequency reached by this QPO in our data. (ii) In both sources, the time lags of the upper kHz QPO are hard, independent of energy or frequency and inconsistent with the soft lags of the lower kHz QPO. (iii) In both sources the intrinsic coherence of the lower kHz QPO remains constant at ∼0.6 between 5 and 12 keV, and drops to zero above that energy. The intrinsic coherence of the upper kHz QPO is consistent with being zero across the full energy range. (iv) In 4U 1636−53, the intrinsic coherence of the lower kHz QPO increases from ∼0 at ∼600 Hz to ∼1, and it decreases to ∼0.5 at 920 Hz; in 4U 1608−52, the intrinsic coherence is consistent with the same trend. (v) In both sources the intrinsic coherence of the upper kHz QPO is consistent with zero over the full frequency range of the QPO, except in 4U 1636−53 between 700 and 900 Hz where the intrinsic coherence marginally increases. We discuss our results in the context of scenarios in which the soft lags are either due to reflection off the accretion disc or up-/down-scattering in a hot medium close to the neutron star. We finally explore the connection between, on one hand the time lags and the intrinsic coherence of the kHz QPOs, and on the other the QPOs’ amplitude and quality factor in these two sources.

Lipid profile of the yolk under the influence of supplementaries sources rich in Ω-3 PUFAs in the diet of laying hens in the time

Two hundred eighty-eight 32-wk-old Hisex White laying hens were used in this research during a 10 weeks period, arranged in a 2 x 5 completely randomized factorial design, with three replicates of eight birds per treatment. Two groups: fish oil (OP) and Marine Algae (AM) with five DHA levels (120, 180, 240, 300 and 360 mg/100 g diet) were assigned including two control groups birds fed corn and soybean basal diet (CON) and a diet supplemented with AM (AM420) to study the effect of time 0, 2, 4, 6 and 8 weeks (wk) on the efficiency of egg yolk fatty acid enrichment. The means varied (p<0.01) of 17.63% (OP360) to 22.08% (AM420) is the total Polyunsaturated Fatty Acids (PUFAs) and 45.8 mg/g (OP360), 40.37 mg/g (OP360, 4 wk) to 65.82 mg/g (AM420) and 68.79 mg/g/yolk (AM120, 8 wk) for n-6 PUFAs. On the influence of sources and levels in the times, the means of n-3 PUFAs increased by 5.58 mg/g (AM120, 2 wk) to 14.16 mg/g (OP360, 6 wk) when compared to average of 3.34 mg PUFAs Ω/g/yolk (CON). Usually, the means DHA also increased from 22.34 (CON) to 176.53 mg (μ, OP360), 187.91 mg (OP360, 8 wk) and 192.96 mg (OP360, 6 wk) and 134.18 mg (μ, OP360), 135.79 mg (AM420, 6 wk), 149.75 mg DHA (AM420, 8 wk) per yolk. The opposite was observed for the means AA, so the effect of the sources, levels and times, decreased (P <0.01) of 99.83 mg (CON) to 31.99 mg (OP360, 4 wk), 40.43 mg (μ, OP360) to 61.21 mg (AM420) and 71.51 mg AA / yolk (μ, AM420). Variations of the average weight of 15.75g (OP360) to 17.08g (AM420) yolks of eggs de 32.55% (AM420) to 34.08% (OP360) of total lipids and 5.28 g (AM240) to 5.84 g (AM120) of fat in the yolk were not affected (p>0.05) by treatments, sources, levels and times studied. Starting of 2 week, the hens increased the level of n-3 PUFAs in the egg yolks, being expressively increased (p<0.01) until 4 weeks, which after the increased levels of n-3 PUFAs tended to if stabilize around of time of 8 experimental weeks, when it was more effective saturation of the tissues and yolk.