Characteristics of acupuncture and moxibustion therapy in Tibetan medicine based on Medical Canon in Four Sections / 中国针灸

By tracing to the origin of Tibetan medicine, it is known that Tibetan medicine absorbs a variety of medical ideas such as traditional Chinese medicine, Vedic medicine, Persian medicine and Byzantine medicine, and forms a unique theoretical system. The meridian-acupoint system and the characteristics and application of external therapies such as bloodletting and moxibustion in Tibetan medicine are analyzed by elaborating the relevant aspects of acupuncture and moxibustion involved in treatment of diseases listed in Medical Canon in Four Sections. The paper emphasizes the introduction of ironing moxibustion and huo'er moxibustion of fire moxibustion and the application of separation-action decoction and ghee therapy in bloodletting, as well as alternative therapy. Besides, by taking the external treatment of cirrhotic ascites and head trauma as an example, the idea of acupuncture and moxibustion therapy in Tibetan medicine embodied in the Medical Canon in Four Sections is explained so as to benefit the development of acupuncture and moxibustion therapy in Tibetan medicine.

Oncologic outcomes of microscopic tumor cut-through in locally advanced oral squamous cell carcinoma

Introduction: The gold standard treatment of oral cavity squamous cell carcinoma (OCSCC) is surgical resection; however, standardization of the margins and the role of frozen section are still debatable. Microscopic tumor cut-thought (MTCT) occurs when the surgeon has an initial positive frozen section margin that is cleared with further resection to negative. Objective: This study aims to determine the impact of MTCT on local recurrence and disease-specific survival in patients with locally advanced T3-T4 OCSCC and compare it with other clinicopathological variables. Methods: A retrospective database analysis of patients diagnosed with locally advanced T3-T4 OCSCC surgically treated and submitted to intraoperative frozen section guiding the margin status. Survival was analyzed using the Kaplan-Meier estimator followed by the Cox model for multivariate analysis. Results: We analyzed 475 patients who met inclusion criteria: MTCT occurred in 29 patients (6.11%) and local recurrence was observed in 131 patients (27.6%). MTCT had an impact on univariate (HR 2.205; 95% CI 1.243 ­ 3.914; p=0.007) and multivariate (HR 1.851; 95% CI 1.285 ­ 2.666; p=0.001) analyses. Similar results were found for disease-specific survival: univariate (HZ 1.669; 95% CI 1.056 ­ 2.635; p=0.028) and multivariate (HZ 1.307; 95% CI 0.816 ­ 2.092; p=0.265) analyses. A total of 231 patients (48.6%) had died of cancer by the end of follow-up. The best predictor for compromised frozen sections was tumor depth of invasion. Conclusion: Even after negative final margins, MTCT is an important factor associated with poorer outcome, and treatment intensification should be considered in these patients.

Conocimiento Especializado del Profesor de Matemáticas en la Enseñanza de la Modelación de la Elipse a Través de Recursos Tecnológicos / Specialized Knowledge of the Mathematics Teacher in teaching the modeling of the ellipse through technological resources / Conhecimento especializado do professor de matemática no ensino da modelagem da elipse por meio de recursos tecnológicos

Resumen Introducción: en la enseñanza de las matemáticas el uso de recursos tecnológicos ha tomado importancia en las prácticas docentes. No obstante, en algunas ocasiones la no profesionalización de profesores en las aulas les impide poder utilizar este tipo de herramientas de manera eficaz y acordes a las necesidades educativas de hoy día. Objetivo: caracterizar el conocimiento especializado del profesor de matemáticas que enseña de manera efectiva la modelación de la elipse a través de las mediaciones tecnológicas. Materiales y Métodos: el enfoque de esta investigación es de tipo cualitativo, con diseño y estudio de caso instrumental. La recolección de la información se llevó a cabo mediante 13 unidades de observación no participantes, diario de campo, cuestionario y una entrevista semiestructurada a un profesor con formación y experiencia en la enseñanza de la elipse haciendo uso de las TIC. Resultados: Se encontró relaciones entre el conocimiento especializado del profesor de los temas y de la enseñanza de las matemáticas, que contribuyen a la aproximación de la enseñanza de la modelación de la elipse mediante el software GeoGebra. Se Concluye que es indispensable que el profesor tenga conocimiento tanto disciplinar, didáctico-pedagógico y del recurso tecnológico que utiliza para la enseñanza de un contenido específico de las matemáticas.

Abstract Introduction: in the teaching of mathematics, the use of technological resources has become important in teaching practices. However, on some occasions the non-professionalization of teachers in the classroom prevents them from being able to use this type of tools effectively and in accordance with today's educational needs. Objective: characterize the specialized knowledge of the mathematics teacher who effectively teaches the modeling of the ellipse through technological mediations. Materials and Methods: the focus of this research is qualitative, with an instrument al case study design. The information was collected through 13 non-participant observation units, a field diary, a questionnaire and a semi-structured interview with a teacher with training and experience in teaching the ellipse using ICT. Results: Relationships were found between the teacher's specialized knowledge of the topics and the teaching of mathematics, which contribute to the teaching approach to ellipse modeling using the GeoGebra software. It was Concluded that it is essential that the teacher has both disciplinary, didactic-pedagogical knowledge and knowledge of the technological resource that he uses to teach a specific content of mathematics.

Resumo Introdução: no ensino de matemática, o uso de recursos tecnológicos tornou-se importante nas práticas pedagógicas. No entanto, em algumas ocasiões, a não profissionalização dos professores em sala de aula os impede de usar esse tipo de ferramentas de forma eficaz e de acordo com as necessidades educacionais atuais. Objetivo: caracterizar o conhecimento especializado do professor de matemática que efetivamente ensina a modelagem da elipse por meio de mediações tecnológicas. Materiais e Métodos: o foco desta pesquisa é qualitativo, com desenho de estudo de caso instrumental. As informações foram coletadas por meio de 13 unidades de observação não participante, diário de campo, questionário e entrevista semiestruturada com uma professora com formação e experiência no ensino da elipse com TIC. Resultados: foram encontradas relações entre o conhecimento especializado do professor sobre os temas e o ensino de matemática, que contribuem para a abordagem de ensino da modelagem de elipses utilizando o software GeoGebra. Conclusão: é fundamental que o professor tenha tanto conhecimento disciplinar, didático-pedagógico e conhecimento do recurso tecnológico que utiliza para ensinar um conteúdo específico de matemática.

Pregnancy with hypothyroidism and its adverse pregnancy outcomes

Background: Thyroid disorders are among the common endocrine disorders in pregnant woman after diabetes mellitus. Pregnancy is a stress test of maternal thyroid function. Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction. Subclinical hypothyroidism occurs in 10% of all pregnancies. Hypothyroidism has adverse effects on mother and fetus like anemia, pre eclampsia, preterm delivery, low birth weight and mental retardation of neonate. Decreased availability of thyroid hormones also impair neurological and intellectual development of the fetus. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus. Materials and methods: This prospective observational study was carried out during the period January 2020 to December 2020 (12 months) at Government General Hospital (GGH), Rangaraya Medical College, Kakinada, Andhra Pradesh, India. Subjects of this study were 170 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Results: In this study out of 170 cases, anemia was seen in-15.29%, pre eclampsia in-11.77%, GDM in-4.11%, Oligohydramnios with IUGR in-5.88%, preterm labor in-3.53%, LSCS in-35.29% and IUFD in-0.59% of case and low birth weight (8.24%), Hyperbilirubinemia (3.53%) and NICU admissions (11.76%). Conclusion: This Study concluded that hypothyroidism in pregnancy leads to preeclampsia, preterm labour, increases caesarean delivery, low birth weight and hyperbilirubinemia in neonates. Henceeffective treatment of hypothyroidism ensures safe pregnancy with minimal maternal and foetal complications.

Hematological and histopathological changes of rat’s hearts experimentally infected with protoscoleces

@#Hydatidosis; is a zoonotic disease caused by Echinococcus granulosus and characterized by infiltration of inflammatory cells. This study was investigated the hematological and histopathological changes in the hearts of rats injected with protoscoleces. Rats were injected with protoscoleces collected from either liver of sheep, goats, and cows (from the abattoir of Al-Muthanna province, south of Iraq) or isolated from infected humans from Al-Hussein Teaching Hospital. Sheep protoscoleces showed a significant increase of lymphocytes that refer to the induction of a high response of the immune system in rats. The numbers of WBC, RBCs, and platelets were generally increased in rats injected with protoscoleces isolated from sheep and goats. These changes could refer to the activation of defense mechanisms against the hydatid injected materials. However, the levels of MCV, MCH, MCHC, MPV and PDW were less than normal values. Heart sections of rats injected with protoscoleces isolated from humans showed clear histological changes. While TSP, TGP and TCP exhibited variant histopathological changes such as infiltration of inflammatory cells, pink glass appearance and congestion of arteries. Thus, these alterations can be considered as additional evidence of how the immune response reacts against the injected materials in the heart.

Increasing the rate of timely completion of a rapid frozen-section pathological report using the PDCA cycle / 中国基层医药

Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.

Overview of systematic reviews/meta analyses on traditional exercise for the improvement of cardiopulmonary function / 国际中医中药杂志

Objective:To evaluate the methodological quality and evidence quality of outcome of the systematic reviews/meta analyses on traditional exercise for the improvement of cardiopulmonary function.Methods:By searching for PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, VIP and CBM databases in Chinese or English, the Systematic Reviews/meta analysis of traditional exercises for improving cardiopulmonary function was conducted. The retrieval time was March 8th, 2020. The AMSTAR 2 scale was used to evaluate the methodological quality of the systematic review/meta-analysis that met the inclusion criteria. Since the included studies cannot reflect the overall effect of traditional exercises on improving cardiopulmonary function, and the methodological quality of systematic reviews was generally low, a secondary analysis of the RCT studies included in the systematic reviews was conducted. The methodological quality evaluation of the original RCT study adopted the Cochrane Reviewers’ Handbook Version 5.0.0 bias risk assessment method (Risk of Bias, ROB), and applied the Revman 5.3 software to merge the original RCT data. The GRADE system was used for evidence evaluation.Results:A total of 32 systematic reviews/meta analysis were included, and the AMSTAR2 scale indicated that only one of the 32 systematic reviews/meta included was of high-quality, 1 was of low-quality, and the others were of extremely low quality. A total of 57 RCTs were included in the 32 systematic reviews for bias risk assessment and data consolidation. GRADE evidence quality evaluation showed that 14 evidences were of medium quality, 26 evidences were of low quality, and 5 evidences were of extremely low quality.Conclusions:Traditional exercises can improve cardiopulmonary function, but with low evidence quality. Thus, clinicians should make clinical decisions based on conditions.

Can the Granulometric Soil Fractions Attenuate the Radiation Differently from the Whole Soil?

Abstract The purpose of this research was to discriminate soil fractions using mineralogical and elemental analyses and to show those fractions that present greater contribution to the soil mass attenuation coefficient (μ) as well as their partial cross-sections for photoelectric absorption (PA), coherent scattering (CS) and incoherent scattering (IS). Soil samples from different places of Brazil classified as Yellow Argisol, Yellow Latosol and Gray Argisol were submitted to elemental and mineralogical analyses through energy dispersive X-ray fluorescence (EDXRF) and Rietveld Method with X-ray diffraction data (RM-XRD). The mixture rule was utilized to calculate μ of each soil. The EDXRF analysis showed as predominant elements Si, Al, Fe and Ti oxides. The highest contents were Si (914.3 to 981.3 g kg-1) in the sand fractions, Al (507.9 to 543.7 g kg-1) and Fe (32.5 to 76.7 g kg-1) in the clay fractions, and Ti (18.0 to 59.0 g kg-1) in the silt fractions. The RM-XRD allowed identifying that the sand fractions are predominantly made of quartz (913.3 to 995.0 g kg-1), while the clay greatest portion is made of kaolinite (465.0 to 660.6 g kg-1) and halloysite (169.0 to 385.0 g kg-1). The main effect responsible for μ was IS (50 to 61.4%) followed by PA (28 to 40.1%) and CS (9.9 to 10.6%). By using the principal component analysis (PC-1: 57.5% and PC-2: 20.9%), the samples were differentiated through the discrimination between physical, chemical and mineralogical properties. The results obtained suggest that general information about the radiation interaction in soils can be obtained through the elemental and mineralogical analyses of their fractions.

Immediate postpartum intrauterine contraceptive device insertions in caesarean and vaginal deliveries: a comparative study

Background: Post-partum family planning is prevention of unintended and closely spaced pregnancies during first 12 months following childbirth. Postpartum IUCD is the best method of all as it is the safest, most effective, has no effect on breast feeding, reliable and with minimum complications.Methods: The cross-sectional study was conducted in AIMSR Bathinda on 400 postpartum patients. It was a prospective, observational study of women who received PPIUCD in our region.Results: Out of total 400, 58% had normal vaginal delivery and 42% had cesarean section. PPIUCD was done in all cases after applying exclusion criteria and the females were called for follow up.  53% cases who had cesarean and 47% of normal vaginal delivery turned up for follow up. Acceptance is more in multipara (20.7%) than in primi patients (13.7%). Almost 90% patients had good continuation rate. There were few problems faced by patients like irregular bleeding for first few months, pain lower abdomen, leucorrhea etc. which were removed by good counseling and some treatment like NSAIDs for bleeding.Conclusions: The acceptance of PPIUCD was high in present study in both types of females delivered by normal vaginal delivery or post LSCS but with good counseling efforts. It was safe and effective and had high retention rate when done at good timing by trained service provider that is within 10 minutes of placental delivery. So the need of time is creating awareness of public towards it and removing fear from minds, breaking taboos and myths.

Effectiveness of bundled interventions in reducing surgical site infections in elective caesarean sections and caesarean hysterectomies in a tertiary care centre

Background: Surgical site infections are the most common and easily preventable infections complicating surgeries. CDC recommends certain bundle interventions for the prevention of SSIs. Hence the present study was undertaken to see the effectiveness and feasibility of the bundle interventions in the elective caesarean sections and caesarean hysterectomies.Methods: A total of 600 patients were taken. Bundled interventions were applied in 278 caesarean sections and 26 caesarean hysterectomies. Routine care was implemented in 262 caesarean sections and 34 caesarean hysterectomies. Rate of SSI, risk factors associated and treatment outcomes were studied.Results: 8 out of 304 cases of the bundled intervention group developed SSI, giving a rate of 2.6%. 52 cases out of 296 in the routine care group developed SSI, the SSI rate being 17.5%. Anemia and diabetes were the most common risk factors.Conclusions: Adherence to bundled interventions can significantly and easily reduce the incidence of SSI.

Pattern of live births in Rio de Janeiro State, Brazil, according to Robson groups and the Kotelchuck index classification - 2015/2016 / Padrão de nascidos vivos no estado do Rio de Janeiro, Brasil, segundo os grupos Robson e a classificação do índice Kotelchuck - 2015/2016

Abstract Objective To investigate the patterns of hospital births in the state of Rio de Janeiro (RJ), Brazil, between 2015 and 2016; considering the classification of obstetric characteristics proposed by Robson and the prenatal care index proposed by Kotelchuck. Methods Data obtained from the Information System on Live Births of the Informatics Department of the Brazilian Unified Health System (SINASC/DATASUS, in the Portuguese acronym) databases were used to group pregnant women relatively to the Robson classification. A descriptive analysis was performed for each Robson group, considering the variables: maternal age, marital status, schooling, parity, Kotelchuck prenatal adequacy index and gestational age. A logistic model estimated odds ratios (ORs) for cesarean sections (C-sections), considering the aforementioned variables. Results Out of the 456,089 live births in Rio de Janeiro state between 2015 and 2016, 391,961 records were retained, 60.3% of which were C-sections. Most pregnant women (58.6%) were classified in groups 5, 2 or 3. The percentage of C-sections in the Robson groups 1, 2, 3, 4, 5 and 8 was much higher than expected. Prenatal care proved to be inadequate for women who subsequently had a vaginal delivery, had an unfavorable family structure and a lower socioeconomic status (mothers without partners and with lower schooling), compared with those undergoing cesarean delivery. For a sameRobson group, the chance of C-section increases when maternal age rises (OR = 3.33 for 41-45 years old), there is the presence of a partner (OR = 1.81) and prenatal care improves (OR = 3.19 for "adequate plus"). Conclusion There are indications that in the state of RJ, from 2015 to 2016, many cesarean deliveries were performed due to nonclinical factors.

Resumo Objetivo Investigar os padrões dos partos hospitalares no estado do Rio de Janeiro (RJ), Brasil, entre 2015 e 2016, considerando a classificação de características obstétricas de Robson e a dos cuidados pré-natais proposta por Kotelchuck. Métodos Dados sistema de informações sobre nascidos vivos (SINASC) do departamento de informática do sistema único de saúde (DATASUS) foram utilizados para agrupar gestantes relativamente à classificação de Robson. Foi efetuada uma análise descritiva para cada grupo de Robson, considerando-se as variáveis idade materna, estado civil, escolaridade, paridade, o índice de Kotelchuck de adequação do pré-natal e a idade gestacional. Também foi realizado o cálculo de razão de chances (RC) para parto cesáreo, considerando-se um modelo logístico. Resultados Dos 456.089 nascimentos vivos ocorridos no RJ de 2015 a 2016, foram incluídos 391.961 registros, sendo 60,3% cesáreas, com maioria de gestantes (58,6%) nos grupos 5, 2 ou 3. O percentual de cesáreas nos grupos 1, 2, 3, 4, 5 e 8 foi bem superior ao sugerido pela literatura. Para gestantes de um mesmo grupo (controladas as demais características), a chance de cesárea se eleva quando aumenta a idade materna (RC = 3,33 para 41-45 anos), existe a presença de um companheiro (RC = 1,81), o nível de escolaridade é maior (RC = 3,11 para ≥ 12 anos) e o pré-natal é mais cuidadoso (RC= 3,19 para "adequado plus"). Conclusão Há indícios que no RJ, de 2015 a 2016, muitos partos cesáreos foram realizados sob influência de fatores extraclínicos.

Demanda de atención obstétrica y densidad de recursos en salud para mujeres mexicanas en edad fértil / Demand for obstetric care and density of health resources for childbearing age Mexican women

Resumen Introducción: México registra aumento de las cesáreas e inequidad y desigualdad en la distribución de recursos para la atención obstétrica. Objetivo: Identificar las entidades y municipios en México que concentran la demanda de atención obstétrica y tasas de cesáreas y su relación con los recursos en salud y mujeres en edad fértil (MEF). Método: Se registraron los nacimientos del periodo 2008-2017, agrupados en cinco estratos municipales, y los recursos en salud y MEF de 2017. Resultados: La tasa nacional de cesáreas 2008-2017 fue de 45.3/100 nacimientos; 95 y 97 % de los nacimientos y cesáreas se concentraron en el estrato “muy alto” (470 municipios), en el cual se utilizó 80 % o más de los recursos en salud y destacó la sobreutilización. La densidad de recursos en salud destinados a las MEF reflejó inequidad y desigualdad. Conclusiones: La alta concentración de la demanda obstétrica y oferta de los recursos en salud pudiera conllevar mayor recurrencia a la cesárea. En las políticas de reducción de cesáreas es necesario considerar la organización y administración adecuadas de los recursos en salud.

Abstract Introduction: In Mexico, there is an increase in the number of C-sections, as well as inequity and inequality in the distribution of resources for obstetric care. Objective: To identify the states and municipalities in Mexico that concentrate the demand for obstetric care and the C-section rates and their relationship with health resources and women of childbearing age (WCBA). Method: Births of the 2008-2017 period were recorded, grouped into five municipal strata, as well as 2017 health resources and WCBA. Results: The 2008-2017 national rate of C-sections was 45.3/100 births; 95 and 97 % of births and C-sections were concentrated in the “very high” stratum, where 80 % or more of health resources were used, with overuse standing out. The density of health resources assigned to WCBAs reflected inequity and inequality Conclusions: The high concentration of obstetric demand and health resources supply could entail a higher recurrence of C-sections. Policies for C-section reduction should consider proper organization and administration of health resources.

Can we have many C-sections

The rate of cesarean section is increasing worldwide. It decreases maternal and fetal mortality when complications happen. However, it is a major surgery that could be associated with maternal and fetal risks especially after repeat cesarean deliveries. We report a case of a woman who had her 9th C-section.

Comparison of four blocking methods for eliminating autofluorescence of mouse liver frozen sections / 第二军医大学学报

Objective To compare different blocking methods for eliminating autofluorescence of mouse liver frozen sections, so as to find the best method to reduce the interference to immunofluorescence positive signals and improve the accuracy of immunofluorescence. Methods Intrasplenic injection-liver colonization nude mice: Hepa1-6-GFP cells were intrasplenically injected into male athymic BALB/c nude mice to create liver colonization models. Liver tissues were frozen and continuously sectioned. Sections were blocked with AB reagent (A reagent: streptavidin reagent, B reagent: biotin reagent), blocking buffer, AB reagent＋blocking buffer, or acetone＋AB reagent＋blocking buffer, and then the autofluorescence of the frozen sections was detected. C57BL/6 mice: the liver tissues of C57BL/6 mice were frozen and continuously sectioned, and then the sections were blocked with AB reagent, blocking buffer, AB reagent＋blocking buffer, or acetone＋AB reagent＋blocking buffer. Liver macrophages (Kupffer cells) were labeled with F4/80, and then the autofluorescence of mouse liver frozen sections was detected. Results In the immunofluorescence staining of liver tissue frozen sections, all the above four blocking methods could reduce the autofluorescence of liver sections, and acetone＋AB reagent＋blocking buffer group had the best effect. Conclusion The combined buffers (acetone＋AB reagent＋blocking buffer) has the best effect in eliminating the autofluorescence of mouse liver frozen section.

Efficacy of combination of oral mifepristone and vaginal misoprostol in termination of pregnancy up to 63 days of gestation

Background: Unsafe and illegal abortions are one of the major problems in women health in India. Despite legal approval for medical termination of pregnancy in 1971, unsafe abortion still remains the third leading cause of maternal deaths in the country, contributes eight percent of such deaths annually. The objective of this study was to study efficacy of Mifepristone 200 mg orally followed 36-48 hours later by Misoprostol 800 microgms per vaginally in women undergoing medical termination of early pregnancy (up to 63 days of gestational age).Methods: The present study included 60 pregnant women requesting termination of pregnancy in the first trimester. Women who fulfilled the inclusion criteria were included in the study. Women without medical or surgical contraindications to Mifepristone and Misoprostol were included. Patients with previous caesarean sections were also included.Results: In our study 60 women were included, majority were in age group 20-29 years of age and majority of cases were primipara or multipara. The success rate in terms of complete abortion was 97%, 2% needed surgical evacuation and 1% lost to follow up. Side effects were nausea, vomiting, diarrhoea, abdominal cramps, pyrexia etc. The method proved to be safe, effective, cheap, non-invasive and has minimal or no complications.Conclusions: Medical termination of pregnancy with oral mifepristone and vaginal misoprostol is an effective method for first trimester abortion. The prerequisite for the method is patient counselling, patient participation and willingness for regular follow up and to report any complication. Hence this method comes out to be a safe alternative to surgical method which is invasive and costly.

Modelos de assistência e taxa de parto cesáreo/vaginal em hospitais com diferentes tipos de gestão: uma análise de 2558496 partos / Assistance models to parturition and cesarean rate in hospitals with different types of management: an analysis of 2558496 parturition

Objetivo: Descrever a tendência temporal no Município de São Paulo do parto cesáreo em relação ao parto vaginal, e sua distribuição por maternidades de diferentes tipos de gestão (pública, privada ou ensino/escola) a partir da observação dos dados do Sistema de Informação de Nascidos Vivos - SINASC. Métodos: trata-se de estudo descritivo, retrospectivo, com utilização de fonte secundária de dados, tendo como alvo os partos ocorridos em maternidades com gestão pública, privada e ensino/escola do Município de São Paulo. A casuística referiu-se à totalidade dos partos ocorridos entre os anos de 2003 e 2018. Foi proposto o cálculo da relação de partos cesáreos sobre os partos vaginais. Utilizou-se a Análise de Variância de Kruskall-Wallis com a finalidade de comparar as relações de partos cesáreos/vaginais de acordo com a gestão hospitalar. Resultados: a amostra se totalizou em 2.559.496 partos, sendo que a proporção de partos cesáreos foi de 31,7% (pública), 84,1% (privada) e 36,6% (ensino/escola), respectivamente. A relação de partos cesáreos/vaginais foi de 0.58 na gestão pública, 5.40 na gestão privada e 0.47 na gestão escolar (p<0,0001*). Quanto a mudança anual da taxa de parto cesáreo/vaginal observou-se uma relação temporal similar entre os anos de 2003 e 2018 [pública (0.40-0.51); privada (4.6-6.6); Escola/ensino (0.55-0.60)]. Conclusões: A relação parto cesário/ vaginal se diferenciou nas instituições com gestão pública e de ensino/escola da instituição privada (ocorre 10 vezes mais parto cesáreo nas instituições privadas) apresentando pequena variação neste cenário ao longo dos anos.

Objective: To describe the temporal trend in the city of São Paulo of cesarean delivery in relation to vaginal delivery, and its distribution among maternity hospitals of different types of management (public, private or teaching / school) from the observation of data from the Information System of Live Births - SINASC. Methods: This is a descriptive, retrospective study using a secondary data source, targeting deliveries in public, private and teaching / school maternity hospitals managed in the city of São Paulo. The series referred to all deliveries that occurred between 2003 and 2018. It was proposed to calculate the ratio of cesarean deliveries to vaginal deliveries. Kruskall-Wallis analysis of variance was used to compare cesarean / vaginal birth ratios according to hospital management. Results: the sample totaled 2,559,496 deliveries, and the proportion of cesarean deliveries was 31.7% (public), 84.1% (private) and 36.6% (teaching / school), respectively. The ratio of cesarean / vaginal deliveries was 0.58 in public management, 5.40 in private management and 0.47 in school management (p <0.0001 *). Regarding the annual change in cesarean / vaginal rate, a similar temporal relationship was observed between 2003 and 2018 [public (0.40-0.51); private (4.6-6.6); School / teaching (0.55-0.60)]. Conclusions: The relationship between cesarean section and vaginal delivery differed in publicly and teaching / school institutions of the private institution (there are 10 times more cesarean section in private institutions), showing little variation in this scenario over the years.

The modeling of the reaction cross sections in the production of teranositic radionuclides / La modelación de las secciones eficaces de reacción en la producción de radionúclidos teranosíticos

Abstract We utilize various nuclear reaction codes with the aim to guide, interpret, and support the experiments in the proton-induced production measurements of radionuclides for the development of innovative radio-pharmaceuticals. The understanding of reaction cross sections at low-intermediate energies is crucial in this context and requires the knowledge of nuclear models available in different codes, such as EMPIRE, TALYS, and FLUKA. These nuclear reaction codes serve as tool to interpret the measurement of production cross-sections and to complete the measurements with estimates of production of contaminants and/or stable isotopes that are difficult to measure. We illustrate different model calculations to simulate isotope production useful in experiments devoted to the measurement of proton-induced production of the two theranostic radio-isotopes 67Cu and 47Sc.

Resumen Utilizamos varios códigos de reacción nuclear con el objetivo de guiar, interpretar y respaldar los experimentos en las mediciones de producción de radionúclidos inducidas por protones para el desarrollo de productos radio-farmacéuticos innovadores. La comprensión de las secciones eficaces de reacción en energías intermedias bajas es crucial en este contexto y requiere el conocimiento de modelos nucleares disponibles en diferentes códigos, como EMPIRE, TALYS y FLUKA. Estos códigos de reacción nuclear sirven como herramienta para interpretar la medición de secciones eficaces de producción y para completar las mediciones con estimaciones de producción de contaminantes y / o isótopos estables que son difíciles de medir. Ilustramos diferentes cálculos de modelos para simular la producción de isótopos útiles en experimentos dedicados a la medición de la producción inducida por protones de los dos isótopos teranósticos 67Cu y 47Sc.

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer / O papel da imagem de banda estreita intraoperatória na microcirurgia transoral a laser para câncer glótico inicial e moderadamente avançado

Abstract Introduction: Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. Objective: The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. Methods: Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. Results: Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. Conclusion: The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.

Resumo Introdução: A microcirurgia transoral a laser é uma técnica bem estabelecida para o tratamento de câncer de laringe inicial e moderadamente avançado. Objetivo: Verificar a utilidade da imagem de banda estreita na avaliação intraoperatória da mucosa laríngea na especificação das margens cirúrgicas. Método: Foram avaliados 44 cânceres glóticos T1-T2 consecutivos, tratados com cordectomia Tipo I-VI, por microcirurgia transoral a laser. As áreas suspeitas (90 amostras/44 pacientes) foram submetidas a biopsia e avaliadas através de imagens de banda estreita e luz branca e enviadas para cortes por congelação. Resultados: Nosso estudo revelou que 75 (83,3%) das 90 amostras apresentaram histopatologia positiva na análise com luz branca e imagens de banda estreita: 30 (40%) foram confirmadas como carcinoma in situ ou carcinoma invasivo e 45 (60%) como displasia moderada a grave. Em seis pacientes, a mucosa apresentou-se suspeita apenas na imagem de banda estreita, sem suspeita sob luz branca. Assim, nesses seis pacientes 18/90 (20%) amostras foram colhidas. Em 5/6 pacientes, 16/18 (88,8%) amostras mostraram resultado positivo na análise de congelação: em 6/18 (33,3%) amostras foi confirmado carcinoma (dois pacientes) e em 10/18 (66,6%) foi confirmada displasia grave (três pacientes). Em um paciente, 2/18 (11,1%) as amostras mostraram resultado negativo na congelação. A análise apresentada mostrou que a sensibilidade, a especificidade e a acurácia da luz branca foram de 79,5%, 20% e 71,1%, respectivamente, enquanto a imagem de banda estreita apresentou como resultados 100%, 0,0% e 85,7%, respectivamente. Conclusão: O uso intraoperatório de imagem de banda estreita provou ser valioso na identificação de áreas suspeitas da mucosa, confirmou as suspeitas verificadas na análise com luz branca e, o que é mais importante, identificou microlesões além do alcance da luz branca.

Intraoperative Frozen Cytology of Central Nervous System Neoplasms: An Ancillary Tool for Frozen Diagnosis

BACKGROUND: Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. METHODS: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. RESULTS: Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. CONCLUSIONS: Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.

Temporal and spatial variation of polysaccharides and alcohol-soluble extractives of Polygonatum cyrtonema / 中国中药杂志

To reveal the variation of polysaccharides and alcohol-soluble extractives of rhizomes Polygonatum cyrtonema from different producing areas,growing years,and harvesting seasons,25 wild samples from the main producing areas( provenances) of China and 6 artificial cultivated samples were collected and detected. The 6-year-old rhizomes of the artificial cultivation were gathered from Qingyuan,Zhejiang every 2 months during 2016 to 2017. Anthrone-sulfuric acid method and hot-dip method were used to determine the contents of polysaccharides and alcohol-soluble extractives respectively. The results showed that provenances,age sections and harvesting seasons affected the quality of Polygonati Rhizoma significantly. The content of polysaccharides from different provenances varied from 6. 96% to 20. 09%,and the content of extractives varied from 32. 08% to 78. 99%. The polysaccharides and extractives' content were the highest at 2-year-age sections,active constituents accumulation peaked in the third year,then decreased significantly with age increasing. The contents of polysaccharides and extractives accumulated were highest when aerial parts,up to 15. 39% and 78. 99% respectively. In summary,the activity and consistency fluctuated with producing areas. while such phenomenon indicated a huge potential of breeding. Additionally,the results showed that collecting Polygonati Rhizoma in February or August as herbal textual recorded were unreasonable,neither in spring or autumn according to the Chinese Pharmacopoeia( 2015 edition). Because these collecting periods didn't have the highest contents of polysaccharides and extractives. Therefore,based on phenological options,the rhizomes of P. cyrtonema should be harvested when the aboveground parts had just withered.