The data were analyzed in accordance with the stages of Rodger's conceptual model. The following were included: books and articles in full, published in Portuguese, English or Spanish, which addressed CT in the teaching and practice of Nursing; articles which did not address aspects related to the concept of CT were excluded.  the sample was made up of 42 works. As a substitute term, emphasis is placed on 'analytical thinking', and, as a related factor, decision-making. In order, the most frequent preceding and consequent attributes were: ability to analyze, training of the student nurse, and clinical decision-making. As the implications of CT, emphasis is placed on achieving effective results in care for the patient, family and community.  CT is a cognitive skill which involves analysis, logical reasoning and clinical judgment, geared towards the resolution of problems, and standing out in the training and practice of the nurse with a view to accurate clinical decision-making and the achieving of effective results. A total of 529 works were located in the databases mentioned. In the second stage, undertaken in February 2015, the authors proceeded to consult with the Cinahl, Lilacs and Bdenf databasesIn the third stage, for collection of the relevant data, identification of the attributes, and the contextual basis of the conceptIn the fourth stage, for analysis of the data and identification of their characteristicsIn the fifth stage, implications or hypotheses for continuity of the development of the concept were listedOf the 42 works selected for analysis, eight were text books and 34 were articles, with 28 (66.6%) published in English, 12 (28.6%) in Portuguese, and two (4.8%) in Spanish. Of these, the oldest dated from 1997, and the most recent from September 2014: items were included by title, authors, and cataloguing data of the book or periodical . The resThe identification of the substitute terms represents the first approximation with the concept to be analyzedDifferently from the substitute terms, the concepts related to CT  have a lCT is characterized by higher-level thinking, which involves knowledge, experiences, dispositions (attitudes or habits of mind) and intellectual abilities. These essential characteristics, or attributes, were identified in the empirical material for analysis as skills and dispositions for CT, and are presented in The antecedents, like the consequences of a concept, are conditioned to a contextual basis, in this case, the concept of CT in Nursing. In addition to this, they are related to the situational, temporal, sociocultural and course-related contexts of the profession at the present timeThe implications and hypotheses represent, respectively, the results and possibilities to be achieved,The concept of CT remains little clarified in the Nursing literatureBased on the empirical material researched, the most frequent substitute term was analytical thinking, followed by critical-creative thinking. These substitute terms, to the contrary of clinical reasoning, are synonyms, as they present a semantic interconnection with CT. As a result, when a nurse assesses a patient's health problem, observing, examining, recognizing and raising hypotheses regarding health problems, she is using analytical thinking, which can also be termed CT-) and clinical reasoning,,On the other hand, the related factors  have a c,-Another term which has been described many times coupled with CT, nearly forming a single term, is the concept of reflexive thinkingGenerally speaking, the identification of the substitute terms and related factors, respectively, made it possible to broaden the list of synonymous concepts and those which are interrelated. As a result, the related concepts allow the correct application of words which contain within themselves similar philosophical presuppositions, in this case, CT. Besides this, they assist in the understanding of the application of the concept of CT in the context of the practice of the student or nurse, and its importance for diagnostic reasoning, clinical judgment and efficacious decision-making. The attributes bring together a real definition of the concept, different from the nominal definition provided in dictionaries, which simply substitute one word or expression with another which is synonymous) describes a significant proportion of the attributes identified in this study, such that these constitute the characteristics examined in most of the psychometric scales for assessing the development of CT. It is inferred, based on these results, that in the literature there is a major influence of the Delphi Report,,,) or the ability to break something down in order to achieve an understanding of a given situation. It is believed that this skill is essential in academic and professional activity in Nursing, in that the understanding of the whole is limited to analysis of the parts, whether in the learning of a technique or in taking the patient history.In the literature analyzed, the skill mentioned most frequently for a critical thinker was "analysis",) or impartiality in assessment, overcoming preconceptions in a rational way for prudent judgment and later decision-making. However, as studies indicate,,The most frequent disposition was "open-mindedness",) is underlined as a necessary path to developing CT skills. As a result, for the improvement in the attributes of CT, the student or professional of Nursing must adopt a stance of seeking, in a careful, rational and active way, the improvement of the cognitive and affective aspects which are inherent to her professional and personal activities,,-) as phenomena which have leveraged the discussions and highlighted the importance of training nurses in the skill of thinking critically. Based on the categories presented in ) bestow curricular flexibility, which viabilizes pedagogical projects geared towards specific goals or demands. As a result, there is the possibility of a teaching permeated by CT, as it progresses towards problematizing training, linking teaching, work and community. In Brazil, the DCNs,,) and the scientific and technological advance-,,Another aspect also evidenced as a predecessor of CT was the seeking of better results in clinical practice,,The challenge of training a nurse who is capable of acting in a way that responds to the demands of a society in constant transformation is closely related to the need for cognitive, attitudinal and instrumental development so as to seek better results in practice and in health managementThe consequences of a concept are closely related to the antecedents and must follow them,,-) and "clinical reasoning",,The consequence identified with the highest frequency was "clinical decision-making",) which assessed the structural elements of CT in 20 nurses from emergency services corroborated these findings, as it emphasized the importance of CT for clinical decision-making, as well as its interconnection in the managerial, multi-professional and teaching ambits. It is relevant to emphasize that the first three consequent terms identified previously also appeared as related concepts in For effective decision-making based in CT, therefore, persistent effort is required for examining any situation or supposed form of knowledge in the light of evidence which supports new conclusions in regard to it,,,The main implications and hypotheses listed in ,-For this, it is important to consider CT as a process of dynamic and continuous improvement which can be learnt by the nurse. As a result, the improvement of reasoning skills, the constant search for new knowledge, the aim of solving problems and issuing judgments is required, enabling the nurse to predict, diagnose and validate the conclusions obtained, always reviewing these critically) assessed CT skills in 134 students, at two points: upon entering the undergraduate course in Nursing, and three years later, after graduating, using the Health Sciences Reasoning Test. It was concluded that the students significantly increased their CT scores after progressing through the course, principally improving their abilities in analysis and deduction. The students who had the highest scores in the test had better academic performance. These results corroborate the importance of the undergraduate course in helping the students to progress in their CT skills. One longitudinal Australian study,,As indicated by the works analyzedThe concept analysis, based in Rodger's evolutionary model, clarified the phenomenon and allowed a correct understanding of CT, with implications for education and care in Nursing. As antecedents of the concept, emphasis was placed on the need for training in critical thinking while still on the undergraduate course, with a consequent search for better results in clinical practice. This being the case, the main concepts related to CT are those which make up the stages of the Nursing Process, such as decision-making, clinical judgment, and clinical reasoning. As a result, the understanding of the related factors, attributes, antecedents and consequences of CT made it possible to infer CT as a cognitive skill which involves a process of analysis, logical reasoning and clinical judgment, geared towards problem resolution. From this perspective, it has been emphasized in the training and care practice of the nurse, with a view to accurate clinical decision-making and to achieving effective results in the Nursing interventions for the patient, family and community.As limitations of the study, the fact is highlighted that studies were selected from Latin American databases, with the exception of Cinahl. However, the study met the needs of the multicentric RIIEE project. As a consequence, broader studies become important, considering that the concept changes over time. Furthermore, it is necessary to develop the clarification of the concept of CT in other areas of knowledge.


Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC.


The nature of global health networks is an important contributor to influence in the global health arena. However, in this editorial the necessarily brief overview of each of eight topics gives a limited picture and does not do justice to the many contextual differences which influence status in the global governance arena and, perhaps more importantly, the status and nature of the health networks themselves.Shiffman’s1 is more between industry and public health networks rather than within or between them). They have succeeded in influencing sympathetic governments and this despite longstanding evidence of the industry’s subversion of alcohol research3 and effective alcohol policy . Another important influence is a relative lack of informed advocates at national level and funding opportunities at both national and global level. This reflects the diffuse nature of alcohol related harm which makes a causal contribution to 60 diseases, and with much harm outside of the traditional health arena ; this has reduced the likelihood of support from any particular quarter, unlike the involvement of cancer and heart health charities in tobacco control. This relative lack of funding is one of the main factors inhibiting the development of the alcohol network.It is certainly possible to draw a strong contrast between the Global Alcohol Policy Alliance (GAPA) and the Framework Convention Alliance, despite the comparable levels of harm experienced globally, and many reasons underpin this difference. One of the more influential has been the role of the industry. Since the widespread commercialisation of the production of both commodities the transnational alcohol corporations, learning from the adverse experience of tobacco, have done an excellent job of framing the problem definition to suit their ends . GAPA has active regional networks, particularly active in Africa which is one of the key foci for the transnational alcohol corporations at the present time. The 2015 biennial conference of the GAPA attracted participants from 60 countries, many from LMICs and funded by development agencies. In 2016 GAPA worked with several member states to ensure the challenges raised by the proliferation of alcohol marketing in the digital world was discussed in a Side Event at the World Health Assembly, and the need for a legally binding international health response was raised.Despite this, considerable progress has been made in recent years and it is not now accurate to characterise the GAPA network as consisting ‘predominantly of researchers from North American and European institutes’  is urgent, given the ambitions of the transnational alcohol producers in the emerging economies of the world. Their expansion is assisted by the proliferation of economic agreements weakening national governments’ role in protecting their populations and the expansion of alcohol marketing in the global digital world. This is why GAPA has determined to advocate for a stronger response in the form of an international binding treaty to control alcohol supply, marketing and the role of the industry in alcohol policy development.There is much to do and Shiffman’s analysisSigned by GAPA Board Members:Professor Sally Casswell, GAPA Chairperson, Massey University, New ZealandProfessor Isidore Obot, GAPA Vice Chair, School of Public Health and Policy, Morgan State University, Baltimore MD, USA and Adjunct Professor of Psychology University of Uyo, NigeriaProfessor David Jernigan, GAPA Chair Scientific Committee, Johns Hopkins Bloomberg School of Public Health, USAØystein Bakke, GAPA Secretary, FORUT—Campaign for Development and Solidarity, NorwayDr. Pham Thi Hoang Anh, Country Director, HealthBridge, VietnamDr. Kumnuan Ungchusak, Board Member, Thai Health Promotion Foundation, ThailandSavera Kalideen, Advocacy Manager, Soul City Institute, South AfricaMs. Paula Johns, REDEH – Human Development Network; founder and director of the ACT Tobacco Control Alliance, BrazilMr. Derek Rutherford, past Chair of the Global Alcohol Policy Alliance, UKProfessor Thomas F Babor, University of Connecticut School of Medicine, USAMr. Sven-Olov Carlsson, past President, IOGT InternationalProfessor Sungsoo Chun, Sahmyook University, South KoreaMr. George Hacker, past Director, Alcohol Policies at Centre for Science in the Public Interest, USAProfessor Ronaldo Laranjeira, Federal University of São Paulo, UNIFESP, Brazil, and Alcohol and Drug Research Unit of UNIADProfessor Charles Parry, Alcohol & Drug Abuse Research Unit, South African Medical Research Council, South AfricaNot applicable.Author declares that she has no competing interests.SC is the single author of the paper, but all board members read and approved the letter.


Journal of Patient-Reported Outcomes (JPRO), we are excited to announce the launch of a new journal sponsored by the International Society for Quality of Life Research (ISOQOL). JPRO is intended to complement and extend ISOQOL’s existing journal, Quality of Life Research. Clearly, Quality of Life Research has a long and successful history of publishing research on methods and applications of health-related quality of life (HRQL) and patient-reported outcomes (PROs). Given increased HRQL and PRO research, and the wider application of these outcomes across a variety of health care and population health settings, there is a need for more publication outlets for scientifically sound PRO research.As founding Co-Editors-in-Chief of the Journal of Patient-Reported Outcomes focus on high quality research in five major areas: (1) PROs in clinical trials; (2) applications of PROs in clinical practice; (3) patient, family, community and public engagement in PRO research; (4) qualitative studies on the development and application of PROs; and (5) social and behavioral determinants of health and PRO measures. These focus areas are only some examples of the types of papers that are considered for publication in JPRO. JPRO is a peer-reviewed journal, with occasional special non-peer reviewed articles relevant to the journal’s aims and scope.The aims and scope of the JPRO are able to present and discuss new and more comprehensive evidence on treatment effects, on measurement properties, interpretation, and the performance of the PRO measures based on data from these clinical studies. The CONSORT extension on PROs will serve as a guide for reviewing the reporting of HRQL and PROs from clinical trials [For many clinical trials, space limitations in clinical journals often preclude reporting on the HRQL and other PRO results in full. We encourage the publication of comprehensive analyses and reporting of evidence based on the use of PROs in clinical trials and other clinical studies. Authors of papers in l trials .JPRO. Methods for, and applications of, individual-level and group-level PRO applications from research studies are considered for publication. Applications such as quality improvement, benchmarking, patient experience with care, decision aids, communication, patient and provider satisfaction, adherence, patient management , and other patient outcomes relying on PROs are considered for publication in JPRO.Increasingly, PROs are being implemented in clinical practice settings to inform patient management and for assessing the quality of health care. The application of PRO measures across health care systems and for use in real-world comparative effectiveness studies are of interest to JPRO. Methods and applications to engage patients, family members, and members of the general public in the process of PRO-related research, and the evaluation of the effects of such engagement, are of interest. Similarly research and evaluations of engaging patients and the general public related to PRO policy formulation and clinical guidelines are welcome, as is participatory action research that use PROs.Patient, family, and community engagement in the planning and implementation of clinical studies and the evaluation of treatments and health care system interventions is growing rapidly . The devJPRO. Studies that give patients a voice and report patient stories using PROs are also welcome.Qualitative methods are frequently used in the development and evaluation of new and existing PRO measures, and increasingly used in conjunction with clinical trials. These studies increase understanding of the effects and burden of illness, and provide more complete understanding of the effects of treatment from the patient perspective. Papers reporting on these activities, the assessment of the usefulness of various qualitative methods for these purposes, and improvements in qualitative methods are considered for publication by JPRO welcomes submissions that report on studies that include HRQL outcomes and other PROs.Studies reporting on cross-sectional and longitudinal observational studies examining the social and behavioral determinants of health with PRO measures are considered for publication, including studies of both general and chronic disease populations. Such studies might examine the antecedents of health-related outcomes such as social support, health-related behaviors, and patient adherence. JPRO considers review articles, brief communications, commentaries, editorials, and reviews of recent books and software advances relevant to the stated aims and scope of the journal, although in general, JPRO does not publish case reports, papers reporting study designs, pilot studies, and feasibility studies.In addition, JPRO and to encouraging sound research and science related to HRQL and PRO applications in clinical trials and clinical practice. Over the past 25 years, we have seen continued and exciting developments in HRQL and PRO research and methods, and we hope to encourage further the reporting of these methods and results in JPRO. To paraphrase a historic moment in cinema, “this is the beginning of a beautiful journal”. We look forward to your support and participation in developing and advancing the new journal.As the inaugural Co-Editors-In-Chief, we are looking forward to the successful development of


In the last decades,this "classic" view of the Middle Ages has been gradually modified with advancesin historiographical studies and the history of science. During that period inWestern Europe, knowledge about the human body suffered a regression in terms ofanatomy and physiology, with the predominance of religious conceptions mainlyabout diseases and their treatments. Knowledge on the cardiovascular system andheart diseases has been classically described as a repetition of the conceptsdeveloped by Galen from the dissection of animals and his keen sense ofobservation. However, the Middle East, especially Persia, was the birth place ofa lot of intellectuals who preserved the ancient knowledge of the Greeks whilebuilding new knowledge and practices, especially from the 8th to the13th century. The invasion of the Arabs in North of Africa andthe Iberian Peninsula and the eclosion of the Crusades resulted in a greatercontact between the East and the West, which in turn brought on the arrival ofthe Arab medical knowledge, among others, to 12th century Europe.Such fact contributed to an extremely important change in the scientific medicalknowledge in the West, leading to the incorporation of different concepts andpractices in the field of cardiovascular Medicine. The new way of teaching andpracticing Medicine of the great Arab doctors, together with the teachinghospitals and foundations in the Koran, transformed the Medicine practiced inEurope definitely. The objective of this paper is to describe the knowledgedrawn up from the Middle Ages about the cardiovascular system, its understandingand therapeutic approach to cardiologists and cardiovascular surgeons.The historical period called the Middle Ages, a long interval between the5 It relates mainly to Western Europe, but it is also extended tothe Byzantine Empire and the Arab kingdoms in the East. The medieval period wasgiven this name by the intellectual people of the 16th century. Eager torevive the Ancient History and its knowledge, they defined the Middle Ages  as the period of time betweentheirs and the ancient ones. Quickly, it was called the Dark Ages because ofreligious predominance, especially by the Christians in the West, as well as thealleged delays in several areas of knowledge and the precarious living conditions ofthe time,2.The Middle Ages is the time period commonly defined between the 5rd and 5th centuries; the plague between the 6th and8th centuries,reducing the population level in Europe to the lowest number since the secondcentury; and the Black Death, between the 14th and 17thcenturies, which caused the death of 1/8 to 2/3 of the European population,depending on the region.Although it is difficult to have reliable statistical estimates in the period due tothe precarious sources, life expectancy was between 20 and 30 years and themortality rate was about 30 and 40 thousand individuals a year, mainly because ofepidemics.This period fits into the models of ancient society, related to quality andexpectancy of life. It is typical of pre-industrial societies, since there were highbirth and death rates, which suffered variations from insurgencies or facts contraryto population growth, such as: plagues, climate change, wars and food shortages.Three great epidemics weakened Medieval Europe. The epidemics of malaria between the3,5. Thus, the act of taking care ofpatients becomes an obligation of religious people , themedical practice becomes an act of charity and hospitals become places which provide more comfort thancure. However, sickpeople were also treated at a distance and in fear because of the possibility ofcontagion, both physical and spiritual. In this context, the barber-surgeons,healers and women who manipulated herbs were increasingly required for medicaltreatment, even by religious people. Medical practice in the West only becomesacademic when doctors are graduated from universities, from the 12thcentury on. Even with universities and physicians with academic knowledge, onlyafter long efforts, between the 13th and 15th centuries, themedical profession became more valued and more required than the healers andbarber-surgeons.Medicine in the Western Middle Ages gained new forms with the religious predominanceof Christianity. Body and soul are interconnected in a complex philosophical andtheological dualism. Diseases and body ailments are seen as consequences of sinsinflicted to God, as the classic example of leprosy, present in theScriptures. Galen'sideas were incorporated and considered dogmas by the Catholic Church. Faith andreligious rituals were the basis to face diseases and epidemics, besides promotingrituals and attitudes which involved prejudice, "witch hunts" and hystericalbehavior by the heavily present society in the Middle Ages(10th-15th centuries). Gradually, the Western worldrenewed its knowledge in different fields, particularly in Medicine, as a result ofthe scientific and cultural splendor happening in the Islamic world. Such scientificsplendor comes to Europe through the knowledge generated by the Arabs, in thereading of Greek texts and new ways to conduct medical training and patient care,while in contact with the Arab world. The purpose of this review is to present theknowledge created in the Middle Ages on the cardiovascular system and also theadvances in understanding diseases and approaches that emerged in the MiddleAges.Medicine theoretical knowledge was based on Galen's formulations (four humors) andextrapolations about anatomy and physiology of the cardiovascular system from animaldissectionsth to the 10th century, is marked mainly by theformation of Germanic kingdoms in Europe, the expansion of Christianity, thefounding of the Catholic Church as an institution, along with the organizationof the Carolingian Empire (800-888) and the formation of the Christian kingdoms,arising from their fragmentation. With the emergence of the Carolingian Empire,suzerain-vassal relations are developed, as well as feudal society. Thepopulation level in Europe suffered a decline because of food shortages and thespread of the plague, being gradually restored at the end of this period due tofurther exploration of fields and forests for agriculture. The High Middle Agesis marked by political stability of the Byzantine Empire in the East, the riseof Islam, and the Arab expansion into Christian territories,9.The Middle Ages is commonly divided into two periods: the Early and Late MiddleAges. The first period, characterized as the time interval from the5thand 15th centuries, is marked by several social, economic andpolitical changes in Europe. There was a strengthening of the feudal societybetween the 11th and 13th centuries, predominantlyagrarian and stratified ones, politically defragmented and under the Church'scultural and social control. However, at the same time, there was increasedpopulation growth, development and spread of cities all over Europe, greatcultural development in arts, literature, education, philosophy and science.This time is also marked by a closer contact between East and West, through theCrusades, trade relations, as well as religious and secular expeditions in orderto know and absorb the knowledge of the Arab people. The final centuries of theMiddle Ages (14th and 15th) are marked by political andreligious crises, the plague outbreak and the European territorial expansion, which promote and permeate great changes that mark the followingcenturies,9.On the other hand, the Late Middle Ages, the period between the 11th century, the practice of curing the body wasclosely connected to that of curing the soul, considering the most identifieddiseases as physical expressions of sins. This way, the task of taking care ofthe sick people is relegated to the religious, including monks, nuns and secularclergy, and to the laypeople who had practical experience on how to deal withthe sick. Hospitals are institutions that took a long time to be built inmedieval Europe, except for Spain, under Muslim control. It can be noticed,before the 13th century, the presence of specific places inmonasteries to deal with itinerant sick people and monks, and also the houses ofGod , placeswhere the major concern was the person's soul salvation, not the cure of thebody itself. Even after the existence of hospitals, from the 13thcentury on, such places were considered a place to provide more comfort than thecure itself-7. Doctors, as professionals, also arise afterthe 12th and 13th centuries, with the creation ofuniversities and the breaking of knowledge monopoly practiced by the monks.Until then, the School of Salerno, founded in the 10th century, wasone of the few learning centers in Europe for medical practices. Despitegraduating from universities, doctors had to make a great effort for theiracademic and practical knowledge to be recognized as the only ones viable inpatients' treatment, constantly fighting against the practice of healers,barber-surgeons, superstitious and quacks, until the end of the MiddleAges.The medical practice itself can be verified in the temporal extents of the MiddleAges. Before the 13nd century by Claudius Galen (129 - 199?). Originallyfrom Pergamum, a Greek city under Roman rule, Galen made use of the majesticcity library, with more than 200 thousand books, to study all the philosophical,scientific and Greek Medicine literature of the time. Galen also made use of theinformation stored in the School of Alexandria, the main learning center of thetime, where he could find the largest library of the Ancient times and completeskeletons, thereby allowing him to study the human body thoroughly. Then, hebecame famous in Greek Roman Medicine,10,11 . After purification, the blood would pass from the rightside to the left by small invisible pores, there it would be again combined withair and pneuma, then it would be distributed throughout thebody; here, he identified the aorta and the pulmonary veins on the left side. Inaddition, Galen gave great importance to the liver, which would turn digestedfood into blood and then send it to the heart to be filtered. Despite achievinggreat advancements regarding blood circulation throughout the body, Galen saidthat the venous and arterial systems were completely separated and notconnected,13,14 , who belonged to one of those tribes, was acaravan merchant for most of his life. From the age of 30 on, he started toreceive revelations from Angel Gabriel. Those revelations were orallytransmitted among the Arabs and later formed the holy book of Islam, theQur'an , are theQur'an (revelation given directly by Allah to Muhammad) andthe Hadeeth . Here,we may see a great importance given to medical knowledge. Arab teachers anddoctors encouraged and constantly searched for new knowledge and research thatresulted in major discoveries based on the sacred writings. Every disease hadbeen created by God and He had created a cure for each of them, not only curesand spiritual treatments, but also the treatment received by doctors wasencouraged, since it was one of the ways whereby God provided the cure for humandiseases. Most of the teachings regarding healing and disease preventioncontained in the sacred books refer to lifestyle, food and personal hygienehabits, besides containing some guidelines on minor surgeries. For all that, theappreciation of doctors as healers authorized by God allowed for theconstruction of new knowledge about the anatomy and physiology of the humanbody, as well as diseases and their treatments discovered by Arabdoctors,20.On the other hand, even regarding the religious aspect, we notice some facts thatcontributed greatly to the development of Arab Medicine. The two sacred Islamicbooks which compose the Sacred Law, or In addition to information on treatments and cures of diseases in general, thesacred writings bring great information about specific heart diseases, and alsophysiological and anatomical information. The heart is considered the center ofemotions, actions, intentions, desires and knowledge, and, many times, thediseases are related to the emotional state  andeven to the spiritual one .Al- Watin (aorta).Nevertheless, besides the spiritual view, there are several references of ananatomical knowledge of the heart, like a muscle, as in the passage in whichAngel Gabriel would have performed a surgery on Muhammad, extracting a bloodclot from his heart. There is also reference to the knowledge of veins andarteries and their vital importance, because the sacred books say that Godcreated man's life and could take it, cutting either his jugular vein or theQur'an.Such references about medical concepts in the sacred books can be derived fromthe contact Muhammad had with doctors graduated from school-hospitals. Many ofthe Arab tribe nomads attended those hospitals, like the Gundishapur one, inorder to go back to their tribes and treat the sick people there. Muhammad hadgreat contact with the doctor al-Harith bin Kalada, who influenced him mainly onhygiene notions present in the th and 13th centuries, provided the advancement ofmedical science knowledge at school-hospitals; this knowledge was based onancient writings and practical experiences, supported by philosophical andreligious bases. Besides thegeneral field of Medicine, there was a great development in knowledge about theheart, regarding its anatomy and physiology, diseases and their treatments. Todemonstrate the scientific advancement of that time, we have chosen three Arabdoctors who showed important contributions to the knowledge of thecardiovascular system: Haly Abbas (? 930-994), Avicenna, or Ibn Sina (980-1037)and Ibn al-Nafis (1210-1288)  .th century, who lived at atime between two great names of Arab Medicine: Rhazes and Avicenna. He was thecourt physician of Adud al-Dawla-Fana Khusraw (936-983), king of Persia, andalso at Azodi Hospital in Baghdad, where he wrote his most important piece ofwork "The Complete Book of Medical Art" , or "The Royal Book" . It is in this encyclopedic book that we can find thegreatest references by Haly Abbas concerning the knowledge of the heart, inwhich we notice his remarkable effort to reject some of Aristotle's and Galen'soutdated ideas. On the question of the venous and arterial system, Haly Abbasmade the first distinctions between veins and arteries based on their thickness,in addition to a detailed description about the descending aorta of the thoracicstructure,21. Yet, his greatestcontribution was making one of the first mentions about a connection between thevenous and arterial system, describing it in the following way in the "RoyalBook": "...There are some foramina within the non-pulsating vessels[veins] that open to the pulsating vessels[arteries]...".Haly Abbas was a Persian physician of the 10,21.Furthermore, he made great advancements in the anatomical description of theheart, although not with the nomenclature being used nowadays. He described theheart as two main chambers, one on the right and another on the left, the latterbeing where the arteries would have their origin, and considering the liver theorigin of the veins. He also recognized the existence of two atria and twoauricles as well as the aortic and mitral valves, describing theircharacteristics and the presence of the pericardiumQur'an, and becoming a famous doctor at the ageof 18. He wrote more than 450 books, namely about astronomy, logic, philosophyand Medicine treaties. Avicenna wrote all this literature living a troubled lifeof persecution and escapes due to his political opposition to the Persiangovernment. His major works on Medicine are: "Canon of Medicine" , "The book on drugs for cardiac diseases", and the less well-known"Book on Pulsology" . He made greatprogress in the anatomical knowledge of the heart, although he had accepted someof Galen's misconceptions, such as the existence of pores connecting the twoventricles of the heart, allowing the passage of blood from the right to theleft side. He recognized the origin of the arteries on the left side of theheart and veins in the liver; moreover, he identified the difference between thethickness of the left and right ventricle walls. In addition, he was the firstto mention the difference in atria and ventricles contractions, as well as theexistence of capillary circulation-26 , which consistedof 300 volumes, though it was not completed, and the "Commentary on Anatomy inAvicenna's Canon" , comprised of 80volumes. Ibn Al-Nafis stands out for the clear criticism of Galen and Avicenna,pointing out the flaws and mistakes in their theories, which was somethingalmost unthinkable to be done at a time when the ancient writings representedthe truth. Most likely he had dissected human bodies to have his greatestachievement: the discovery of the pulmonary circulation-35  or invisible pores .The blood from the right chamber must flow through the vena arteriosa(pulmonary artery) to the lungs, spread through its substance, be mingledwith air while in the lungs, pass through the arteria venosa (pulmonaryvein) to reach the left chamber of the heart to form the vitalspirit".Ib-Al-Nafis described the pulmonary circulation like this: ".Moreover, he was the first to describe the role of coronary arteries, which aretruly responsible for nourishing the heart,36.All this knowledge produced by the Arab masters, added to the varioustranslations of the Greek classics into their language, reached the ChristianWest and changed deeply the way of teaching and practicing Medicine. The mostremarkable contact between the Christian West and the Muslim East was clearlywarlike. The crusades greatly marked the way of thinking of the time, causinggreat aversion to Islam in Europe, especially among the religious ones. However,the contact with Arab culture as a result of the Crusades conduced to a searchfor Arab works and their translations in order to better understand the enemyagainst whom the Christian West foughtth century,keeping constant trade with the East, and the Muslim-ruled Iberia was quite opento contact with the European Christians, considering they were coming from atradition of tolerance toward Christians and Jews within their own boundaries.It was through those commercial and cultural contact centers that Arab scrollsentered the Western Christian world, being translated into Latin and influencingmany intellectuals of the time. Particularly noteworthy is a doctor called Constantine,the African, who worked for forty years in Syria, India, Egypt and Ethiopiabefore taking part in the doctors' and teachers' group at Salerno school, thefirst medical school in Europe. He came up with several manuscripts, extensivebackground and medical techniques. Thus, Greek classics which were forgotten for a long timein the West, such as Hippocrates', Galen's and Aristotle's, as well as newwritings made by the Arabs in the fields of philosophy, arithmetic, Medicine,among others, entered the medieval Christian area early in the Late Middle Ages.During this period of time, between the 12th and 13thcenturies, Europe experienced an outbreak and growth of cities, the creation ofthe first universities and a greater knowledge secularization. Arab works, then,were read by intellectuals, scholars and even religious people, modifyinggradually the philosophical and scientific conceptions of medievalEurope,36.Italy had already flourished in business since the 11th and 15th centuries, thegraduated doctors fought against healers and barber-surgeons, with the purposeof being recognized as the most prepared ones to deal with patients. Moreover,it is when the need for body anatomy knowledge in medical training arose inEurope. In 1240, Emperor Frederick II, of Naples, insisted that it was necessaryfor the surgeons to have anatomy training. However, the first milestone in thehistory of public dissections at universities, in terms of teaching, occurredonly in 1315, in Bologna, by physician Mondino De' Luzzi; the same happened inMontpellier, only in 1376, and in Paris in 1407. Despite being discreet andfacing various religious difficulties, this first step towards an observationscience marked the beginning of progress made in the Renaissance in Italy,mainly in the medical field.Therefore, the great names of the Renaissance, such as Leonardo Da Vinci,Michael Servetus, Andreas Vesalius and William Harvey could dissect and observecorpses, making great advances in Medicine and especially on the knowledge ofthe cardiovascular system,21,37, probably being great readers of Arab works on thesubject. Michael Servetus in his "Christianismi Restitutio"work of 1553 talks about Ibn Al- Nafis' great advances regarding pulmonarycirculation, compiling part of his work. But, not mentioning the Arab author,pretending to be the original author of the groundbreaking discoveries until notlong after finding Ibn Al- Nafis' books,33-35.The reading of Arab medical works and the change in the intellectual scene inEurope generate important transformations in Medicine at the time. Gradually,professionals who had only practical knowledge go to universities in search ofgreater knowledge. During the 13Medicine and cardiovascular science in the medieval times, rather than presenting agreat stagnation, received important contributions from philosophical ideas, as wellas Arab medical knowledge. Arab medical science had already made great contributionsin the sacred books of Islam, in particular on disease prevention and thecardiovascular system anatomy. At the same time, bright doctors and teachers,especially Avicenna, revolutionized cardiovascular knowledge, founded and taught atthe first school-hospitals, and refuted the traditional knowledge present in Galen'swork. During this time, when Europe remained under the aegis of the Catholic Church,it received strong and definite influence from the Arabs, such as the creation ofthe first medical schools and universities. That influence provided advancesconcerning the knowledge of the cardiovascular system produced in theRenaissance.


The was an error in the Competing Interests section. The correct version of the section is available below.Dr. Gregory Hand has received consultancy fees from the National Institutes of Health (NIH) and grants from the NIH, and The Coca-Cola Company. Dr. Steven Blair receives book royalties  from Human Kinetics; honoraria for service on the Scientific/Medical Advisory Boards for Clarity, Technogym, Santech, and Jenny Craig; and honoraria for lectures and consultations from scientific, educational, and lay groups which are donated to the University of South Carolina or not-for-profit organizations. Dr. Blair is a consultant on research projects with the University of Texas-Southwestern Medical School and the University of Miami. During the past 5-year period Dr. Blair has received research grants from The Coca-Cola Company, the National Institutes of Health, and Department of Defense. Funding for the study was provided by an unrestricted research grant from The Coca-Cola Company. The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report, and does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.The corresponding author should be contacted at: archer.edwardc@gmail.com


The 31st Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS), November 5–7, 2015, was a vibrant and stimulating conference, with many highlights from the opening on the 10th anniversary of Hurricane Katrina; the keynotes of Anke Ehlers, John Krystal, and Regina Sullivan; the vivid panel discussions with recognized leaders in the field of traumatic stress studies; inspiring and eloquent presentations by master methodologists and clinicians; and much more. The atmosphere was excellent, not only within the conference venue, but also outside—we were in The Big Easy. For those who missed it, and for those who like to refresh their memories, we have assembled here in this special issue the highlights of the ISTSS-2015!The topic of the meeting was “Back to Basics: Integrating Clinical and Scientific Knowledge to Advance the Field of Trauma.” Basic science in the field of stress and trauma has always been an important platform for the development of evidence-based treatments for posttraumatic stress disorder (PTSD). In the past 20 years, research on the effects of trauma and processes of recovery has evolved at great pace. We also know that, despite these advances, the vast majority of those affected by traumatic stress still do not receive optimal care, and even when they do, many patients are not cured after treatment and remain deeply affected by their experiences  and their international partner ISTSS have a long-standing collaboration Gersons,  and we aWith this special issue that presents highlights of the ISTSS-2015, we hope to boost future critical discussions on the advancement of science and evidence-based treatments, and challenge all of you to engage in this process. To optimally advance the field of trauma, we need clever scientists and dedicated clinicians. However, to stay open-minded in this world of constant change and dominant ideologies, we also need “disrupters, disbelievers, sceptics, and revolutionaries” (see Yehuda et al., Bernet Elzinga Institute of Psychology Section Clinical Psychology Leiden University Leiden, The NetherlandsChristian Schmahl Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University Mannheim, GermanyMiranda Olff Department of Psychiatry, Academic Medical Center University of Amsterdam Amsterdam, The NetherlandsDiemen, The NetherlandsArq Psychotrauma Expert Group


Researchers and academic institutions need assessment and rating to measure their performance. The criteria are designed to evaluate quality and adequacy of research and welcome by most universities as an international process to increase monitoring academic achievements. The study aimed to evaluate the increasing trend in global ranking of Iranian medical universities websites emphasizing on comparative approach.This is a cross-sectional study involving websites of Iranian medical universities. Sampling was conducted by census selecting universities affiliated to the Ministry of Health in webometrics rating system. Web sites of Iranian medical universities were investigated based on the webometrics indicators, global ranking as well as the process of changing their rating. Universities of medical sciences were associated with improved ratings in seven periods from Jan 2012 until Jan 2015.The highest rank was in Jan 2014. Tehran University of Medical Sciences ranked the first in all periods. The highest ratings were about impact factor in universities of medical sciences reflecting the low level of this index in university websites. The least ranking was observed in type 1 universities.Despite the criticisms and weaknesses of these webometrics criteria, they are critical to this equation and should be checked for authenticity and suitability of goals. Therefore, localizing these criteria by the advantages model, ranking systems features, continuous development and medical universities evaluation based on these indicators provide new opportunities for the development of the country especially through online media. Researchers and academic institutions increasingly need assessment and rating as a measure of individual and organizational performance. This is an international process. Increasing surveillance on the academic achievements through the assessment of excellence in research , UK research assessment, Performance-Based Research Funding in New Zealand have attracted the attention of the universities. All these criteria manifest the quality and efficiency of research . Rating The development of this ranking can lead to the development of scientific institutions while providing support for investment in research .Today, the web is an important tool for formal and informal communication and cooperation among individuals including researchers. Increased number of indexed web pages paved the way for the emergence of the methods and measures of web resources .Website and access to the web visibility of the university is one of the important factors for the success of the university; therefore, evaluation and ranking of universities’ websites is as crucial as evaluation and ranking of research and educational activities of universities. Thus, evaluation of universities on the web is one of the priorities of the country as a tool for evaluating the academic and research performance of universities .The number of web pages in the university websiteTotal number of PowerPoint, Word and PDF files available on the website of the universityThe qualitative papers of the university among the 10% most cited articles in SCImago website .Ranking systems of university websites recognize internet as a source for large volumes of documents and a tool to disseminate and access knowledge. Rankings of Shanghai, Times and QS are some of the most important systems of the world university rankings. Indicators such as scientific achievements, professional judgment score, quality of education, the number of foreign students, winners of the Nobel Prize are evaluated in most of these systems. Webometrics Rating system examines the overview and comprehensive images of a university . It alsoThe number of links to the university website (2015) Webometrics is introduced as the quantitative aspects of the structure and use of information resources, structures and web technologies outlining approaches to information and bibliometrics. It also takes into grant four main areas of analysis of the content and structure of the web, web use and technologies applied to the web. Webometrics may become one of the most interesting research areas for a wide array of electronic information , 9.Thus, considering the importance of academic websites, this study examined websites based on the Webometrics in order to improve in webometrics ranking and to reveal a complete perspective of the status of science and research in the field of health in the country and the presence and success of the universities of medical sciences.In this cross-sectional study, the population of the research included websites of Iranian medical universities. Sampling was conducted by census. In the first stage, all medical universities were recovered in terms of ranking in the webometrics database by selecting the Asia and Iran, respectively. Then, type one, two and three universities of Ministry of Health and Medical Education were separated in webometrics database in terms of rating among the items recovered. Secondly, web content of universities was investigated based on the webometrics indicators (presented in Jan 2015), their national webometrics ranking and changes in their rating at 7 periods . The increasing trend in ranking of websites of recovered universities was compared using descriptive statistics . Web ranking of universities in global webometrics ranking system is done on 4 criteria including Presence (the number of web pages in the university website), Openness , Excellence  and Impact (the number of links to the university website).Rank status and development of medical universities is as follows with regard to webometrics ranking results in the time of Jan 2012 until Jan 2015:Medical universities of Tehran, Isfahan, and Shiraz ranked first and third, respectively in Jan 2012. Medical universities of Lorestan (43%), Tehran (35%), Isfahan (31%), Shahrekord (29%), Kermanshah (25%) and Mazandaran (24%) showed considerable growth. The results suggested that 74% of medical universities have been associated with increased global ranking in Jan 2012 and the total number was 35 universities.Rating of universities in Kerman, Mazandaran, Arak, Kurdistan, Tehran, Kermanshah, Semnan, Birjand, Babol, and Hamadan indicated a growth more than 20% in Jul 2012 compared to the first results of the ranking in Jul 2011. 61.4% of medical universities in 2012 were associated with an increase in global ranking .Three medical universities of Tehran, Isfahan, and Shahid Beheshti received top ratings in Jan 2013 and medical universities of Qazvin, Gonabad, Kurdistan, Hormozgan, Arak and Bushehr showed a growth more than 20% compared to the previous rating. 61.4% of medical universities in 2013 were associated with an increase in global ranking .Three medical universities of Tehran, Shiraz, and Isfahan received top ratings in Jul 2013 and medical universities of Fasa, North Khorasan, and Army indicated a growth more than 20% compared to the previous rating. Twenty-six percent of medical universities in 2013 were associated with an increase in global ranking . Medical universities of Dezful and Torbat were also added to the list of webometrics ranking.Medical universities of Tehran, Shiraz, and Isfahan received top ratings in Jan 2014 and medical universities of North Khorasan, Gonabad, Ahvaz, Army, Lorestan, Zahedan, Qom, Hamadan, Mashhad, and Shiraz showed an increase more than 25% compared to the previous rating. 91.6% of medical universities in Jan 2014 were associated with an increase in global ranking. Medical universities of Isfahan, Arak, and Fasa also showed degradation.Medical universities of Tehran, Tarbiat Modares, and Shiraz received top ratings in Jul 2014 and medical universities of Ardebil, Modares, Shahrekord, Qazvin, Kashan, Kerman and Shiraz indicated a growth more than 40% compared to the previous rating. 81.2% of medical universities in Jul 2014 were associated with an increase in global ranking. The nine medical universities of Semnam, Zahedan, Sabzevar, Babol, Tavanbakshi, Torbat Heydarieh, Yasouj, Qom, and Dezful also indicated a ranking decrease.Medical universities of Tehran, Shahid Beheshti, and Isfahan received top ratings in Jan 2015; while, medical universities of Kordestan, Torbat Heydarieh, Rafsanjan and Birjand indicated a growth more than 15% compared to the previous rating. Among 50 universities of medical sciences in the global webometrics ranking, 44% associated with improved global ranking in recent rating. They are generally ranked 37.2% lower than the previous rating. The medical universities of IAU, Shiraz, North Khorasan, Lorestan, Isfahan, Tavanbakshi, Dezful, Zahedan, Hormozgan, Sabzevar, Babol, Kerman, Ilam, Yasouj, Qom, Fasa, Tabriz, Jahrom, Arak, Shahed, Golestan, Zabol, Qazvin, Gonabad, Shahroud, Kermanshah, Ardebil and Hamedan also indicated a backward .The highest index in rating is observed in universities of Tehran, Birjand and Shiraz, respectively and the lowest rank is seen in universities of Torbat Heydarieh and IAU. The highest impact indicator is observed in universities of Tehran, Tarbiat Modares, and Shahid Beheshti; whereas, the lowest impact indicator is seen in Sabzevar University. The highest rank in the field of excellence indicator is observed in the universities of Tehran, Tarbiat Modares, and Shahid Beheshti. The average index of rating showed that the highest rank results from impact factor. It is determined by numeration of external links to university subdomains. This obviously is more important than the other indices with a 50% of allocation. External link indicates the reputation of the organization, academic performance, value and usefulness of services presented in web pages. They are obtained by two important suppliers named Majestic SEO and Ahrefs given that the highest rating reflects a low level of this index in the university websites .The study of growth rate in type 1 medical universities indicated that the highest growth rate is seen in medical universities of Kerman, Shahid Beheshti, and Tehran, while, medical universities of Ahvaz and Isfahan faced with negative growth. If severance of years is considered, the greatest growth in Jan 2015 is seen in Shahid Beheshti University of Medical Sciences (12%) and the highest negative growth is seen in Shiraz University of Medical Sciences (79%). The greatest growth in Jul 2014 is seen by Kerman University of Medical Sciences (42%) and the highest negative growth is seen in Mashhad University of Medical Sciences (15%). The highest growth in Jan 2014 is manifested in Ahvaz University of Medical Sciences (27%), whereas, the highest negative growth is seen in Kerman University of Medical Sciences (9%). All universities had negative growth in Jul 2013 and the highest negative growth is seen in Ahvaz. %). The best growth in Jan 2013 is seen in Isfahan University of Medical Sciences (37%); whereas, medical universities of Shiraz, Tabriz, and Mashhad presented a negative growth. The greatest growth in Jul 2012 is seen in Kerman University of Medical Sciences (54%); unlike this, the highest negative growth is seen in Isfahan University of Medical Sciences (77%). If we consider the whole period of rating, the greatest growth in Jul 2012 is manifested in Kerman University of Medical Sciences and the highest negative growth is seen in Shiraz University of Medical Sciences in Jan 2015 .The study of growth rate in type 2 medical universities indicated that the highest growth rate is seen in medical universities of Arak, Hormozgan, and Qazvin; while, medical universities of Lorestan, Semnan, and Shahed faced with negative growth.If we consider the severance of the years, the following universities indicated considerable growth: Rafsanjan with 16% growth in Jan 2015, Ardebil with 55% growth in Jul 2014, Zahedan with 35% growth in Jan 2014, Babol with 16% growth in Jul 2013, Qazvin with 52% growth in Jan 2013, Zahedan with 50% growth in Jul 2012 .The study of growth rate in type 3 medical universities indicated that the highest growth rate is seen in medical universities of Kurdistan, Army, and North Khorasan; whereas, medical universities of Jahrom and Sabzevar faced with negative growth. If the severance of the years is considered, the following universities indicated considerable growth: Kordestan with 32% growth in Jan 2015, Gonabad with 47% growth in Jul 2014, Fasa with 46% growth in Jan 2014, Qom with 50% growth in Jul 2013, Shahrekord with 51% growth in Jan 2013, Kordestan with 33% growth in Jul 2012. Universities of North Khorasan, Torbat Heydarieh and Dezful have been inserted in webometrics rating system from Jul 2013 .Active presence on the Web and publication of research findings are considered as performance indicator of universities and research institutes in the assessment of development. Websites must continually be evaluated in terms of the importance for websites, applicability, and success in achieving the goals. Webometrics assessment of websites of universities and research institutes also has the advantage that puts the spotlight on the current situation and the performance of universities in relation to the web environment from one side. On the other hand, leaders of these organizations try to provide the necessary conditions for their institutions for the active presence on the web according to international standards in order to gain further credibility. Therefore, the universities should care about periodic evaluations. This study elaborates the ranking of the national medical universities. Medical universities of Tehran, Shahid Beheshti, and Isfahan received top ratings in Jan 2015 and medical universities of Kordestan, Torbat Heydarieh, Rafsanjan and Birjand indicated a growth more than 15% compared to the previous rating. Recent results suggest that among 50 universities of medical sciences in the global webometrics ranking, 44% associated with improved global ranking in recent rating. They are generally ranked 37.2% lower than the previous rating. The medical universities of IAU, Shiraz, North Khorasan, Lorestan, Isfahan, Tavanbakshi, Dezful, Zahedan, Hormozgan, Sabzevar, Babol, Kerman, Ilam, Yasouj, Qom, Fasa, Tabriz, Jahrom, Arak, Shahed, Golestan, Zabol, Qazvin, Gonabad, Shahroud, Kermanshah, Ardebil and Hamedan also indicated a decrease.There are different rating fluctuations in type 1, type 2 and type 3 medical universities considering the above findings from Jul 2012 to Jan 2015. The most promotion at this time was seen in medical universities of Kerman, Qazvin, Fars, Qom, Ardebil and Kurdistan . The most growth in rating of all medical universities is seen in Jan 2014 and the lowest growth is seen in Jan 2015. Changing the method of calculation is one of the reasons to justify this change and negative fluctuation, to calculate the index, previously known as scholar; the results of the evaluation from Google scholar search engine were also used in addition to Scimago.The ranking fluctuations and downgrading during different time is reported . In a reThe findings of the evaluation system of universities and research institutes websites at Regional Information Center for Science and Technology suggest that medical universities of Tehran, Isfahan, and Shiraz are in the top rankings, respectively. Shahid Beheshti University of Medical Sciences is in the fifth ranking conveying the successful results .Although there is a positive correlation between webometrics rating of webometrics system and other university ranking systems, the results of the ranking become somewhat different by using different criteria in the ranking systems . HEEACT The webometrics rating of universities in Jan 2015 includes significant points, websites of medical universities of Tehran, Isfahan and Shahid Beheshti in the presence index; websites of medical universities of Tehran, Isfahan and Shahid Beheshti in the impact factor index; in terms of access to rich files the medical universities of Tehran, Birjand and Shiraz; and finally the medical universities of Tehran, Tarbiat Modares, and Shahid Beheshti showed the best science ranking index. The Medical University of Tehran exceeds the points both in web presence and number of links involved followed by two universities of Guilan and Mashhad . A web sth, while the Rich files ranking appeared to be the third nationally  have been completely observed by the authors.


Exosomes and ectosomes, extracellular vesicles of two types generated by all cells at multivesicular bodies and the plasma membrane, respectively, play critical roles in physiology and pathology. A key mechanism of their function, analogous for both types of vesicles, is the fusion of their membrane to the plasma membrane of specific target cells, followed by discharge to the cytoplasm of their luminal cargo containing proteins, RNAs, and DNA. Here we summarize the present knowledge about the interactions, binding and fusions of vesicles with the cell plasma membrane. The sequence initiates with dynamic interactions, during which vesicles roll over the plasma membrane, followed by the binding of specific membrane proteins to their cell receptors. Membrane binding is then converted rapidly into fusion by mechanisms analogous to those of retroviruses. Specifically, proteins of the extracellular vesicle membranes are structurally rearranged, and their hydrophobic sequences insert into the target cell plasma membrane which undergoes lipid reorganization, protein restructuring and membrane dimpling. Single fusions are not the only process of vesicle/cell interactions. Upon intracellular reassembly of their luminal cargoes, vesicles can be regenerated, released and fused horizontally to other target cells. Fusions of extracellular vesicles are relevant also for specific therapy processes, now intensely investigated. During the last 15 years, exosomes and ectosomes, the two types of extracellular vesicles (EVs) endowed with physiological and pathological functions, have been among the structures attracting the greatest attention in the scientific community. Exosomes were identified in 2000 as the vesicles trapped within multivesicular bodies (MVBs). Their release to the extracellular space takes place upon the exocytosis of the latter organelles .Numerous aspects of exosome and ectosome generation are known to be different. Among these are the sites of their origin, at the MVBs and the plasma membrane; the length of their intracellular life before discharge, long for exosomes  and much shorter for ectosomes (a few tens of seconds for their generation at the plasma membrane); their size ; the mechanisms for the accumulation, within their luminal content, of proteins and other macromolecules indicated here as their cargo. In addition, the two types of EVs are often considered molecularly different. Thus, quite a few proteins were proposed as markers of exosomes. Recent studies, however, have shown many such molecules to be present also in ectosomes, although at lower levels. Real markers now recognized, specific of either type of EV, are few. Nevertheless, they remain useful for the identification of the two EVs [Once generated and released, the destinies of the two types of EVs become similar, if not identical. Fractions of both types of EVs undergo dissolution of their membrane. As a consequence, the factors accumulated in their cargo are released to the extracellular space. Most other EVs, however, do not dissolve, but pursue their navigation in the extracellular fluid. In vivo, the navigation of some of them is long-term, sufficient to reach the large fluids of the bodies. Other EVs, however, remain local, establishing interactions with cells defined here as target cells. Such interactions are at least of two types. Some EVs, taken up by various forms of endocytosis, can either be discharged into lysosomes or fuse with endocytic membranes, with ensuing release of their cargo into the cytoplasm. Alternatively, the binding of EVs to target cells is followed by their fusion with the plasma membrane. The different conditions of the two pathways, acidic within endosomes, near neutral in the extracellular space, appear critical for the EV membrane fusion. The process occurring upon uptake of EVs  into endosomes has been extensively investigated and recently illustrated in comprehensive reviews ,5. In coAs already mentioned, exosomes and ectosomes are generated and released by all types of cells. This property may suggest the two types of EVs to be homogeneous in terms of composition. This is not the case. The two EV types are, in fact, distinct in composition. This can be the case of EVs released from different cells. Even when EVs originate from the same type of cell, some of their properties can be different, depending on reasons such as the state of development of their cells of origin, their functions, and the degree of their stimulation. Large differences have been reported also between wild-type EVs and the analogous EVs of cancer cells . These dIn order to clarify in detail the properties of the EV-cell interactions, the investigation has been expanded using new approaches by which the temporality and the dynamics of the process can be established . ExcelleIn view of the specificities summarized above, the variable properties of the EV-cell interactions can be attributed to the genes expressed by the original and target cells. Specifically, the interactions appear due to the cell surface proteins necessary for EV binding and compatible for the ensuing fusion to get started.N-ethylmaleimide-sensitive protein receptor (SNARE), which have nothing to do with the surface binding and fusion processes. Among the latter processes, the ones previously intensely investigated are virus fusions, which occur with the participation of four classes of proteins [Binding and fusion of EVs to the external surface of their target cells should be first distinguished from the apparently analogous fusion processes taking place inside the cell, during organelle traffic, exocytosis, endocytosis and other events. Intracellular binding and fusion require the involvement of various proteins, including actin, other cytoskeletal proteins and numerous forms of soluble proteins . ProteinThe initial interactions of EVs are expected to require specific, high affinity binding of at least two surface proteins, one protruding from the EVs, the other from the plasma membrane of the target cells. The surface proteins of class I, syncytin-1 and syncytin-2, were discovered on placental trophoblast plasma membrane, where they participate in the cell-to-cell fusion process ,13. ThesN-glycosylations of the protein [The interest in these proteins was greatly increased by the identification of two high affinity binding proteins, the receptors Major Facilitator Superfamily Domain 2a (MFSD2a) and Soluble Carrier Family 1 (ASCT-2). These proteins belong to families of carbohydrate and neutral amino acid transporters, respectively ,19,20. P protein . Interes protein . Moreove protein . SummingThe knowledge about EV/target cell fusion , analogoDuring the time between the pre-folding and post-folding of their fusogenic proteins, the EV and cell plasma membranes become continuous . This prEV transfer from the cell of origin to a target cell does not necessarily account for a complete interaction process. In target cells, in fact, the cargo and membrane molecules transferred upon EV fusion can accumulate again into vesicles that are released and then fuse to other target cells. This horizontal transfer, taking place among the cells of a tissue, could be expanded also to other cell types, contributing to many physiological processes such as coagulation, stem cell renewal and expansion, and also to the pathogenesis of diseases including inflammation diseases , diabetes, and the growth, invasion and metastases of tumors ,25,26,27Knowledge about their origin and properties stimulated the idea of employing EVs for therapy . A problThe task of the present review was the demonstration that specific binding and fusion of EVs with the plasma membrane of target cells is a process of great interest for cell physiology and pathology. Binding and fusion of EVs does occur also upon their uptake by the endocytic system, extensively presented in ,5. HowevThe EVs are often defined as structures that have displaced the external borders of cells, from the plasma membrane to the limit of their navigation. The findings reported here have documented additional properties of EVs including, among others, their horizontal intercellular transfer of macromolecules; their target cell signaling induced by the intercellular traffic of macromolecules; their long-term control of gene expression. The identification of these and other extraordinary processes has introduced new concepts and ideas, not only in cell biology and physiology, but also in medicine. At present, in fact, the role of EVs is being evaluated also by procedures employed for the diagnosis, prognosis, evaluation and therapy of single patients. Based on the results of their intense, ongoing investigation, the EVs can therefore be envisaged as new tools, employed for the progress of biomedical sciences, destined to be further expanded in the next few years.


The use of green plants to remove, contain, inactivate, or degrade harmful environmental contaminants  is an emerging technology. In this paper, an overview is given of existing information concerning the use of plants for the remediation of metal-contaminated soils. Both site decontamination (phytoextraction) and stabilization techniques (phytostabilization) are described. In addition to the plant itself, the use of soil amendments for mobilization (in case of phytoextraction) and immobilization (in case of phytostabilization) is discussed. Also, the economical impacts of changed land-use, eventual valorization of biomass, and cost-benefit aspects of phytoremediation are treated. In spite of the growing public and commercial interest and success, more fundamental research is needed still to better exploit the metabolic diversity of the plants themselves, but also to better understand the complex interactions between metals, soil, plant roots, and micro-organisms (bacteria and mycorrhiza) in the rhizosphere. Further, more demonstration experiments are needed to measure the underlying economics, for publicacceptance and last but not least, to convince policy makers.


In article , severalInternational Journal of Molecular Sciences is a member of COPE and takes research integrity, including the correct reporting of figures, very seriously.The article will be marked as retracted. The


Nursing and research,nursing care. Maria Ivete Ribeiro de Oliveira, Dean of the University of BahiaSchool of Nursing, stated in an keynote lecture the need for a systematized body ofscientific knowledge, which, grounded on nursing theories, would be the basis forgeneralizations, in order to proceed with further investigations, new knowledge and,consequently, the renewal and modernization of professional practice.Research is an instrument by which the researcher obtains tools to strengthen the science,but it is also a political act that, as a social practice, contributes to the improvementof the quality of life of the human being. The first issues related to the development ofnursing research in Brazil were approached in the official agenda of the 16th BrazilianCongress of Nursing, in 1964, in Salvador/Bahia, entitled, The discussions resulted in important decisions. The Brazilian Association of Nursing(Associação Brasileira de Enfermagem - ABEn) was recommended to encourage nursing schoolsto prepare: their faculty for research, by means of courses and seminars on researchmethodology; nurses for using research in daily work, producing elements to evaluate thecare providedThe Brazilian nurses dedicated to research can be classified according to the internationalcriteria, namely: the generation of pioneers, which emerged in the 1950s; the generation ofthose who were self-taught, which emerged in the 1960s; the generation of individualacademic development, which appeared in the 1970s; the generation of systematic andcollective production, which was established around the 1980s and 1990s; and in 2000s, thegeneration of scientific production, oriented toward the care settings, through theso-called “good practices”, and practices based on evidenceBeginning in the 1970s, Brazilian nursing started to develop its own knowledge, based onnursing theories, with the aim of systematization of the care provided by professionals,and stimulating the research of new objects from different qualitative perspectives.,which stated that scientific findings were more reliable as a basis for clinical decisionsthan the opinions of authorities, which influenced the other health disciplines of theworldMaslow’s theory of basic human needs and the classification of JoãoMohana, Wanda de Aguiar Horta, proposed the methodology called the “Nursing Process” ,which was and still is widely used throughout the countryTechnological advances in the health area and the competitive labor market stimulatednurses to consider specificities of therapeutic care and the identification of nursing’srole in the multiprofessional team. This path motivated the development of specificknowledge, by means of theoretical elaborations, providing a new manner of perceiving thephenomena involved in the care practice. Thus, the need to investigate the objects ofnursing with new glasses was disseminated, and qualitative research was used; with that,nursing actions were improved, based on scientific theory. In the 1970s, according toThe limited use and impact of scientific production related to nursing in the practicesetting needs consideration when referring to nursing research in Brazil, as a challenge ofthe present times. Several hypotheses can be assigned to this, but it is necessary toenable the dissemination and impact of the knowledge produced, as an issue of socialresponsibility, and considering that, according to ethical and moral reasoning, knowledgemust always be shared for the good of humanity. We need to fight for the visibility ofnursing researchHowever, it is necessary to understand nursing research as a manner of growth, developmentand valuing of the profession for society, and not only as an instrument that nurses use inorder to obtain knowledge for their daily practice. This means the awakening andunderstanding of a class that is perceived not only as a work force, but also one thatpartakes of the full exercise of a profession, making use of the incessant search forknowledge.In the last 30 years, the scientific knowledge production generated in postgraduateprograms, applied to the health needs of the Brazilian population, has enabled an effectivearticulation of the centers of formation of doctorally- and masters-prepared nurses withthe society, in a practice that favored different contexts of health and disease. This newknowledge also renews and modernizes undergraduate education, as well as improve thenursing care in a cycle that establishes and nurtures the work of the profession.(The nursing profession, and that of health in general, followed the evolution of thetechnological and computational resources for generation and use of information, favoringthe improvement of actions aimed at attending the population. In the last decades,initiatives for the development of nursing research, whether individual, collaborative ormulti-centered, have multiplied all over the world, with the objective of improving theprovision of quality care, patient safety and more effective health policies.Evidence-based practices, clinical research, systematic reviews, convergent-care research,historical studies, phenomenological studies and social representations, have the samegoal: to answer questions of professional practice I believe that the Brazilian scientific nursing community has expressed concern inpromoting, funding and encouraging the development of intervention research, or, in otherwords, research that provokes changes in care practice, in the face of important healthproblems. The vacuum that still needs to be filled, in my view, is the strengthening ofstudies that really aim at the transformation and integration between the scientificcommunity and the care community. Partnerships between schools, health services, andscientists are essential, with a change of roles from the one who produces the knowledgeand the one who applies the knowledge that has been produced.


From May 29 to May 31 2017, the imposing building of the Palace of Parliament hosted the fifth Edition of the Congress of “Carol Davila” University of Medicine and Pharmacy, Bucharest, the oldest and most important University of Medicine and Pharmacy in Romania, on the anniversary of 160 years since it was founded. Under the already famous motto, “Initiation, Evolution, Excellency”, 35 scientific sessions took place in five session rooms, in which prestigious speakers from Romania and from abroad presented their latest works and researches in the field of Medicine. The participation was numerous, as always, over 300 papers drawing the public’s attention through novelty and originality, the young researchers being remarked through enthusiasm and innovation. The plenary sessions that should be mentioned are the following: Plenary session organized in collaboration with the Romanian Association of Urology: Updates in Urology; Multiple/ Plenary session Neurology: Alzheimer’s Disease – A multifactorial etiology disorder, A matter of complex interactions; Plenary session Cardiology: Heart failure in the comorbidities context; Plenary session Endocrinology: Parathyroid Diseases: Growing incidence or better diagnosis?; Plenary session organized in collaboration with the Romanian Society of Surgery and Traumatology: Research today and tomorrow. Moreover, the latest subjects that were discussed and that enjoyed a numerous participation and a special attention, are the following: Unrestricted Educational Grant from Biomedica: High-end molecular technologies in human diagnostic; Impact of atrial fibrillation in hematological, endocrine, gastroenterological, and neurological disorders; Interdisciplinary researches for innovative therapeutical systems development; From fundamental neuroscience to clinical practice in child and adolescent psychiatry; Patient-physician communication: Online communities, ethical perspectives, and patient satisfaction; Romanian Geriatrics and Gerontology at 65 years of presence in Europe: Prevention, intervention or anti-aging; Interdisciplinarity from the Dental Medicine perspective; Contemporaneity and interdisciplinarity in pediatric pathology; Multidisciplinary approach of the coronary artery disease: From the atherosclerotic plaque to management.Many prizes were awarded to the best of the best, such as Young Investigator Award , Young Investigator Award , and Young Investigator Award , prizes that presupposed the financial support of their participation in international prestigious congresses. The opening ceremony was honored by some famous Romanian personalities such as Pavel Nastase – The Ministry of National Education, Serban-Constantin Valeca – The Ministry of Research and Innovation, Corina Pop –Secretary of State, Ministry of Health, Diana Paun – Presidential Consultant, Sorin Cimpeanu – President of the Rectors’ Council, Mircea Dumitru – Rector of University of Bucharest, Mihnea Costoiu – Rector of Polytechnic University in Bucharest.A special moment of the opening ceremony was the one of unveiling the bust of the founder of the Romanian Medical School, General Doctor Carol Davila, which was sculpted by the famous sculptor, Rodion Gheorghita and given to “Carol Davila” University of Medicine and Pharmacy, Bucharest. In his speech on that occasion, the sculptor mentioned that among the 79 sculptures of the incomparable Constantin Brancusi, that no longer exist, that was the 26th, which he managed “to bring back to life” from a photo, his dream being the realizing of “an infinity column” of 50 meters, which he would place in front of the Palace of Parliament. The Congress also occasioned the awarding of the “Honoris Causa” title to some remarkable personalities in the field of universal medicine. ARNULF STENZLHe was born on August 2, 1955 in Klagenfurt, Austria. From 1973 to 1980, he studied at the Medical School, Karl-Franzens University in Graz, and in 1980, he obtained the title of Doctor medicinae universalis (M.D.). From 1990 to 1992, he was Assistant professor in the Department of Urology, Inselspital, University of Bern, Switzerland, and from 1992 to 2002, he was Professor in the Department of Urology, University of Innsbruck, Austria. In 2002, he became Head of the Department of Urology, in Eberhard-Karls University Tuebingen, in Tubingen, Germany. He is member of many associations and committees in the medical field, such as Austrian Urological Association, German Urological Association, Austrian Association of Experimental Surgery, European Society of Urologic Oncology, and Endocrinology (ESUOE), Educational Committee of the Austrian Urological Association, Scientific Committee “Polish Journal of Urology”, Vice chairman of the MITT , since 2006 and Chairman of the Reinhard-Nagel Foundation Board, since 2013.In his entire career in Medicine, he was offered many awards, such as AUA Annual Audio-Visual Award, in 1994 ; Honorary Member of the Bristol Urological Institute, Bristol, UK, in November 1997; Best study-center of the year 2005/ 2006, German Association of Urologic Oncology, in 2006; Werner-Stähler-memorial prize of the South-west German Association of Urology, in 2007, 2009, 2010 and 2011, etc. Moreover, he is the owner of some patents for important discoveries in the field of Urology, such as C-Trap, an implantable device that treats urinary incontinence. PETAR M. SEFEROVIĆHe was born on January 20, 1951 in Belgrade. At present, he is the President-elect of the Heart Failure Association of the ESC, Corresponding member of the Serbian Academy of Sciences and Arts, Chair of internal medicine in Belgrade University School of Medicine and President of the Heart Failure Society of Serbia.Regarding his education, he became Professor in 1996 in Belgrade University School of Medicine, in 1994 he became Head of Cardiology II, Department of Cardiology, University Institute for Cardiovascular Diseases, Belgrade, Serbian and Montenegro, and in 1994 he became Expert for Myocardial and Pericardial Diseases, Fed. Ministry of Science. Moreover, in 1982 he became Specialist in Internal Medicine. He is member of the European Society of Cardiology Activities such as HFA Board, Executive Committee of HFA Board, and was a Scientific Chairperson of the Heart Failure Association Annual Meeting in 2012. Even more, he is fellow of the European Society of Cardiology, member of the American College of Cardiology, honorary member of the Cardiac Promotion Society in Marburg, Germany, member of the Scientific Executive Committee of the International Academy of Cardiology and fellow of the Serbian Medical Association and Yugoslav Society of Cardiology.As far as his research is concerned, he made studies regarding the heart muscle disease and pericardial disease, as well as invasive and interventional cardiology. JENS RASSWEILERProf. Rassweiler studied Medicine at the Universities of Stuttgart, Freiburg, and Tuebingen, in Germany. In 1982, he started his urological education at the Katharinenhospital Stuttgart and was directly involved in the clinical introduction of ESWL, URS, and PCNL. From 1988 to 1994, he served as Vice-chairman at the Medical School in Mannheim. He was the first German surgeon to perform a laparoscopic nephrectomy in 1992. In 1994, he became the Head of the Department of Urology at Klinikum Heilbronn, Academic Hospital of University of Heidelberg.Prof. Rassweiler is an active member of various urological societies and member in the editorial board of a variety of international journals in the field of Medicine. In 1999, he received the Best Publication Award from the EAU. He also served in the board of the European School of Urology from 1999 to 2010. Since 2008, he has served as Chairman of the EAU Section of Uro-technology (ESUT). In 2009, he was President of the World Congress of Endourology & SWL, which he organized in Munich together with Prof. Christian Chaussy. He was President of the Engineering Society of Urologic Surgeons (EUS) and became President of the German Shock Wave Society in 2010. In the same year, he received the title “Doctor Honoris Causa” from “Victor Babes” University in Timisoara, Romania and, in 2013, he received the title “Doctor Honoris Causa” from “Iuliu Hatieganu” University of Medicine in Cluj-Napoca, Romania.In 2016, he was elected Chairman of the EAU-section Office and recipient of the Gustav-Simon-Medal by the South-west German Society of Urology (SWDGU). In 2017, he was elected member of the American Association of Genitourinary Surgeons (AAGUS).He is honorary member of the Endourological Societies of Hungary, Chile, Poland, Italy, and Turkey and honorary member of the Polish and Bulgarian Association of Urology. Professor Rassweiler has published more than 400 articles and more than 150 book chapters.JOHN PAUL BILEZIKIANHe is currently Professor of Medicine and Professor of Pharmacology at the College of Physicians & Surgeons, Columbia University; Vice chair of the Department of Medicine for International Education and Research and Chief, Emeritus, of the Division of Endocrinology and Director of the Metabolic Bone Diseases Program at Columbia University Medical Center. In 1965, he graduated Magna Cum Laude from Harvard College, Cambridge, Massachusetts (B.A. in Biochemistry). In 1969, he became M.D., after graduating the College of Physicians and Surgeons, from Columbia University, in New York. He is member of the International Board of Medical Advisors, Yerevan State Medical University, Yerevan, Armenia; Director of the Annual Symposia on Osteoporosis, Yerevan State Medical University and American University of Armenia, Yerevan, Armenia. Moreover, from 2008 until present, he has been International Advisor of the Chinese Journal of Osteoporosis and Bone Mineral Research, and from 2011, he has been activating in the International Advisory Board of the Glucocorticoid Induced Osteoporosis Skeletal Endocrinology Group. From 2013 to 2015, he was member of the Scientific Statement Task Force of the Endocrine Society. Moreover, from 1983 to 1987 he was the Editor of “Endocrinology”. Starting from 2005 he has been Section Editor of the Journal of Women’s Health, member of the Editorial Board of “Journal of Clinical Densitometry” (from 2011), and, from 2016 he has been member of the editorial board of “Osteoporosis and Sarcopenia”. He was offered many awards and distinctions, among which the following should be mentioned: L.J. Henderson Prize in Biochemistry, by Harvard College, in 1965; Lifetime Achievement Award by the Armenian American Medical Society of California, in 2006; Laureate Distinguished Educator Award by The Endocrine Society, in 2014; Oscar Gluck Humanitarian Award, by the International Society for Clinical Densitometry, in 2014; Honorary Member, by the Russian Osteoporosis Association, in 2017, etc. He has an impressive number of citations in ISI Web of Science and an h-index of 83. ANDREAS LEITHNERHe was born on April 23, 1974 in Vienna, Austria. From 1984 to 1998, he studied at the Medical Faculty of Vienna University. In 2005, he graduated venia docendi for “orthopaedics and orthopedic surgery” at the Medical University in Graz, thus obtaining the Austrian Specialist Diploma in Orthopaedic Surgery. From 2012 to 2016, he was Head of the Department of Orthopaedic Surgery, Medical University in Graz, and starting from 2017, he has been Head of the Department of Orthopaedics and Trauma Surgery, Medical University, in Graz. He is currently member of the Vienna Society of Physicians (since 2000); member of the German Society of Orthopaedic Surgery (DGOOC), (since 2009); member of the European Orthopaedic Research Society (EORS) (since 2012) and member of the Austrian Society of Orthopaedics and Traumatology (OGOuT), (since 2016). Moreover, he is General Secretary of the Austrian Society of Orthopaedic Surgery (OGO), since 2015, and Board Member of the same society. Since 2012, he has been the Editorial Board Member of “Sarcoma”; since 2015, he has been member of the “World Journal of Clinical Oncology” and, since the same year, he has been member of the “Scientific Reports”. Even more, he was the reviewer of the following journals: Acta Orthopaedica (2012-2016), American Journal of Clinical Oncology (2006-2012), NioMed Research International (2016), BMC Cancer (2012), etc. BENGT WINBLADStarting from 2000, he has been the Head of the Division for Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society. Moreover, he has been the Director of the Clinical Trial Unit, Memory Clinic, Karolinska University Hospital, in Huddinge, starting from 2013, and Director of the Swedish Brain Power (Center for Early Diagnosis and Therapy Research for Neurodegenerative diseases – a Swedish Network), starting from 2005. From 2014 to 2015, he was Director of the Center for Alzheimer Research at Karolinska Institutet. Moreover, from 1987 to 2013 he was Chief Physician, at the Geriatric Clinic, Karolinska University Hospital, Huddinge, in Sweden. Regarding his professional activity, he is Chair of the EADC (European Alzheimer Disease Consortium), was Member of the Nobel Assembly for the Prize of Medicine and Physiology, in KI, in Stockholm (1988-2010) and also Chairman of the Department of Clinical Neuroscience and Family Medicine, in KI, Stockholm (1993-1999). Among all the awards he received, the following should be mentioned: 1997 – The Royal Swedish Academy of Medical Sciences Award for Dementia Research; 2002 – The Nordic Prize in Gerontology; 2008 – Award given by the Alzheimer’s Association, US, “Bengt Winblad Lifetime Achievement Awards in AD” to be given out every year at ICAD conferences; 2010 – Wajlit and Eric Forsgrens Award; 2013 – Research and Education Award 2013 by Queen Silvia Foundation; 2015 – The Swedish ”Hjärnfonden Jubilee Award”; 2016 – Alzheimer Association ”Henry Wisniewsky Life Time Achievement” award.As far as his publishing activity is concerned, he published a total number of 1270 papers, he has a number of 53.591 citations, and his h-index is 114. In the closing ceremony of the Congress, the Rector of “Carol Davila” University of Medicine and Pharmacy in Bucharest, Academician Ioanel Sinescu, especially thanked all the participants from the University, the whole country and abroad, and, at the same time, reminded them that “Carol Davila” University of Medicine and Pharmacy in Bucharest is the first university of medicine in Romania, which enjoys a well deserved prestige and recognition in the national and international academic environment, being a true leader of the Romanian medical education. Executive EditorProfessor Eng. Victor Lorin Purcarea, PhD.