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

Meat yield of Callinectes bocourti A. Milne Edwards, 1879 (Crustacea, Portunidae) in Iguape, São Paulo, Brazil

The objective of the present study was to analyze the meat yield for both sexes of the crab Callinectes bocourti in the region of Iguape, Brazil. The carapace width for males was 78.1-114.0 mm (96.7 ± 9.5 mm) and for females 76.0-106.3 mm (93.0 ± 7.8 mm). In males, the total wet weight ranged from 65.53 to 224.36 g (134.04 ± 40.77 g) and for females from 56.66 to 164.74 g (105.93 ± 26.88 g). A comparison of morphological structures revealed that the greatest meat yield was in the carapace (55.1%), followed by the right chela (16.9%), the left chela (15.9%), and the legs (12.1%). The total yield from the males (28.5%) was slightly higher than that from the females (22.1%). In general, portunids yield more meat than other crab species. The results of this study will allow the optimization of meat production for this crab species. Manual meat removal makes the process more expensive. This activity could offer an alternative to the fishing communities that live exclusively from this fishery resource. © 2007 Escuela de Ciencias del Mar Pontificia Universidad Católica de Valparaíso

Estrutura populacional de Callinectes ornatus Ordway (Crustacea, Portunidae) no Balneário Shangri-Lá, Pontal do Paraná, Paraná, Brasil

Swimming crabs are commonly found in the otter-trawl shrimp fishery by-catch, which operate intensively in the Coastal Plain of Leste Beach, where is located Shangri-lá Beach (25°37'30"S and 48°25'08"W), Paraná State. This work aimed to study the population structure of Callinectes ornatus Ordway, 1863, the most abundant swimming crab in this beach. Between March 2000 and April 2001, fortnightly visits were accomplished in Shangri-lá at the fish market, where all swimming crabs of one otter-trawl were collected. The following data from each individual of C. ornatus were obtained: sex, carapace width (excluding lateral spines), weight, and the gonadal maturation stage, based on its color and size. Juveniles and mature males were dominant, mean sexual proportion was 2.2:1 (males:females). Two recruitment periods were detected, but few ovigerous females were obtained. Size at sexual maturation was estimated at 55mm for males, and 48 mm for females. Both sexes presented positives allometric growths. The results indicate that an important portion of C. ornatus population is captured in the otter-trawl shrimp fishery in Shangri-lá Beach (Paraná). Such information is important for futures plans of by-catch management in that area