Abstract The authors aim to study Religiosity/Spirituality (R/S) and Quality of Life (QoL) in patients with Crohn's disease and their correlation with the disease phenotypes. Methods Prospective cross-sectional cohort study with 151 consecutive patients enrolled from March 2021 to October 2021 at the Colorectal IBD Outpatient of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Sociodemographic, Religiosity/Spirituality (Duke University Religion Index - Durel) questionnaires and QoL (Inflammatory Bowel Disease Questionnaire - Short IBDQ-S) were applied. When necessary, qualitative variables were evaluated using the chi-square or Fisher's exact test. The Mann-Whitney and Kruskall-Wallis tests were used to analyze quantitative variables and compare more than two groups, both non-parametric statistical techniques. Results The most frequent location was Ileocolonic followed by Ileal and colonic (41.1 %, 27.2 %, and 25.2 %); only 6.6 % of subjects had a perianal presentation. Inflammatory, stenosing, and penetrating behaviors showed 36.4 %, 19.1 %, and 44.4 % respectively. The majority of the population is Catholic, Evangelical, or Spiritualist (92.4 %). QoL score showed no significant difference in the phenotypes. The scores for DUREL domains were 61.4 % for organizational religiosity, 75 % for non-organizational religiosity, 98.6 %, 93.6 % and 89.3 % for intrinsic spirituality, with high results in all disease phenotypes. Conclusions The studied population presented homogeneous sociodemographic results and high religious and spiritual activity. R/S in a positive context were not associated with better QoL or phenotype. R/S is present in the patients’ lives and could be seen as an important tool for adherence to treatment and the professional relationship between doctor and patient. The homogeneity of the sample difficult for an appropriate evaluation, which leads us to suggest new studies with more heterogeneous groups. ReligiositySpirituality Religiosity Spirituality RS R S (R/S (QoL Crohns Crohn s phenotypes crosssectional cross sectional 15 202 HCFMUSP. HCFMUSP . (HCFMUSP) Sociodemographic Duke Durel Inflammatory IBDQS IBDQ IBDQ-S applied necessary chisquare chi square Fishers Fisher test MannWhitney Mann Whitney KruskallWallis Kruskall Wallis groups nonparametric non parametric techniques 41.1 411 41 1 (41. 272 27 2 27. 252 25 25. %) 66 6 6. presentation stenosing 364 36 4 36. 191 19 19. 444 44 44. respectively Catholic Evangelical 92.4 924 92 (92. %. 614 61 61. religiosity 7 nonorganizational 986 98 98. 936 93 93. 893 89 3 89. spirituality activity phenotype patient evaluation 20 (HCFMUSP 41. (41 92. 9 (92 8 (4 (9 (

RESUMO No ano em que completa 20 anos, a Pancreatoduodenectomia Laparoscópica, embora factível e segura em mãos experientes, não obteve uma esperada popularização como aquela observada em vários outros procedimentos no campo da cirurgia digestiva. A ausência de uma clara vantagem sobre a cirurgia aberta associada a complexidade do procedimento com consequente difícil e demorada curvas de aprendizado são os principais obstáculos. Em nosso país onde se dispõe de poucos serviços de cirurgia pancreática as consequências da prática desse procedimento sem um adequado treinamento pode trazer sérios prejuizos. Torna-se imperativo, agora com difusão das plataformas robóticas e enquanto se aguarda os estudos prospectivos e randomizados com essa nova tecnologia, que uma ampla discussão seja feita com chancela das sociedades de cirurgia sobre o valor, a aplicação e a forma de implantação das diversas técnicas de pancreatoduodenectomia minimamente invasivas. 2 anos Laparoscópica experientes digestiva obstáculos prejuizos Tornase Torna imperativo tecnologia valor invasivas

ABSTRACT In its 20th anniversary, laparoscopic pancreatoduodenectomy, while feasible and safe in the hands of experienced surgeons, has not seen the anticipated popularity observed in other digestive surgery procedures. The primary hurdle remains the absence of a clear advantage over traditional open surgery, paired with the procedures complexity and a consequent steep learning curve. In regions with limited pancreatic surgery services, conducting this procedure without adequate training can have serious repercussions. Given the advent of robotic platforms and the anticipation of prospective and randomized studies on this new technology, it is imperative to engage in comprehensive discussions, endorsed by surgical societies, on the value, application, and implementation strategies for various minimally invasive pancreatoduodenectomy techniques. Such dialogue is crucial for advancing the field and ensuring optimal patient outcomes. th anniversary surgeons curve services repercussions technology discussions societies value application techniques outcomes

ABSTRACT BACKGROUND: Minimally invasive distal pancreatectomy (MIDP) is associated with less blood loss and faster functional recovery. However, the benefits of robotic assisted distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) are unknown. AIMS: To compare RDP versus LDP for surgical treatment of benign lesions, pre-malignant and borderline malignant pancreatic neoplasias. METHODS: This is a retrospective study comparing LDP with RDP. Main outcomes were overall morbidity and overall costs. Secondary outcomes were pancreatic fistula (PF), infectious complications, readmission, operative time (OT) and length of hospital stay (LOS). RESULTS: Thirty patients submitted to LDP and 29 submitted to RDP were included in the study. There was no difference regarding preoperative characteristics. There was no difference regarding overall complications (RDP – 72,4% versus LDP – 80%, p=0,49). Costs were superior for patients submitted to RDP (RDP=US$ 6,688 versus LDP=US$ 6,149, p=0,02), mostly due to higher costs of surgical materials (RDP=US$ 2,364 versus LDP=1,421, p=0,00005). Twenty-one patients submitted to RDP and 24 to LDP developed pancreatic fistula (PF), but only 4 RDP and 7 LDP experienced infectious complications associated with PF. OT (RDP=224 min. versus LDP=213 min., p=0.36) was similar, as well as conversion to open procedure (1 RDP and 2 LDP). CONCLUSIONS: The postoperative morbidity of robotic distal pancreatectomy is comparable to laparoscopic distal pancreatectomy. However, the costs of robotic distal pancreatectomy are slightly higher. BACKGROUND MIDP (MIDP recovery However (LDP unknown AIMS lesions premalignant pre neoplasias METHODS PF, PF , (PF) readmission (OT LOS. LOS . (LOS) RESULTS characteristics 724 72 72,4 80 80% p=0,49. p049 p p=0,49 0 49 p=0,49) RDP=US$ RDPUS US (RDP=US 6688 6 688 6,68 LDPUS LDP=US 6149 149 6,149 p=0,02, p002 p=0,02 02 p=0,02) 2364 364 2,36 LDP1421 1 421 LDP=1,421 p=0,00005. p000005 p=0,00005 00005 p=0,00005) Twentyone Twenty one RDP=224 RDP224 224 (RDP=22 min LDP213 213 LDP=21 p=0.36 p036 36 similar ( LDP. LDP) CONCLUSIONS (PF (LOS 72, 8 p04 p=0,4 RDP=US 668 68 6,6 614 14 6,14 p00 p=0,0 236 2,3 LDP142 42 LDP=1,42 p00000 p=0,0000 0000 RDP=22 RDP22 22 (RDP=2 LDP21 21 LDP=2 p=0.3 p03 3 p0 p=0, 66 6, 61 6,1 23 2, LDP14 LDP=1,4 p0000 p=0,000 000 RDP=2 RDP2 (RDP= LDP2 LDP= p=0. p=0 LDP1 LDP=1, p000 p=0,00 00 RDP= p= LDP=1

RESUMO RACIONAL: A pancreatectomia distal minimamente invasiva (PDMI) está associada a menos perda sanguínea e recuperação funcional mais rápida, no entanto, os benefícios da pancreatectomia distal robótica (PDR) são desconhecidos quando comparada a pancreatectomia distal laparoscópica (PDL). OBJETIVOS: Comparar PDR versus PDL no tratamento cirúrgico de lesões benignas, neoplasias pancreáticas malignas, pré-malignas e limítrofes. MÉTODOS: Estudo retrospectivo comparando PDL com PDR. Os desfechos primários avaliados foram morbidade e custos hospitalares. Os desfechos secundários foram fístula pancreática (FP), complicações infecciosas, readmissão, tempo cirúrgico e tempo de internação hospitalar (TIH). RESULTADOS: Trinta pacientes submetidos a PDL e 29 submetidos a PDR foram incluídos no estudo. Não houve diferença em relação às características pré-operatórias. Não houve diferença em relação às complicações gerais (PDL – 72,4% versus PRD – 80%, p=0,49). Os custos foram superiores para PDR (PDR=US$ 6688 versus PDL=US$ 6149, p=0,02), principalmente devido aos custos mais elevados de materiais cirúrgicos (PDR=US$ 2364 versus PDL=1421, p=0,00005). Vinte e um pacientes submetidos a PDR e 24 submetidos a PDL desenvolveram fístula pancreática (PF), no entanto, apenas 4 submetidos PDR e 7 a PDL apresentaram complicações infecciosas associadas a FP. O tempo cirúrgico (PDR=224 min. versus PDL=213 min., p=0,36) e a conversão para cirurgia aberta (1 PDR e 2 PDL) não tiveram diferença estatística. CONCLUSÕES: A morbidade pós operatória da pancreatectomia distal robótica é comparável à pancreatectomia distal laparoscópica. Entretando, os custos da pancreatectomia distal robótica são mais elevados. RACIONAL PDMI (PDMI rápida entanto (PDR PDL. . (PDL) OBJETIVOS benignas malignas prémalignas pré limítrofes MÉTODOS hospitalares FP, FP , (FP) readmissão TIH. TIH (TIH) RESULTADOS estudo préoperatórias. préoperatórias operatórias. operatórias pré-operatórias 724 72 72,4 80 80% p=0,49. p049 p p=0,49 0 49 p=0,49) PDR=US$ PDRUS US (PDR=US 668 PDLUS PDL=US 6149 p=0,02, p002 p=0,02 02 p=0,02) 236 PDL1421 1421 PDL=1421 p=0,00005. p000005 p=0,00005 00005 p=0,00005) PF, PF (PF) PDR=224 PDR224 224 (PDR=22 min PDL213 213 PDL=21 p=0,36 p036 36 1 ( estatística CONCLUSÕES Entretando (FP (TIH 72, 8 p04 p=0,4 PDR=US 66 614 p00 p=0,0 23 PDL142 142 PDL=142 p00000 p=0,0000 0000 (PF PDR=22 PDR22 22 (PDR=2 PDL21 21 PDL=2 p=0,3 p03 3 p0 p=0, 6 61 PDL14 14 PDL=14 p0000 p=0,000 000 PDR=2 PDR2 (PDR= PDL2 PDL= p=0 PDL1 PDL=1 p000 p=0,00 00 PDR= p=

ABSTRACT BACKGROUND: There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS: To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS: Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version’s translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS: Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS: The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation. BACKGROUND Brazil AIMS Portuguese METHODS Translation adaptation validation. . validation) versions s specialists day times 7day 7 interval nonconstipated non constipated volunteers groups RESULTS 8 89 female 5 schooling 965 96 96.5% 6 867 86 86.7 0991 0 991 0.99 0987 987 0.987 p0001 p 001 p<0.001 4 2 male 3 pre posttreatment post 1 (p<0.001) 22 CONCLUSIONS Índice Intestinal 9 96.5 86. 099 99 0.9 098 98 0.98 p000 00 p<0.00 (p<0.001 96. 09 0. p00 p<0.0 (p<0.00 p0 p<0. (p<0.0 p<0 (p<0. p< (p<0 (p< (p

RESUMO RACIONAL: No Brasil há escassez de instrumentos específicos e validados para a avaliação da gravidade da constipação intestinal crônica. OBJETIVOS: Validar o instrumento Constipation Scoring System para pacientes com constipação crônica. MÉTODOS: Tradução, adaptação cultural e validação propriamente dita. Tradução: versão definitiva a partir de traduções do original avaliadas por especialistas. Adaptação cultural: avaliação do conteúdo por entrevista a pacientes. Confiabilidade interobservadores: entrevista por dois pesquisadores no mesmo dia. Confiabilidade intraobservador: duas entrevistas pelo mesmo pesquisador (intervalo de 7 dias). Validação divergente: voluntários não constipados. Validação convergente: dois grupos, boa resposta e refratários ao tratamento clínico. RESULTADOS: Adaptação cultural: 81 pacientes, sendo 89% do sexo feminino, com média de idade de 55 anos e 7 anos de escolaridade. O índice de validade de conteúdo global foi de 96,5%. Confiabilidade interobservadores e intraobservador: 60 pacientes, sendo 86,7% do sexo feminino, com média de idade de 56 anos e 6 anos de escolaridade. O coeficiente de correlação intraclasse foi de 0,991 e 0,987 (p<0,001), respectivamente. Validação divergente: 40 voluntários, sendo 62,5% do sexo masculino, com média de idade de 49 anos e pontuação média: 0. Validação convergente dos pacientes com boa resposta do tratamento clínico: 47 pacientes, sendo 83% do sexo feminino, com média de idade de 60 anos e 6 anos de escolaridade. Os índices pré e pós-tratamento foram 19 e 8 (p<0,001), respectivamente. Validação convergente dos pacientes refratários ao tratamento clínico: 75 pacientes sendo 93% do sexo feminino, com média de idade de 53 anos e 7 anos escolaridade. A pontuação média foi 22. CONCLUSÕES: O Constipation Scoring System validado para população brasileira (Índice de Gravidade da Constipação Intestinal), é instrumento confiável para a aferição da gravidade da constipação intestinal crônica. RACIONAL crônica OBJETIVOS MÉTODOS Tradução dita especialistas dia intraobservador intervalo dias. dias . dias) divergente constipados grupos clínico RESULTADOS 89 feminino 5 escolaridade 965 96 96,5% 867 86 86,7 0991 0 991 0,99 0987 987 0,98 p<0,001, p0001 p p<0,001 , 001 (p<0,001) respectivamente 4 625 62 62,5 masculino 83 póstratamento pós 1 93 22 CONCLUSÕES Índice Intestinal, Intestinal Intestinal) 9 96,5 86, 099 99 0,9 098 98 p000 p<0,00 00 (p<0,001 62, 2 96, 09 0, p00 p<0,0 (p<0,00 p0 p<0, (p<0,0 p<0 (p<0, p< (p<0 (p< (p

Abstract In Malignant Hilar Biliary Stricture (MHBS) palliative biliary drainage is a frequent strategy, improving the quality of life, reducing pruritus, loss of appetite and relieving cholangitis. The endoscopic approach is an effective, although challenging procedure. This study aimed to evaluate technical and clinical success rates of biliary drainage by ERCP. This is a retrospective study including all patients with MHBS referred to Instituto do Cancer do Hospital de São Paulo (ICESP) submitted to biliary drainage by ERCP, between January 2010 and December 2017. Multivariable logistic regression was performed to evaluate predictors of clinical failure, as total bilirubin levels, Bismuth classification, number of hepatic sectors drained and presence of cholangitis. In total, 82 patients presenting unresectable MHBS were included in this study. 58.5% female and 41.5% male, with a mean age of 60±13 years. Bismuth classification grades II, IIIA, IIIB and IV were noted in 23.2%, 15.9%, 14.6% and 46.3%, respectively. Technical and clinical success was achieved in 92.7% and 53.7% respectively. At multivariable logistic-regression analyses, Bismuth IV strictures were related to higher clinical failure rates when compared to other strictures levels, with an Odds Ratio of 5.8 (95% CI 1.28‒20.88). In conclusion, endoscopic biliary drainage for malignant hilar biliary stricture had a high technical success but suboptimal clinical success rate. Proximal strictures (Bismuth IV) were associated with poor drainage outcomes. (MHBS strategy life pruritus cholangitis effective procedure ERCP ICESP (ICESP 201 2017 levels 8 585 58 5 58.5 415 41 41.5 male 6013 60 13 60±1 years II IIIA 232 23 2 23.2% 159 15 9 15.9% 146 14 6 14.6 463 46 3 46.3% respectively 927 92 7 92.7 537 53 53.7 logisticregression analyses 5. 95% 95 (95 1.28‒20.88. 1282088 1.28‒20.88 . 1 28 20 88 1.28‒20.88) conclusion rate outcomes 58. 4 41. 601 60± 23.2 15.9 14. 46.3 92. 53. (9 128208 1.28‒20.8 23. 15. 46. ( 12820 1.28‒20. 1282 1.28‒20 128 1.28‒2 12 1.28‒ 1.28 1.2 1.

ABSTRACT BACKGROUND: Solid pseudopapillary neoplasm of the pancreas is an uncommon pancreatic tumor, which is more frequent in young adult women. Familial adenomatous polyposis is a genetic condition associated with colorectal cancer that also increases the risk of developing other tumors as well. AIM: The aim of this study was to discuss the association of familial adenomatous polyposis with solid pseudopapillary neoplasm of the pancreas, which is very rare. METHODS: We report two cases of patients with familial adenomatous polyposis who developed solid pseudopapillary neoplasm of the pancreas of the pancreas and were submitted to laparoscopic pancreatic resections with splenic preservation (one male and one female). RESULTS: ß-catenin and Wnt signaling pathways have been found to play an important role in the tumorigenesis of solid pseudopapillary neoplasm of the pancreas, and their constitutive activation due to adenomatous polyposis coli gene inactivation in familial adenomatous polyposis may explain the relationship between familial adenomatous polyposis and solid pseudopapillary neoplasm of the pancreas. CONCLUSION: Colonic resection must be prioritized, and a minimally invasive approach is preferred to minimize the risk of developing desmoid tumor. Pancreatic resection usually does not require extensive lymphadenectomy for solid pseudopapillary neoplasm of the pancreas, and splenic preservation is feasible. BACKGROUND tumor women well AIM rare METHODS female. female . female) RESULTS ßcatenin ß catenin CONCLUSION prioritized feasible

RESUMO RACIONAL: A neoplasia sólida pseudopapilífera do pâncreas é um tumor pancreático incomum, mais frequente em mulheres jovens. A polipose adenomatosa familiar, por sua vez, é uma condição genética associada a câncer colorretal e que também aumenta o risco de desenvolvimento de outros tumores. OBJETIVOS: Discutir a associação entre polipose adenomatosa familiar e neoplasia sólida pseudopapilífera, que é bastante rara. MÉTODOS: Reportamos dois casos de pacientes com polipose adenomatosa familiar, um homem e uma mulher, que desenvolveram neoplasia sólida pseudopapilífera do pâncreas e foram submetidos a ressecção laparoscópica com preservação esplênica. RESULTADOS: As vias de sinalização da ß-catenina e Wnt tem um papel importante na tumorigênese da neoplasia sólida pseudopapilífera, e sua ativação constitutiva devido a inativação do gene adenomatous polyposis coli na polipose adenomatosa familiar pode explicar a relação entre polipose adenomatosa familiar e neoplasia sólida pseudopapilífera. CONCLUSÕES: A ressecção do cólon deve ser priorizada, com preferência pela abordagem minimamente invasiva para minimizar o risco de desenvolvimento de tumor desmoide. A ressecção pancreática geralmente não requer linfadenectomia extensa para neoplasia sólida pseudopapilífera, portanto, a preservação esplênica é factível. RACIONAL incomum jovens vez tumores OBJETIVOS rara MÉTODOS mulher RESULTADOS ßcatenina ß catenina CONCLUSÕES priorizada desmoide portanto factível

Despite a growing number of investigative studies on pancreatic fat deposition, there remains no clear indication regarding the clinical relevance of fat infiltration in the pancreas, also called fatty pancreas (FP). An individual’s body weight is correlated with their pancreatic weight. Moreover, lipid infiltration causes disorders that compromise not only morphology but also metabolic functions. Fat infiltration leads to insulin resistance, type II diabetes mellitus, and pancreatic cancer; however, knowledge about pancreatic fat content and aspects related to the clinical profile remains unclear in the literature. The present review describes the current knowledge of FP, including its pathophysiology and clinical implications, as well as lifestyle changes in FP.

OBJECTIVES: Our goal was to compare the hydrogen potential (pH) and residual gastric volume (RGV) of patients undergoing colonoscopy after 3 and 6 hours of colon preparation with mannitol. METHODS: We described a prospective randomized trial with a 50:50 allocation rate of two distinct times of colonoscopy after colon preparation with 10% mannitol. We included outpatients aged over 18 years, with no history of gastric surgeries and an American Society of Anesthesiologists (ASA)-rated anesthetic risk below III. Colonoscopy was performed after upper digestive endoscopy at two different times: 3 versus 6-hour after mannitol ingestion. During upper gastrointestinal endoscopy, we measured RGV and evaluated pH with a digital pH meter. Clinical trials.gov: 71123317.9.3001.0065 RESULTS: We randomized a total of 100 participants to the 3 and 6-hour groups, with the patients in the 6-hour group being younger and presenting a higher body mass index (BMI). The intervention did not result in any statistically significant differences between the two groups, neither for the RGV (p=0.98) or the pH (p=0.732). However, the subgroup of patients with diabetes mellitus showed statistically significant higher RGV values in the 3-hour group. CONCLUSION There was no difference between RGV and pH values at 3 versus 6-hour after bowel preparation with mannitol, except for RGV in diabetic patients at 3 hours. As prolonged fasting protocols may result in adverse events such as dehydration and electrolyte imbalance, we can infer that colonic preparation with mannitol in shorter fasting periods, such as 3 hours, can be adopted safely and routinely.

Pancreatic cancer is the second most common malignancy of the gastrointestinal tract in the US, and adenocarcinoma has been identified as the most common type of pancreatic cancer. Different types of pancreatic cancers have been classified: adenocarcinoma, ductal adenosquamous carcinoma, solid pseudopapillary tumors, endocrine neoplasms, acinar cell carcinoma, squamous cell carcinoma, cystic tumors, primary lymphoma of the pancreas, and metastatic lesions of the pancreas. Adenosquamous carcinoma is extremely rare, behave in a very aggressive way and is responsible for the 1 to 4% of the pancreatic exocrine neoplastic lesions. We describe the case of an 82-years-old African American female, presenting to our institution with quantifiable weight loss (12 kg in 3 months), jaundice and abdominal pain. On admission, laboratory tests were obtained: total bilirubin: 11.07 mg/dl with a direct fraction of 10.32 mg/dl. Cross-sectional abdominal CT scan with contrast, showed a lesion localized in the pancreatic head (hypodense on T1, measuring 3.5 x 3.5 x 2.5 cm), with vascular invasion of the portal vein. EUS showed a solid, hypoechoic, not well-defined lesion (measuring 3.98 x 3.80 cm), localized between the head and neck of the pancreas. EUS-FNA was performed with a 22G needle using the fanning technique. The cytological specimens demonstrated components of both squamous carcinoma and adenocarcinoma. The patient underwent ERCP procedure, and biliary drainage was performed with an entirely covered metallic stent placement. After a month from the procedures, the patient died due to the severity of the disease. Endoscopic ultrasound has proven to be the best method to diagnose solid pancreatic lesions, including rare and aggressive type of tumors like primary adenosquamous cell carcinoma that we described in this very interesting case report

Objetivo: Avaliar os resultados preliminares sobre a Medicina III do up-grade oportunizado pela Capes para todas as áreas. Métodos: Foram utilizados os documentos de áreas e os relevantes ao tema disponíveis online no site da Capes entre 2009 e 2013. Procurou-se focar a pesquisa em dois aspectos para responder duas perguntas: 1) a estratificação do Qualis é semelhante nas três áreas da medicina? e 2) a evolução do Qualis da Medicina III foi maior? Resultados: A Medicina III apresentou evolução em sua classificação Qualis e está publicando em revistas com maior fator de impacto e é praticamente igual ao da Medicina I e II. Conclusão: A área foi a que apresentou maior evolução nestes últimos triênios

Objective: To evaluate the preliminary results related to journals up-grade that was used by Medicine III, through opportunity offered by Capes to all agency areas programs. Methods: Were used area document of Medicine I, II and III, besides other relevant topics available online at Capes site, between 2009 and 2013. The research was focused to answer two questions: 1) the stratification of Qualis is similar in the three areas of medicine? and 2) the evolution of Qualis in Medicine III was higher? Results: Medicine III showed an increase in its Qualis classification and is publishing in journals with higher impact factors, virtually the same as the Medicine I and II. Conclusion: The area showed the strongest growth in recent three-year periods.

OBJETIVO: Investigar os efeitos da pentoxifilina (PTX) na pancreatite aguda (PA) experimental administrando a droga após a indução da doença. MÉTODOS: Cem ratos machos Wistar foram submetidos à indução da PA através da infusão de taurocolato de sódio e divididos em três grupos: Grupo Sham: sham-operated ratos, Grupo Salina: AP e solução salina, e Grupo PTX: AP e PTX. Solução salina e PTX foram administradas 1 hora após a indução da PA. Três horas após indução da PA os níveis de fator de necrose tumoral (TNF)-α no líquido peritoneal e os níveis séricos de interleucina (IL)-6 e IL-10 foram analisados pelo método de Enzima Imunoensaio (ELISA). A atividade da mieloperoxidase (MPO) foi analisada no pulmão e foram realizadas análises histológicas do pulmão e pâncreas, além do estudo da mortalidade. RESULTADOS: A administração de PTX 1 hora após a indução da PA reduziu significativamente os níveis de TNF-α peritoneal e os níveis séricos de IL-6 e IL-10 quando comparado ao grupo salina. Redução na mortalidade foi observado após o tratamento com PTX comparado ao grupo salina. CONCLUSÃO: A administração de PTX após a indução da PA diminuiu os níveis sistêmicos de citocinas pró-inflamatórias, sugerindo a possibilidade de que existe uma janela terapêutica para PTX após o início do PA.

PURPOSE: To investigate the effects of pentoxifylline (PTX) in experimental acute pancreatitis (AP) starting drug administration after the induction of the disease. METHODS: One hundred male Wistar rats were submitted to taurocholate-induced AP and divided into three groups: Group Sham: sham-operated rats, Group Saline: AP plus saline solution, and Group PTX: AP plus PTX. Saline solution and PTX were administered 1 hour after induction of AP. At 3 hours after AP induction, peritoneal levels of tumor necrosis factor (TNF)-α, and serum levels of interleukin (IL)-6 and IL-10 levels were assayed by Enzyme-Linked Immunosorbent Assay (ELISA). Determinations of lung myeloperoxidase activity (MPO), histological analysis of lung and pancreas, and mortality study were performed. RESULTS: PTX administration 1 hour after induction of AP caused a significant decrease in peritoneal levels of TNF-α and in serum levels of IL-6 and IL-10 when compared to the saline group. There were no differences in lung MPO activity between the two groups with AP. A decrease in mortality was observed in the PTX treatment compared to the saline group. CONCLUSIONS: Administration of PTX after the onset of AP decreased the systemic levels of proinflammatory cytokines, raising the possibility that there is an early therapeutic window for PTX after the initiation of AP.

OBJETIVO: Avaliar a evolução dos trabalhos publicados sobre cirurgia do aparelho digestivo em revistas brasileiras nos últimos 20 anos, observando se houve melhora no nível de evidência destes trabalhos além da incorporação de procedimentos estatísticos e a sua correta aplicação. MÉTODOS: Selecionamos todos os artigos originais relacionados à cirurgia do aparelho digestivo publicados nos anos de 1987 e 2007 em quatro revistas cirúrgicas nacionais de renome. Os estudos foram divididos de acordo com o nível de evidência (I: prospectivo, randomizado e controlado, II: prospectivo sem controle ou randomização e III: retrospectivo) e comparados para avaliar se houve melhora do nível de evidência entre os dois anos avaliados. Também observamos se ocorreu aumento no uso de estatística analítica e a correta aplicação dos procedimentos estatísticos. RESULTADOS: Comparando os artigos publicados em 1987 com os de 2007, não observamos melhora no nível de evidência, com mais de metade dos artigos publicados tratando de séries de casos e estudos retrospectivos (56,14%). Houve um aumento significante na utilização de estatística analítica (70,4% em 2007 vs. 40% em 1987) nos últimos 20 anos, mas 16,7% dos estudos publicados em 2007 não aplicavam corretamente ou descreviam adequadamente a análise estatística utilizada. CONCLUSÃO: Neste estudo observamos que não houve melhora no nível de evidência das publicações brasileiras relacionadas à cirurgia do aparelho digestivo nos últimos 20 anos. Houve aumento do uso de estatística analítica, porém existe a necessidade de se observar a correta aplicação dos procedimentos estatísticos.

OBJECTIVE: To evaluate the evolution of scientific papers published on digestive tract surgery in Brazilian journals in 20 years and examine whether the level of evidence in the studies has improved, as well as the incorporation of statistical procedures and their proper application. METHODS: We selected all original articles related to digestive tract surgery published in the years of 1987 and 2007 in 4 leading Brazilian surgical journals. Studies were divided according to the level of evidence (I: prospective, controlled and randomized, II: prospective without control or randomization and III: retrospective) and compared them to assess whether there was an improvement in the level of evidence between these two years surveyed. We also assessed whether there was increased use of analytical statistics and correct application of statistical procedures. RESULTS: Comparing the articles published in 1987 with those of 2007, we observed no improvement with respect to the level of evidence, with more than half of the articles published being case series and retrospective studies (56.14%). There has been a significant increase in the use of analytical statistics (70.4% in 2007 vs. 40% in 1987) in the 20 years, however 16.7% of the studies published in 2007 did not correctly apply or adequately describe the statistical analyses used. CONCLUSION: In this study, we observed no improvement in the level of evidence presented in publications on digestive tract surgery in the last 20 years. There was an increased use of statistical analysis, but there is a need to correctly apply statistical procedures.

OBJECTIVES: To evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. INTRODUCTION: The prevalence and management of cholelithiasis in renal transplant patients is not well established. METHODS: A total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index). RESULTS: Cholelithiasis was found in 41 out of 342 patients (12%). Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5%) were symptomatic. Their mean age was 54 (range 32-74) years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76%) out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. CONCLUSIONS: The frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications.