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.

Is the colon mucosa affected by ten days of gastric restriction in an animal model?

Abstract Purpose To identify whether the colon mucosa is affected by ten days of gastric restriction in an animal model. Methods An experimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy, and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided into three groups: the stomach restriction group (R10); the sham group (S10), which underwent the same procedure except for the loofah insertion; and the control group (C10). The expression of neutral and acid mucins was evaluated using histochemical techniques. Goblet cells and protein content were compared between groups using generalized estimation equations (GEEs). Bonferroni's multiple comparison was applied to identify differences between the groups. All tests considered a 5% significance level. Results There was an increased expression of neutral mucins, acid mucins and goblet cells in the R10 group. Collagen was also enhanced in the R10 group. Conclusion The colon mucosa is affected by ten days of gastric restriction in an animal model, increasing neutral mucins, acid mucins and collagen content with trophic maintenance.

Linfonodos do nível VI: estudo anatômico dos linfonodos localizados entre o nervo laríngeo recorrente e a artéria carótida comum direita / Level VI lymph nodes: an anatomic study of lymph nodes located between the recurrent laryngeal nerve and the right common carotid artery

RESUMO Objetivo: descrever a presença de linfonodos e suas relações com características demográficas e antropométricas em uma região específica ainda não descrita pelos compêndios de anatomia, por nós denominada de Recesso Carotídeo Recorrencial (RCR), localizada entre o nervo laríngeo recorrente direito, a artéria carótida comum direita e a artéria tireoidea inferior direita. Métodos: foram dissecadas 32 regiões cervicais à direita de cadáveres com até 24 horas de post mortem. O tecido fibrogorduroso do RCR foi ressecado e preparado com fixação em formol. Em seguida, foi submetido a uma sequência crescente de álcoois (70%, 80% e 90%), posteriormente a uma solução de Xilol e, por fim, a uma solução de Salicilato de Metila, respeitando o tempo necessário de cada etapa. O estudo macroscópico foi realizado na peça diafanizada, observando a presença ou não de linfonodos. Quando presentes, foram fotografados e suas medidas foram aferidas com um paquímetro digital. No estudo microscópico, foi utilizada a coloração hematoxilina-eosina para confirmação do linfonodo. Resultados: observou-se a presença de linfonodos em 22 dos 32 espécimes (68,75%), com o número de linfonodos por cadáver variando de zero a seis (média de 1,56±0,29) e tamanho com média de 7,82mmx3,86mm (diâmetros longitudinal x transversal). Conclusão: a relação entre dados antropométricos e presença de linfonodos no RCR (teste exato de Fischer) foi significante para indivíduos normolíneos (p=0,03) e também significante entre a etnia branca (p=0,04).

ABSTRACT Objective: to describe the presence of lymph nodes and their relationships with demographic and anthropometric characteristics in a specific region, not yet described in anatomy compendiums, called by us Recurrent Carotid Recess (RCR) and located among the right recurrent laryngeal nerve, the right common carotid artery, and the right inferior thyroid artery. Methods: 32 right cervical regions were harvested from cadavers within 24 hours post-mortem. The fibro-fatty tissue of the RCR was resected and prepared with formalin fixation. It was then subjected to an increasing sequence of alcohols (70%, 80%, and 90%), subsequently to a solution of Xylol, and finally to a solution of Methyl Salicylate, respecting the time required for each step. The macroscopic study was carried out on the diaphanized piece, observing the presence or not of lymph nodes. When present, they were photographed and their measurements were gauged with a digital caliper. In the microscopic study, hematoxylin-eosin staining was used to confirm the lymph node. Results: the presence of lymph nodes was observed in 22 (68.75%) of the 32 specimens. The number of lymph nodes ranged from zero to six (mean of 1.56±0.29), per cadaver, and their mean size was 7.82mmx3.86mm (longitudinal x transversal diameters). Conclusion: the relationship between anthropometric data and presence of lymph nodes in the RCR (Fisher's exact test) was significant for medium-height individuals (p=0.03) and also white ones (p=0.04).

Experimental model of Achilles tendon injury in rats

PURPOSE: To describe an effective experimental model to study the Achilles tendon healing. METHODS: Forty male Rattus norvegicus albinus, Wistar lineage adult male weighing 250 to 300g were used for this experiment and thirty were surgically submitted to bilateral partial transverse section of the Achilles tendon. The right tendon was treated with radio waves (RF) whereas the left tendon served as control. On the third postoperative day, the rats were divided into four experimental groups consisting of ten rats each which were treated with monopolar RF adjusted to 650 kHz and 2w, for two minutes twice a week and a group of normal animals without any intervention, until they were sacrificed on the 7th, 14th and 28th days, respectively. Tendons were weighed and collagen quantification was evaluated by hydroxyprolin content. RESULTS: Significant reduction in collagen content on day 7, 14 and 28 was related to control experiment to normal tendon (7 days, p<0.01; 14 e 28 days, p<0.05). CONCLUSION: The experimental model has been effective and available to be used to study Achilles tendon healing. .

Anatomical basis of the myofascial trigger points of the trapezius muscle / Bases anatómicas de los puntos de gatillo miofasciales del músculo trapecio

This study aimed to bring the trapezius muscle, knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTPs). Although anatomoclinical correlations represent a major feature of MTP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Eight points were identified: In all cases, these locations corresponded to clinically described MTPs. The eight points where common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MPT is useful to achieve a better understanding of the anatomical correlation of MTP and the physiopathology of these disorders and may provide a scientific basis for their treatment, providing useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.

El objetivo de este estudio fue correlacionar los sitios de entrada de los ramos del nervio accesorio en el músculo trapecio con placas motoras y los puntos de gatillo miofasciales. A pesar de las correlaciones anatomoclínicas se constituyeren en la principal característica de los puntos de gatillo, no hay informes en la literatura describiendo sobre la distribución de los ramos del nervio accesorio y su relación anatómica con los puntos de gatillo. Ambos músculos trapecio de doce cadáveres adultos fueron disecados por los autores (profesores de anatomía y estudiantes de postgrado en Medicina) para observar el punto exacto donde los ramos del nervio accesorio espinal penetraban en el vientre muscular. La disección se llevó a cabo respetando las capas estratigráficas para preservar la inervación del músculo ubicada profundamente a éste. Ocho puntos fueron identificados: En todos los casos correspondieron a la descripción clínica de los puntos gatillo miofasciales y eran comunes a todos los cadáveres. Esta correlación anatomoclínica entre la ramificación del nervio espinal accesorio y los puntos de gatillo miofascial es útil para una mejor comprensión de la fisiopatología de los puntos gatillo y puede proporcionar una base para un abordaje diagnóstico y terapéutico racional para estos trastornos.