ABSTRACT Purpose The clinical outcomes of kidney transplantation from deceased donors have seen significant improvements with the use of machine perfusion (MP), now a standard practice in transplant centers. However, the use of perfusate biomarkers for assessing organ quality remains a subject of debate. Despite this, some centers incorporate them into their decision-making process for donor kidney acceptance. Recent studies have indicated that lactate dehydrogenase (LDH), glutathione S-transferase, interleukin-18, and neutrophil gelatinase-associated lipocalin (NGAL) could predict post-transplant outcomes. Materials and Methods Between August 2016 and June 2017, 31 deceased-donor after brain death were included and stroke was the main cause of death. Pediatric patients, hypersensitized recipients were excluded. 43 kidneys were subjected to machine perfusion. Perfusate samples were collected just before the transplantation and stored at -80ºC. Kidney transplant recipients have an average age of 52 years, 34,9% female, with a BMI 24,6±3,7. We employed receiver operating characteristic analysis to investigate associations between these perfusate biomarkers and two key clinical outcomes: delayed graft function and primary non-function. Results The incidence of delayed graft function was 23.3% and primary non-function was 14%. A strong association was found between NGAL concentration and DGF (AUC=0.766, 95% CI, P=0.012), and between LDH concentration and PNF (AUC=0.84, 95% CI, P=0.027). Other perfusate biomarkers did not show significant correlations with these clinical outcomes. Conclusion The concentrations of NGAL and LDH during machine perfusion could assist transplant physicians in improving the allocation of donated organs and making challenging decisions regarding organ discarding. Further, larger-scale studies are required. MP, MP , (MP) However debate this decisionmaking decision acceptance LDH, (LDH) Stransferase, Stransferase S transferase, transferase S-transferase interleukin18, interleukin18 interleukin 18, 18 interleukin-18 gelatinaseassociated gelatinase associated (NGAL posttransplant post 201 2017 3 deceaseddonor patients excluded 4 80ºC. 80ºC ºC -80ºC 5 years 349 34 9 34,9 female 24637 24 6 7 24,6±3,7 nonfunction. nonfunction non function. 233 23 23.3 14 14% AUC=0.766, AUC0766 AUC 0 766 (AUC=0.766 95 CI P=0.012, P0012 P P=0.012 012 P=0.012) AUC=0.84, AUC084 84 (AUC=0.84 P=0.027. P0027 P=0.027 . 027 P=0.027) discarding Further largerscale larger scale required (MP (LDH interleukin1 1 interleukin-1 20 34, 2463 2 24,6±3, 23. AUC=0.766 AUC076 76 (AUC=0.76 P001 P=0.01 01 AUC=0.84 AUC08 8 (AUC=0.8 P002 P=0.02 02 interleukin- 246 24,6±3 AUC=0.76 AUC07 (AUC=0.7 P00 P=0.0 AUC=0.8 AUC0 (AUC=0. 24,6± AUC=0.7 P0 P=0. AUC=0. (AUC=0 24,6 P=0 AUC=0 (AUC= 24, P= AUC= (AUC

RESUMO RACIONAL: A relação entre trombose e câncer é baseada em evidências de que o câncer promove alterações protrombóticas no sistema hemostático do hospedeiro. A ativação da coagulação sanguínea está intimamente ligada ao crescimento e disseminação do tumor. OBJETIVOS: Avaliar se as quantificações do ácido desoxirribonucleico (DNA) tumoral na circulação plasmática e do complexo trombina-antitrombina poderiam atuar como preditores de eventos trombóticos e morte em pacientes com adenocarcinomas gástricos ou colorretais, avaliando também o status de desempenho de Karnofsky. MÉTODOS: Oitenta e dois pacientes foram incluídos no estudo e divididos em três grupos: controles (n=20), adenocarcinomas gástricos (n=21) e adenocarcinomas colorretais (n=41). No cálculo do índice de Karnofsky foram coletadas informações para medir a capacidade do paciente de realizar tarefas diárias comuns. As seguintes dosagens séricas foram realizadas: hemograma completo, contagem de plaquetas, ácido desoxirribonucleico extracelular e complexo trombina-antitrombina. RESULTADOS: Dez pacientes (16%) apresentaram trombose durante o tratamento. Pacientes com níveis de complexo trombina-antitrombina superiores a 0,53 apresentaram risco cinco vezes maior de trombose. A baixa classificação de desempenho de Karnofsky também foi considerada um fator de risco para o evento nesta população. Nem o complexo trombina-antitrombina, nem o DNA tumoral da circulação plasmática foram preditores de morte após ajuste multivariado. O índice Karnofsky sinalizou um melhor prognóstico de sobrevida global para pacientes com adenocarcinoma colorretal e gástrico. CONCLUSÕES: O complexo trombina-antitrombina atua como marcador de trombose em pacientes com adenocarcinoma colorretal e gástrico. Recomendamos anticoagulação profilática quando o valor do Karnofsky for baixo e/ou a concentração do complexo trombina-antitrombina for superior a 0,53 ng/ml. RACIONAL hospedeiro tumor OBJETIVOS (DNA trombinaantitrombina trombina antitrombina MÉTODOS grupos n=20, n20 n n=20 , 20 (n=20) n=21 n21 21 (n=21 n=41. n41 n=41 . 41 (n=41) comuns realizadas completo plaquetas trombinaantitrombina. antitrombina. RESULTADOS 16% 16 (16% tratamento 053 0 53 0,5 população trombinaantitrombina, antitrombina, multivariado gástrico CONCLUSÕES eou ngml ng ml ng/ml n2 n=2 2 (n=20 (n=2 n4 n=4 4 (n=41 1 (16 05 5 0, n= (n= (n=4 (1 (n (

ABSTRACT BACKGROUND: The relationship between thrombosis and cancer is based on evidence that cancer promotes prothrombotic changes in the host hemostatic system. The activation of blood coagulation is closely linked to tumor growth and dissemination. AIMS: To evaluate whether quantifications of plasma circulation tumor deoxyribonucleic acid (DNA) and thrombin-antithrombin complex could act as predictors for thrombotic events and death in patients with gastric or colorectal adenocarcinomas, while also evaluating the Karnofsky Performance Status. METHODS: Eighty-two patients were included in the study and divided into three groups: controls (n=20), gastric adenocarcinomas (n=21), and colorectal adenocarcinomas (n=41). In order to calculate the Karnofsky index, information was collected to measure the patient’s ability to perform common daily tasks. The following serum measurements were conducted: complete blood count, platelet count, extracellular deoxyribonucleic acid, and thrombin-antithrombin complex. RESULTS: Ten patients (16%) experienced thrombosis during treatment. Patients with thrombin-antithrombin complex levels greater than 0.53 had a five-times higher risk of thrombosis. Lower Karnofsky Performance Status was also a risk factor for the event in this population. Neither thrombin-antithrombin complex nor plasma circulation tumor DNA were predictors of death after multivariate adjustment. Thus, Karnofsky index signaled a better overall survival prognosis for colorectal and gastric adenocarcinoma patients. CONCLUSIONS: Thrombin-antithrombin complex acts as a marker for thrombosis in patients with colorectal and gastric adenocarcinomas. We recommend prophylactic anticoagulation when the Karnofsky value is low and/or the thrombin-antithrombin complex concentration is greater than 0.53 ng/ml. BACKGROUND system dissemination AIMS (DNA thrombinantithrombin thrombin antithrombin METHODS Eightytwo Eighty two groups n=20, n20 n n=20 , 20 (n=20) n=21, n21 n=21 21 (n=21) n=41. n41 n=41 . 41 (n=41) patient s tasks conducted count RESULTS 16% 16 (16% treatment 053 0 53 0.5 fivetimes five times population adjustment Thus CONCLUSIONS Thrombinantithrombin Thrombin andor ngml ng ml ng/ml n2 n=2 2 (n=20 (n=21 n4 n=4 4 (n=41 1 (16 05 5 0. n= (n=2 (n=4 (1 (n= ( (n

Abstract Purpose: Budget cuts among other factors undermine the use of state-of-the-art equipment by many research groups. This doesn’t mean that their scientific data are not reliable or top-notch. Resort to adaptations is a recurrent need in their reality. The aim of this study was to assess whether scintigraphy with 99mTcO4 is effective in evaluating the functionality of thyroid grafts after cryopreservation in rats. Material and methods: 24 rats were randomly distributed into 3 groups: Control Group (CG), without surgical procedure, Hypothyroidism Group (HTG), submitted to total thyroidectomy, and Transplanted Group (TG), with total thyroidectomy and cryopreservation of the thyroid gland for 7 days followed by grafting of a thyroid lobe. A protocol using a gamma camera imaging was conducted fourteen weeks after transplantation, and the whole body 99mTc, focusing on the topic of heterotopic thyroid uptake was evaluated. Results: The images acquired had good quality with no noise and artifacts that could jeopardize its analysis. On the 14th day, HTG displayed no thyroid uptake, and the TG had a clear uptake of the thyroid graft in the topography of the biceps femoris muscle. Presented data also showed that both equipment spatial resolution and alignment (4.375 mm) did not interfere with the physiological uptake of 99mTc by the thyroid graft. Conclusion: The viability and functionality of cryopreserved thyroid autotransplantation in rats who underwent total thyroidectomy were successfully accessed by the scintigraphy protocol developed. HIGHLIGHTS Adaptations in validated methods are a recurrent trend due to limited budgets which does not diminish their functionality. Scintigraphy with 99mTcO4 is effective in evaluating the functionality of thyroid grafts after cryopreservation in rats. It is possible to adapt human SPECT for other animals for clinical and research purposes.

Resumo Introdução e objetivos: O sugamadex é uma substância farmacológica alternativa capaz de reverter o bloqueio neuromuscular sem as limitações apresentadas pelos anticolinesterásicos. Entretanto, há relatos de transtornos de coagulação relacionados ao tratamento com sugamadex sem que mecanismos exatos de seus efeitos sobre a coagulação sejam totalmente compreendidos. O objetivo da presente pesquisa foi avaliar os efeitos do rocurônio, sugamadex e do complexo rocurônio-sugamadex sobre a coagulação em um modelo experimental com ratos. Métodos: Este é um estudo randomizado experimental animal. Ratos Wistar foram aleatoriamente designados aos seguintes grupos: grupo controle; Grupo Ssal - 0,5 mL de solução salina intravenosa; Grupo sugamadex - sugamadex intravenoso (100 mg.kg-1); e Grupo rocurônio-sugamadex - solução intravenosa com rocurônio (3,75 mg.kg-1) e sugamadex (100 mg.kg-1). A anestesia foi realizada utilizando-se isoflurano com ventilação controlada. Os fatores de coagulação foram medidos 10 minutos após o final do preparo pré-operatório e 30 minutos após a administração de drogas de acordo com os grupos escolhidos. Resultados: Contagem de plaquetas, tempo de protrombina e tempo de tromboplastina parcial ativada foram semelhantes entre os grupos e entre os momentos dentro de cada grupo. Houve redução nos níveis de fibrinogênio plasmático entre os tempos 1 e 2 no grupo rocurônio-sugamadex (p = 0,035). Conclusões: O complexo rocurônio-sugamadex promoveu reduções na contagem de fibrinogênio plasmático, apesar de os níveis continuarem dentro dos limites normais.

Abstract Background and objectives: Sugammadex is an alternative pharmacological drug capable of reversing neuromuscular blockades without the limitations that are presented by anticholinesterase drugs. Coagulation disorders that are related to treatment with sugammadex were reported. The exact mechanism of the effects on coagulation are not fully understood. The objective of this research is to evaluate the effects of rocuronium, sugammadex and the rocuronium-sugammadex complex on coagulation in an experimental model in rats. Methods: This is an experimental randomized animal study. Wistar rats were randomly assigned into the following groups: the Control Group; the Ssal Group - 0.5 mL of intravenous saline; the Sugammadex Group - intravenous sugammadex (100 mg kg−1); and the Rocuronium-Sugammadex Group - intravenous solution with rocuronium (3.75 mg kg−1) and sugammadex (100 mg kg−1). Anesthesia was performed by using isoflurane with controlled ventilation. Coagulation factors were measured 10 minutes after the end of the preoperative preparation and 30 minutes after the administration of the drugs in accordance with the chosen groups. Results: Platelet counts, prothrombin times, and activated partial thromboplastin times were similar between the groups and between the moments within each group. There were reductions in the plasma fibrinogen levels between sample times 1 and 2 in the Rocuronium-Sugammadex group (p = 0.035). Conclusions: The rocuronium-sugammadex complex promoted reductions in plasma fibrinogen counts, although the levels were still within normal limits.

Abstract Purpose: To evaluate liver regeneration after selective ligation of portal vein and hepatic artery by 3D Computed Tomography in an experimental model. Methods: Sixteen Wistar rats were randomized into four equal groups: Group I- control (sham), Group II- isolated selective ligation of the hepatic artery, Group III- isolated selective ligation of the portal vein and Group IV- combined ligation of portal vein and hepatic artery. Before procedure and five days after a 3D CT Scan was performed to analyze the hypertrophy, weight and function of the remnant liver. Results: The largest regeneration rate and increase of weight in the hypertrophied lobe was detected in group IV, the first with an average of 3.99 (p=0.006) and the last varying from 6.10g to 9.64g (p=0.01). However, total liver weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was higher in group III (P<0.001) when compared with groups I, II and IV and showed no difference between them. The immunohistochemical examination with PCNA also found higher percentages with statistical significance differences in rats of groups III and IV. It was possible to confirm a strong correlation between hypertrophied lobe weight and its imaging volumetric study. Liver function tests only showed a significant difference in serum gamma-glutamyltransferase and phosphorous. Conclusion: There is a largest liver regeneration after combined ligation of portal vein and hepatic artery and this evidence may improve the knowledge of surgical treatment of liver injuries, with a translational impact in anima nobile.

RESUMO Com a utilização crescente da máquina de perfusão no transplante renal, tem sido constatado que a isquemia dinâmica correlaciona-se à melhora da preservação orgânica. Nesse contexto, realizamos uma revisão sistemática que procurou avaliar a eficácia do uso de máquina de perfusão portátil (LifePort Kidney Transporter Machine®), utilizada no Brasil, comparada ao armazenamento estático, no que tange à função retardada do transplante renal de doadores com morte encefálica. Foi efetuada pesquisa bibliográfica, nas bases LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, SciELO, além de busca manual no Google acadêmico. A revisão sistemática, finalizada em abril 2017, foi constituída somente por ensaios clínicos randomizados. Para metanálise, foram avaliadas Razão de Risco e Razão de Chance. Foram identificados 86 documentos e selecionados, ao final, dois artigos com critérios de elegibilidade para metanálise, de grupos europeus e brasileiros. Nestes, 374 rins foram alocados para a máquina de perfusão, e igual número para o armazenamento estático. A função retardada do enxerto foi constatada em 84 e 110 pacientes, respectivamente. Na metanálise, foram obtidas uma Razão de Risco de 0,7568 (p=0,0151) e uma Razão de Chance de 0,6665 (p=0,0225), ambas com intervalo de confiança de 95%. A máquina de perfusão reduziu a incidência de função retardada do enxerto de doadores com morte encefálica.

ABSTRACT With the increasing use of machine perfusion in kidney transplantation, it has been observed that dynamic ischemia correlates with the improvement of organ preservation. In this context, we performed a systematic review that aimed to evaluate the efficacy of the portable machine perfusion (LifePort Kidney Transporter Machine®), used in Brazil, compared to cold storage, regarding the delayed graft function of deceased donors with brain death. Literature search was carried out in LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, and SciELO, as well as in Google Scholar manually. The systematic review consisted only of randomized clinical trials. For meta-analysis, relative risk and odds ratio were evaluated. Eighty-six documents were identified and two papers from European and Brazilian groups were selected at the end, with eligibility criteria for meta-analysis. In these, 374 kidneys were assigned to machine perfusion and 374 kidneys were assigned to cold storage. Delayed graft function was observed in 84 and 110 patients, respectively. In meta-analysis, a risk ratio of 0.7568 (p=0.0151) and an odds ratio of 0.6665 (p=0.0225) were obtained, both with a 95% confidence interval. Machine perfusion reduced the incidence of delayed graft function of deceased donors with brain death.

Abstract Purpose: To evaluate the most frequent surgical techniques of high-risk colorectal anastomoses in rats. Methods: Wistar rats were enrolled in three different models comprising inflammatory (TNBS enema), vascular (portal vein occlusion) or obstructive (a non-ischemic constricting ring) mechanisms associated with colonic anastomosis that had accomplished after these former lesions. Histological analyses (Hematoxylin and eosin and Picrosirius red) were performed. Results: All anastomoses techniques were associated with risk factors and had complications, mainly anastomotic leakage. In Study 1, the use of a pharmacological agent, trinitrobenzene sulfonic acid (TNBS) mimicked an inflammatory bowel disease such as Crohn’s disease with 50% of anastomosis leakage, the higher percentage among all models tested. In Study 2, after portal ischemia followed by reperfusion it was observed a dense neutrophil infiltrate in the midst of necrotic tissue and fibrin at the anastomotic site and 5 days after the anastomosis, no collagen was produced. In Study 3, 5 days after the mechanical obstruction some denuded areas of epithelium with marked oedema of mucosa and submucosa were seen, at the anastomotic site and anastomosis group showed some reduction of collagen density when compared with Control/Sham group. Conclusion: All the experimental surgical techniques tested in rats were associated with high-risk colorectal anastomoses and were useful to study colonic anastomotic healing and intestinal leakage.

Abstract Purpose: To evaluate a novel and adapted low-cost set model for laparoscopic surgery in rats. Methods: Nine Wistar rats underwent two different laparoscopic procedures, splenectomy (n=3) and distal pancreatectomy with splenectomy (n = 6), after assembling a low-cost set replacing the conventional one (monitor, micro camera, image processor, light source, laparoscope and insufflator). The new set included an Android Tablet 10.5 ", a 5mm USB Endoscope and semiautomatic sphygmomanometer monitor. Results: The same surgeon performed the laparoscopic procedures. Total surgical time ranged from 36 to 60 minutes with a mean of 45.8 minutes. Three rats died during the distal pancreatic and splenectomy procedure (33.3%), due to respiratory failure (n = 1), uncontrolled abdominal hemorrhage (n=1) and iatrogenic gastric perforation (n = 1). We followed the other six rats (66.6%) for seven days with no further evidence of complications. Conclusions: The laparoscopic partial pancreatectomy and splenectomy can be performed with the novel low-cost set assembled in the present experimental study. Both specific training and skills development are required to validate more advanced laparoscopic procedures and achieve a desirable outcome.

Abstract Purpose: To evaluate the actual incidence of both microlithiasis and acute cholecystitis during treatment with intravenous ceftriaxone in a new rabbit model. Methods: New Zealand rabbits were treated with intravenous ceftriaxone or saline for 21 days. Ultrasound monitoring of the gallbladder was performed every seven days until the 21st day when histopathology, immunohistochemistry for proliferating cell nuclear antigen (PCNA), pro-caspase-3 and CD68, liver enzyme biochemistry, and chromatography analysis of the bile and sediments were also performed. Results: All animals treated with ceftriaxone developed acute cholecystitis, confirmed by histopathology (P<0.05) and biliary microlithiasis, except one that exhibited sediment precipitation. In the group treated with ceftriaxone there was an increase in pro-caspase-3, gamma-glutamyl transpeptidase concentration, PCNA expression and in the number of cells positive for anti-CD68 (P<0.05). In the ceftriaxone group, the cholesterol and lecithin concentrations increased in the bile and a high concentration of ceftriaxone was found in the microlithiasis. Conclusion: Ceftriaxone administered intravenously at therapeutic doses causes a high predisposition for lithogenic bile formation and the development of acute lithiasic cholecystitis.

Abstract Purpose: To evaluate whether undergraduate students feel motivated to develop surgical skills and know their impression about the importance of having a surgical technique discipline in the curriculum of a medical school. Methods: A prospective study including three classes in a row, from the 8th period (n = 265) evaluated the knowledge acquired at the Center of Experimental Surgery, Department of Surgery, School of Medicine of Federal University of Rio de Janeiro (UFRJ). The importance of the discipline for medical training as a way of encouragement to arouse and deepen the interest in surgical technique was emphasized. The questions were scored from 1 to 5 (worst to best grade) . Results: Concerning the importance of the discipline for medical training, 78% and 18% of the students assigned a score 5 and 4, respectively. Regarding the stimulus to improve their surgical technical skills, 40% and 32% attributed the score 5 and 4, respectively. Conclusion: Undergraduate students from the Medical School of UFRJ effectively shared the understanding that the operative technique bases improve the formative process with significant impact, not only in the development of skills, but also to arouse vocations and stimulate new attitudes aimed to knowledge acquirement in the field of Surgery.

ABSTRACT PURPOSE: To critically analyze and standardize the rat pancreatectomy nomenclature variants. METHODS: It was performed a review of indexed manuscripts in PUBMED from 01/01/1945 to 31/12/2015 with the combined keywords "rat pancreatectomy" and "rat pancreas resection". The following parameters was considered: A. Frequency of publications; B. Purpose of the pancreatectomy in each article; C. Bibliographic references; D. Nomenclature of techniques according to the pancreatic parenchyma resection percentage RESULTS: Among the 468, the main objectives were to surgically induce diabetes and to study the genes regulations and expressions. Five rat pancreatectomy technique references received 15 or more citations. Twenty different terminologies were identified for the pancreas resection: according to the resected parenchyma percentage (30 to 95%); to the procedure type (total, subtotal and partial); or based on the selected anatomical region (distal, longitudinal and segmental). A nomenclature systematization was gathered by cross-checking information between the main surgical techniques, the anatomic parameters descriptions and the resected parenchyma percentages. CONCLUSION: The subtotal pancreatectomy nomenclature for parenchymal resection between 80 and 95% establishes a surgical parameter that also defines the total and partial pancreatectomy limits and standardizes these surgical procedures in rats.

Objetivo: avaliar o sistema de mapeamento dos egressos dos Programas de Pós-Graduação da área Medicina III da CAPES. Métodos: compôs-se da análise dos Cadernos de indicadores e do Documento de área dos Programas de Pós-Graduação em Cirurgia e da consulta à literatura sobre o tema. Resultados: Constatou-se uma escassez de dados no que tange a avaliação dos egressos, junto a maior parte dos Programas. O sistema vigente para mapeamento de egressos carece de padronização e suporte institucional. Há uma concentração de pós-graduados médicos no sistema público, no entanto, estes representam uma pequena parcela dos alunos formados pelos Cursos de Graduação em Medicina no Brasil. No contexto atual, a procura pela Pós-Graduação e, consequentemente, pela pesquisa e carreira docente vem cedendo espaço para as atividades assistenciais não acadêmicas, na iniciativa privada e no mercado de trabalho. Conclusão: urge instituir não políticas de Ciência, Tecnologia e Inovação, mas de Educação e Saúde que atuem harmonicamente, estimulem a qualificação e a carreira docente e aprimorem a Pós-Graduação. Faz-se necessária a elaboração de um formulário único, sob a égide institucional da CAPES, por meio da criação de um Programa Nacional de Egressos, objetivando consolidar diretrizes para o mapeamento dos egressos dos Programas de Pós-Graduação em Cirurgia no país.

Objective: to evaluate the system to outline the graduate students from the Post-Graduate Programs of CAPES Medicine III area. Method: it was analyzed the book of indicators and the Document of Area of the Post-Graduate Programs of Surgery, also checking the literature about this issue. Results: there was a paucity of data from most of the programs, as regards to the methods for evaluation of graduate students. The current system lacks a standard and an institutional support to outline the graduate students. In the public system there is a concentration of postgraduate students in Medicine; however, they represent a small part of those Brazilians students who finished their graduation courses in Medicine. In the current context, the quest for the post graduate courses and consequently for a research field or even a teaching career, has been replaced by the private sector jobs and the labor market, both in non-academic assistance activities. Conclusion: it is imperative to establish not only science and technology innovation policies but also educational and health policies acting harmoniously and stimulating the qualification and the teaching career, improving the post-graduate courses. It is necessary to develop a single form under the institutional guidance of CAPES with the conception of a National Program for Graduate Student in order to consolidate guidelines to mapping the graduate students of post-graduate programs in surgery, in our country.

O suporte a pacientes com a Síndrome do Desconforto Respiratório Agudo (SDRA), realizado com baixos volumes correntes e limite da pressão positiva ao final da expiração (PEEP), é o padrão ouro no tratamento de pacientes internados em Unidades de Terapia Intensiva. No entanto, essas estratégias podem promover o desrecrutamento pulmonar levando ao fechamento e reabertura cíclicos de alvéolos colapsados e de pequenas vias aéreas. As manobras de recrutamento (MR) podem ser usadas em conjunto a outros métodos, como a PEEP e posicionamento dos pacientes, para promover melhora no volume pulmonar aerado. Diversos métodos são utilizados na prática clínica, mas o mais adequado e a seleção de qual paciente se beneficiaria de MR ainda não estão estabelecidos. Além disso, ainda permanecem consideráveis incertezas em relação a adequação da MR. Esta revisão objetiva discutir as últimas descobertas acerca das MR existentes e compará-las no que tange a suas eficácias, indicações e complicações. Descobertas recentes incluem evidencias clínicas e experimentais que a manobra de recrutamento em "STEP" pode promover uma melhora do volume pulmonar aerado e reduzir o impacto biológico observado na insulflação sustentada tradicionalmente usada. O posicionamento em prona pode reduzir a mortalidade em pacientes com SDRA grave e ser um coadjuvante nas manobras de recrutamento e estratégias ventilatórias avançadas como a ventilação variável e o BIVENT tem se mostrado úteis em proporcionar recrutamento pulmonar.

Supporting patients with acute respiratory distress syndrome (ARDS), using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP) is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM) can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

Objetivo: Analisar criticamente a eficácia e valor de indicadores bibliométricos dos periódicos da Cirurgia e Cirurgia Cardiovascular no contexto dos Programas de Pós-Graduação da área Medicina III da CAPES. Métodos: Foi avaliada uma amostragem com 16 programas acadêmicos e um mestrado profissional da área de Medicina III, compreendendo a Cirurgia Geral e do Aparelho Digestivo, a Cirurgia Cardiovascular e Cursos Multidisciplinares com estes conteúdos. Utilizaram-se as bases de dados Thomson Reuters/ISI (JCR), Elsevier/Scopus (SJR), além do Scielo. Resultados: Somente nos programas 7, os docentes têm média de artigos Qualis A1 maior ou igual que os demais estratos. Apenas 11 periódicos da área de Cirurgia estão no estrato A1 (5%) e na Cirurgia Cardiovascular são 25%. Dos seis periódicos com o maior número de publicações na área Medicina III, Qualis A1, cinco não são específicos da área. A Acta Cirúrgica Brasileira representou 58% das publicações no estrato A2. Há alguns óbices na classificação Qualis com pouca uniformidade entre as Medicinas I, II e III. Conclusões: Se impõe a criação de um comitê permanente para atualização do Qualis, composto pelas três áreas da Medicina. Deve-se ponderar a utilização de outras bases de indexação e a unificação dos critérios Qualis para as revistas das áreas de medicina. Critérios de classificação dos periódicos multi e transdisciplinares precisam ser revistos. É imprescindível suporte financeiro institucional aos periódicos nacionais escolhidos pelos pares visando informatização completa e prover revisão profissional da língua inglesa, tendo como meta a elevação do fator de impacto.

Objective: To analyze critically the effectiveness and value of bibliometric indicators in journals of Surgery or Cardiovacular Surgery in the context of the postgraduate programs of CAPES Medicine III. Methods: A sampling with 16 academic programs and one professional master of Medicine III, encompassing the General and Digestive System Surgery, Cardiovascular Surgery and Multidisciplinary courses with such contents, was evaluated. Thomson Reuters/ISI (JCR), Elsevier/Scopus (SJR), and also Scielo databases were used. Results: Only in seven programs, the teachers had an average of Qualis A1 articles greater than the others strata. Eleven journals in the surgical area are in stratum A1 (5%) and it reaches 25% in Cardiovascular Surgery. Among the six journals with the largest number of publications Qualis A1 in area Medicine III, five are from non-specific areas. The Acta Cirúrgica Brasileira represented 58% of the publications in the stratum A2. There are some obstacles in the Qualis classification with little uniformity among the Medicine areas I, II and III. Conclusions: A permanent committee should be set to update the Qualis, composed by the three medical areas. It should be considered using other index databases and the unification of the Qualis criteria for journals in medicine. Rating criteria of multi and transdisciplinary journals need to be reviewed. It is essential an institutional financial support for national journals chosen by peers aiming to provide a full computerization process and a professional reviewer of the English language, in order to increase the impact factor.

Os autores detalham o desenvolvimento experimental de uma técnica para a reconstrução do ureter, utilizando um retalho muscular da parede abdominal, na forma tubular. O resultado preliminar indica a viabilidade desta técnica operatória.

The authors detail the experimental development of a technique for the reconstruction of the ureter using a tubular shape, muscle flap of the abdominal wall. the preliminary results indicate the feasibility of this surgical technique.