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

Influence of the family nucleus on obesity in children from northeastern Brazil: a cross-sectional study

Abstract Background Obesity is considered to be caused by a combination of heredity and environmental factors with typical onset during childhood. The aim of this study was to identify family risk factors for the development of obesity in children from Brazil. Methods Cross-sectional study with 699 children, randomly and proportionally selected, ranging from 5 to 9 years of age, from public and private schools in Feira de Santana-BA. Overweight and obesity were defined using IOTF standards. Analyses of the interviews with the children's guardians were used to determine the influence of the family nucleus on obesity. Results The children were classified into four groups based on weight percentiles (underweight, normal, overweight and obese). Significant differences between the groups in relation to ethnicity, social and economical status (ρ = 000.0 for all) were found. The following variables were associated with the development of childhood obesity: fathers' obesity (ρ = 0.001), mothers' (ρ = 0.021) and both parents' (ρ = 0.000). There was no significant statistical difference between fathers and mothers who did (ρ = 0.81) or did not work out (ρ = 0.15). Obesity (ρ = 0.07) tended to be less prevalent in the child whose parents were separated. Family history of obesity (OR = 3.3; IC = 2.0 – 5.5; ρ = 0.000) and high social class (OR = 3.0; IC = 1.1 – 7.7; ρ = 0.020) were predictive and independent associated factors. Conclusion This study confirms the influence of genetic and/or behavioral factors on the origin of childhood obesity. Thus, effective intervention strategies must be focused not only on the children but on the entire family nucleus.</p

A new heparan sulfate from the mollusk Nodipecten nodosus inhibits merozoite invasion and disrupts rosetting and cytoadherence of Plasmodium falciparum

Submitted by Manoel Barata ([email protected]) on 2019-06-27T15:34:18Z No. of bitstreams: 1 1678-8060-mioc.pdf: 520671 bytes, checksum: 678320acb1c80df35766372da3fa46c9 (MD5)Approved for entry into archive by Manoel Barata ([email protected]) on 2019-07-12T19:40:48Z (GMT) No. of bitstreams: 1 1678-8060-mioc.pdf: 520671 bytes, checksum: 678320acb1c80df35766372da3fa46c9 (MD5)Made available in DSpace on 2019-07-12T19:40:48Z (GMT). No. of bitstreams: 1 1678-8060-mioc.pdf: 520671 bytes, checksum: 678320acb1c80df35766372da3fa46c9 (MD5) Previous issue date: 2019Universidade Estadual de Campinas. Departamento de Genética, Evolução, Microbiologia e Imunologia. Laboratório de Doenças Tropicais. Campinas, SP, Brasil.Fundação Oswaldo Cruz. Instituto Carlos Chagas. Curitiba, PR, Brasil.Cleveland Clinic Lerner Research Institute. Department of Biomedical Engineering. Cleveland, OH, USA.Fundação Oswaldo Cruz. Instituto Leônidas e Maria Deane. Manaus, AM, Brasil.Universidade Estadual de Campinas. Departamento de Biologia Estrutural e Funcional. Campinas, SP, Brasil.Fundação Oswaldo Cruz. Instituto Carlos Chagas. Curitiba, PR, Brasil.Universidade Estadual de Campinas. Departamento de Genética, Evolução, Microbiologia e Imunologia. Laboratório de Doenças Tropicais. Campinas, SP, Brasil.Universidade Federal do Rio de Janeiro. Centro de Ciências da Saúde. Instituto de Ciências Biomédicas. Hospital Clementino Fraga Filho. Laboratório de Tecido Conjuntivo. Rio de Janeiro, RJ, Brasil.Universidade Estadual de Campinas. Departamento de Bioquímica e Biologia Tecidual. Campinas, SP, Brasil.Universidade Federal do Rio de Janeiro. Instituto de Bioquímica Médica Leopoldo Meis. Programa de Glicobiologia. Rio de Janeiro, RJ, Brasil.Universidade Estadual de Campinas. Departamento de Genética, Evolução, Microbiologia e Imunologia. Laboratório de Doenças Tropicais. Campinas, SP, Brasil.Despite treatment with effective antimalarial drugs, the mortality rate is still high in severe cases of the disease, highlighting the need to find adjunct therapies that can inhibit the adhesion of Plasmodium falciparum-infected erythrocytes (Pf-iEs). In this context, we evaluated a new heparan sulfate (HS) from Nodipecten nodosus for antimalarial activity and inhibition of P. falciparum cytoadhesion and rosetting. Parasite inhibition was measured by SYBR green using a cytometer. HS was assessed in rosetting and cytoadhesion assays under static and flow conditions using Chinese hamster ovary (CHO) and human lymphatic endothelial cell (HLEC) cells expressing intercellular adhesion molecule-1 (ICAM1) and chondroitin sulfate A (CSA), respectively. As findings, hast this HS inhibited merozoite invasion similar to heparin. Moreover, mollusk HS decreased cytoadherence of P. falciparum to CSA and ICAM-1 on the surface of endothelial cells under static and flow conditions. In addition, this glycan efficiently disrupted rosettes