Weight loss and outcomes in subjects with progressive pulmonary fibrosis: data from the INBUILD trial

BACKGROUND: Lower body mass index (BMI) and weight loss have been associated with worse outcomes in some studies in patients with pulmonary fibrosis. We analyzed outcomes in subgroups by BMI at baseline and associations between weight change and outcomes in subjects with progressive pulmonary fibrosis (PPF) in the INBUILD trial. METHODS: Subjects with PPF other than idiopathic pulmonary fibrosis were randomized to receive nintedanib or placebo. In subgroups by BMI at baseline (< 25, ≥ 25 to < 30, ≥ 30 kg/m2), we analyzed the rate of decline in FVC (mL/year) over 52 weeks and time-to-event endpoints indicating disease progression over the whole trial. We used a joint modelling approach to assess associations between change in weight and the time-to-event endpoints. RESULTS: Among 662 subjects, 28.4%, 36.6% and 35.0% had BMI < 25, ≥ 25 to < 30 and ≥ 30 kg/m2, respectively. The rate of decline in FVC over 52 weeks was numerically greater in subjects with baseline BMI < 25 than ≥ 25 to < 30 or ≥ 30 kg/m2 (nintedanib: - 123.4, - 83.3, - 46.9 mL/year, respectively; placebo: - 229.5; - 176.9; - 171.2 mL/year, respectively). No heterogeneity was detected in the effect of nintedanib on reducing the rate of FVC decline among these subgroups (interaction p = 0.83). In the placebo group, in subjects with baseline BMI < 25, ≥ 25 to < 30 and ≥ 30 kg/m2, respectively, 24.5%, 21.4% and 14.0% of subjects had an acute exacerbation or died, and 60.2%, 54.5% and 50.4% of subjects had ILD progression (absolute decline in FVC % predicted ≥ 10%) or died over the whole trial. The proportions of subjects with these events were similar or lower in subjects who received nintedanib versus placebo across the subgroups. Based on a joint modelling approach, over the whole trial, a 4 kg weight decrease corresponded to a 1.38-fold (95% CI 1.13, 1.68) increase in the risk of acute exacerbation or death. No association was detected between weight loss and the risk of ILD progression or the risk of ILD progression or death. CONCLUSIONS: In patients with PPF, lower BMI at baseline and weight loss may be associated with worse outcomes and measures to prevent weight loss may be required. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02999178

Spatial Distribution of Dung in Integrated Dairy Systems

Animals in grazing work as catalyst in the nutrient cycling processes of the ecosystems. Part of biomass that animal intake returning to soil in the degraded way like faeces and urine. The return is around 90% of the mineral nutrients, including nitrogen. However, it is necessary to know how these dejects are distributed on the area by animals. The environment management affects directly spatial distribution of these dejects. Drinking fountain, salt and feed trough, portress, rest area and shadow are structures that change the way that animal graze. Sward structure and herbage morphology affect the grazing behaviour as well. So, the objective this experiment was evaluate the spatial distribution of dung from dairy heifers in integrated systems of production at Mato Grosso, Brazil. The experiment was accomplished at Embrapa (Sinop/Mato Grosso/ Brazil). The experimental area was 10 ha divided in three systems: full sun, marginal shadowing (300 trees per ha) and intensive shadowing (750 trees per ha). Each system had different sizes, but 2.4 ha was useful area for all systems divided in 10 paddocks each. The tree used was Eucalyptus urograndis, H13 clone and the pasture was piata Grass (Urochloa brizantha). The grazing was done when the sward reached 95% light interception. It was evaluated a group of 24 breed heifers with 350 kg in three periods of year. Each paddock was divided in 25 grids for count of faeces boards. The spatial faeces distribution was evaluated with GPS, by walking and capturing points where there was faeces boards in all steps for the grassland paddocks, in three periods of year (rainy, rainy-drought transition and dry period). The dataset was analysed by SAS 9.2 version, using PROC MIXED and PDIFF to 5% of significance. The spatial distribution of dung had significant difference only in rainy-drought transition period (P=0.0165) and interaction effect between shadowing and site (P=0.0025) in this period of year and dry period as well (P=0. 0465). In both periods, the distribution was the same. The full sun system promoted more concentration of faeces boards in sites next portress and border fence in site opposite to portress. In marginal shadowing system, the major concentration was in the central area and under shadow. In intensive shadowing system, the major concentration of dung boards was under shadow, sites preferred by heifers for rumination and leisure activities. The kind of shade and the year periods affected in spatial dung distribution. There were places with more dung concentration, in all kind of shade, but when the pasture had the intensive shade, the dispersion was more homogeneous. Unlike expected, the dung deposition didn?t happens only under treetops. The distribution is more homogeneous when trees are in large quantities. The shadow area available in the grassland affected the spatial dung distribution, and can be more homogeneous than no shadow

Toxidez por alumínio e a seleção de plantas tolerantes com base na expressão fenotípica.

bitstream/CPACT-2010/12324/1/documento-265.pd

Produção de Tifton 85 no primeiro ciclo de pastejo em área irrigada e de sequeiro: 2012/2013.

Salão do conhecimento

StarHorse: A Bayesian tool for determining stellar masses, ages, distances, and extinctions for field stars

Understanding the formation and evolution of our Galaxy requires accurate distances, ages and chemistry for large populations of field stars. Here we present several updates to our spectro-photometric distance code, that can now also be used to estimate ages, masses, and extinctions for individual stars. Given a set of measured spectro-photometric parameters, we calculate the posterior probability distribution over a given grid of stellar evolutionary models, using flexible Galactic stellar-population priors. The code (called {\tt StarHorse}) can acommodate different observational datasets, prior options, partially missing data, and the inclusion of parallax information into the estimated probabilities. We validate the code using a variety of simulated stars as well as real stars with parameters determined from asteroseismology, eclipsing binaries, and isochrone fits to star clusters. Our main goal in this validation process is to test the applicability of the code to field stars with known {\it Gaia}-like parallaxes. The typical internal precision (obtained from realistic simulations of an APOGEE+Gaia-like sample) are $\simeq 8\%$ in distance, $\simeq 20\%$ in age,$\simeq 6\$ in mass, and $\simeq 0.04$ mag in $A_V$. The median external precision (derived from comparisons with earlier work for real stars) varies with the sample used, but lies in the range of $\simeq [0,2]\%$ for distances, $\simeq [12,31]\%$ for ages, $\simeq [4,12]\%$ for masses, and $\simeq 0.07$ mag for $A_V$. We provide StarHorse distances and extinctions for the APOGEE DR14, RAVE DR5, GES DR3 and GALAH DR1 catalogues.Comment: 21 pages, 12 figures, accepte

Alveolar fluid in acute respiratory distress syndrome promotes fibroblast migration: role of platelet-derived growth factor pathway

OBJECTIVES: Fibroblast migration is an initiating step in fibroproliferation; its involvement during acute lung injury and acute respiratory distress syndrome remains poorly understood. The aims of this study were: 1) to determine whether bronchoalveolar lavage fluids from patients with acute lung injury/acute respiratory distress syndrome modulate lung fibroblast migration; 2) to assess lung fibroblast migration\u27s clinical relevance; and 3) to evaluate the role of the platelet-derived growth factor pathway in this effect. DESIGN: Prospective cohort study. SETTING: Three intensive care units of a large tertiary referral center. PATIENTS: Ninety-three ventilated patients requiring bronchoalveolar lavage fluids were enrolled (48 with acute respiratory distress syndrome, 33 with acute lung injury, and 12 ventilated patients without acute lung injury/acute respiratory distress syndrome). INTERVENTIONS: After bronchoalveolar lavage fluids collection during standard care, the patients were followed up for 28 days and clinical outcomes were recorded. Migration assays were performed by using a Transwell model; bronchoalveolar lavage fluids platelet-derived growth factor and soluble platelet-derived growth factor receptor-alpha were characterized by Western blot and measured by ELISA. MEASUREMENTS AND MAIN RESULTS: Most of the bronchoalveolar lavage fluids inhibited basal fibroblast migration. Bronchoalveolar lavage fluids chemotactic index increased with severity of lung injury (28% in patients without acute lung injury/acute respiratory distress syndrome and with acute lung injury vs. 91% in acute respiratory distress syndrome patients; p = .016). In acute lung injury/acute respiratory distress syndrome patients, inhibition of basal fibroblast migration by bronchoalveolar lavage fluids below 52% was independently associated with a lower 28-day mortality (odds ratio [95% confidence interval] 0.313 [0.10-0.98], p = .046). Platelet-derived growth factor-related peptides and soluble platelet-derived growth factor-Ralpha were detected in all bronchoalveolar lavage fluids from acute lung injury/acute respiratory distress syndrome patients. The effect of bronchoalveolar lavage fluids stimulating migration was inhibited by a specific platelet-derived growth factor receptor inhibitor (AG1296). Bronchoalveolar lavage fluids inhibiting migration reversed the effect of rh-platelet-derived growth factor-BB and reduced by 40% the binding of 125I-platelet-derived growth factor-BB to fibroblast cell surface in favor of a role for platelet-derived growth factor-sRalpha. CONCLUSIONS: : Together, our results suggest that during acute lung injury, fibroblast migration is modulated by bronchoalveolar lavage fluids through a platelet-derived growth factor/platelet-derived growth factor-sRalpha balance. Migration is associated with clinical severity and patient 28-day mortality

Plaster Layout Process in Civil Works with a Focus on Clean Production

The constant expansion of civil construction and the increasing use of plaster gives rise to a solid waste generation problem causing difficulties for the disposal or reuse of this material. The generation of plaster waste represents an economic problem, with serious consequences and impacts. In order to contribute to sustainability, this study sought to evaluate the reduction of plaster waste in an apartment construction project, employing the layout method. With the adequate arrangement of plates, a reduction of 4.41% in the use of plaster could be obtained, This reduction will consequently result in the minimization of waste from civil works, bringing invaluable economic and environmental benefits

Safety and survival data in patients with idiopathic pulmonary fibrosis treated with nintedanib: Pooled data from six clinical trials

Introduction Nintedanib slows disease progression in patients with idiopathic pulmonary fibrosis (IPF) by reducing the rate of decline in forced vital capacity, with an adverse event profile that is manageable for most patients. We used data from six clinical trials to characterise the safety and tolerability profile of nintedanib and to investigate its effects on survival. Methods Data from patients treated with 651 dose of nintedanib 150 mg two times per day or placebo in the 52-week TOMORROW trial and/or its open-label extension; the two 52-week INPULSIS trials and/or their open-label extension, INPULSIS-ON; and a Phase IIIb trial with a placebo-controlled period of 656 months followed by open-label nintedanib were pooled. All adverse events, irrespective of causality, were included in descriptive analyses. Parametric survival distributions were fit to pooled Kaplan-Meier survival data from the trials and extrapolated to estimate long-term survival. Results There were 1126 patients in the pooled nintedanib group and 565 patients in the pooled placebo group. The mean duration of nintedanib treatment was 28 months. No new safety signals were observed. Incidence rates of bleeding, liver enzyme elevations and cardiovascular events were consistent with those observed in the INPULSIS trials. Diarrhoea was reported at a lower event rate in the pooled nintedanib group than in nintedanib-treated patients in the INPULSIS trials (76.5 vs 112.6 events per 100 patient exposure-years) and infrequently led to permanent treatment discontinuation (3.6 events per 100 patient exposure-years). Based on the Weibull distribution, mean (95% CI) survival was estimated as 11.6 (9.6, 14.1) years in nintedanib-treated patients and 3.7 (2.5, 5.4) years in placebo-treated patients. Conclusions Based on pooled data from six clinical trials, the adverse event profile of nintedanib was manageable for most patients. Exploratory analyses based on extrapolation of survival data suggest that nintedanib extends life expectancy in patients with IPF