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

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

In vitro efficacy of the essential oil of Piper cubeba L. (Piperaceae) against Schistosoma mansoni

In this paper, cercariae, schistosomula, and adult Schistosoma mansoni worms were incubated in vitro with the essential oil of Piper cubeba (PC-EO) at concentrations from 12.5 to 200 mu g/mL, and the viability was evaluated using an inverted microscopy. The effects of PC-EO at 100 and 200 mu g/mL on the stages of S. mansoni were similar to those of the positive control (PZQ at 12.5 mu g/mL), with total absence of mobility after 120 h. However, at concentrations from 12.5 to 50 mu g/mL, PC-EO caused a reduction in the viability of cercariae and schistosomula when compared with the negative control groups (RPMI 1640 or dechlorinated water) or (RPMI 1640 + 0.1% DMSO or dechlorinated water + 0.1% DMSO). On the other hand, adult S. mansoni worms remained normally active when incubated with PC-EO at concentrations of 12.5 and 25 mu g/mL, and their viabilities were similar to those of the negative control groups. In addition, at concentrations ranging from 50 to 200 mu g/mL, separation of all the coupled adult worms was observed after 24 h of incubation, which is related to the fact of the reduction in egg production at this concentration. The main chemical constituents of PC-EO were identified by gas chromatography-mass spectrometry as being sabinene (19.99%), eucalyptol (11.87%), 4-terpineol (6.36%), beta-pinene (5.81%), camphor (5.61%), and delta-3-carene (5.34%). The cytotoxicity of the PC-EO was determined, and a significant cytotoxicity was only obtained in the concentration of 200 mu g/mL after 24 h treatment. The results suggest that PC-EO possesses an effect against cercariae, schistosomula, and adult worms of the S. mansoni.CNPqCNPqFAPESPFAPESPFAPESPFAPESP [2009/15207-4, 2007/54241-8

Outcomes in Critically Ill Patients with Cancer-Related Complications

<div><p>Introduction</p><p>Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients.</p><p>Materials and Methods</p><p>Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality.</p><p>Results</p><p>Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (<i>P</i><0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (<i>P</i><0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94–1.66), <i>P</i> = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11–12.92), <i>P</i> = 0.033], gastrointestinal involvement [OR = 3.05 (1.57–5.91), <i>P</i> = <0.001] and respiratory failure [OR = 1.96(1.04–3.71), <i>P</i> = 0.038] were independently associated with in-hospital mortality.</p><p>Conclusions</p><p>The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication <i>per se</i> should not guide decisions to admit a patient to ICU.</p></div

Land use and occupation analysis of Permanent Preservation Areas in Lavras County, MG Análise do uso e ocupação da terra em Áreas de Preservação Permanente no município de Lavras, MG

The Permanent Preservation Areas (PPAs) are considered essential for the maintenance of local biodiversity, so that your protection is regulated by the Brazilian legislation. This work had the objective of delimiting permanent preservation areas according to determinations of the current Brazilian environmental legislation, and identify the occurrence of conflict between the land use and legislation in Lavras county, MG, by combination of technologies of remote sensing and geographic information systems. The PPAs correspond to 42.33% of Lavras county's territory. The conflict between the land use and environmental legislation occurs in 63.48% of PPAs' territory, mainly corresponding to the pasture areas, bare soil and agriculture. The PPAs of tops of hills showed the highest conflicts with the legislation, with 48.48% of the territory occupied by pastures, and 13.62% by agriculture. The PPAs located in the surrounding of water courses and in the slopes with declivity higher than 45º presented 59.99% and 92.03%, respectively of the territory occupied by native vegetation of semi-deciduous forest and natural fields.<br>As Áreas de Preservação Permanente (APPs) são consideradas essenciais para a manutenção da biodiversidade local, de modo que a sua proteção é regulamentada pela legislação brasileira. Neste trabalho, objetivou-se delimitar as áreas de preservação permanente de acordo com as determinações da legislação ambiental brasileira vigente, e identificar a ocorrência de conflito entre o uso da terra e a legislação no município de Lavras, MG, mediante a combinação de tecnologias de sensoriamento remoto e sistemas de informações geográficas. As APPs correspondem a 42,33% do território do munícipio de Lavras. O conflito entre o uso da terra e a legislação ambiental ocorre em 63,48% do território das APPs, correspondendo principalmente as áreas de pastagem, solo exposto e agricultura. As APPs de topos de morro foram as que apresentaram maiores conflitos com a legislação, com 48,48% do seu território ocupado por pastagens e 13,62% ocupado pela agricultura. As APPs localizadas no entorno dos cursos d'água e nas encostas com declividade superior a 45º apresentaram, respectivamente, 59,99% e 92,03% do seu território ocupados por vegetação nativa de floresta semidecídua e campos naturais

Multivariable analysis of variables associated with hospital mortality.

<p>Multivariable analysis of variables associated with hospital mortality.</p

Multivariable analysis and adjusted odds ratios for hospital mortality of critically ill patients with cancer-related complications.

<p>Odds ratios greater than 1.0 indicate an increased risk of death. Constant: -4.476. Hosmer-Lemeshow goodness-of-fit (<i>χ</i>² = 7.270; <i>P</i> = 0.508). CI = confidence interval.</p