27 research outputs found

    Placental sampling for understanding viral infections - A simplified protocol for the COVID-19 pandemic

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    OBJECTIVE:  The coronavirus disease 2019 (COVID-19) is a pandemic viral disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The impact of the disease among the obstetric population remains unclear, and the study of the placenta can provide valuable information. Adequate sampling of the placental tissue can help characterize the pathways of viral infections. METHODS:  A protocol of placental sampling is proposed, aiming at guaranteeing representativity of the placenta and describing the adequate conservation of samples and their integrity for future analysis. The protocol is presented in its complete and simplified versions, allowing its implementation in different complexity settings. RESULTS:  Sampling with the minimum possible interval from childbirth is the key for adequate sampling and storage. This protocol has already been implemented during the Zika virus outbreak. CONCLUSION:  A protocol for adequate sampling and storage of placental tissue is fundamental for adequate evaluation of viral infections on the placenta. During the COVID-19 pandemic, implementation of this protocol may help to elucidate critical aspects of the SARS-CoV-2 infection

    Environmental drivers of water use for Caatinga woody plant species: combining remote sensing phenology and sap flow measurements

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    Abstract: We investigated the water use of Caatinga vegetation, the largest seasonally dry forest in South America. We identified and analysed the environmental drivers of phenology in woody species and their relationship with transpiration. To monitor the phenological evolution we used remote sensing indices at different spatial and temporal scales: normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and green chromatic coordinate (GCC). To represent the phenology we used the GCC extracted from in-situ automated digital camera images; indices calculated based on sensors included NDVI, SAVI and GCC from Sentinel-2A and B satellites images, and NDVI products MYD13Q1 and MOD13Q1 from moderate-resolution imaging spectroradiometer (MODIS). Environmental drivers included continuously monitored rainfall, air temperature, soil moisture, net radiation, and vapour pressure deficit. To monitor soil water status and vegetation water use we installed soil moisture sensors along three soil profiles and sap flow sensors for five plant species. Our study demonstrated that the near-surface GCC data played an important role in allowing individual monitoring of species whereas the species’ sap flow data correlated better with NDVI, SAVI and GCC than with species’ near-surface GCC. The wood density appeared to affect the transpiration cessation times in the dry season given species with the lowest wood density reach negligible values of transpiration earlier in the season than those with high woody density. Our results show that soil water availability is the main limiting factor for transpiration during more than 80 % of the year, and that both the phenological response and water use are directly related to water availability when relative saturation of the soil profile falls below 0.25

    Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

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    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
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