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

Desproporção congênita de fibras: atrofia de fibras tipo I- relato de 11 casos

Os autores relatam 11 casos de desproporção congênita de fibras, comprovados pelos exames clínicos e complementares, em que as retrações fibrotendinosas precoces foram freqüentes, o CPK mostrou-se elevado e, na biópsia muscular, a histoquímica revelou atrofia seletiva das fibras tipo I. Trata-se de distrofia congênita pouco freqüente, de progressão lenta e evolução benigna

Associação de fases meióticas e estádios dos micrósporos com características morfológicas de botões florais de pimentão Association of meiotic phases and microspore stages with morphological characters of floral buds of pepper

Fases meióticas e estádios de micrósporos de pimentão (Capsicum annuum L. cv. Azeth) foram determinados e associados com características morfológicas adotadas para a seleção de botões florais a serem utilizados na indução de androgênese. Plantas foram mantidas em casa-de-vegetação para coleta dos botões florais, que foram separados em seis classes de acordo com a relação de tamanho entre cálice e corola e presença de pigmentos nas anteras. As anteras foram fixadas em metanol: ácido acético na proporção de 3:1 e armazenadas a -20º C. Preparações citogenéticas desse material foram montadas pela técnica de dissociação e secagem ao ar e coradas com solução de Giemsa. As observações dos botões foram realizadas sob lupa e as preparações citogenéticas em microscópio ótico. Imagens dos botões florais, das anteras e das fases meióticas foram digitalizadas em computador para documentação. Variações de fases meióticas dentro de cada classe de botão floral foram observadas. Embora o critério de presença de antocianina na extremidade das anteras tenha sido aplicado para outras variedades, o mesmo não se mostrou adequado para a determinação do estádio de micrósporo neste estudo. As fases meióticas foram citogeneticamente identificadas; contudo, não foi possível estabelecer sua associação com as classes dos botões florais. Entretanto, botões com o tamanho de cálice coincidindo com o da corola apresentaram maior número de micrósporos em estádio adequado para a cultura de anteras.<br>In the present study, morphological characters adopted for floral bud selection used for androgenesis induction were associated with pepper (Capsicum annuum L. cv. Azeth) meiotic phases and microspore stages. Floral buds were harvested from greenhouse-grown plants and separated into six classes according to size relationships between calyx and corolla, and anthocyanin pigmentation in anthers. After sorting by size, buds were fixed using a methanol: acetic acid (3:1) solution at -20ºC. Cytogenetic preparations were mounted using an adaptation of an air-drying technique and staining through a phosphate buffer Giemsa solution. Bud observations were accomplished under a stereo-microscope and the cytogenetic preparations in an optic microscope. Recordings of floral buds and meiotic phases were performed with an image digitizing computer system. Variations on the meiotic phases were observed within each class. Although the approach based on anthocyanin pigmentation on anthers has been applied to another pepper varieties, it was not a reliable trait for determination of the microspore stage. Meiotic phases were citogeneticaly identified, although bud stage could not be associated with it. On the other hand, buds having the same calyx and corolla sizes presented a larger number of microspores in a suitable stage for anther culture

A concepção socialista da educação e os atuais paradigmas da qualificação para o trabalho: notas introdutórias The socialist concept of education and the current paradigms of the qualification to work: some questions

A literatura educacional brasileira inspirou-se nas idéias socialistas para apresentar propostas alternativas para a escola. No entanto, o socialismo real entrou em crise. Viria essa situação abalar os ideais socialistas de uma escola para todos? Neste texto, argumenta-se que o socialismo real, devido às suas contradições internas, não foi, no Brasil, referência para o debate sobre a concepção socialista da escola. Este fundamentou-se mais na filosofia política do socialismo do que na prática concreta das sociedades do leste europeu. No entanto, o conceito socialista da escola, tanto quanto antes da débâcle do socialismo real, permanece confuso. A unidade das formações geral e técnica, tema relevante desse ideário, vem sendo retomada em face de demandas contemporâneas do capitalismo, no campo da qualificação profissional, exigindo novas pesquisas sobre o assunto.<br>The Brazilian educational literature was inspired by socialist ideas to present alternative scholastic proposals. However real socialism fell into crisis. Will this situation affect the socialist ideals about a quality public school for everybody? In this text we support the argument that real socialism, owing to its inherent contradictions, did not give references, in Brazil, to the debate on a socialist concept of education. This was influenced more by the political philosophy of socialism than by the concrete practise of the societies of eastern Europe. However, the socialist concept of school remains today as confused as it was before the débâcle of real socialism. Actually, the unity of general and technical education that is the relevant theme on this conception is again undergoing demands of capitalism in the field of professional qualification, so requiring new research on the subject

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.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt