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INTRODUCTION: A tracheal membranous injury is a known complication of tracheostomy. After esophageal resection, such injury may prove fatal. No natural buttressing of the lesion occurs, and severe sepsis and mediastinitis may occur. In these situations, a circumferential tracheal resection is the treatment of choice, sometimes on cardiopulmonary bypass. However, the outcome is not always favorable.CASE PRESENTATION: We report a case of a long tracheal membranous wall defect (> 7cm) after esophageal resection. We successfully performed a transtracheal direct repair of the defect through a partial sternotomy, and reconstructed the ventrolateral wall with a muscle flap using the right pectoralis major muscle.CONCLUSION: Tracheal reconstruction through a T-shaped incision and anastomotic buttressing using a pectoralis major muscle flap could prove to be useful when reconstructing a posterior tracheal wall injury, especially after esophageal resection.

Background Predicted postoperative forced expiratory volume in 1 s (ppoFEV1) and expected transfer factor for CO (TLCO) values < 30–35% are often considered to be a contraindication for anatomical lung resection in patients with lung cancer. Based on our prior positive experience in lung volume reduction surgery (LVRS), we retrospectively analyzed all patients with impaired pulmonary function undergoing anatomical minimally-invasive lung resection, either for LVRS or treatment of non-small cell lung cancer (NSCLC) at our institute. Methods From August 2016 to April 2021, n = 42 consecutive anatomical lung resections were performed in patients with poor lung function (< 35% ppoFEV1). We retrospectively searched our records and investigated the patients’ pre- and postoperative conditions and their outcome. Results We included 16 patients (9 males, age 68.4 ± 8.9 years old) scheduled for lung cancer surgery. The procedures were performed via uniportal video assisted thoracoscopic surgery (VATS; n = 10, 62.5%, including one non-intubated VATS) or via thoracotomy (n = 6, 37.5%) and included lobectomy (9 patients, 55.3%) or (multiple) segmentectomy. Resected parenchyma as described by total number of removed segments was 3.9 ± 1.6 segments. Preoperative FEV1 was 35.1 ± 7.2%, with an expected ppoFEV1 28.1 ± 5.9%. Measured postoperative FEV1 was 39 ± 8.7% (p < 0.001). Postoperative complications included persistent air leak (PAL) in 7 patients (43.8%), atelectasis in 3 (18.8%), pleural effusion in 4 (25%), pneumonia in 1 (6.3%), and empyema in one (6.3%), patients. No patient required continuous O2 therapy or died. Conclusions Even in severely impaired lung function, anatomical resection appears to be feasible with reasonable morbidity and mortality. Highlight box Key findings Surgical indications for anatomical lung resection might be now expanded and include a larger number of patients with limited lung capacity previously considered unresectable. What is known and what is new? In the aging society, the number of lung cancer patients with low lung function patients is increasing. In our retrospective study, the result of anatomical lung resection for patients with low lung function was acceptable. What is the implication, and what should change now? Our result may expand the operative indication related to lung function and increase the radical resection possibility in elderly patients, a large group of lung cancer patients.

Background: It's well known that worldwide popular explosion especially in the Arab World and deficiency in sources of nutrition especially in difficult conditions like natural disaster and wars. To overcome this problem we must find an alternative sources of nutrition that deals with it in this study. Objective: This application a trial to prove alternative nutrition for human in difficult conditions especially in natural disaster and wars. Material and Methods: This study included many stages:First stage: water extraction from Alhagi roots ( L J)plant and calculate their concentration. Second stage: determination the composition extract qualitatively like carbohydrate, protein, fats, minerals and vitamins by Biochemical methods. Third stage: Applied a specific dose extract to animal lab rodent (rats) though out three groups (fifteen rats were divided in to three groups, five rats for each group. 1st group (G1) feeds with extract only, 2nd group (G2) feeds with extract and ordinary rats food and 3rd group control group feeds with ordinary rats food only. All rats feeds for six weeks, and studies the psychological behaviors like general appearance, sensorimotor behavior immobility and its reflexes, locomotion, skilled movement, and species-specific behaviors. Fourth stage: hematological tests, random blood sugar, lipid profile, renal function test, liver function test and estimation of serum electrolytes. Final stage: histopathology tests for kidney, liver, spleen, pancreas, stomach and intestine.Results: We monitoring the amount of this extract (L J)that drinking by rats and found the rats in both groups satisfied this drinking and drink as increasing manners each week and weighting the rats weekly and found there are no significant differences in the mean of weights of rats among all groups and all rats were increase its weights progressively each week. All the physiological, biochemical, hematological and histological results showed within normal values with no any significant changes between controls and study groups.Conclusion: we can use (L J) extract as supplement and complement alternative food supply without any toxic effect.

In the paper estimate of the shape parameter for power function distribution was proposed. For different sample sizes (small, medium, and large). Using different methods, Maximum likelihood method, Moment method, Shrinkage methods, and Least square method. mean square error (MSE) was implemented as an indicator of performance and comparisons of performance have been carried out through data analysis and computer simulation between the estimation methods according to the applied indicator. It was observed from the results that the shrinkage method (constant weight factor ( sh 2 )) estimates for the shape parameter are the best in performance for each case.