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Lev Semionovitch Vigotski nasceu em Orsha, uma cidade do Bielorussia, em 1896, e faleceu na capital da Russia, Moscou, em 1934. Nestes 38 anos de vida, estudou Direito, Literatura e Historia da Arte, dedicando-se, paralelamente, a Psicologia, area em que se tornou um nome proeminente, passando entao a se dedicar a area, aos estudos, pesquisas e cursos sobre Psicologia. Alem disso, dedicou-se a pesquisa do desenvolvimento da consciencia humana, bem como, da aquisicao e desenvolvimento da linguagem. A formacao social da mente e Pensamento e Linguagem sao duas de suas obras mais conhecidas na area da Educacao e da Psicologia. O presente livro, Imaginacao e Criacao na Infância , aborda a questao da imaginacao, seus conceitos e sua formacao na infância e versa tambem sobre a criacao literaria, teatral e do desenho. Nesta obra, Vigotski define quatro formas principais de relacao entre a atividade de imaginacao e a realidade. A primeira forma consiste na ideia de que a imaginacao apoia-se sempre em elementos da realidade e experiencias vividas pela pessoa. Mesmo construcoes mais fantasiosas, como podemos encontrar nos contos, mitos, lendas e sonhos, por exemplo, sao submetidas aos elementos da realidade, modificados na nossa imaginacao: “A atividade criadora da imaginacao depende diretamente da riqueza e da diversidade da experiencia anterior da pessoa porque essa experiencia constitui o material com que se criam as construcoes da fantasia” (p. 24). A segunda forma de relacao entre fantasia e realidade esta pautada no inverso da primeira forma, ou seja, pode-se dizer que a experiencia real que se apoia na imaginacao. Dessa forma, pode-se concluir que, ao criarmos, por exemplo, uma narrativa fantastica, teremos de buscar elementos de nossa imaginacao para compo-la: “A pessoa nao se restringe ao circulo e a limites estreitos de sua experiencia, mas pode aventurar-se para alem deles, assimilando a experiencia historica ou social alheias com a ajuda da imaginacao” (p. 27). Por outro lado, a terceira forma – que o autor define como a lei da realidade emocional – trabalha com o carater emocional, baseando-se na influencia que esse fator tem sobre a fantasia. Podemos observar que, ao contemplarmos uma pintura, tanto suas cores quanto as expressoes das personagens, essa pintura pode causar-nos espanto e tristeza ou alegria e contentamento, dependendo das cores e expressoes utilizadas pelo pintor, pois exercem influencia direta em nossas emocoes: “As paixoes e os destinos de herois inventados, sua alegria e desgraca, perturbam-nos, inquietam-nos e contagiam-nos, apesar de estarmos diante de acontecimentos inveridicos, de invencoes da fantasia” (p. 30). Finalmente, a quarta forma demonstra que a construcao da fantasia pode tornar-se realidade – sendo assim, uma pessoa pode usar de sua imaginacao e fantasia para construir uma maquina ou um instrumento nunca antes conhecido; Vigotski define essa forma como imaginacao cristalizada ou encarnada. Na sequencia de suas consideracoes, o autor relata como a criacao literaria na idade escolar se desenvolve, partindo da ideia de que, no periodo da pre-escola, a crianca se expressa com mais facilidade, por meio do ato de desenhar, como algo espontâneo e criativo, porem, com o passar dos anos, esse interesse vai se enfraquecendo e muitas delas perdem por completo a vontade de desenhar. No periodo escolar, a crianca vai tomando contato com outras formas de expressao, como a criacao literaria (a escrita), sendo que o desenho passa a ser desestimulado. Vygotski trata tambem da criacao teatral na idade escolar, destacando a importância do ato de encenar e de dramatizar, pois, por meio dele, a crianca e estimulada a brincar, criar, improvisar, preparar, desenhar etc. tudo quanto ela precisar para a apresentacao de sua cena, fortalecendo diretamente a imaginacao. Entretanto, Vigotski afirma que essa criacao teatral deve ser realizada e estimulada de forma espontânea e nao impositiva, de maneira que as criancas nao sejam meros transmissores de palavras de outrem, atividade desestimulante e pouco criativa. No ultimo capitulo do livro, o autor detalha dados sobre quando a crianca perde o interesse em desenhar e quando o adquire novamente, em alguns casos; demonstra idades e pesquisas a esse respeito e disponibiliza, em anexo, desenhos de criancas de diferentes faixas etarias, em diversas circunstâncias e experiencias de vida. Por fim, Vigotski ratifica a importância do estimulo a criacao e a imaginacao durante a vida escolar da crianca, pois tais estimulos auxiliarao, de forma bastante positiva, na tomada de decisoes, na forma de enxergar o outro e nas situacoes a sua volta, ao longo de toda a vida. Diante de todos esses conceitos, podemos refletir o quanto o processo educacional a que uma crianca estara submetida durante grande parte de sua vida pode ou nao contribuir para a formacao de uma pessoa, com riqueza de saberes, de estimulos, vivencias e experiencias, sendo que, dessa forma, todos esses aprendizados vao compor a integralidade do ser. O livro de Vygotski contribui, com certeza, para essa tomada de consciencia e para que aprendamos mais acerca da importância da imaginacao e da criacao nos primeiros anos de vida da crianca.

BACKGROUND: English is the lingua franca of science; it is the language of the two last world superpowers and the language of four out of the world's ten greatest producers of science; it is a fairly simple language and the most hybridized language in history, with Latin and French contributing 60% of the entire English lexicon. The object of this study is to determine whether the frequency of use of imported words is a function of literary genre. METHOD: Texts were randomly selected from (a) medical scientific original articles, (b) newspaper financial reports, (c) sport reportages, (d) literary texts and (e) colloquial English; for comparison a collection of similarly distributed texts were selected from Portuguese; the frequency of occurrence of Latin or Neo-Latin words was determined in the English texts as well as the occurrence of non-Latin or non-Neo-Latin words in the Portuguese texts; a oneway analysis of variance was used to determine whether significant differences occurred between genres in the two languages. RESULTS: The frequency of occurrence of Latin/French words in English text was significantly dependent on the literary genre, being maximal in medical scientific texts and minimal in colloquial English; in contrast, the frequency of occurrence of non-Latin words in Portuguese was constant throughout the same literary genres. CONCLUSION: The use of Latin/French words in English is directly proportional to the complexity of the literary genre, a phenomenon not observed in Portuguese, a typical Neo-Latin language. CONTEXTO: O inglês é a língua franca da ciência; é a língua das duas mais recentes superpotências mundiais e a língua de quatro dos dez maiores produtores de ciência do mundo; é uma língua bastante simples e o idioma mais hibridizado da história, com o latim e o francês contribuindo com aproximadamente 60% do léxico inglês. O objetivo deste estudo é determinar se a frequência de uso de palavras importadas é uma função do gênero literário. MÉTODO: os textos foram selecionados aleatoriamente de (a) artigos científicos médicos, (b) relatórios financeiros dos jornais, (c) reportagens desportivas, (d) textos literários, (e) inglês coloquial; Para comparação, uma coleção de textos distribuídos de forma semelhante foi selecionada a partir do português; a frequência de ocorrência de palavras latinas ou neolatinas foi determinada nos textos em inglês e na ocorrência de palavras não latinas ou não neolatinas nos textos portugueses; uma análise de variância unidirecional foi utilizada para determinar se diferenças significativas ocorreram entre gêneros nas duas línguas. RESULTADOS: A frequência de ocorrência de palavras latinas / francesas em textos ingleses foi significativamente dependente do gênero literário, sendo máxima em textos científicos médicos e mínima em inglês coloquial; em contraste, a frequência de ocorrência de palavras não latinas em português foi constante ao longo dos mesmos gêneros literários. CONCLUSÃO: O uso de palavras de origem latina ou francesa em inglês é diretamente proporcional à complexidade do gênero literário, fenômeno não observado em português, uma língua neolatina típica.

Pentoxifylline (PTX) has been shown to have beneficial effects on microcirculatory blood flow. In this study we evaluate the potential hemodynamic and metabolic benefits of PTX during hepatic ischemia. We also test the hypothesis that portal PTX infusion can minimize the I/R injury when compared to systemic infusion. Methods. Twenty-four dogs ( kg) were subjected to portal triad occlusion (PTO) for 45 min. The animals were assigned to 3 groups: CT (control, PTO, ), PTX-syst (PTO + 25 mg/Kg of PTX IV, ), and PTX-pv (PTO + 25 mg/Kg of PTX in the portal vein, ). Animals were followed for 120 min. Systemic hemodynamics, gastrointestinal tract perfusion, oxygen-derived variables, and liver enzymes were evaluated throughout the experiment. Results. Animals treated with PTX presented significantly higher CO in the first hour after reperfusion, when compared to the CT (~3.7 vs. 2.1 L/min, ). Alanine aminotransferase (ALT) was similar in the PTX groups two hours after reperfusion but significantly higher in the CT (227 vs. ~64 U/L, ). Conclusion. PTX infusion was associated with hemodynamic benefits and was able to minimize liver injury during normothermic hepatic I/R. However, local PTX infusion was not associated with any significant advantage over systemic route.

CLINICS is a multidisciplinary medical journal. This editorial highlights the field of cardiovascular research. We have selected papers published from 2011-2012 and focused on the concept of Continuously Variable Rating, which we have recently introduced as an alternative and hopefully superior method for evaluating published scientific papers (1).

Revisar os artigos publicados recentemente na imprensa científica brasileira sobre o tema geral de exercício físico. Todos os artigos publicados em 2010/2011 encontrados por meio do descritor exercício foram coletados em 11 periódicos brasileiros. Eles foram filtrados manualmente de modo a excluir todos os artigos de pesquisa que não fossem originais. Foram agrupados de acordo com categorias e subcategorias de assunto. Foi elaborado um breve resumo de todos os artigos incluídos, comparando os similares entre si. As interações mais comuns referem-se a exercício e sistema cardiovascular e metabolismo e sistema locomotor, nessa ordem. O volume de pesquisa científica nesse campo é grande e de qualidade suficiente que justifica o destaque.To review recently published papers in the Brazilian Scientific press on the general subject of physical exercise. All articles published in 2010/2011 found through the keyword exercise were collected from 11 Brazilian Journals. They were hand filtered to exclude all but original research papers. They were grouped according to subject categories and subcategories. A brief summary of all included articles was produced, comparing similar articles between them. The most commonly found interactions refer to exercise vs. the cardiovascular system, metabolism and the locomotor system, in this order. The volume of scientific research in the field is high and of sufficient quality to justify highlighting.

Este estudo faz o levantamento de artigos publicados em periódicos científicos brasileiros nos últimos anos. O principal objetivo é chamar a atenção do público leitor da Acta Ortopédica Brasileira para as contribuições originais recentemente publicadas em periódicos não especialistas neste tema. Esperamos que isso sirva de atualização científica geral para os leitores. Cobrimos amplamente os artigos publicados em seis periódicos não-ortopédicos indexados pelo ISI, através de pesquisa realizada em 14 desses periódicos.This paper is a review of articles published in Brazilian scientific periodicals in recent years. Its main purpose is to bring to the attention of the readership of Acta Ortopedica Brasileira original contributions to the field published in non-specialized journals. We hope that this will serve as a general scientific update for readers. The review includes works published in six ISI indexed non-orthopedic journals, following a literature search conducted in fourteen such journals.

Dear Authors, Readers, Reviewers If MedicalExpress can claim one asset, this has to be it: in our last three issues (Dec/15, Feb and Apr/16) articles were online, on average, 31 days (range 6 60 days) after acceptance: we take responsibility for some of the longer delays, but many are due to slow turnaround times of draft-PDFs by some of our authors, not forgetting that January is the peak summer month for for Brazilian authors. So, we are keeping to our pledge to publish within 45 days after acceptance. Only 15% of our articles exceeded this time limit in this period. We are now effectively in SciELO. For Brazilian graduate students and teachers, this means we can look

Cardiology has been and is a very significant fraction of the Brazilian contribution to science. In older days, the most significant part of this work was directed to foreign periodicals, but the quasi-simultaneous emergence of SciELO and PUBMED has ordained a redirection of much of this work to Brazilian periodicals. We here survey some of this more recent contribution for the benefit of readers of Revista Brasileira de Cirurgia Cardiovascular. This is offered as an update. Articles on the general themes of Cardiology and Pneumology published by four ISI Indexed Brazilian journals not specializing in cardiology are re-visited, after a search through 10 journals.A Cardiologia foi, e continua sendo, responsável por uma fracção muito significativa da contribuição brasileira para a ciência. No passado, os trabalhos mais importantes eram direcionados para periódicos estrangeiros, mas o surgimento quase simultâneo do SciELO e PUBMED facilitou um redirecionamento de grande parte desses trabalhos a periódicos brasileiros. Neste artigo, examinamos algumas das contribuições mais recentes em benefício aos leitores da Revista Brasileira de Cirurgia Cardiovascular. Esta discussão é oferecida como uma atualização. Artigos sobre os temas gerais da cardiologia e pneumologia publicados por quatro revistas brasileiras indexadas no ISI - não especializadas em cardiologia - são revistos.

Cardiology has been and is a very significant fractionof the Brazilian contribution to science. In older days,the most significant part of this work was directed toforeign periodicals, but the quasi-simultaneousemergence of SciELO and PUBMED has ordained aredirection of much of this work to Brazilian periodicals.W e here survey some of this more recent contribution forthe benefit of readers of Revista Brasileira de CirurgiaCardiovascular. This is offered as an update. Articles onthe general themes of Cardiology and Pneumologypublished by four ISI Indexed Brazilian journals notspecializing in cardiology are re-visited, after a searchthrough 10 journals.ResumoA Cardiologia foi, e continua sendo, responsavel por umafraccao muito significativa da contribuicao brasileira para aciencia. No passado, os trabalhos mais importantes eramdirecionados para periodicos estrangeiros, mas o surgimentoquase simultâneo do SciELO e PUBMED facilitou umredirecionamento de grande parte desses trabalhos aperiodicos brasileiros. Neste artigo, examinamos algumasdas contribuicoes mais recentes em beneficio aos leitoresda Revista Brasileira de Cirurgia Cardiovascular. Estadiscussao e oferecida como uma atualizacao. Artigos sobreos temas gerais da cardiologia e pneumologia publicadospor quatro revistas brasileiras indexadas no ISI - naoespecializadas em cardiologia - sao revistos.

This review surveys articles appertaining to the general field of pediatrics that have been published in Brazilian scientific periodicals over recent years. its main purpose was to bring to the attention of the readership of the Sao Paulo Medical Journal original contributions from specialty and non-specialty journals. we hope that this can be seen as a general scientific update for the readers. We have covered articles appearing in Brazilian ISI-indexed journals, following a PubMed search.

CLINICS covers all medical areas. This editorial highlights the field of pulmonary research. We have selected papers published from 2010-11 concerning the Continuously Variable Rating concept, which we have recently put forward as an alternative and hopefully superior method of evaluating published scientific papers (1).

As a multidisciplinary medical journal CLINICS has covered virtually every medical area. We here highlight one of our strongest fields, Pediatrics, responsible for slightly over 10% of all our original research papers over 2010-11.

New journals cannot survive without friends: for who else, except real friends, would ever send papers to a journal that, to begin with, does not even exist, then barely survives; if it eventually finds its way into a serious database it begins to look at a real existence. So, this editorial celebrates two auspicious landmarks: MedicalExpress has made it into SciELO and is closing out volume two, year 2015; the entire collection will become visible in www.scielo.org sometime early next year. But even before appearing in SciELO, with nothing but Google Scholar and our own site (www. medicalexpress.net.br), we can boast close to 30 citations (and counting) to the 61 articles published in 2014. This means that we now have practically 0.5 citations/article. This is not an impact factor; it is better! For those familiar with the intricacies of this metric, 0.5 citations/year in the year immediately following publication foretells a pretty good Impact Factor twelve months hence. But at this point guesswork is still a dangerous sport. Published articles have been downloaded close to 35,000 times, 50 times/day. And we are sticking to our main offer: we publish in 40 ± 10 days after acceptance, which is faster than most of the competition. But far above celebrations, this is the time for a number of thank yous: MedicalExpress is forever indebted to the authors of the 100-plus papers, which were published throughout 2014-15 and paved the way for the future. As I said, new journals do not survive without friends. Thanks are also due to our sponsors, who believed in us to start from, and still apparently do. The last, certainly not least, “thanks a lot” simply has to go from the editor to his wife, Vera Lucia, who put up with a lot of anxiety, with numerous bouts of foul humor and who never failed to keep telling the editor that success was just around the corner. Did she really know? Did she really believe in it? It has often been said that smart ladies always know! It goes without saying that articles from the, oh so loyal friends are still hoped for, still expected, still

Background Several studies have shown that the distribution of cardiac output to the intra-abdominal organs may vary during low-flow states. In this study, we developed an experimental model to selectively reduce the abdominal aortic blood flow in order to assess the initial impact of selective hepatosplanchnic hypoperfusion on regional blood flow redistribution. Methods Eight anesthetized and mechanically ventilated mongrel dogs were subjected to aortic blood flow reduction with an occluder in a stepwise manner by 50% and 100% for 45 min. After the ischemic period, the occluder was released, and animals were observed for an additional 45 min. Systemic hemodynamics were evaluated through a Swan-Ganz and arterial catheters, and gastrointestinal tract perfusion was evaluated by portal vein and hepatic arterial blood flows measurements (ultrasonic flowprobe). Intestinal O 2 -derived variables, intestinal mucosal (tonometric)-arterial and tonometric-(end-tidal-carbon-dioxide) gradients (D t-a pCO 2 and D t-Et pCO 2 ) were also calculated. Results No significant changes in systemic and regional oxygen consumption were observed during the 50% reduction of aortic blood flow. On the other hand, both microregional pCO 2 gradients (D t-a pCO 2 e D t-Et pCO 2 ) showed a significant increase during this period. Aortic occlusion was associated with a marked reduction of systemic and regional oxygen delivery and consumption. During the reperfusion, no significant improvement in the tonometry-based pCO 2 gradients was observed, in spite of the partial reestablishment of blood flow to the hepatosplanchnic territory. Conclusion During selective intra-abdominal low-flow, a proportional reduction in the splanchnic and hepatic blood flows occurs. A selective reduction of approximately 50% in splanchnic oxygen delivery was not associated with significant changes in macroregional markers of hypoperfusion. In this situation, tonometry-based pCO 2 gradients can be used for the assessment of hepatosplanchnic perfusion and histologic changes.

In the last few years, a huge increment in the quality of scientific articles published in Brazilian Medical Journals has been observed. Several reasons were related to this feature including the SciELO free access initiative, the English language adopted by most journals, and, more importantly, the increase in the number and quality of Brazilian researchers. This article highlights, in the cardiovascular and respiratory areas, the best articles that have been published in these journals in the last few months. The reader will have a general overview of these areas and can select the original articles for deeper information. Nos últimos anos, houve um aumento considerável na qualidade dos artigos científicos publicados em periódicos médicos brasileiros. As razões para tal incremento são muitas, incluindo a iniciativa de open access da base SciELO, a adoção do inglês por vários periódicos e, a mais relevante, o aumento em número e qualidade dos pesquisadores brasileiros. Este artigo indica os melhores artigos sobre os sistemas cardiovascular e respiratório publicados recentemente nesses periódicos. Será oferecido ao leitor um panorama dessas áreas e alguns artigos podem ser selecionados para maiores informações.

Recentemente CLINICS propos para debate a ideia de que o QUALIS 2010 era passivel de aperfeicoamento, atraves do conceito dos tres erres (Remover periodicos de revisao, Reconhecer outras metricas de avaliacao, Reavaliar periodicos brasileiros).1 Submetido ao debate por pares por ocasiao do II Seminario Satelite para Editores Plenos (ABEC Novembro de 2010), concluiu‐se que idealmente haveria que focalizar num unico erre, a saber, o reconhecimento por parte da CAPES para 2013 das metricas de avaliacao SCImago (cites/document) e SciELO (Impact Factor). Ja demonstramos anteriormente que o Impact Factor ISI THOMSON, unica metrica reconhecida pela CAPES, e praticamente identico ao cites/document da SCImago. A correlacao geral por amostragem entre os dois indices e maior que 0,9 e o coeficiente angular e indistinguivel da unidade. A recente divulgacao da colecao 2009 do SCImago Journal & Country Rank2 junta‐se aos ja divulgados Fatores de Impacto JCR‐ISI e SciELO para aquele ano e permite o cotejo em tempo real dos tres indices. Salientamos que este cotejo nao se aplica a qualquer tabela QUALIS, pois a Tabela 2010 ja e historia e a Tabela 2013 sera decidida no futuro. Em outras palavras, o cotejo que se segue, relativo ao ano 2009, e oferecido como base argumentativa adequada para reivindicar a correcao de curso relativa a exclusao dos indices SCImago e SciELO. Vamos pois ao cenario 2009 como simulacao de uma hipotetica tabela Qualis: na versao 2009 do Journal of Citations Report – ISI a representacao brasileira saltou de 31 a 71 periodicos; ja no SCImago Journal Ranking essa representacao manteve‐se constante em 235 periodicos. Existem, portanto 164 periodicos brasileiros (138 com impacto maior que zero) ausentes da tabela JCR‐ISI. Mantida a norma Qualis aplicada em 2010, estes 138 periodicos cairiam nas categorias “sem fator de impacto”. A Figura 1 mostra a identidade entre ISI e SCImago para as 64 revistas incluidas nos dois indices: o coeficiente angular unitario e o elevado coeficiente de correlacao significam que, conhecendo‐se um dos indices, pode‐se estimar o outro com 95% de probabilidade de errar por menos de 5%. Figura 1 Correlacao entre fatores do impacto J. Citation Reports (ISI – Thomson) e SCImago (2009) para 64 periodicos brasileiros representados nos dois indices com valores maiores que zero. A identidade entre metricas ... A tabela 1 exibe a relacao desses 138 periodicos brasileiros com Cites/Document SCImago > zero, mas sem Fator de Impacto JCR‐ISI. Ressalte‐se que nao sao periodicos de impacto nitidamente mais baixo que os da colecao JCR‐ISI. Os quatro primeiros apresentam impacto > 1.00, o que os colocaria entre os 15 melhores do Brasil. Outros dez apresentam impacto maior que 0.50, acima da mediana dos periodicos brasileiros no JCR‐ISI. Todos os 138 titulos evidentemente fariam jus a classificacao “com fator de impacto”. Tabela 1 Cento e trinta e oito periodicos brasileiros excluidos do QUALIS com Fator de Impacto SCIMAGO (simulacao 2009). Outra correlacao interessante ocorre entre SCImago e SciELO. Em primeiro lugar vale notar que existe extensa concordância: a colecao SCImago contem 235 titulos brasileiros e a colecao SciELO contem 223. As inclusoes nao sao 100% concordante: a colecao SCImago contem 69 periodicos ausentes da colecao SciELO; reciprocamente a colecao SciELO contem 56 periodicos ausentes da colecao SCImago. Por si so esta convergencia revela a consistencia de qualidade dos periodicos incluidos na colecao SciELO. E facil intuir que, para qualquer periodico brasileiro incluido nas duas colecoes, ha que se esperar que o impacto SCImago seja maior que o SciELO, porque a colecao SCImago contem 18.732 periodicos, contra apenas 759 na colecao SciELO. Surpreendentemente, porem, o efeito dessa enorme desproporcao entre bases de dados e menor do que o esperado, como se pode ver a figura 2: dentre os 142 periodicos brasileiros presentes nas duas colecoes apenas 88 (62%) apresentam SCImago > SciELO, enquanto 45 (32%) apresentam SciELO > SCImago e nove (6%) apresentam igualdade. Esta discrepância entre o esperado e o observado merece estudo bibliometrico adicional, mas uma boa hipotese seria que artigos brasileiros citam outros artigos brasileiros com mais intensidade em virtude de um pronunciado interesse local especifico. A correlacao entre os impactos (Figura 3) e igualmente reveladora: o coeficiente angular (0,54) sugere que o impacto medio SciELO e apenas 40% menor que o impacto SCImago. Ja o alto indice de correlacao (r2 = 0.62; p SciELO a diferenca e frequentemente grande ... Figura 3 Correlacao entre fatores do impacto SciELO e SCImago (2009) para 142 periodicos brasileiros representados nos dois indices com valor maior que zero. O coeficiente angular indica um angulo de 28° e um impacto SciELO ... Caso a CAPES reconheca o Cites/Document SCImago estara resgatada a maior parte dos periodicos brasileiros com impacto > 0. Porem a Tabela 2 mostra que, se a decisao fosse tomada neste momento restariam 35 periodicos brasileiros com impacto SciELO maior que zero mas ausentes do JCR‐ISI e do SCImago. Aqui tambem encontramos impactos nao triviais: quatro periodicos apresentam impactos maiores que a mediana da colecao ISI. Sem esquecer a forte possibilidade de que estes 35 impactos SciELO infra‐estimem o que seriam seus impactos ISI ou SCImago. Tabela 2 Trinta e cinco periodicos brasileiros excluidos do QUALIS com Fator de Impacto SciELO (simulacao 2009). Desta simulacao, podemos concluir que teriamos 173 periodicos brasileiros com IMPACTO > ZERO tratados como “SEM FATOR DE IMPACTO” pelo QUALIS caso a avaliacao fosse agora e caso os criterios 2010 fossem repetidos. Sabemos que esta “simulada exclusao” nao e estatica: quando a tabela Qualis “fechar” para a proxima avaliacao muita coisa tera mudado: dentre elas, com certeza, as tabelas ISI‐JCR, SCImago e SciELO, bem como (esperamos!) os criterios CAPES de avaliacao. Mas defendemos a tese de que reconhecer tao somente o Fator de Impacto ISI‐JCR nao seria logico. Por isso entendemos que esta simulacao e a base racional para um alerta, em tempo, pela adocao de novos criterios. NOTA: este editorial e publicado por CLINICS livre de restricoes de copyright. Oferecemo‐lo aos periodicos cientificos brasileiros para reproducao integral ou parcial. Alternativamente sugerimos que apoiem esta ideia, em editoriais originais. Tais acoes sinalizarao nossa vontade politica de exercer o direito republicano de peticionar perante o poder publico em defesa desta que e uma reivindicacao legitima e generalizada da comunidade editorial cientifica brasileira.

This review covers recent publications on the motor system (orthopedics and movement) in Brazilian journals recently admitted to the ISI-Thomson Journal of Citations Index. Two of these are still pleading for admission into PubMed which will eventually enhance their global visibility. We offer this contribution to experts on these areas who are regular readers of Revista da Associação Médica Brasileira. Full free copies of all of them are available at www.scielo.br. The main areas covered are orthopedics of limb articulations, fractures, movement, posture, gait, exercise and animal modelsEsta revisão abrange publicações recentes sobre o sistema locomotor (ortopedia e movimento) em periódicos brasileiros recentemente incluídos na plataforma de citações ISI-Thomson. Dois destes periódicos ainda estão pleiteando inclusão no PubMed o que aumentará sua visibilidade. Oferecemos esta contribuição para especialistas nestas áreas de interesse e que são leitores regulares da Revista da Associação Médica Brasileira. Cópias integrais dos artigos citados estão disponíveis gratuitamente no site www.scielo.br. Os principais temas cobertos são ortopedia e articulações dos membros, fraturas, movimento, postura, marcha e modelos animais

Hydroxyethylstarch (HES) is a synthetic polymer of glucose that has been suggested for therapeutic use in long-term plasma expansion. The aim of this study was to test the hypothesis that the infusion of a small volume of HES may provide benefits in systemic and regional hemodynamics and metabolism in a brain-dead canine model compared with large volume crystalloid resuscitation.Fourteen mongrel dogs were subjected to a brain-death protocol by consecutive insufflations of a balloon catheter in the epidural space. One hour after induction of brain-death, the animals were randomly assigned to two groups: NS (0.9% NaCl, 33 mL/kg), and HES (6%HES 450/0.7, 17 mL/Kg). Systemic and regional hemodynamics were evaluated using Swan-Ganz, ultrasonic flowprobes, and arterial catheters. Serial blood samples were collected for blood gas, electrolyte, and serum chemistry analysis. Systemic, hepatic, and splanchnic O(2)-derived variables were also calculated.Epidural balloon insufflations induced a significant increase in mean arterial pressure, cardiac output (MAP and CO, respectively), regional blood flow, and systemic vascular resistance. Following the hyperdynamic phase, severe hypotension with normalization of systemic and regional blood flow was observed. Fluid resuscitation induced a prompt increase in MAP, CO, and portal vein blood flow, and a significant reduction in systemic and pulmonary vascular resistance. There were no differences between groups in metabolic indices, liver function tests (LFTs), or renal function tests. HES was more effective than NS in restoring cardiac performance in the first 2h after fluid resuscitation (P0.05). Both tested solutions partially and temporarily restored systemic and regional oxygen delivery.Small volumes of 6% HES 450/0.7 improved cardiovascular performance and provided the same regional hemodynamic and metabolic benefits of large volumes of isotonic crystalloid solutions.

Several factors have been implicated in the high-mortality rate of posttraumatic pneumonectomy. In this study, we evaluated the hemodynamic and echocardiographic changes induced by pneumonectomy and fluid resuscitation after hemorrhagic shock.: Fourteen dogs were bled to a target mean arterial pressure of 40 mmHg. The animals were assigned to two groups: control (no fluid resuscitation) and lactated Ringer's (3 x shed blood volume). The left pulmonary hilum was cross clamped, and the animals were observed for 60 minutes. Systemic hemodynamics was evaluated using Swan-Ganz, arterial catheter, and ultrasonic flow probe. Systemic O2-derived variables were calculated. Ejection fraction was determined by two-dimensional echocardiography.: Fluid resuscitation improved the mean arterial pressure and systemic oxygen delivery. After pneumonectomy, no significant increase in right ventricular pressure was observed in the LR group. No signs of major ventricular dilation or changes in arterial oxygenation were observed.: Our data suggest that pneumonectomy is not associated with early pulmonary hypertension; gentle fluid resuscitation improves cardiovascular performance and is not associated with an increase in right ventricular pressure.

OBJECTIVE: To make recent selected publications on the locomotor system available to the readership of Clinics. METHOD: A general survey of articles published in selected Brazilian journals was inspected and 91 articles were critically analyzed. They were categorized and briefly described. A final summary of themes is reproduced here. RESULTS: Papers fall into two main categories: articular and muscular pathology and therapeutics; medical sports. A number of papers are not classifiable under these headings. CONCLUSION: The locomotor system has been extensively analyzed and discussed in the Brazilian scientific press in recent years. Not surprisingly, knee and ankle pathology, soccer and running are dominant themes.

collection. The Science Citation Edition for 2008 includes 6620 journals, of which 6567 (99.2% of the total) from 72 countries (where England, Scotland and Wales are counted as three separate countries much as they would be for Rugby and Football, although I did miss Northern Ireland) exhibited an IF > 0. The Social Sciences Citation Edition comprises 1985 journals from 45 countries (including England and Scotland, but not Wales), of which 1974 (99.4% of the total) have an IF > 0. Thus, the entire JCR-ISI collection totaled 8,541 in 2008. The SCImago collection is considerably larger, comprising 16,032 journals from 233 countries, of which 14,649 journals (91.3% of the total) boast a C/D > 0. It is thus a more comprehensive index, covering twice as many journals from thrice as many countries. Two other differences should be mentioned: (a) SCImago is freely accessible, whereas the JCR-ISI can only be accessed by fee-paying subscribers, and (b) JCR-ISI has a bias in favor of English-speaking countries, while SCImago has a broader base. However, it must be noted that JCR-ISI has been broadening its non-English speaking base over recent years. The obvious questions are as follows: what do these indexes measure and how reliable are they? Given that it is generally believed that citations of articles are an indirect measure of quality, it is generally assumed that both IF and C/D reflect quality. However, no gold standard has ever been described that effectively measures journal quality. Consequently, no proof exists to show that IF or C/D truly reflect quality, even though there is a general gut feeling that they do. Generally speaking, journals with a high IF or C/D are desirable places to publish scientific findings; it is also true that most (but certainly not all) of the truly relevant

Professor Doutor Jorge GuimaraesDD Presidente, CAPESSao Paulo, 2 de agosto de 2009.Meu caro JorgeVoce ja viu, nao e, o Novo Qualis esta dandopano pra mangas! Ate rendeu excelente materia em“O Estado de Sao Paulo” sob o sugestivo tituloRanking coloca revistas cientificas brasileiras em‘risco de extincao’.

Recently, studies have been conducted examining the efficacy of 3% hypertonic saline solution (HS) for the treatment of traumatic brain injury; however, few studies have analyzed the effects of 3% hemorrhagic shock during hemorrhagic shock. The aim of this study was to test the potential immunomodulatory benefits of 3% hemorrhagic shock resuscitation over standard fluid resuscitation.Wistar rats were bled to a mean arterial pressure of 35 mm Hg and then randomized into 3 groups: those treated with lactated Ringer's solution (LR; 33 mL/kg, n = 7), 3% HS (10 mL/kg, n = 7), and 7.5% HS (4 mL/kg, n = 7). Half of the extracted blood was reinfused after fluid resuscitation. Animals that did not undergo shock served as controls (n = 5). Four hours after hemorrhagic shock, blood was collected for the evaluation of tumor necrosis factor-alpha and interleukin-6 by enzyme immunoassay. Lung and intestinal samples were obtained for histopathologic analysis.Animals in the HS groups had significantly higher mean arterial pressure than those in the LR group 1 hour after treatment. Osmolarity and sodium levels were markedly elevated in the HS groups. Tumor necrosis factor-alpha and interleukin-6 levels were similar between the control and HS groups but significantly higher in the LR group (P.05). The lung injury score was significantly higher in the LR group compared with the 7.5% HS and 3% HS groups (5.7 +/- 0.7, 2.1 +/- 0.4, and 2.7 +/- 0.5, respectively). Intestinal injury was attenuated in the 7.5% HS and 3% HS groups compared with the LR group (2.0 +/- 0.6, 2.3 +/- 0.4, and 5.9 +/- 0.6, respectively).A small-volume resuscitation strategy modulates the inflammatory response and decreases end-organ damage after HS. Three percent HS provides immunomodulatory and metabolic effects similar to those observed with conventional concentrations of HS.

Para marcianos recem-desembarcados, Qualis e definido pela CAPES como uma lista de veiculos utilizados para a divulgacao da producao intelectual dos programas de pos-graduacao stricto sensu (mestrado e doutorado). Ate recentemente estes veiculos eram classificados quanto ao âmbito de circulacao (Local, Nacional, Internacional) e quanto a qualidade (A, B, C), para cada area de avaliacao. Serve para fundamentar o processo de avaliacao do Sistema Nacional de Pos-Graduacao da CAPES. Esta classificacao foi de grande importância como primeira medida de qualidade do produto da pos-graduacao. Praticamente todos concordam que ela ja esgotou seu ciclo de validade e deve ser substituida. O evidente crescimento em qualidade da producao cientifica brasileira extrapolou os limites deste metro, que perdeu seu poder discriminativo. Uma nova tabela Qualis esta em vias de ser ativada. Nao me sinto capacitado a avalia-la para outras areas, mas o produto oferecido a consideracao da comunidade medica merece comentarios. As premissas em que se baseia sao tres. A primeira e que a distribuicao de frequencia de conceitos dos programas brasileiros de pos-graduacao deve ser normal, ou Gaussiana. Poder-se-ia aqui indagar como foi que se chegou a conclusao de que essa distribuicao e naturalmente normal. A segunda premissa estabelece que apenas 25% dos programas podem ter conceito maximo (6 ou 7) em qualquer area de avaliacao. Caso o numero de programas merecedores de conceito maximo supere o limite, as normas de avaliacao serao automaticamente “apertadas” para manter o limite. Igualmente, pode-se perguntar se nao e absurdo mudar as regras do jogo no meio da partida para rebaixar o conceito de programas que a primeira vista pareciam excelentes. A terceira premissa diz respeito a nova tabela Qualis para periodicos, que passa a ter sete niveis conforme a Tabela 1. Esta vale para todas as areas do conhecimento, devendo cada area estabelecer os niveis especificos de corte de tal modo a assegurar que apenas 25% dos periodicos estejam no nivel mais alto (Qualis A) e que haja maior numero de periodicos A2 que A1. Embora isso nao seja explicito, parece evidente que estes 25% derivam diretamente dos 25% do conceito anterior.

OBJECTIVES: Experimental studies on sepsis have demonstrated that ethyl pyruvate is endowed with antioxidant and anti-inflammatory properties. This study aimed to investigate the effects of ethyl pyruvate on leukocyte-endothelial interactions in the mesenteric microcirculation in a live Escherichia coli-induced sepsis model in rats. METHODS: Male Wistar rats were administered an intravenous suspension of E. coli bacteria or were subjected to a sham procedure. Three hours after bacterial infusion, the rats were randomized into the following groups: a control group without treatment, a group treated with lactated Ringer’s solution (4 mL/kg, i.v.), and a group treated with lactated Ringer’s solution (4 mL/kg, i.v.) plus ethyl pyruvate (50 mg/kg). At 24 h after bacterial infusion, leukocyte-endothelial interactions were investigated using intravital microscopy, and the expression of P-selectin and intercellular adhesion molecule-1 was evaluated via immunohistochemistry. White blood cell and platelet counts were also determined at baseline and 3 h and 24 h after E. coli inoculation. RESULTS: The non-treated and lactated Ringer’s solution-treated groups exhibited increases in the numbers of rolling leukocytes (∼2.5-fold increase), adherent cells (∼3.0-fold), and migrated cells (∼3.5-fold) compared with the sham group. In contrast, treatment with Ringer’s ethyl pyruvate solution reduced the numbers of rolling, adherent and migrated leukocytes to the levels observed in the sham group. Additionally, the expression of P-selectin and intercellular adhesion molecule-1 was significantly increased on mesenteric microvessels in the non-treated group compared with the sham group (p

Traumatic brain injury (TBI) is the main cause of trauma-related deaths. Systemic hypotension and intracranial hypertension causes cerebral ischemia by altering metabolism of prostanoids. We describe prostanoid, pupilar and pathological response during resuscitation with hypertonic saline solution (HSS) in TBI.Method Fifteen dogs were randomized in three groups according to resuscitation after TBI (control group; lactated Ringer’s (LR) group and HSS group), with measurement of thromboxane, prostaglandin, macroscopic and microscopic pathological evaluation and pupil evaluation.Result Concentration of prostaglandin is greater in the cerebral venous blood than in plasma and the opposite happens with concentration of thromboxane. Pathology revealed edema in groups with the exception of group treated with HSS.Discussion and conclusion There is a balance between the concentrations of prostaglandin and thromboxane. HSS prevented the formation of cerebral edema macroscopically detectable. Pupillary reversal occurred earlier in HSS group than in LR group. O traumatismo cranioencefálico (TCE) é a principal causa de morte relacionada ao trauma. O choque hemorrágico e hipertensão intracraniana causam isquemia cerebral alterando o metabolismo de prostanóides. Neste estudo, relatamos o comportamento dos prostanóides, resposta pupilar e patologia durante a reposição volêmica com solução salina hipertônica (SSH) no TCE.Método Quinze cachorros foram randomizados em três grupos (controle, grupo de Ringer lactato e grupo de SSH) e foram avaliados tromboxane, prostaglandina, avaliação patológica macroscópica e microscópica e status pupilar.Resultado A concentração de prostaglandina é maior no sangue cerebral em comparação ao plasma, e o inverso ocorre com o tromboxane. A patologia revelou edema em todos os grupos, com exceção do grupo tratado com SSH.Discussão e conclusão Existe um equilíbrio entre concentrações cerebrais e plasmáticas de prostaglandina e tromboxane. A SSH protegeu o cérebro da formação de edema pós traumático.

Experimental models of human pathology are useful guides to new approaches towards improving clinical and surgical treatments. A systematic search through PubMed using the syntax (shock) AND (trauma) AND (animal model) AND (cardiovascular) AND ("2010/01/01"[PDat]: "2015/12/31"[PDat]) found 88 articles, which were reduced by manual inspection to 43 entries. These were divided into themes and each theme is subsequently narrated and discussed conjointly. Taken together, these articles indicate that valuable information has been developed over the past 5 years concerning endothelial stability, mesenteric lymph, vascular reactivity, traumatic injuries, burn and sepsis. A surviving interest in hypertonic saline resuscitation still exists.

Hemorrhagic shock/reperfusion (HS/R) followed by sepsis triggers systemic microcirculatory disturbances that may induce multiple organ failure. The present study evaluated the effects of HS/R and cecal ligation and puncture, followed by necrotic cecal resection/peritoneal lavage (REL) on leukocyte-endothelium interactions at the mesentery. Eighty-one anesthetized Wistar rats (200-250 g) were randomly assigned to a first injury: (1) control-HS-no hemorrhagic shock/no reperfusion group, (2) HS/blood-HS/R with 25% shed blood, and (3) HS/blood + LR-HS/R with 25% of the shed blood + lactated Ringer's solution, 3x shed blood volume. Twenty-four hours post-HS/R, animals were submitted to cecal ligation and puncture and, 24 h thereafter, to REL. Leukocyte-endothelium interactions were assessed by intravital microscopy and intercellular adhesion molecule (ICAM) 1 and P-selectin expression by immunohistochemistry. Lungs were observed for ICAM-1 expression and neutrophil infiltration. Single and double injury induced significant increases in rolling (approximately 2-fold), adherent (approximately 5-fold), and migrated leukocytes (approximately 7-fold); ICAM-1 expression (approximately 1/2-fold), and P-selectin expression (approximately 1/2-fold) at the mesentery compared with control-HS group. REL normalized leukocyte-endothelium interactions at the mesentery in single-injured animals. However, in double-injured rats, adherence and migration of leukocytes decreased but did not normalize. Similar results were observed on ICAM-1 expression and neutrophil infiltration in the lungs from these animals. In conclusion, the current in vivo observation of the mesenteric microcirculation after a double injury followed by REL is a suitable model for the systematic evaluation of the inflammatory reaction at local and distant sites. In addition, data presented herein emphasized the importance of surgical removal of the septic focus in controlling the otherwise lethal sepsis-induced multiple organ dysfunction syndrome.

OBJETIVO: Avaliar os efeitos hemodinâmicos sistêmicos e esplâncnico da expansão volêmica inicial com SSH em modelo de choque hemorrágico controlado. MÉTODOS: Dez cães foram submetidos a sangramento controlado (20 ml/min) até uma pressão arterial média de 40±5 mmHg (PAM). Após 30 minutos de choque, receberam 4 ml/Kg de SSH em 5 minutos e posteriormente observados sem intervenções adicionais durante 60 minutos. As variáveis hemodinâmicas sistêmicas foram obtidas de um cateter arterial e de um cateter de Swan-Ganz, enquanto as regionais através da cateterização da veia porta, fluxômetro ultrassônico na veia porta e um tonômetro na cavidade. A oferta, taxa de extração e consumo esplâncnico de oxigênio, pH intramucoso e os gradientes veno-arterial, porta-arterial e mucosa-arterial da pCO2 (Dap-a pCO2, Dvp-a pCO2 e Dt-a pCO2, respectivamente), foram calculados. RESULTADOS: A hemorragia (29,8±2,4 ml/Kg) reduziu a pressão arterial média (125±6 para 42±1 mmHg), o DC (1,9±0,2 para 0,6±0,1 L/min) e o fluxo porta (504±73 para 126±12 ml/min), enquanto elevou o Dap-a pCO2 (5,3±0,8 para 19,9±1,6 mmHg), Dvp-a pCO2 (5,4±1,4 para 22,6±2,1 mmHg) e o Dt-a pCO2 (6,1±1,1 para 43,8±7,5 mmHg). A infusão de SSH resultou em recuperação parcial dos fluxos sistêmico e porta. Atenuou os gradientes de CO2 com menor impacto sobre o Dt-a pCO2. CONCLUSÃO: A SSH promoveu benefícios parciais na perfusão sistêmica e esplâncnica, os quais foram especialmente limitados na microcirculação regional, como demonstrado pelo Dt-a pCO2. Além disso, as variáveis sistêmicas e regionais dependentes de oxigênio, não refletem a adequação da perfusão da mucosa gástrica, enfatizando a importância da monitorização deste território - pela tonometria - durante os estados de choque. PURPOSE: To evaluate the effects of SSH resuscitation on systemic and splanchnic hemodynamic variables in an experimental model of controlled hemorrhagic shock. METHODS: Ten mongrel dogs were bled (20 ml/min) to a target mean arterial pressure (MAP) of 40±5 mmHg. After 30 minutes of shock, animals received SSH infused in 5-minute and they were observed for 60 minutes thereafter. Systemic hemodynamics were evaluated through a Swan-Ganz and arterial catheters while gastrointestinal tract perfusion by a catheter inside the portal vein, an ultrasonic flowprobe around portal vein blood flow (PVBF) and a gastric tonometer. Splanchnic oxygen delivery and consumption, intramucosal pH and veno-arterial, portal-arterial and mucosal-arterial pCO2-gradients (Dap-a pCO2, Dvp-a pCO2 e Dt-a pCO2, respectively) were assessed. RESULTS: Hemorrhage (29.8±2.4ml/Kg) induced significant decreases in MAP (125±6 to 42±1 mmHg), in CO (1.9±0.2 to 0.6±0.1 L/min), and PVBF (504±73 to 126±12 ml/min) while significant increases were detected in Dap-a pCO2 (5.3±0.8 to 19.9±1.6 mmHg) Dvp-a pCO2 (5.4±1.4 to 22.6±2.1 mmHg) and Dt-a pCO2 (6.1±1.1 to 43.8±7.5 mmHg). SSH infusion promoted only partial benefits in systemic and splanchnic blood flows. Reduced pCO2 gradients but fewer effects in Dt-a pCO2 were observed. CONCLUSION: The SSH infusion promoted partial systemic and splanchnic hemodynamic benefits. Those benefits were especially poor at the splanchnic microcirculation, as evaluated by Dt-a pCO2. In addition, systemic and regional oxygen-derived variables do not reflect the regional microcirculation disturbances. Gastrointestinal tonometry clearly represents a useful tool for monitoring splanchnic perfusion in patients in hemodynamic shock.

OBJETIVO: Avaliar os efeitos hemodinâmicos sistêmicos e esplâncnico da expansão volêmica inicial com SSH em modelo de choque hemorrágico controlado. MÉTODOS: Dez cães foram submetidos a sangramento controlado (20 ml/min) até uma pressão arterial média de 40±5 mmHg (PAM). Após 30 minutos de choque, receberam 4 ml/Kg de SSH em 5 minutos e posteriormente observados sem intervenções adicionais durante 60 minutos. As variáveis hemodinâmicas sistêmicas foram obtidas de um cateter arterial e de um cateter de Swan-Ganz, enquanto as regionais através da cateterização da veia porta, fluxômetro ultrassônico na veia porta e um tonômetro na cavidade. A oferta, taxa de extração e consumo esplâncnico de oxigênio, pH intramucoso e os gradientes veno-arterial, porta-arterial e mucosa-arterial da pCO2 (Dap-a pCO2, Dvp-a pCO2 e Dt-a pCO2, respectivamente), foram calculados. RESULTADOS: A hemorragia (29,8±2,4 ml/Kg) reduziu a pressão arterial média (125±6 para 42±1 mmHg), o DC (1,9±0,2 para 0,6±0,1 L/min) e o fluxo porta (504±73 para 126±12 ml/min), enquanto elevou o Dap-a pCO2 (5,3±0,8 para 19,9±1,6 mmHg), Dvp-a pCO2 (5,4±1,4 para 22,6±2,1 mmHg) e o Dt-a pCO2 (6,1±1,1 para 43,8±7,5 mmHg). A infusão de SSH resultou em recuperação parcial dos fluxos sistêmico e porta. Atenuou os gradientes de CO2 com menor impacto sobre o Dt-a pCO2. CONCLUSÃO: A SSH promoveu benefícios parciais na perfusão sistêmica e esplâncnica, os quais foram especialmente limitados na microcirculação regional, como demonstrado pelo Dt-a pCO2. Além disso, as variáveis sistêmicas e regionais dependentes de oxigênio, não refletem a adequação da perfusão da mucosa gástrica, enfatizando a importância da monitorização deste território - pela tonometria - durante os estados de choque.PURPOSE: To evaluate the effects of SSH resuscitation on systemic and splanchnic hemodynamic variables in an experimental model of controlled hemorrhagic shock. METHODS: Ten mongrel dogs were bled (20 ml/min) to a target mean arterial pressure (MAP) of 40±5 mmHg. After 30 minutes of shock, animals received SSH infused in 5-minute and they were observed for 60 minutes thereafter. Systemic hemodynamics were evaluated through a Swan-Ganz and arterial catheters while gastrointestinal tract perfusion by a catheter inside the portal vein, an ultrasonic flowprobe around portal vein blood flow (PVBF) and a gastric tonometer. Splanchnic oxygen delivery and consumption, intramucosal pH and veno-arterial, portal-arterial and mucosal-arterial pCO2-gradients (Dap-a pCO2, Dvp-a pCO2 e Dt-a pCO2, respectively) were assessed. RESULTS: Hemorrhage (29.8±2.4ml/Kg) induced significant decreases in MAP (125±6 to 42±1 mmHg), in CO (1.9±0.2 to 0.6±0.1 L/min), and PVBF (504±73 to 126±12 ml/min) while significant increases were detected in Dap-a pCO2 (5.3±0.8 to 19.9±1.6 mmHg) Dvp-a pCO2 (5.4±1.4 to 22.6±2.1 mmHg) and Dt-a pCO2 (6.1±1.1 to 43.8±7.5 mmHg). SSH infusion promoted only partial benefits in systemic and splanchnic blood flows. Reduced pCO2 gradients but fewer effects in Dt-a pCO2 were observed. CONCLUSION: The SSH infusion promoted partial systemic and splanchnic hemodynamic benefits. Those benefits were especially poor at the splanchnic microcirculation, as evaluated by Dt-a pCO2. In addition, systemic and regional oxygen-derived variables do not reflect the regional microcirculation disturbances. Gastrointestinal tonometry clearly represents a useful tool for monitoring splanchnic perfusion in patients in hemodynamic shock.

RACIONAL: Apesar dos recentes avanços nos métodos de imagem e no cuidado dos doentes críticos, a taxa de mortalidade do abdome agudo vascular nas últimas duas décadas continua praticamente inalterada. OBJETIVOS: Avaliar as alterações imediatas dos gradientes regionais da pCO2 induzidas pela isquemia e reperfusão mesentérica. Determinar se outros marcadores sistêmicos de hipoperfusão esplâncnica são capazes de detectar precocemente as alterações circulatórias ocorridas na mucosa intestinal após oclusão da artéria mesentérica superior. MÉTODOS: Foram utilizados sete cães machos sem raça definida (20,6 ± 1,1 kg), submetidos a oclusão da artéria mesentérica superior por 45 minutos, sendo os animais observados por período adicional de 2 horas após a reperfusão. Variáveis hemodinâmicas sistêmicas foram avaliadas por meio de cateter arterial e Swan-Ganz. A perfusão do sistema digestório foi avaliada pela medida do fluxo sangüíneo da veia mesentérica superior e da serosa jejunal (fluxômetro ultra-sônico). Oferta, taxa de extração e consumo intestinal de oxigênio (DO2intest, TEO2intest e VO2intest, respectivamente), pH intramucoso (tonometria a gás) e os gradientes veia mesentérica-arterial e mucosa-arterial da pCO2 (Dvm-a pCO2 e Dt-a pCO2, respectivamente), foram calculados. RESULTADOS: A oclusão da artéria mesentérica superior não esteve associada a alterações hemodinâmicas sistêmicas, mas pôde-se observar aumento significativo do Dvm-a pCO2 (1,7 ± 0,5 para 5,7 ± 1,8 mm Hg) e do Dt-a pCO2 (8,2 ± 4,8 para 48,7 ± 4,6 mm Hg). Na fase de reperfusão observou-se redução da DO2intest (67,7 ± 9,9 para 38,8 ± 5,3 mL/min) e conseqüente aumento da TEO2intest de 5,0 ± 1,1% para 12,4 ± 2,7%. Não houve correlação entre os gradientes da pCO2 analisados. CONCLUSÃO: A tonometria permite detectar de maneira precoce a redução de fluxo intestinal. Além disso, pudemos demonstrar que as variações dos gradientes regionais e/ou sistêmicos da pCO2 não são capazes de avaliar a magnitude da redução de fluxo da mucosa intestinal durante o fenômeno de isquemia e reperfusão mesentérica.BACKGROUND: Mesenteric ischemia is a life-threatening emergency with a mortality rates still ranging between 60% and 100%. AIM: To evaluate the systemic and regional pCO2 gradients changes induced by mesenteric ischemia-reperfusion injury. In addition, we sought to determine if other systemic marker of splanchnic hypoperfusion could detect the initial changes in intestinal mucosal microcirculation after superior mesenteric artery occlusion. METHODS: Seven pentobarbital anesthetized mongrel dogs (20.6 ± 1.1 kg) were subjected to superior mesenteric artery occlusion for 45 minutes, and followed for an additional 120 minutes. Systemic hemodynamic was evaluated through a Swan-Ganz and arterial catheters, while gastrointestinal tract perfusion by superior mesenteric vein and jejunal serosal blood flows (ultrasonic flowprobe). Intestinal oxygen delivery, extraction and consumption (DO2intest, ERO2intest and VO2intest, respectively), intramucosal pH (gas tonometry), and mesenteric-arterial and mucosal arterial pCO2 gradients (Dvm-a pCO2 and Dt-a pCO2, respectively) were calculated. RESULTS: Superior mesenteric artery occlusion was not associated with significant changes on systemic hemodynamics parameters. A significant increase of Dvm-a pCO2 (1.7 ± 0.5 to 5.7 ± 1.8 mm Hg) and Dt-a pCO2 (8.2 ± 4.8 to 48.7 ± 4.6 mm Hg) were detected. During the reperfusion period a significant decrease on DO2intest (67.7 ± 9.9 to 38.8 ± 5.3 mL/min) and a compensatory increase on ERO2intest from 5.0 ± 1.1% to 12.4 ± 2.7% was observed. CONCLUSION: We conclude that gas tonometry can detect the mesenteric blood flow disturbances sooner than other analyzed parameters. Additionally, we demonstrated that changes on systemic or regional pCO2 gradients are not able to detect the magnitude of intestinal mucosal blood flow reduction after mesenteric ischemia-reperfusion injury.

With this issue, MEDICALEXPRESS [2014; 1(6)] successfully completes its first volume, its first year of existence. Fourteen months have gone by since we began setting up this journal. Starting fromsquare zero inOctober, 2013weareproud tohave published six issues in a timelymanner. In thiswemustheartily thank our authors for providing us with some extremely interesting science;wealso thankandacknowledge the effort of our editors and reviewers who have given much of their valuable timeandeffort tohelpmake this journal anadequately peer reviewed journal from its inception. MedicalExpress obviously still has a very long way to go, in terms of its configuration and indexing. Configuration is still going through minor adjustments; in terms of indexing, at this point we have made applications to LATINDEX, LILACS, SCIELO AND PUBMEDCENTRAL. At the time of writing, we are still expecting to hear from them. But MedicalExpress has covered some ground: the total output published in these six issues is 68 articles, comprising 8 editorials, 38 original research articles, 4 rapid communications, and 18 critical reviews. In all of this MedicalExpress has rigorously stuck to its most basic project, namely to publish articles in 40-60 days after acceptance. Continuous flow is not something showing spectacularly in a rather small journal as this, but we have been able to upload articles in small batches into www.medicalexpress.net.br usually ahead of the nominal publication date. MedicalExpress is extremely proud to list the geographical origin of our authors, comprising work by from Brazil, China, Germany, India, Iran, Italy, Japan, Portugal, Spain, Turkey and the United States of America. To the best of our knowledge articles published MedicalExpress have yet to be cited; this is obviously not a surprise, because the absolute minimum latency for citations is 6 months, but usually something more like 1 year. So citations are definitely still in the future. MedicalExpress will start 2015 on a highly confident note: we strongly believe that indexing will come very shortly. When it does arrive, it will automatically include our entire collection from volume 1(1), because every article has been formatted exactly as required by the indexing institutions. Therefore we reiterate our invitation to submit your science to the journal. You will be speedily and positively peerreviewed, edited for style and language and last but certainly not least published according to a very agile timeline.

Este fasciculo de CLINICS encerra nosso primeiro ano de existencia. Tecnicamente, CLINICS e um periodico novo, mas na realidade da-se continuidade aos 59 anos da Revista do Hospital das Clinicas da Faculdade de Medicina. De Pedro Puech Leao, Editor entre 1998 e 2004, CLINICS herdou um saudavel ritmo de crescimento, mas neste ano conseguimos varias melhorias. O novo nome esta registrado no SCIELO e no PUBMED desde o primeiro fasciculo, adotamos editoracao eletronica “on-the-web” e ampliamos nosso Corpo Editorial. Ao [...]

Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.O uso de soluções hipertônicas para reanimação de pacientes em choque é um conceito relativamente novo. Baseou-se originalmente na idéia de que uma expansão volêmica significativa podia ser obtida às custas de um volume relativamente diminuto de infusão, aproveitando a propriedade física de osmose. Logo ficou claro que a capacidade fisiológica de produzir vasodilatação, compartilhada por todas as soluções hipertônicas, seria valiosa para reperfundir territórios tornados isquêmicos pelo choque, embora os malefícios da seqüência isquemia - reperfusão devessem ser considerados. Pesquisa subseqüente revelou propriedades antes insuspeitadas da reanimação hipertônica. Verificou-se que este procedimento revertia instantaneamente o edema endotelial e de hemácias, com importantes conseqüências em termos de circulação capilar. Mais recentemente, um conjunto de efeitos da hipertonicidade sobre o sistema imune vem sendo estudado, mas as possíveis implicações destas descobertas em relação ao cenário clínico ainda suscitam discussão. As soluções hipertônicas estão em uso em algumas partes do mundo, apesar de objeções levantadas contra tal uso, em virtude de dados experimentais derivados de experimentos de hemorragia não controlada. Tais objeções não parecem se justificar em face dos resultados obtidos numa série de ensaios clínicos e no uso corrente destas soluções. Esta revisão procura cobrir um pouco da história, remota e recente, deste campo do conhecimento.

Transesophageal Doppler (TED) monitoring has been considered a noninvasive and accurate alternative to pulmonary artery catheterization for volume replacement and cardiac output measurement in patients undergoing major surgery. This study tested the hypothesis that TED can accurately predict cardiac output during hemorrhage, shock, and resuscitation, by comparing it to total pulmonary artery blood flow (PABF) and to standard intermittent bolus cardiac output (ICO). In eight anesthetized dogs (18 +/- 1.0 kg), PABF was measured with an ultrasonic flowprobe while ICO and mixed venous O2 saturation (SvO2) were measured through a Swan-Ganz catheter. A TED probe (CardioQ, Deltex Medical Inc., Irving, TX, U.S.A.), designed for adult use (minimum 30 kg, 16 years), was placed in midesophageous to evaluate stroke volume. A graded hemorrhage (20 mL/min) was produced (H5-H35) to a mean arterial pressure (MAP) of 40 mm Hg and maintained by additional blood removal for 30 min (S1-S30). Total shed blood volume was retransfused (541 +/- 54.2 mL) over 30 min (T5-T30), after which a massive hemorrhage, 100 mL/min rate, was produced over 10 min (MH5-MH10). In general, TED overestimated PABF (r2 = 0.3472), but changes in TED paralleled PABF throughout the experimental protocol, particularly during massive hemorrhage (r2 = 0.9001). We concluded that TED accurately reflected the direction and magnitude of the changes of cardiac output over time during abrupt hemodynamic changes. Probes designed for lower weights and smaller aortas may improve its accuracy in medium size animal models under less dramatic alterations induced by hemorrhage, shock, and resuscitation.

Background Supraceliac aortic occlusion (AO) has been recommended to avoid hypotension during hepatic vascular exclusion (HVE). We hypothesized that AO may negatively affect splanchnic perfusion during HVE. Methods Twenty-six dogs (16 ± 0.3 kg) were randomly assigned to HVE (n = 13) or HVE+AO (n = 13), during 30 minutes followed by a 60-minute reperfusion period. Cardiac output (CO), mean arterial pressure (MAP), superior mesenteric artery blood flow (SMABF, ultrasonic flowprobe), gastric mucosal PCO 2 (gas tonometry) and PCO 2 -gap were evaluated. Results HVE alone induced decreases in MAP from 115 ± 5.1 to 26 ± 1 mm Hg, in CO from 2.0 ± 0.1 to 0.4 ± 0.1 L/min and SMABF from 398 ± 42 to 16 ± 7.6 mL/min, while PCO 2 gap increased from 4 ± 3.7 to 52 ± 5.4 mm Hg. Supraceliac aortic occlusion only avoided severe hypotension. During reperfusion MAP, CO, and SMABF were partially restored, while PCO 2 gap showed no improvements in either group. Conclusions HVE promotes major systemic and splanchnic perfusional derangement. Concomitant AO may avoid HVE-induced hypotension without producing further deleterious effects.