Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Condições de ambiente favoráveis à germinação e à infecção de Puccinia substriata var. penicillariae em diferentes cultivares de milheto pérola

A ferrugem do milheto (Pennisetum glaucum), causada por Puccinia substriata var. penicillariae, provoca perdas na produção da forragem. Tendo em vista a escassez de informações sobre a doença no Brasil realizou-se o presente trabalho sobre a sua epidemiologia. Avaliaram-se, em casa-de-vegetação, o período latente médio, a freqüência de infecção e tamanho das lesões da ferrugem em quatro genótipos de milheto: ENA 1, Composto II, BRS 1501 e HKP. In vitro, monitorou-se a germinação dos urediniósporos em diferentes temperaturas (10, 15, 20 e 25ºC), na presença ou não de luz. Após isto, avaliou-se o processo de infecção nos genótipos Guerguera, Souna III, BRS 1501 e ENA 1, em câmara de crescimento, utilizando-se 0, 1, 2, 4, 8 e 12 h de molhamento foliar, na presença ou não de luz, e em casa-de-vegetação, nos genótipos ENA 1, Guerguera e Souna III, utilizando-se 3/4, 1, 2, 4, 6 e 8 h de molhamento foliar. O período latente médio da ferrugem do milheto variou entre 10 e 12 dias, e os urediniósporos germinaram em faixa ampla de temperatura, de 10ºC a 25ºC, na presença ou não de luz, com germinação máxima a 17,5ºC no escuro. Nestas condições, os primeiros esporos germinaram com menos de 45 min. e atingiram taxa máxima, 88,2%, em 1,7 h de incubação. Infecções de folhas foram observadas em plantas submetidas a apenas 45 min de molhamento foliar após a inoculação, porém, com efeito benéfico do escuro e do aumento do período de molhamento foliar.The rust caused by Puccinia substriata var. penicillariae in Pearl millet (Pennisetum glaucum) induces yield losses in this forage crop. Considering the lack of information about this disease in Brazil, this research on its epidemiology has been carried out. The mean latency period, the frequency of infection process and size of lesions on four genotypes of pearl millet (Pennisetum glaucum) ENA 1, Composto II, BRS 1501 and HKP were evaluated in the greenhouse. In vitro, the germination of the urediniospores was monitored at different temperatures (10, 15, 20 and 25ºC), with or without light. After this, the infection process was compared for the genotypes Guerguera, Souna III, BRS 1501 and ENA 1, in a growth chamber, with the leaf wetting time of 0, 1, 2, 4, 8 and 12 hours, with or without light, and in greenhouse, on the genotypes ENA 1, Guerguera and Souna III, with the leaf wetting times of 3/4, 1, 2, 4, 6 and 8 hours. A mean latency period for pearl millet rust between 10 and 12 days was shown, and the urediniospores germinated in a wide range of temperatures, from 10 to 25ºC, with or without light, with a maximum germination at 17.5ºC in the dark. In these conditions, the germination of first spores initiated for less than 45 min at a maximum percentage of 88.2%, with 1.7 h of incubation. Leaf infection can also start after 45 min of leaf wetting after inoculation, but there is a beneficial effect of dark and longer leaf wetting time