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

Suscetibilidade de cercas-vivas, quebra-ventos e plantas invasoras ao vírus da leprose e sua transmissão para laranjeiras por Brevipalpus phoenicis (Geijskes) (Acari: Tenuipalpidae)

Objetivou-se avaliar a potencialidade de algumas plantas freqüentes em pomares cítricos de hospedar o vírus da leprose, transmitido por Brevipalpus phoenicis (Geijskes). Foram utilizadas as seguintes plantas: Hibiscus sp. L., Malvaviscus mollis DC., Grevillea robusta A. Cunn., Mimosa caesalpiniaefolia Benth., Bixa orellana L., Commelina benghalensis L., Bidens pilosa L., Sida cordifolia L. e Ageratum conyzoides L.. Duas criações-estoque do ácaro foram realizadas, sendo uma sobre frutos com sintomas de leprose e outra sobre frutos sem sintomas. de cada planta hospedeira do ácaro, escolheram-se duas folhas, delimitando-se na face inferior de cada planta uma área, que recebeu ácaros criados sobre frutos com lesões de leprose, que aí permaneceram durante sete dias. Os ácaros foram em seguida transferidos para mudas cítricas das variedades Natal e Valência e mantidos em casa de vegetação. As folhas das diferentes espécies vegetais sobre as quais os ácaros estavam anteriormente, foram destacadas e conservadas em placas de Petri, sobre algodão e papel-filtro umedecido. Ácaros criados sobre frutos sem lesões de leprose foram mantidos por três dias sobre essas folhas e, posteriormente, transferidos para novas mudas cítricas, que também foram subseqüentemente mantidas em uma casa de vegetação. Após 60 dias, quantificou-se o número de lesões de leprose nas mudas cítricas. Os resultados evidenciaram que o ácaro não perdeu a capacidade de transmissão do vírus para mudas cítricas após acesso alimentar por sete dias sobre qualquer uma das plantas intermediárias consideradas no estudo. Ácaros provenientes de frutos sem lesões de leprose adquiriram o vírus da leprose e o transmitiram a mudas cítricas quando tiveram acesso alimentar a C. benghalensis, A. conyzoides, B. pilosa, S. cordifolia e B. orellana, onde, anteriormente, ácaros criados sobre frutos com lesões de leprose permaneceram por sete dias. Estes resultados evidenciam a potencialidade de estas plantas serem depositárias e fonte de transmissão do vírus para plantas cítricas suscetíveis.The objective was to evaluate the potential of some common plants in and around citrus orchards to host the leprosies virus, transmitted by the mite Brevipalpus phoenicis (Geijskes).It was used the following plants: Hibiscus sp. L., Malvaviscus mollis DC., Grevillea robusta A. Cunn., Mimosa caesalpiniaefolia Benth., Bixa orellana L., Commelina benghalensis L., Bidens pilosa L., Sida cordifolia L. and Ageratum conyzoides L.. Two stock colonies of the mite were set up; one on fruits with leprosies symptoms and other on fruits without symptoms. Two leaves were selected from each host plant, on which mites reared on fruits with leprosies lesions, and were confined during seven days. Subsequently, the mites were transferred to citrus seedlings variety Natal and Valencia and taken to a greenhouse. The leaves infested with mites were removed and placed on cotton and filter paper in Petri dishes. Mites reared on fruit without leprosies lesions were allowed to feed on the host plant leaves during three days, and were then transferred to citrus seedlings, which were taken to the greenhouse. After 60 days, the number of lesions on the citrus seedlings was counted. The mites continued to transmit the virus to citrus seedlings, even after seven days of feeding on the host plants. Mites reared on fruit without leprosies lesions, acquired the virus and transmitted it to citrus seedlings when kept on C. benghalensis, A. conyzoides, B. pilosa, S. cordifolia or B. orellana leaves on where mites from leprosies lesions had been previously reared. It was conclude that these plants can be depositories and sources for transmission of leprosies virus to susceptible citrus plants.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Transmissibilidade do vírus da leprose de cercas-vivas, quebra-ventos e plantas daninhas para laranjeiras através de Brevipalpus phoenicis (Geijskes)

O ácaro Brevipalpus phoenicis (Geijskes) é transmissor do vírus da leprose dos citros, doença responsável por significativa redução da produtividade. Objetivou-se avaliar neste trabalho a possibilidade de algumas plantas utilizadas como cercas-vivas e quebra-ventos, além de plantas daninhas de pomares cítricos serem hospedeiras do vírus da leprose. O experimento foi realizado em laboratório e casa-de-vegetação na FCAV/UNESP, Jaboticabal-SP-Brasil. de uma criação-estoque de ácaros, criados sobre frutos de citros (Citrus sinensis) contendo lesões de leprose, foram transferidos 100 ácaros para uma unidade experimental das seguintes espécies: Hibiscus sp., Malvaviscus mollis, Grevillea robusta, Mimosa caesalpiniaefolia, Bixa orellana, Commelina benghalensis, Sida cordifolia, Ageratum conyzoides e Citrus sinensis, e mantidas em casa de vegetação por um período de 90 dias. Depois desse período, 160 ácaros foram recuperados dessas espécies vegetais e transferidos para quatro mudas das variedades cítricas 'Natal' e 'Valência' (20 ácaros/planta), e foram mantidas por 60 dias em casa de vegetação. Decorrido esse período, quantificou-se o número de lesões de leprose presentes nas folhas, ramos e caules das mudas cítricas. em mudas cítricas da variedade 'Natal', foram observados sintomas da leprose decorrentes da transferência de ácaros provenientes de C. sinensis, A. conyzoides, C. benghalensis e B. orellana. Na variedade 'Valência', sintomas de leprose ocorreram em mudas infestadas com ácaros criados sobre C. sinensis, S. cordifolia benghalensis, B. orellana e A. conyzoides. Mudas cítricas das variedades 'Natal' e 'Valência' não manifestaram sintomas de leprose com ácaros procedentes de M. mollis, Hibiscus sp., G. robusta e M. caesalpiniaefolia.The mite Brevipalpus phoenicis (Geijskes) is a vector of the citrus leprosies virus, a disease that significantly reduces orange production. We examined whether some plant species used in hedgerows or as windbreaks, as well as various weeds found within the orchard, could serve as alternative hosts for the leprosis virus. This experiment was done in a greenhouse at FCAV/UNESP, Jaboticabal-SP-Brasil. One hundred mites were transferred from a stock colony, which was reared on citrus fruits (Citrus sinensis) that had leprosis lesions, to each of the following plant species: Hibiscus sp., Malvaviscus mollis, Grevillea robusta, Mimosa caesalpiniaefolia, Bixa orellana, Commelina benghalensis, Sida cordifolia, Ageratum conyzoides and Citrus sinensis. These artificially-infested plants were maintained in a greenhouse for 90 days. After this period, 160 mites were recovered from each of these plant species and were transferred to four small citrus trees of the varieties 'Natal' and 'Valência' (20 mites/plant). These were maintained for 60 days in a greenhouse. After this period, the number of leprosis lesions were counted on the leaves, branches and stems of the citrus trees. 'Natal' trees had leprosis symptoms when infested with mites from C. sinensis, A. conyzoides, C. benghalensis and B. orellana. 'Valência' trees were affected when infested with mites from C. sinensis, S. cordifolia, C. benghalensis, B. orellana and A. conyzoides. Neither of these citrus varieties was affected when infested with mites from M. mollis, Hibiscus sp., G. robusta, or M. caesalpiniaefolia.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Efeito da adição de óleos mineral e vegetal a acaricidas no controle do ácaro-da-leprose dos citros Brevipalpus phoenicis (Geijskes) (Acari: Tenuipalpide)

Com a finalidade de esclarecer os efeitos da adição de óleo vegetal e mineral aos acaricidas foi conduzido um ensaio de campo em 1994 no município de Viradouro, SP, utilizando-se de Assist, Triona e Natur'l Óleo, na dosagem de 500 mL por 100 litros de água, adicionados aos acaricidas: pyridaben nas formulações 200 CE e 750 PM, nas dosagens de 75 mL e 20 g; propargite 720 CE a 100 mL; óxido de fenbutatina 500 SC a 80 mL e cyhexatin 500 PM a 50 g. O delineamento estatístico adotado foi o de blocos casualizados. As aplicações foram feitas com pulverizador tipo pistola. Após a preparação da calda, foi determinado o pH. Empregou-se máquina de varredura e microscópio estereoscópico para as avaliações da população acarina. A adição de Natur'l Óleo pode afetar negativamente a eficiência do pyridaben 200 CE e 750 PM e cyhexatin 500 PM, no controle do ácaro-da-leprose. Triona e Assist não afetaram as eficiências dos acaricidas testados. Pelo índice de iodo, mediu-se o grau de insaturação das misturas dos acaricidas com Natur'l Óleo, concluindo-se que houve incorporação das moléculas dos acaricidas pelas ligações insaturadas do óleo; porém, isto não explica o diferente comportamento dos produtos no controle do ácaro da leprose dos citros.Aiming to study the influence of adition of oil to acaricides, a field experiment was conducted in 1994, at Viradouro, SP, using Assist, Triona and Natur'l Óleo, in dosages of 500 mL per 100 liters of water, added to the acaricides: pyridaben (formulations 200 EC and 750 WP) at 75 mL and 20 g; propargite 720 EC at 100 mL; fenbutatine oxide 500 SC at 80 mL; and cyhexatin 500 WP at 50 g. The experimental design used was randomized blocks. The applications were carried out by a gun sprayer. After the preparation of the solution, the pH was determined. The brushing machine and the steroscopic microscope were used to estimate the mite populations. The addition of Natur'l Óleo can affect negatively the efficiency of acaricides in the control of the citrus leprosis mite, as occured with pyridaben 200 EC and 750 WP and cyhexatin 500 WP. Triona and Assist did not affect the efficiency of the acaricides tested. The insaturation level of the acaricide mistures with Natur'l Óleo was measured using the iodine index method indicating that there was incorporation of the acaricide molecules by the insaturated links of the oil; however, this doesn't explain the different behavior of the products in the control of the citrus leprosis mite

Residual toxicity of the main pesticides recommended in citrus orchards on predaceous mite Neoseiulus californicus (McGregor) (Acari: Phytoseiidae)

This work was carried out to determine the residual toxicity of the main pesticides used in citrus, on Neoseiulus californicus (McGregor) under laboratory conditions. For this, it was used the residual contact bioassay. Citrus leaves of the variety Pêra were sprayed in a Potter tower. The residual action was evaluated at 2 hours and 1; 3; 5; 7; 10; 14 e 21 days after treatment. Ten adult females of N. californicus were transferred to each ring, together with an enough amount of Tetranychus urticae nymphs and adults to feed the predator. Mortality evaluations were performed at 72 hours after treatment. Bioassays indicate that the pesticides: acrinathrin, deltamethrin, dinocap, sulphur, fenpropathrin, fenbutatin oxide and propargite were innocuous to N. californicus. On the other hand, abamectin, azocyclotin e cyhexatin caused mortalities of 29.8; 32.0 e 34.1%, respectively, two hours after transference. Dicofol, pyridaben and chlorfenapyr were extremely toxic to the predator mite, causing 100% of mortality two hours after the application. This way, to this population of N. californicus, the releases can be performed safely 3 days after the application, except for cyhexatin (5 days), dicofol and pyridaben (14 days) and chlorfenapyr (21 days), without risk of significant adult mortality rates due to the application of pesticides