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

Evaluation of marine microalgae Lingulodinium polyedrum exposed to phenol: biotransformation and antioxidant activity

Devido à necessidade de se conhecer os impactos que as diversas atividades antropogênicas exercem sobre os ecossistemas torna-se relevante o estudo dos organismos aquáticos perante os resíduos tóxicos resultantes, com o objetivo de facilitar a identificação de áreas poluiídas ou contaminadas e estudos de meios atingidos por estes agentes poluentes. Estudo da microalga em contato com o fenol em concentrações conhecidas, compreende a determinação dos efeitos tóxicos e geração de metabólitos, caracterizando uma possível utilização deste microorganismo como bioindicador para contaminações do poluente. Determinou-se as concentrações de fenol capazes de em 24 horas inibirem o crescimento das células de L. polyedrum em 20 e 50% (IC 20 e IC 50) respectivamente 40 µmol.L-1 e 120 µmol.L-1. Identificou-se a necessidade de padronização das variáveis na execução dos ensaios dose-resposta com algas, permitindo construir protocolos que auxiliariam a obtenção de legislações que assegurem os limites de compostos tóxicos aos organismos costeiros. Calculou-se que a microalga L. polyedrum possui uma taxa de biodegradação do fenol por célula na média de aproximadamente (0,02 µmol.h-1.cel-1), capaz de biotransformar 120 µmol.L-1 de fenol em um período de 16 horas. Vias de biotransformação do fenol na microalga L.polyedrum se dão pela conjugação com a glutationa, catalisada por glutationa S-transferase e pela via metabólica de fenol hidroxilase e catecol 2,3-dihidroxigenase. Identificou-se a geração do ácido 2-hidroximucônico semialdeído, 1,2-dihidroxibenzeno (Catecol) e ácido 2-oxo 4-pentenóico como metabólitos resultantes da exposição de L. polyedrum ao fenol. O composto orgânico fenol é capaz de induzir um estado de aumento na atividade antioxidante da microalga L. polyedrum, sendo as enzimas superóxido dismutase e catalase os melhores biomarcadores, por terem sua expressão até três vezes maior no grupo exposto. Determinou-se que a razão GSH/GSSG no grupo tratado com fenol é menor, devido ao aumento de 20 ng.mL-1 de GSSG, expressando o efeito oxidativo no sistema glutationa, que em condições normais possui os níveis de GSSG muito abaixo dos de GSH. A avaliação fotossintética sugeriu que o fenol interferiu relativamente na fotossíntese da microalga em um curto intervalo de tempo, demonstrando a promissora sensibilidade a este poluente presente no ambiente marinho.Due necessity of knowing and understand the impacts of diverse anthropogenic activities exerted above ecosystems became relevant the study of aquatic organisms exposed to toxic waste, this can facilitate the identification of polluted or contaminated areas. Study of microalgae in contact with phenol at known concentrations, comprehended a determination of the toxic effects and generation metabolites of characterizing the possible use of the organism as a bioindicator to contamination of the pollutant. In this work it was determined in 24 hours those inhibitor phenol concentrations of cell growth of L.polyedrum on 20% and 50% (IC 20 and IC 50) respectively 40 µmol.L-1 and 120 µmol.L-1. Acknowledged need for standardization of variables in the implementation of dose-response tests with algae, allowing you to build protocols that would help to obtain laws that ensure the limits of toxic compounds to coastal organisms. It was assumed that the L. polyedrum microalgae has a biodegradation rate of phenol per cell on average of about (0,02 µmol.h-1.cel-1), capable of biotransformation 120 µmol.L-1 of phenol in a period of 16 hours. Biotransformation pathways of phenol in the microalgae L. polyedrum occur by conjugation with glutathione, catalyzed by glutathione S-transferase and the metabolic pathway of phenol hydroxylase and catechol 2,3-dihydroxygenase. We identified 2- hydroxy muconic semialdehyde acid, 1,2-dihydroxybenzene (catechol) and 2-oxo-4-pentenoic acid as metabolites resulting from exposure to phenol. The phenol is able to induce a high active antioxidant enzymes on L. polyhedron, and the enzymes superoxide dismutase and catalase the best biomarkers since were induced three times more in the exposed group. It was determined that the GSH / GSSG ratio in the group treated with phenol, GSSG has an increase of 20 ng.mL-1. Evaluation suggested that the phenol interfered on photosynthesis of microalgae in a short time, showing promising sensitivity to this pollutant in the marine environment

Evaluation of marine microalgae Lingulodinium polyedrum exposed to phenol: biotransformation and antioxidant activity

Devido à necessidade de se conhecer os impactos que as diversas atividades antropogênicas exercem sobre os ecossistemas torna-se relevante o estudo dos organismos aquáticos perante os resíduos tóxicos resultantes, com o objetivo de facilitar a identificação de áreas poluiídas ou contaminadas e estudos de meios atingidos por estes agentes poluentes. Estudo da microalga em contato com o fenol em concentrações conhecidas, compreende a determinação dos efeitos tóxicos e geração de metabólitos, caracterizando uma possível utilização deste microorganismo como bioindicador para contaminações do poluente. Determinou-se as concentrações de fenol capazes de em 24 horas inibirem o crescimento das células de L. polyedrum em 20 e 50% (IC 20 e IC 50) respectivamente 40 µmol.L-1 e 120 µmol.L-1. Identificou-se a necessidade de padronização das variáveis na execução dos ensaios dose-resposta com algas, permitindo construir protocolos que auxiliariam a obtenção de legislações que assegurem os limites de compostos tóxicos aos organismos costeiros. Calculou-se que a microalga L. polyedrum possui uma taxa de biodegradação do fenol por célula na média de aproximadamente (0,02 µmol.h-1.cel-1), capaz de biotransformar 120 µmol.L-1 de fenol em um período de 16 horas. Vias de biotransformação do fenol na microalga L.polyedrum se dão pela conjugação com a glutationa, catalisada por glutationa S-transferase e pela via metabólica de fenol hidroxilase e catecol 2,3-dihidroxigenase. Identificou-se a geração do ácido 2-hidroximucônico semialdeído, 1,2-dihidroxibenzeno (Catecol) e ácido 2-oxo 4-pentenóico como metabólitos resultantes da exposição de L. polyedrum ao fenol. O composto orgânico fenol é capaz de induzir um estado de aumento na atividade antioxidante da microalga L. polyedrum, sendo as enzimas superóxido dismutase e catalase os melhores biomarcadores, por terem sua expressão até três vezes maior no grupo exposto. Determinou-se que a razão GSH/GSSG no grupo tratado com fenol é menor, devido ao aumento de 20 ng.mL-1 de GSSG, expressando o efeito oxidativo no sistema glutationa, que em condições normais possui os níveis de GSSG muito abaixo dos de GSH. A avaliação fotossintética sugeriu que o fenol interferiu relativamente na fotossíntese da microalga em um curto intervalo de tempo, demonstrando a promissora sensibilidade a este poluente presente no ambiente marinho.Due necessity of knowing and understand the impacts of diverse anthropogenic activities exerted above ecosystems became relevant the study of aquatic organisms exposed to toxic waste, this can facilitate the identification of polluted or contaminated areas. Study of microalgae in contact with phenol at known concentrations, comprehended a determination of the toxic effects and generation metabolites of characterizing the possible use of the organism as a bioindicator to contamination of the pollutant. In this work it was determined in 24 hours those inhibitor phenol concentrations of cell growth of L.polyedrum on 20% and 50% (IC 20 and IC 50) respectively 40 µmol.L-1 and 120 µmol.L-1. Acknowledged need for standardization of variables in the implementation of dose-response tests with algae, allowing you to build protocols that would help to obtain laws that ensure the limits of toxic compounds to coastal organisms. It was assumed that the L. polyedrum microalgae has a biodegradation rate of phenol per cell on average of about (0,02 µmol.h-1.cel-1), capable of biotransformation 120 µmol.L-1 of phenol in a period of 16 hours. Biotransformation pathways of phenol in the microalgae L. polyedrum occur by conjugation with glutathione, catalyzed by glutathione S-transferase and the metabolic pathway of phenol hydroxylase and catechol 2,3-dihydroxygenase. We identified 2- hydroxy muconic semialdehyde acid, 1,2-dihydroxybenzene (catechol) and 2-oxo-4-pentenoic acid as metabolites resulting from exposure to phenol. The phenol is able to induce a high active antioxidant enzymes on L. polyhedron, and the enzymes superoxide dismutase and catalase the best biomarkers since were induced three times more in the exposed group. It was determined that the GSH / GSSG ratio in the group treated with phenol, GSSG has an increase of 20 ng.mL-1. Evaluation suggested that the phenol interfered on photosynthesis of microalgae in a short time, showing promising sensitivity to this pollutant in the marine environment

Lactobacillus fermentation of jussara pulp leads to the enzymatic conversion of anthocyanins increasing antioxidant activity

Bacteria possessing an enzymatic system able to metabolize anthocyanins may play a major role in the production of compounds with different bioavailability and biological activity. In this study, Lactobacillus and Bifidobacterium strains were screened for the enzymatic activities of alpha-galactosidase, beta-galactosidase and beta-glucosidase. These strains were also screened for their ability to convert the anthocyanins from jussara. The nine evaluated strains produced at least two of the three enzymesthey were also capable of changing the main anthocyanin's chromatographic profile. The values of cyanidin 3-glucoside and cyanidin 3-rutinoside, following fermentation, ranged from 0 to 3217.7 and 4323.3 to 17190.9 mu g/100 mL of medium fermented, respectively. The Lactobacillus deubruekii strain was able to change the anthocyanins from jussara pulp more extensively. Therefore, a culture medium containing jussara pulp and glucose was optimized using the experimental design as a statistical tool. Medium maximization occurred with a mixture composing 20% jussara pulp and 10% glucose in which the microorganism was able to reach the highest enzymatic production as well as produce the most extensive conversion of the main anthocyanins. Protocatechuic acid was the main enzymatic bioconversion product identified following fermentation. In addition, there was an observed increase in antioxidant activity following the jussara pulp fermentation process.Sao Paulo Research Foundation (FAPESP)Fed Univ Sao Paulo UNIFESP, Dept Biosci, Silva Jardim Str 136, BR-11015020 Santos, SP, BrazilSao Paulo State Univ UNESP, Biosci Inst, Coastal Campus Sao Vicente, BR-11330900 Sao Vicente, SP, BrazilFed Univ Sao Paulo UNIFESP, Dept Biosci, Silva Jardim Str 136, BR-11015020 Santos, SP, BrazilFAPESP: 2014/09301-6Web of Scienc

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